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Ingelson B, Dahlke S, O'Rourke H, Low G. A Scoping Review on Nurse's Pain Management of Older Patients with Dementia in a Hospital Environment. Pain Manag Nurs 2024; 25:104-112. [PMID: 37968142 DOI: 10.1016/j.pmn.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES Hospitalized persons living with dementia often experience unrelieved pain. Unmanaged pain during hospitalization has a significant negative effect on quality of life for persons living with dementia. Despite the central role of nurses in pain management, little is known about how nurses manage pain in this patient population in the hospital environment. DESIGN A scoping review explored the nurses' pain management practices when caring for persons living with dementia in a hospital setting. DATA SOURCES AND REVIEW/ANALYSIS METHODS After an extensive search for all available evidence on how nurses manage pain in hospitalized persons living with dementia, data were extracted on pain management methods that included assessment, intervention, effectiveness of pain management, and the barriers nurses encountered when managing pain. A descriptive content analysis was used to extract data from qualitative studies. RESULTS Six articles published between 2016 and 2021 met the inclusion criteria; four utilized qualitative methods, and the others used mixed-methods and quantitative study designs. A narrative description of the findings was summarized after data were categorized into pain management data elements and barriers nurses encountered when managing pain. Barriers were grouped into the subcategories of communication challenges (nurse to patient), information sharing (nurse to nurse), lack of knowledge, time constraints, and nursing stressors. CONCLUSION We identified six articles that met our inclusion criteria, highlighting a noticeable gap in the literature. Managing pain in this population is complex and lacks organizational support. Review findings indicate that pain management methods lack consistency and standardization, making it difficult to assess their effectiveness. Nurses also described knowledge deficits resulting in practice gaps that, when combined with barriers and challenges, result in underrecognized and undermanaged pain.
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Affiliation(s)
| | | | | | - Gail Low
- University of Alberta, Edmonton, Alberta, Canada.
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Fahsold A, Roes M, Holle B, Kuliga S. Methods for the involvement of people living with dementia in research focused on the built environment: a protocol for a scoping review. BMJ Open 2023; 13:e075350. [PMID: 37620266 PMCID: PMC10450054 DOI: 10.1136/bmjopen-2023-075350] [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: 05/05/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The positive influence of a well-designed built environment in dementia-specific care has been known for several years. Many studies focusing on the built environment have captured the perspectives of people living with dementia. However, it remains unclear to what degree and with which methods these individuals have been actively involved in research especially when attempting to understand their perspective. The planned scoping review aims to (1) synthesise methods and results from research about the built environment according to active involvement of people living with dementia and (2) describe facilitators and barriers to this active involvement to capture their perspectives in research. METHODS AND ANALYSIS We will use four search strategies: (1) searches in academic databases MEDLINE via PubMed, CINAHL and APA PsycINFO via EBSCO, and Scopus; (2) grey literature searches via Google Scholar; (3) handsearches of non-academic environmental planning and design journals and (4) identifying other publications of key authors in the field. Additionally, backward and forward citation tracking will be performed via reference lists and Google Scholar, respectively. Relevant literature published between 2013 and 2023 will be identified for data extraction and synthesis. One researcher will perform each strategy. Title-abstract/full text-screening will be conducted using Covidence by two researchers. Results will be displayed in a table and through figures illustrating identified facilitators and barriers. ETHICS AND DISSEMINATION We raised no ethical concerns for the planned scoping review. We will prepare the findings including the identified barriers with long-term care practitioners from our network to identify how changes in practical application methods can be addressed. This dialogue can serve as a basis for including people living with dementia to discuss highlighted barriers when researching their perspectives on the built environment. The scoping review results will be reported in both academic and non-academic journals and at academic conferences.
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Affiliation(s)
- Anne Fahsold
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort Witten, Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort Witten, Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort Witten, Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Saskia Kuliga
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Standort Witten, Witten, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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Dörner J, Hüsken JM, Schmüdderich K, Dinand C, Dichter MN, Halek M. Perspectives on sleep of people living with dementia in nursing homes: a qualitative interview study. BMC Geriatr 2023; 23:331. [PMID: 37237308 DOI: 10.1186/s12877-023-04052-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Disturbed sleep among people living with dementia in nursing homes is widespread and is associated with diseases and all-cause mortality. This study examined the sleep of people living with dementia from their perspectives in nursing homes and that of the nurses who care for people living with dementia. METHODS A qualitative cross-sectional study was conducted. A total of 15 people living with dementia and 15 nurses in 11 German nursing homes were enrolled in this study. Data was collected between February and August 2021 through semistructured interviews, which were audio recorded and transcribed. Thematic analyses were performed by three independent researchers. Thematic mind maps and controversial findings were discussed with the Research Working Group of People with Dementia of the German Alzheimer Association. RESULTS Thematic analysis identified five overarching themes from the nursing home participants regarding sleep patterns: (1) characteristics of good sleep, (2) characteristics of bad sleep, (3) personal influences of people living with dementia on sleep, (4) environmental factors on sleep, and (5) sleep strategies of people living with dementia. Analysis also identified five overarching themes from the nurses participants: (1) characteristics of good sleep, (2) characteristics of bad sleep, (3) personal influences on sleep, (4) environmental factors on sleep, and (5) interventions for sleep promotion. CONCLUSIONS The thematic analyses demonstrated that the perspectives of people living with dementia and nurses indicate the need to give more consideration to psychosocial factors and individual aspects of sleep in clinical practice. The results could also be helpful for the development of targeted assessment instruments and complex non-pharmacological interventions to promote sleep.
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Affiliation(s)
- Jonas Dörner
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer st. 12, 58453, Witten, Germany.
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred- Herrhausen-st. 45, 58455, Witten, Germany.
| | - Johann-Moritz Hüsken
- German Institute of Applied Nursing Research, Hülchrather st. 15, 50670, Cologne, Germany
| | - Kathrin Schmüdderich
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer st. 12, 58453, Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred- Herrhausen-st. 45, 58455, Witten, Germany
| | - Claudia Dinand
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred- Herrhausen-st. 45, 58455, Witten, Germany
| | - Martin N Dichter
- Institute of Nursing Science, Medical Faculty and University Hospital of Cologne, University of Cologne, Gleueler st. 176-178, 50935, Cologne, Germany
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred- Herrhausen-st. 45, 58455, Witten, Germany
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Vo QT, Koethe B, Holmes S, Simoni-Wastila L, Briesacher BA. Patient Outcomes After Delirium Screening and Incident Alzheimer's Disease or Related Dementias in Skilled Nursing Facilities. J Gen Intern Med 2023; 38:414-420. [PMID: 35970959 PMCID: PMC9905370 DOI: 10.1007/s11606-022-07760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The extent to which a positive delirium screening and new diagnosis of Alzheimer's disease or related dementias (ADRD) increases the risk for re-hospitalization, long-term nursing home placement, and death remains unknown. OBJECTIVE To compare long-term outcomes among newly admitted skilled nursing facility (SNF) patients with delirium, incident ADRD, and both conditions. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of Medicare beneficiaries who entered a SNF from hospital with a minimum 14-day stay (n = 100,832) from 2015 to 2016. MAIN MEASURES Return to home, hospital readmission, admission to a long-term care facility, or death. KEY RESULTS Patients with delirium were as likely to be discharged home as patients diagnosed with ADRD (HR: 0.63, 95% CI: 0.59, 0.67; HR: 0.65, 95% CI: 0.64, 0.67). Patients with both delirium and ADRD were less likely to be discharged home (HR: 0.49, 95% CI: 0.47, 0.52) and showed increased risk of death (HR: 1.30, 95% CI: 1.17, 1.45). Patients with ADRD, regardless of delirium screening status, had increased risk for long-term nursing home care transfer (HR: 1.66, 95% CI: 1.63, 1.70; HR: 1.76, 95% CI: 1.69, 1.82). Patients with delirium and no ADRD showed increased risk of transfer to long-term nursing home care (HR: 1.25, 95% CI: 1.18, 1.33). The rate of deaths was higher among patients who screened positive for delirium without ADRD compared to the no delirium and no ADRD groups (HR: 2.35, 95% CI: 2.11, 2.61). CONCLUSION A positive delirium screening increased risk of death and transfer to long-term care in the first 100 days after admission regardless of incident ADRD diagnosis. Patients with delirium and/or ADRD also are less likely to be discharged home. Our study builds on the evidence base that delirium is important to address in older adults as it is associated with negative outcomes.
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Affiliation(s)
- Quynh T Vo
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.
| | - Benjamin Koethe
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sarah Holmes
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore School of Pharmacy, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore School of Pharmacy, Baltimore, MD, USA
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore School of Pharmacy, Baltimore, MD, USA
| | - Becky A Briesacher
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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Long A, Timmons S, Di Lorito C, Booth V, Logan P. "We Just Don't Know Where They Are": The Geographical Distribution of Exercise Classes for Older People, Including Those Living with Dementia in the East Midlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2142. [PMID: 36767510 PMCID: PMC9915375 DOI: 10.3390/ijerph20032142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Older people living with dementia are advised to exercise to remain independent. Although several exercise classes for older people take place across the UK, there is limited information about the geographical distribution of these classes. This study identified the location and explored the population characteristics of the classes in a UK region, to aid improved access to exercise. Using a geographical information system, data were collected on population characteristics, including size and age, socio-economic status, and rurality of the exercise classes in one area of the UK (East Midlands, population 5 million). The relationship between data sets was explored and a visual representation of these patterns was provided. A systematic internet search identified 520 exercise classes, evenly spread across the region and areas of socio-economic deprivation: 471 (90%) were in urban areas; 428 (80%) were in areas where less than 20% of the population was over 65 years of age; and 13 (2%) stated that they were suitable for people with dementia. People living with dementia are less likely than older people without dementia to have access to exercise classes.
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Affiliation(s)
- Annabelle Long
- Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, Nottingham NG8 1BB, UK
| | - Claudio Di Lorito
- Nottingham University Business School, University of Nottingham, Nottingham NG8 1BB, UK
| | - Vicky Booth
- Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham NG7 2UH, UK
| | - Pip Logan
- Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham City Care Partnership, Nottingham NG6 8WR, UK
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Matsuda S, Yoshimura H. Personal identification systems for persons with dementia: a systematic review. Psychogeriatrics 2021; 21:832-838. [PMID: 34355469 DOI: 10.1111/psyg.12752] [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] [Received: 06/14/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/11/2022]
Abstract
People with dementia can become missing and unable to be identified due to their cognitive decline and may not have belongings, including personally identifiable information. The aim of this systematic review was to summarise and discuss the current status of personal identification systems for missing and unidentified persons with dementia. An electronic systematic literature search was conducted by using PubMed, Web of Science, Cochrane Library, and CINAHL. By performing an electronic literature search, 128 texts were extracted. However, only three eligible texts were included in this review, and these were divided on the basis of the analysis target as follows: medical and human community support systems and digital systems. It is important to develop medical and social care systems and to construct and advance social personal identification systems, including medical and human community support systems and digital systems, for persons with dementia. However, this systematic review clarified that there have only been a few reports about the development and construction of social systems for missing and unidentified persons with dementia. People who interact with persons with dementia should consider this problem, which is increasing each year, and strive to build a social system that can be applied to personal identification as soon as possible.
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Affiliation(s)
- Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Riello M, Rusconi E, Treccani B. The Role of Brief Global Cognitive Tests and Neuropsychological Expertise in the Detection and Differential Diagnosis of Dementia. Front Aging Neurosci 2021; 13:648310. [PMID: 34177551 PMCID: PMC8222681 DOI: 10.3389/fnagi.2021.648310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Dementia is a global public health problem and its impact is bound to increase in the next decades, with a rapidly aging world population. Dementia is by no means an obligatory outcome of aging, although its incidence increases exponentially in old age, and its onset may be insidious. In the absence of unequivocal biomarkers, the accuracy of cognitive profiling plays a fundamental role in the diagnosis of this condition. In this Perspective article, we highlight the utility of brief global cognitive tests in the diagnostic process, from the initial detection stage for which they are designed, through the differential diagnosis of dementia. We also argue that neuropsychological training and expertise are critical in order for the information gathered from these omnibus cognitive tests to be used in an efficient and effective way, and thus, ultimately, for them to fulfill their potential.
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Affiliation(s)
- Marianna Riello
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Elena Rusconi
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Barbara Treccani
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
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Schmüdderich K, Holle D, Ströbel A, Holle B, Palm R. Relationship between the severity of agitation and quality of life in residents with dementia living in German nursing homes - a secondary data analysis. BMC Psychiatry 2021; 21:191. [PMID: 33849487 PMCID: PMC8042694 DOI: 10.1186/s12888-021-03167-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe agitation and its relation to single dimensions of quality of life are not well understood. The aim of this study was to gain more knowledge about severe agitation and to examine the relationships between the severity of agitation and single dimensions of quality of life among residents with dementia living in German nursing homes. METHODS This exploratory secondary analysis included data from 1947 residents of 66 German nursing homes from the DemenzMonitor study. The construct of agitation was defined as a composite score of the items agitation/aggression, irritability/lability and disinhibition from the Neuropsychiatric Inventory Questionnaire (NPI-Q); the resident was classified as severely agitated if at least one of these symptoms was rated as 'severe'. The single dimensions of quality of life were measured with the short version of the QUALIDEM instrument. To avoid selection bias, two controls with mild or no agitation were selected for each resident with severe agitation using propensity score matching. Mixed linear regression models were then generated to determine the differences in the dimensions of quality of life for the severity of agitation and the defining items. RESULTS For four out of five dimensions of quality of life of the short version of QUALIDEM, residents with severe agitation had significantly lower values than residents without severe agitation. Converted to scale size, the greatest difference between both groups was found in the dimension social isolation with 23.0% (-2.07 (95% CI: -2.57, -1.57)). Further differences were found in the dimensions restless tense behaviour with 16.9% (-1.52 (95% CI: -2.04, -1.00)), positive affect with 14.0% (-1.68 (95% CI: -2.28, -1.09)) and social relations with 12.4% (-1.12 (95% CI: -1.54, -0.71)). CONCLUSIONS Severe agitation is a relevant phenomenon among nursing home residents with dementia and is associated with lower values of quality of life in the dimensions social isolation, restless tense behaviour, positive affect and social relations from the QUALIDEM instrument. Therefore, more attention should be paid to severe agitation in nursing practice and research. Moreover, care strategies used to reduce severe agitation should be considered in terms of their impact on the dimensions of quality of life.
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Affiliation(s)
- Kathrin Schmüdderich
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
| | - Daniela Holle
- University of Applied Sciences (hsg Bochum), Department of Nursing Science, Gesundheitscampus 6-8, Bochum, 44801 Germany
| | - Armin Ströbel
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Universitätsklinikum Erlangen, Center for Clinical Studies, Krankenhausstraße 12, Erlangen, 91054 Germany
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
| | - Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
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Elkhouly A, Rahim HA, Abdulaziz N, Abd Malek MF. Modelling Audiograms for People with Dementia Who Experience Hearing Loss Using Multiple Linear Regression Method. 2020 INTERNATIONAL CONFERENCE ON COMMUNICATIONS, COMPUTING, CYBERSECURITY, AND INFORMATICS (CCCI) 2020. [DOI: 10.1109/ccci49893.2020.9256679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Russo A, Picciarella A, Russo R, Sabetta F. Clinical features, therapy and outcome of patients hospitalized or not for nursing-home acquired pneumonia. J Infect Chemother 2020; 26:807-812. [PMID: 32273175 DOI: 10.1016/j.jiac.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/24/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND nursing home-acquired pneumonia (NHAP), is among the main causes of hospitalization and mortality of frail elderly patients. Aim of this study was analysis of patients residing in long-term care facilities (LTCF) and developing pneumonia to reach a better knowledge of criteria for hospitalization and outcomes. MATERIALS/METHODS this is a prospective, observational study in which patients residing in 3 LTCFs (metropolitan area of Rome, Italy) and developing pneumonia, hospitalized or treated in LTCF, were recruited and followed up from January 2017 to June 2019. Primary endpoint was 30-day mortality, secondary endpoint was analysis of risk factors associated with hospitalization. RESULTS Overall, 146 episodes of NHAP were enrolled in the study: 57 patients were treated in LTCF, while 89 patients were hospitalized. Overall incidence rates of NHAP varied from 2.6 to 7.5 per 1000 residents. Methicillin-resistant Staphylococcus aureus was the most frequently isolated pathogen (25%), and in 28 (55%) patients was documented a MDR pathogen. For hospitalized patients was reported a higher 30-day mortality (43.8% Vs 7%, p < 0.001). Multivariate analysis showed that severe pneumonia, neoplasm, chronic hepatitis, antibiotic monotherapy, and malnutrition were independent risk factors for hospitalization from LTCF. MDR pathogen, severe pneumonia, COPD, and moderate to severe renal disease were independently associated with death at 30 days. CONCLUSION frail elderly patients in LTCF have a high risk of MDR etiology with a higher risk to receive an inadequate antibiotic therapy and a fatal outcome. These results point to the need for increased provision of acute care and strategies in LTCF.
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Affiliation(s)
| | | | - Roberta Russo
- Internal Medicine Unit, Policlinico Casilino, Rome, Italy
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Quality of life in people with dementia living in nursing homes: validation of an eight-item version of the QUALIDEM for intensive longitudinal assessment. Qual Life Res 2020; 29:1721-1730. [PMID: 31955375 PMCID: PMC7253522 DOI: 10.1007/s11136-020-02418-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 01/17/2023]
Abstract
Purpose Our aim was to examine whether quality of life which was repeatedly assessed over time is related with the comprehensive assessment of quality of life (QoL) and thereby to validate a brief QoL assessment. Method This longitudinal study used a comprehensive assessment of quality of life at baseline (QUALIDEM; 37 items) to validate an eight-item version of QUALIDEM to assess momentary quality of life which was repeatedly administered using a tablet device after baseline. In all, 150 people with dementia from 10 long-term facilities participated. Momentary quality of life and comprehensive quality of life, age, gender, activities of daily living (Barthel Index), Functional assessment staging (FAST), and Geriatric Depression (GDS) have been assessed. Results Comprehensive and momentary quality of life showed good internal consistency with Cronbach’s alpha of .86 and .88 to .93, respectively. For multiple associations of momentary quality of life with the comprehensive quality of life, momentary quality of life was significantly related to comprehensive quality of life (B = .14, CI .08/.20) and GDS (B = − .13, CI − .19/− .06). More specifically, the comprehensive QUALIDEM subscales ‘positive affect’, ‘negative affect’, ‘restlessness’, and ‘social relationships’ showed significant positive associations with momentary quality of life (p < .001). Conclusion We found that momentary quality of life, reliably assessed by tablet, was associated with comprehensive measures of quality of life and depressive symptoms in people with dementia. Broader use of tablet-based assessments within frequent QoL measurements may enhance time management of nursing staff and may improve the care quality and communication between staff and people with dementia. Electronic supplementary material The online version of this article (10.1007/s11136-020-02418-4) contains supplementary material, which is available to authorized users.
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Long A, Robinson K, Goldberg S, Gordon AL. Effectiveness of exercise interventions for adults over 65 with moderate-to-severe dementia in community settings: a systematic review. Eur Geriatr Med 2019; 10:843-852. [PMID: 34652766 DOI: 10.1007/s41999-019-00236-7] [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: 05/10/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To conduct a systematic review of the literature to evaluate the effectiveness of exercise interventions for people with moderate-to-severe dementia in community settings. METHODS Eight electronic databases (MEDLINE, Embase, CINAHL, AMED, PsycINFO, PEDro, The Cochrane Library and BNI) were searched from inception to July 2018. Snowball searching identified additional articles not identified initially. Articles were included if they: reported randomised or quasi-randomised controlled trials comparing exercise with usual care or no treatment; and involved people over 65 with moderate-to-severe dementia in community settings. Outcome measures of interest were strength, endurance, mobility, mood and quality of life. Titles and abstracts of all studies were screened by one reviewer. Two reviewers independently screened full text articles for all eligible studies, extracted data and assessed quality and risk of bias. RESULTS Eight studies with 819 participants were included. Interventions were variable in terms of content, duration and frequency. There was some evidence exercise programmes may improve physical function of people with moderate-to-severe dementia, with significant effects seen for gait speed and endurance, and a trend towards improvement in strength. There was little evidence to suggest exercise programmes improve mood. Most studies were of low quality. CONCLUSION Exercise was associated with improvements in gait speed and endurance for older people with moderate-to-severe dementia living in the community, but the quality of evidence was low. There was no conclusive evidence regarding effect on strength or mood. Findings are limited by the quality of the available evidence.
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Affiliation(s)
- Annabelle Long
- Division of Rehabilitation and Ageing, School of Medicine, B109, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Katie Robinson
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK.,East Midlands Collaboration for Leadership in Applied Health Research and Care (EM-CLAHRC), Nottingham, UK
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- East Midlands Collaboration for Leadership in Applied Health Research and Care (EM-CLAHRC), Nottingham, UK.,Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.,University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Palm R, Sorg CGG, Ströbel A, Gerritsen DL, Holle B. Severe Agitation in Dementia: An Explorative Secondary Data Analysis on the Prevalence and Associated Factors in Nursing Home Residents. J Alzheimers Dis 2019; 66:1463-1470. [PMID: 30412491 PMCID: PMC6294574 DOI: 10.3233/jad-180647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: The phenomena of severe agitation is not well understood and often not adequately treated. Objective: This article determines the prevalence and associated factors of severe agitation in nursing home residents with dementia. Methods: Secondary data analysis within an observational study in German nursing homes with n = 1,967 participants. We assessed severity of agitation with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and defined the construct of agitation as a composite score of the NPI-Q items agitation/aggression, disinhibition, and irritability/lability; the dependent variable of severe agitation was considered as being present in residents who scored ‘severe’ in at least one of these symptoms. A binary logistic regression model was calculated to estimate associations. Results: The prevalence of severe agitation was 6.3% (n = 124). The strongest associations were found for elation/euphoria (OR 7.6, CI 3.1–18.5), delusions (OR 7.3, CI 4.0–13.2), apathy/indifference (OR 2.8, CI 1.7–4.7), anxiety (OR 2.2, CI 1.2–3.8), nighttime behaviors (OR 2.4, CI 1.4–4.2), motor disturbances (OR 2.4, CI 1.4–4.1), and male sex (OR 2.4. CI 1.3–4.2). Conclusion: Severe agitation in nursing home residents with dementia is a relevant clinical issue as approximately 70% of residents have a dementia. Residents with elation/euphoria and delusions may have a stronger risk of showing severe agitation. We consider delusions as a possible cause of agitation and therefore a prelude to agitation. Although it might be possible that elation/euphoria follows from agitation, we hypothesize that the residents first experience elation/ euphoria and exhibit agitation afterwards.
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Affiliation(s)
- Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Witten, Germany
| | | | - Armin Ströbel
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
| | - Debby L Gerritsen
- Department of Primary and Community Care and Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Witten, Germany
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14
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Alisi L, Cao R, De Angelis C, Cafolla A, Caramia F, Cartocci G, Librando A, Fiorelli M. The Relationships Between Vitamin K and Cognition: A Review of Current Evidence. Front Neurol 2019; 10:239. [PMID: 30949117 PMCID: PMC6436180 DOI: 10.3389/fneur.2019.00239] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022] Open
Abstract
Vitamin K is a fat-soluble nutrient discovered in 1935 and its role in blood coagulation has been thoroughly explored. In recent years, studies conducted in vitro and on animals highlighted vitamin K involvement in brain cells development and survival. In particular, vitamin K seems to have an antiapoptotic and anti-inflammatory effect mediated by the activation of Growth Arrest Specific Gene 6 and Protein S. Moreover, this vitamin is involved in sphingolipids metabolism, a class of lipids that participate in the proliferation, differentiation, and survival of brain cells. An altered expression in sphingolipids profile has been related to neuroinflammation and neurodegeneration. This review stems from a growing interest in the role of vitamin K in brain functions, especially in cognition, also in view of an expected increase of prevalence of Alzheimer's disease and other forms of dementia. It collects recent researches that show interesting, even though not definitive, evidence of a direct correlation between vitamin K levels and cognitive performance. Moreover, vitamin K antagonists, used worldwide as oral anticoagulants, according to recent studies may have a negative influence on cognitive domains such as visual memory, verbal fluency and brain volume. The aim of this review is to analyze the evidence of clinical studies carried out up to date on the relationship between vitamin K intake and cognitive performances. The involvement of vitamin K antagonists (VKAs) in declining cognitive performances is also addressed separately.
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Affiliation(s)
- Ludovico Alisi
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Roberta Cao
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina De Angelis
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Arturo Cafolla
- Department of Cell Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Francesca Caramia
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Gaia Cartocci
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Aloisa Librando
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco Fiorelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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15
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Prunty MM, Foli KJ. Guilt experienced by caregivers to individuals with dementia: A concept analysis. Int J Older People Nurs 2019; 14:e12227. [PMID: 30793838 DOI: 10.1111/opn.12227] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Abstract
AIM To create a comprehensive understanding and definition of guilt in caregivers of individuals with dementia. Through this concept analysis, we hope to empower nurses to more accurately identify guilt in caregivers and tailor interventions to specifically reduce these symptoms of guilt. BACKGROUND Individuals with dementia are often cared for by relatives, friends and neighbours. Many caregivers express feelings of guilt, increasing the risk of depression and psychological burden. In turn, this impacts their availability to render care. DESIGN Concept analysis according to Walker and Avant (Strategies for theory construction in nursing. Boston, MA: Prentice Hall; 2011). METHOD A literature search was completed utilising the following databases Cumulative Index to Nursing and Allied Health, PubMed, PsycINFO and Google Scholar for the years 2003-2017. Common definitions and lay usage were also considered. RESULTS The identified critical attributes of guilt experienced by caregivers to individuals with dementia include the following: (a) The expectation of a moral responsibility to care for the individual with dementia; (b) a negative, subjective appraisal of one's own caregiving performance, including neglecting other roles and responsibilities and self-neglect; and (c) a sense of transgression or violation of a moral standard as a caregiver to the individual with dementia. These defining attributes were then applied in three cases: model, borderline and contrary. Pertinent antecedents and consequences to the concept of guilt in caregivers to individuals with dementia were identified. DISCUSSION As a result of the guilt, the caregiver may experience poor mental and physical health, symptoms of anxiety and depression, and a greater sense of caregiver burden. CONCLUSION A new, comprehensive conceptual definition of guilt in caregivers to individuals with dementia is described. IMPLICATIONS FOR PRACTICE A conceptual definition of guilt in caregivers of individuals with dementia allows nurses to assess and identify caregivers at risk for, or currently experiencing, guilt and help direct caregivers to appropriate interventions and supportive services.
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Affiliation(s)
- Maggie M Prunty
- Purdue University School of Nursing, West Lafayette, Indiana
| | - Karen J Foli
- Purdue University School of Nursing, West Lafayette, Indiana
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16
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Gillès de Pélichy E, Ebbing K, Matos Queiros A, Hanon C, von Gunten A, Sellah Z, Verloo H. Demographics, Clinical Characteristics, and Therapeutic Approaches among Older Adults Referred to Mobile Psychiatric Crisis Intervention Teams: A Retrospective Study. Dement Geriatr Cogn Dis Extra 2018; 8:402-413. [PMID: 30483306 PMCID: PMC6243965 DOI: 10.1159/000493525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Abstract
Background / Aims The advent of mobile old age psychiatry intervention teams supports policies maintaining older adults in their habitual living environments, even those who are very old and suffering from acute cognitive and psychiatric impairments. Analyzing sociodemographic data, clinical and health characteristics, reasons for crisis-oriented psychiatric consultations, and other therapeutic suggestions for supporting home- or nursing home-dwelling older adult patients suffering from an onset of a psychiatric crisis. Methods Reviews of the medical records and discharge letters of home- or nursing home-dwelling older adults who had undergone a consultation with the Lausanne region's Mobile Old Age Psychiatry Teams (MOAPTs), between May 2016 and December 2017. Results Of 570 older adult patients referred for consultation with MOAPTs, 333 had medical records and discharge letters eligible for retrospective analysis (59%). The majority of these older adult patients were women aged over 80 years suffering from dementia, mood disorders with and without a risk of suicide, and delirium. Challenging behaviors related to different stages of cognitive impairment were the most important clinical reason for crisis consultations. Nonpharmacological and pharmacological treatments were delivered concurrently in 68% of crisis consultations. Conclusion Appropriate responses by dual nurse-psychiatrist teams using crisis-oriented nonpharmacological and pharmacological interventions decreased hospitalization.
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Affiliation(s)
- Estelle Gillès de Pélichy
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
- Administration of Health and Social Welfare, Service of Public Health, Lausanne, Switzerland
- *Estelle Gillès de Pélichy, MD, FRC-Psych, Department of Psychiatry, Lausanne University Hospital, CH-1197 Prangins (Switzerland), E-Mail , Karsten Ebbing, MD, FRC-Psych, Department of Psychiatry, Lausanne University Hospital, CH-1011 Lausanne (Switzerland), E-Mail
| | - Karsten Ebbing
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
| | - Alcina Matos Queiros
- Administration of Health and Social Welfare, Service of Public Health, Lausanne, Switzerland
| | - Cécile Hanon
- Regional Resource Center of Old Age Psychiatry, Mobile Team for Old Age Psychiatric Subjects – EMPSA 92 South, Paris University Hospitals-West, Corentin-Celton Hospital, Issy-Les-Moulineaux, France
| | - Armin von Gunten
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
| | - Zaia Sellah
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
| | - Henk Verloo
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
- University of Applied Sciences Western Switzerland, Nursing Sciences, Sion, Switzerland
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17
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Auer SR, Höfler M, Linsmayer E, Beránková A, Prieschl D, Ratajczak P, Šteffl M, Holmerová I. Cross-sectional study of prevalence of dementia, behavioural symptoms, mobility, pain and other health parameters in nursing homes in Austria and the Czech Republic: results from the DEMDATA project. BMC Geriatr 2018; 18:178. [PMID: 30103672 PMCID: PMC6090593 DOI: 10.1186/s12877-018-0870-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022] Open
Abstract
Background This paper provides a first comparative exploratory analysis of our findings from DEMDATA, a collaborative project between Austria and the Czech Republic. Analysed here are data from the residents and the environment assessment protocol. Methods In a cross sectional study design, residents from randomly drawn and stratified nursing homes were investigated using a common study protocol. Results From a total resident pool of 1666 persons, 1085 (571 in Austria, 514 in the Czech Republic) persons signed a consent form and participated in the data collection. More than 70% of residents assessed were female and the population was on average 85 years old. A discrepancy between the presence of a medical diagnosis in the charts of the residents and the results of cognitive testing was found. In Austria, 85.2%, in the Czech Republic 53.0% of residents had cognitive impairment. In Austria 80.0%, and in the Czech Republic 56.7% had behavioural problems. With respect to pain, 44.8% in Austria, and 51.5% in the Czech Republic had mild to severe pain. 78.4% of Austrian and 74.5% of the residents had problems with mobility and both populations were in danger of malnutrition. Conclusions Most of the prevalence rates are comparable with previous studies also using direct resident assessment. Variations in prevalence rates seem to result mainly from the assessment technique (direct cognitive testing vs. medical chart review). The high prevalence rates for dementia, behavioural symptoms, pain and malnutrition indicate an immediate call for attention to further research and practice development.
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Affiliation(s)
- Stefanie R Auer
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria. .,MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria.
| | - Margit Höfler
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | | | - Anna Beránková
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
| | - Doris Prieschl
- MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria
| | - Paulina Ratajczak
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | - Michal Šteffl
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
| | - Iva Holmerová
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
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18
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Kvæl LAH, Bergland A, Telenius EW. Associations between physical function and depression in nursing home residents with mild and moderate dementia: a cross-sectional study. BMJ Open 2017; 7:e016875. [PMID: 28729326 PMCID: PMC5541615 DOI: 10.1136/bmjopen-2017-016875] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The primary aim of this study is to describe depression and physical function in nursing home residents with dementia, as well as to examine the associations between depression and balance function, lower limb muscle strength, mobility and activities of daily living. The secondary aim is to examine the differences in physical function between the groups classified as depressed and not depressed. DESIGN The study has a cross-sectional design. SETTING A convenience sample of 18 nursing homes in, and around, Oslo, Norway, participated. PARTICIPANTS We included 170 nursing home residents aged 60-100 years with mild or moderate degree of dementia defined by a score of 1 or 2 on the Clinical Dementia Rating Scale (CDR). OUTCOME MEASURES Assessments used were Cornell Scale for Depression in Dementia (CSDD), Berg Balance Scale (BBS), 'the 6-metre walking test' (walking speed), 30 s Chair Stand Test (CST) and the Barthel Index (BI). RESULTS Nursing home residents with dementia are a heterogeneous group in terms of physical function and depression. By applying the recommended cut-off of ≥8 on CSDD, 23.5% of the participants were classified as being depressed. The results revealed significant associations between higher scores on CSDD (indicating more symptoms of depression) and lower scores on BBS (95% CI -0.12 to -0.02, p=0.006), 30 s CST (95% CI -0.54 to -0.07, p=0.001) as well as maximum walking speed (95% CI -4.56 to -0.20, p=0.003) (indicating lower level of physical function). CONCLUSION Better muscle strength, balance and higher walking speed were significantly associated with less depressive symptoms. The potential interaction of dementia with poor physical function and depression indicates an area to explore in future epidemiological studies with a prospective design. TRIAL REGISTRATION NUMBER NCT02262104.
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Affiliation(s)
- Linda Aimée Hartford Kvæl
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
- Ryen Helsehus/Short-term Rehabilitation, Nursing Home Agency, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Elisabeth Wiken Telenius
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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19
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Falcone M, Russo A, Gentiloni Silverj F, Marzorati D, Bagarolo R, Monti M, Velleca R, D'Angelo R, Frustaglia A, Zuccarelli GC, Prina R, Vignati M, Marnati MG, Venditti M, Tinelli M. Predictors of mortality in nursing-home residents with pneumonia: a multicentre study. Clin Microbiol Infect 2017; 24:72-77. [PMID: 28583738 DOI: 10.1016/j.cmi.2017.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/26/2017] [Accepted: 05/27/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate predictors of mortality in patients residing in nursing-homes (NHs) or long-term care facilities (LTCFs) with diagnosis of NH-acquired pneumonia (NHAP). METHODS We conducted an observational, prospective study (December 2013-December 2015) of patients residing in nine NHs/LTCFs of Central and Northern Italy with diagnosis of NHAP. Data on demographics, comorbidities, microbiology, and therapies were entered into an electronic database. To identify risk factors associated with 30-day mortality, we performed univariable and multivariable analyses, and predictors were internally validated using a bootstrap resampling procedure. We derived a prediction rule using the coefficients obtained from the multivariable logistic regression. The model obtained was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS Overall, 446 patients with NHAP were included in the final cohort. The median age was 80 (IQR 75-87) years. A definite aetiology was obtained in 120 (26.9%) patients; of these, 66 (55%) had a culture positive for a multidrug-resistant pathogen. The 30-day mortality was 28.7%. On multivariate analysis, malnutrition (OR 7.8; 95% CI 3-20.2, 2 points), bilateral pneumonia (OR 3.7; 95% CI 1.4-9.8, 1 point), acute mental status deterioration (OR 6.2; 95% CI 2.2-17.6, 2 points), hypotension (OR 7.7; 95% CI 2.3-24.9, 2 points), and PaO2/FiO2 ratio ≤250 (OR 7.4; 95% CI 2.2-24.2, 2 points) were independently associated with 30-day mortality. The derived prediction rule showed an AUROC of 0.83 (95% CI 0.78-0.87, p <0.001). CONCLUSIONS NH residents with pneumonia have specific risk factors associated with 30-day mortality. Malnutrition and acute mental change appear as major determinants of death in this population.
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Affiliation(s)
- M Falcone
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
| | - A Russo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy
| | | | - D Marzorati
- Italian Auxological Institute, "San Luca" Hospital, Milan, Italy
| | - R Bagarolo
- "Don Gnocchi Foundation", Palazzolo Long Term Care Facility, Milan, Italy
| | - M Monti
- "Pio Albergo Trivulzio" Long Term Care Facility, Milan, Italy
| | - R Velleca
- "Pio Albergo Trivulzio" Long Term Care Facility, Milan, Italy
| | - R D'Angelo
- "Golgi-Redaelli" Long Term Care Facility, Milan, Italy
| | - A Frustaglia
- "Golgi-Redaelli" Long Term Care Facility, Vimodrone, Italy
| | - G C Zuccarelli
- "Golgi-Redaelli" Long Term Care Facility, Vimodrone, Italy
| | - R Prina
- "Golgi-Redaelli" Long Term Care Facility, Vimodrone, Italy
| | - M Vignati
- "Sandro Pertini" Long Term Care Facility, Garbagnate, Italy
| | | | - M Venditti
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy
| | - M Tinelli
- Division of Infectious and Tropical Diseases, Hospital of Lodi, Lodi, Italy
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20
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Røen I, Selbæk G, Kirkevold Ø, Engedal K, Testad I, Bergh S. Resourse Use and Disease Couse in dementia - Nursing Home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homes. BMC Health Serv Res 2017; 17:365. [PMID: 28532443 PMCID: PMC5441072 DOI: 10.1186/s12913-017-2289-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/03/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home. METHODS We included 696 patients at admission to a nursing home and followed them with biannual assessments until death. Baseline data were collected between March 2012 and November 2014. In October 2016, patients had either completed an 18-month follow-up (n = 349), passed 18 months without assessments (n = 22), or left the study (n = 324). Data on demographics, cognition, NPS, activities of daily living (ADL) functioning, physical health, medication, Quality of Life (QoL), resource use, and caregiver burden, in addition to DNA samples were collected. RESULTS Mean age of the participants at inclusion was 84.5 years (SD 7.5, range 50 - 105), 63.9% were women. According to data collected in the study, 83.8% had dementia, but only 55.9% of them had a diagnosis of dementia registered in their records. The most frequent dementia diagnosis was Alzheimer's disease, which was present in 71% of those with dementia. Patients with dementia more often experienced delusions, hallucinations, agitation, anxiety, disinhibition, irritability, and aberrant motor behaviour compared to patients without dementia. Depression and anxiety were the most common NPS symptoms. CONCLUSIONS Dementia and NPS were highly prevalent among persons admitted to nursing homes. Only 55.9% of the patients with dementia had a diagnosis of dementia registered in their records.
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Affiliation(s)
- Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Geir Selbæk
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Kirkevold
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Norwegian University of Science and Technology (NTNU), Department of Health Science in Gjøvik, Gjøvik, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ingelin Testad
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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