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Hartmann CW, Clark V, Nash P, Sloup S, Toms R, Snow AL. Improving Nursing Home Safety through Adoption of a Practical Resilient Health Care Approach. J Am Med Dir Assoc 2024:105014. [PMID: 39093244 DOI: 10.1016/j.jamda.2024.03.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 08/04/2024]
Abstract
Nursing homes struggle with safety issues, despite decades of intervention. This may, in part, stem from a reliance on a historical perspective that views safety as an intrinsic part of well-designed systems, with errors resulting from knowable, fixable causes. A new perspective (Resilient Health Care) assumes, instead, that in complex systems such as nursing homes, uncertainties and trade-offs occur in the course of everyday work. In this view, Resilient Health Care performance requires adapting to changes at different system levels to maintain high-quality care. An evidence-based program known as LOCK offers nursing homes a practical method for operationalizing a Resilient Health Care perspective. The LOCK program provides structures and processes that support frontline staff to successfully and safely navigate the complex interactions and factors that affect their daily provision of care.
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Affiliation(s)
- Christine W Hartmann
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA; Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA.
| | - Valerie Clark
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Princess Nash
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | - Sharon Sloup
- Office of Geriatrics and Extended Care (12GEC), Department of Veterans Affairs, Washington, DC, USA
| | - Rhonda Toms
- Office of Geriatrics and Extended Care (12GEC), Department of Veterans Affairs, Washington, DC, USA
| | - A Lynn Snow
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA; Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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Hartmann CW, Clark V, Nash P, Sloup S, Toms R, Snow AL. Improving nursing home safety through Adoption of a practical Resilient Health Care approach. Geriatr Nurs 2024:S0197-4572(24)00152-6. [PMID: 39097469 DOI: 10.1016/j.gerinurse.2024.06.014] [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: 08/05/2024]
Abstract
Nursing homes struggle with safety issues, despite decades of intervention. This may, in part, stem from a reliance on a historical perspective that views safety as an intrinsic part of well-designed systems, with errors resulting from knowable, fixable causes. A new perspective (Resilient Health Care) assumes, instead, that in complex systems such as nursing homes, uncertainties and trade-offs occur in the course of everyday work. In this view, Resilient Health Care performance requires adapting to changes at different system levels to maintain high-quality care. An evidence-based program known as LOCK offers nursing homes a practical method for operationalizing a Resilient Health Care perspective. The LOCK program provides structures and processes that support frontline staff to successfully and safely navigate the complex interactions and factors that affect their daily provision of care. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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Affiliation(s)
- Christine W Hartmann
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA; Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA.
| | - Valerie Clark
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Princess Nash
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | - Sharon Sloup
- Office of Geriatrics and Extended Care (12GEC), Department of Veterans Affairs, Washington, DC, USA
| | - Rhonda Toms
- Office of Geriatrics and Extended Care (12GEC), Department of Veterans Affairs, Washington, DC, USA
| | - A Lynn Snow
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA; Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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Aryankhesal A, Blake J, Wong G, Megson M, Briscoe S, Allan L, Broomfield NM, Eastwood Z, Greene L, Hilton A, Killett A, Lazar AS, Litherland R, Livingston G, Maidment I, Reeve J, Rook G, Scott S, Um J, van Horik J, Fox C. Sleep disturbance in people living with dementia or mild cognitive impairment: a realist review of general practice. Br J Gen Pract 2024; 74:e233-e241. [PMID: 38499365 PMCID: PMC10962510 DOI: 10.3399/bjgp.2023.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/23/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group. AIM To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment. DESIGN AND SETTING A realist review of existing literature conducted in 2022. METHOD Six bibliographic databases were searched. Context-mechanism-outcome configurations (CMOCs) were developed and refined. RESULTS In total, 60 records were included from 1869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of sleep disturbance among primary care clinicians and patients, combined with time and resource constraints, meant that identifying sleep disturbance was difficult and not prioritised. Medication was perceived by clinicians and patients as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good-quality sleep. CONCLUSION In primary care, sleep disturbance among PLwD or MCI is not adequately addressed. Over-reliance on medication, underutilisation of non-pharmacological strategies, and inflexible care home routines were reported as a result of low confidence in sleep management and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of sleep disturbance to the needs of individuals and their informal carers without overstretching services.
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Affiliation(s)
- Aidin Aryankhesal
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Jessica Blake
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Molly Megson
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull
| | | | | | - Niall M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich
| | - Zenahrai Eastwood
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | | | - Andrea Hilton
- School of Paramedical PeriOperative and Advanced Practice, Faculty of Health Sciences, University of Hull, Hull
| | - Anne Killett
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Alpar S Lazar
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | | | - Gill Livingston
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London
| | - Ian Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull
| | | | - Sion Scott
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester
| | - Jinpil Um
- University of Exeter Medical School, Exeter
| | | | - Chris Fox
- University of Exeter Medical School, Exeter
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Garcia CM, Schrier EF, Carey C, Valle KA, Evans JL, Kushel M. Sleep Quality among Homeless-Experienced Older Adults: Exploratory Results from the HOPE HOME Study. J Gen Intern Med 2024; 39:460-469. [PMID: 37783981 PMCID: PMC10897106 DOI: 10.1007/s11606-023-08429-4] [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: 03/30/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Sleep is essential to health and affected by environmental and clinical factors. There is limited longitudinal research examining sleep quality in homeless older adults. OBJECTIVE To examine the factors associated with poor sleep quality in a cohort of older adults in Oakland, California recruited while homeless using venue-based sampling and followed regardless of housing status. DESIGN Longitudinal cohort study. PARTICIPANTS 244 homeless-experienced adults aged ≥ 50 from the Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME) cohort. MAIN MEASURES We assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI). We captured variables via biannual questionnaires and clinical assessments. KEY RESULTS Our sample was predominantly men (71.3%), Black (82.8%), and had a median age of 58.0 years old (IQR 54.0, 61.0). Two-thirds of participants (67.2%) reported poor sleep during one or more study visits; sleep duration was the worst rated subdomain. In a multivariable model, having moderate-to-severe depressive symptoms (AOR 2.03, 95% CI 1.40-2.95), trouble remembering (AOR 1.56, 95% CI 1.11-2.19), fair or poor physical health (AOR 1.49, 95% CI 1.07-2.08), two or more chronic health conditions (AOR 1.76, 95% CI 1.18-2.62), any ADL impairment (AOR 1.85, 95% CI 1.36-2.52), and being lonely (AOR 1.55, 95% CI 1.13-2.12) were associated with increased odds of poor sleep quality. Having at least one confidant was associated with decreased odds of poor sleep (AOR 0.56, 95% CI 0.37-0.85). Current housing status was not significantly associated with poor sleep quality. CONCLUSIONS Homeless-experienced older adults have a high prevalence of poor sleep. We found that participants' physical and mental health was related to poor sleep quality. Poor sleep continued when participants re-entered housing. Access to physical and mental healthcare, caregiving support, and programs that promote community may improve homeless-experienced older adults sleep quality, and therefore, their overall health.
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Affiliation(s)
- Cheyenne M Garcia
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
- UCSF Benioff Homelessness and Housing Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth F Schrier
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Caitlin Carey
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
- UCSF Benioff Homelessness and Housing Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Karen A Valle
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
- UCSF Benioff Homelessness and Housing Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer L Evans
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
- UCSF Benioff Homelessness and Housing Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Margot Kushel
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA.
- UCSF Benioff Homelessness and Housing Initiative, University of California, San Francisco, San Francisco, CA, USA.
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Gu HJ, Lee OS. Effects of Non-Pharmacological Sleep Interventions in Older Adults: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3101. [PMID: 36833796 PMCID: PMC9966498 DOI: 10.3390/ijerph20043101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/01/2023]
Abstract
This study investigated the effects of non-pharmacological interventions on sleep in older people through a systematic review and meta-analysis. We conducted a literature search using eight electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Participant characteristics, the contents of the evaluated interventions, and the measured outcomes were systematically reviewed for 15 selected studies. We performed a meta-analysis to estimate the effect size for overall, aggregated sleep outcomes. Due to the small number of studies available for each intervention, only the overall effectiveness of non-pharmacological sleep interventions was evaluated. The evaluated interventions included exercise, aromatherapy, acupressure, cognitive behavior therapy, and meditation. Our results demonstrated that non-pharmacological interventions showed statistically significant effects on sleep (effect size = 1.00, 95% confidence interval: 0.16, 1.85, I2 = 92%, p < 0.001). After confirming publication bias and removing outliers, we found no heterogeneity (I2 = 17%, p = 0.298), with a decrease in effect size to 0.70 (95% confidence interval: 0.47, 0.93). Non-pharmacological interventions are effective for improving sleep in older adults. Future studies should continue to investigate sleep problems and interventions addressing these problems in this demographic, particularly in older women. Objective measures should be used to follow-up on the evaluated sleep interventions over the long term.
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Affiliation(s)
- Hye-Ja Gu
- Department of Nursing Science, Kyungsung University, Busan 48434, Republic of Korea
| | - Oi-Sun Lee
- Department of Nursing, Gyeongnam Geochang University, Geochang-gun 50147, Republic of Korea
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Wittenberg GF, Reddy A, Gifford DR, McLaughlin MM, Leung V, Baier RR. Design of a Nursing Home Infection Control Peer Coaching Program. J Am Med Dir Assoc 2023; 24:573-579. [PMID: 36708742 DOI: 10.1016/j.jamda.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 12/09/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To pilot test and refine an infection control peer coaching program, Infection Control Amplification in Nursing Centers (ICAN), in partnership with providers. DESIGN Intervention design and pilot test. SETTING AND PARTICIPANTS Infection preventionists (IPs) from 7 Connecticut nursing homes (NHs). METHODS We codesigned and pilot tested the ICAN program with NH IPs. The initial program involved designating peer coaches to provide real-time feedback on infection control practices to coworkers and targeting coaches' observations using data from both observations shared by coaches in daily huddles and weekly audit data about hand hygiene, masking, and transmission-based precautions. IPs tested the initial program while providing feedback to the research team during weekly calls. We used information from the calls, participant surveys, and the pilot process to update the program. RESULTS Despite IPs reporting that the initial program was highly aligned with facility priorities and needs, their weekly call attendance dropped as they dealt with short staffing and COVID-19-related outbreaks and none implemented all of the program's components as intended. Most IPs described making changes to increase feasibility and reduce burden on staff amid short staffing and other ongoing issues exacerbated by the SARS-CoV-2 pandemic. We used information from the IPs and the pilot to update the program, including shifting from having IPs lead implementation solo to using a team-based approach. The updated program retains peer coaches and audit data, while broadening the mode of feedback from huddles only to communication using one-on-one meetings or emails, huddles, or other strategies. It also provides NH staff with flexibility to tailor implementation of each to their needs and constraints. CONCLUSIONS AND IMPLICATIONS Working with staff, we developed an infection control peer coaching program that may be of use to NH leaders seeking strategies to strengthen infection control practices. Future work should involve implementing and evaluating the updated program.
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Affiliation(s)
- Grace F Wittenberg
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Ann Reddy
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - David R Gifford
- American Health Care Association/National Center for Assisted Living, Washington, DC, USA
| | - Marguerite M McLaughlin
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Vivian Leung
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Rosa R Baier
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
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Haddad R, Decalf V, Monaghan TF, Van Laecke E, Bower W, Goessaert AS, Petrovic M, Everaert K. Nocturia severely impairs the sleep quality of nursing home residents: results from a multi-center study. Geriatr Nurs 2022; 48:164-168. [PMID: 36257221 DOI: 10.1016/j.gerinurse.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the association between self-reported sleep quality and nocturia in nursing home residents. METHODS The association between self-reported poor sleep quality and nocturia was examined in eighty nursing home residents from two nursing facilities using logistic regression analysis. RESULTS Poor sleep quality was reported by 29% of the eighty participants (median age 89±7 years, 77% of women). Nocturia was more frequent in patients with versus without self-reported poor sleep quality (78% vs 47%, p=0.01). Nocturia was independently associated with self-reported poor sleep quality after controlling for age, gender, self-rated health status, cognitive frailty score, antidepressant and hypnosedative use (OR[95%CI] of 6.1[1.8-25.4]). CONCLUSION Nocturia severely impaired sleep quality in nursing home residents. Nocturia should be investigated in nursing home residents to optimize sleep quality.
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Affiliation(s)
- Rebecca Haddad
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
| | - Veerle Decalf
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Thomas F Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wendy Bower
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - An-Sofie Goessaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Benca R, Herring WJ, Khandker R, Qureshi ZP. Burden of Insomnia and Sleep Disturbances and the Impact of Sleep Treatments in Patients with Probable or Possible Alzheimer's Disease: A Structured Literature Review. J Alzheimers Dis 2022; 86:83-109. [PMID: 35001893 PMCID: PMC9028660 DOI: 10.3233/jad-215324] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Sleep disturbances are frequent in Alzheimer’s disease (AD). Objective: To summarize the impact of sleep disturbances on AD patients and their caregivers and the effects of currently available sleep therapies. Methods: Published studies (January 1985–March 2020) assessing the burden associated with insomnia/sleep disturbances in the AD population and insomnia treatment effects were identified by searching PubMed, Embase, and Cochrane Library and screened against inclusion criteria. Results: 58 studies assessing patient and caregiver burden, institutionalization, and insomnia treatments in AD patients with sleep disturbances were identified. Sleep disturbances were associated with worse cognition, functional ability, and behavioral and neuropsychological functioning. Health status and quality of life of both patients and caregivers were reduced in the presence of sleep disturbances. Sleep disturbances were also associated with institutionalization. Although significant associations between sleep problems and clinical outcomes were apparent, there was generally no control for other influencing factors (e.g., cognitive status). Bright light and behavioral therapies as well as drugs showed some promise in AD patients, but studies were primarily small and limited data were available, particularly in regard to the effect on associated clinical burden. Conclusion: Sleep disturbances are a significant problem for AD patients and caregivers, associated with behavioral and psychological problems and cognitive decline. However, they remain poorly characterized and under-researched. As the global population is aging and AD is on thes rise, data from larger, prospective trials are required to fully understand the clinical correlates of sleep disturbances and the impact insomnia treatments can have.
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Affiliation(s)
- Ruth Benca
- University of California, Irvine, Irvine, CA, USA
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