1
|
Myhre J, Lichtwarck B. How and why does it work? A video-based qualitative analysis of case conferences to reduce BPSD through the lens of Habermas's theory of communicative action. BMC Psychiatry 2024; 24:520. [PMID: 39039488 PMCID: PMC11265080 DOI: 10.1186/s12888-024-05959-x] [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: 05/09/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Case conferences are described as a goal-oriented, systematic method that team members can use to exchange professional opinions and develop treatment actions for a particular care problem. However, not all case conferences have proven to be effective. The Norwegian Targeted Interdisciplinary Model for the Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) is an effective multicomponent model based on case conferences that informs approaches to behavioural and psychological symptoms in residents with dementia in nursing homes. Our aim was to explore how TIME case conferences structured based on cognitive behavioural therapy (CBT) contributed to person-centred actions and how the specific inductive structure of the TIME may have contributed to the effectiveness of the model. METHODS We used video observation of six case conferences and analysed these videos by performing a thematic cross-case analysis of the transcripts from the videos and by iteratively watching the videos. According to Habermas's theory of communicative action, we emphasized the case conference content, i.e., what was talked about in the case conferences, and the display of communication between the participants in the case conferences. RESULTS Our findings showed that the theoretical principles behind the TIME, including both person-centred care and the inductive structure of CBT, reflected many aspects of Habermas's theory of communicative actions. In particular, the TIME case conferences emphasized the lifeworld perspective for both residents and staff and contributed to what Habermas labelled communicative rationality as a means to develop shared understanding among staff and create person-centred action. CONCLUSIONS One causal assumption of how and why the TIME case conferences contributed to the effectiveness of the TIME in reducing BPSD in nursing homes is that the specific inductive structure of the case conferences with the column technique based on the ABC method together with PCC, emphasized the importance of the lifeworld for both the resident and the staff. Even though case conferences have been highlighted as useful, it is not indifferent how these case conferences are structured and conducted. CLINICAL TRIAL REGISTRATION The trial TIME was registered January 6, 2016, with clinicaltrials.gov (NCT02655003).
Collapse
Affiliation(s)
- Janne Myhre
- The Research Centre for Age-Related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway.
- Department of Health and Nursing Science, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, INN University, Elverum, Norway.
- Norwegian Centre for Violence and Traumatic Stress Studies, (NKVTS), Oslo, Norway.
| | - Bjørn Lichtwarck
- The Research Centre for Age-Related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway
| |
Collapse
|
2
|
Zhu CW, Schneider LS, Elder GA, Soleimani L, Grossman HT, Aloysi A, Schimming C, Sano M. Neuropsychiatric Symptom Profile in Alzheimer's Disease and Their Relationship With Functional Decline. Am J Geriatr Psychiatry 2024:S1064-7481(24)00375-0. [PMID: 39013750 DOI: 10.1016/j.jagp.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Understanding the course of individual neuropsychiatric symptoms (NPS) and their relationship with function is important for planning targeted interventions for preventing and delaying functional decline. This study aims to disentangle relative contributions of individual NPS on functional decline. METHODS Longitudinal study of 9,358 well-characterized participants with baseline diagnoses of Mild Cognitive Impairment or AD in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured using the Functional Assessment Questionnaire (FAQ). Clinician judgment of seven common behavioral symptoms were examined simultaneously: apathy-withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, and agitation. RESULTS Apathy was the most common NPS at baseline (33.7%) and throughout follow-up, endorsed by clinicians in 63.7% of visits. Apathy was the most persistent with 36.7% of participants having clinician-endorsed apathy in ≥50% of their visits. Apathy strongly correlated with faster rate of functional decline. Compared to those who never had apathy, baseline FAQ was worse in those with intermittent or persistent/always apathy (intermittent: estimated coefficient ±SE=1.228±0.210, 95% CI=[0.817, 1.639]; persistent/always: 2.354±0.244 (95% CI=[1.876, 2.832], both p <0.001). Over time, rate of functional decline was faster in those with intermittent and persistent/always apathy (intermittent: 0.454±0.091, 95% CI=[0.276, 0.632]; persistent/always: 0.635±0.102, 95% CI=[0.436, 0.835], both p <0.001). Worse agitation, delusions, and hallucinations also correlated with functional decline, but magnitudes of the estimates were smaller. CONCLUSION Individual NPS may be sensitive targets for tracking longitudinal change in function. The study raises awareness of the need for more comprehensive assessment of functional decline in AD patients with noncognitive symptoms.
Collapse
Affiliation(s)
- Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine (CWZ), Icahn School of Medicine at Mount Sinai, New York, NY; James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Lon S Schneider
- Department of Psychiatry, Neurology, and Gerontology (LSS), Keck School of Medicine and Leonard Davis School of Gerontology, University of Southern, CA
| | - Gregory A Elder
- James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laili Soleimani
- Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hillel T Grossman
- James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Aloysi
- Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Corbett Schimming
- James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary Sano
- James J Peters VA Medical Center (CWZ, GAE, HTG, CS, MS), Bronx, NY; Department of Psychiatry, (CWZ, GAE, LS, HTG, AA, CS, MS), Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
3
|
Bjørk E, Aabenhus R, Larsen SP, Ryg J, Henriksen DP, Lundby C, Pottegård A. Use of antibiotics for urinary tract infections up to and after care home admission in Denmark: a nationwide study. Eur Geriatr Med 2024; 15:797-805. [PMID: 38698277 PMCID: PMC11329397 DOI: 10.1007/s41999-024-00976-1] [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: 08/28/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Older people have the highest use of antibiotics for acute and chronic urinary tract infection (UTI), despite diagnostic uncertainty and the growing problem of antibiotic resistance. We aim to describe use-patterns of UTI antibiotics two years prior to and following care home admission in Denmark. METHODS This was a register-based nationwide drug-utilization study. In a cohort comprising all Danish residents admitted into a care home from 2015 to 2021, we described the use of UTI antibiotics, and examined differences between regions and individual care homes in rates of UTI antibiotic use. Further, we described trends in UTI-related contacts with hospitals in the two years prior to and following care home admission. RESULTS The cohort comprised 101,297 residents (61% female; median age 84 years). UTI antibiotic use doubled from 7 to 14 treatments/100 residents/month two months prior to care home admission and remained at 10 treatments/100 residents/month the following two years. Prescription of pivmecillinam (55%) was most common. Primary care practitioners prescribed the majority (92%) of UTI antibiotics. UTI-related hospital contacts peaked at two months prior to care home admission, with 6 admissions/100 residents/month, subsequently dropping to 2 admission/100 residents/month. We found considerable variation in UTI antibiotic use, with 10% of care homes responsible for 20% of treatments in 2021. CONCLUSION Use of UTI antibiotics increased prior to and remained at a stable high level following care home admission in Denmark. Despite variation in use across regions and individual care homes, an overall decrease was seen throughout the years 2016-2021.
Collapse
Affiliation(s)
- Emma Bjørk
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, JB Winsløwsvej 19, 2, 5000, Odense C, Denmark.
- Odense Deprescribing Initiative (ODIN), Odense University Hospital, University of Southern Denmark, Odense C, Denmark.
| | - Rune Aabenhus
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jesper Ryg
- Odense Deprescribing Initiative (ODIN), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Daniel P Henriksen
- Department of Clinical Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Carina Lundby
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, JB Winsløwsvej 19, 2, 5000, Odense C, Denmark
- Odense Deprescribing Initiative (ODIN), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
- Department of Public Health, Research Unit of General Practice, University of Southern, Odense C, Denmark
| | - Anton Pottegård
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, JB Winsløwsvej 19, 2, 5000, Odense C, Denmark
- Odense Deprescribing Initiative (ODIN), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| |
Collapse
|
4
|
Lund SB, Malmedal WK, Mosqueda L, Skolbekken JA. "Just pee in the diaper" - a constructivist grounded theory study of moral distress enabling neglect in nursing homes. BMC Geriatr 2024; 24:366. [PMID: 38658812 PMCID: PMC11040955 DOI: 10.1186/s12877-024-04920-7] [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: 08/04/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND A growing body of evidence shows that many nursing home residents' basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: "How do nursing home staff manage their moral distress related to neglectful care practices?" METHODS A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway. RESULTS Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes. CONCLUSIONS Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.
Collapse
Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, PO Box 8905, Norway.
| | - Wenche K Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, PO Box 8905, Norway
| | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, PO Box 8905, Norway
| |
Collapse
|
5
|
Prick AEJC, Zuidema SU, van Domburg P, Verboon P, Vink AC, Schols JMGA, van Hooren S. Effects of a music therapy and music listening intervention for nursing home residents with dementia: a randomized controlled trial. Front Med (Lausanne) 2024; 11:1304349. [PMID: 38379562 PMCID: PMC10877716 DOI: 10.3389/fmed.2024.1304349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction The aim of the present study was to evaluate the effects of an individual music therapy intervention and an individual music listening intervention on neuropsychiatric symptoms and quality of life in people with dementia living in a nursing home and on professional caregiver's burden to be able to make statements about their specific value of application in clinical practice. Methods A multicenter single blind randomized controlled trial with three groups was performed: an individual music therapy intervention (IMTI) group (n = 49), an individual music listening intervention (IMLI) group (n = 56) and a control group (n = 53) receiving usual care. The interventions were given during three weeks, three times a week on non-consecutive days during 30-45 minutes for in total nine sessions. The endpoint of the study is the difference from baseline to interim (1,5 week), post-intervention (3 weeks) and follow-up (6 weeks) in reported scores of problem behaviour (NPI-NH) and quality of life (Qualidem) in people with dementia and occupational disruptiveness (NPI-NH) in care professionals. Results In total 158 people with dementia were randomized to one of the two intervention groups or the control group. Multilevel analyses demonstrated that hyperactive behaviour assessed by the NPI-NH was significantly more reduced for the IMLI group at follow up and that restless behaviour assessed by the Qualidem was significantly more reduced for the IMTI group at post and follow-up measurement compared to the control group. No significant effects between groups were found in other NPI-NH clusters or Qualidem subscales. Conclusion In conclusion, because we found no convincing evidence that the IMTI or IMLI is more effective than the other both interventions should be considered in clinical practice. For the future, we advise further research into the sustainability of the effects with alternative designs, like a single case experimental design.
Collapse
Affiliation(s)
- Anna-Eva J. C. Prick
- Department of Creative Arts Therapies, Zuyd Hogeschool, Heerlen, Netherlands
- Department of Clinical Psychology, Open Universiteit, Heerlen, Netherlands
| | - Sytse U. Zuidema
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Alzheimer Centrum Groningen, Groningen, Netherlands
| | - Peter van Domburg
- Department of Neurology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Peter Verboon
- Department of Methods and Statistics, Open Universiteit, Heerlen, Netherlands
| | - Annemieke C. Vink
- Department of Music Therapy, ArtEZ University of the Arts, Arnhem, Netherlands
| | - Jos M. G. A. Schols
- Department of HSR, Maastricht University, Maastricht, Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, Netherlands
| | - Susan van Hooren
- Department of Clinical Psychology, Open Universiteit, Heerlen, Netherlands
| |
Collapse
|
6
|
Helvik AS, Bergh S, Šaltytė Benth J, Borza T, Husebø B, Tevik K. Pain and quality of life in nursing home residents with dementia after admission - a longitudinal study. BMC Health Serv Res 2023; 23:1032. [PMID: 37759201 PMCID: PMC10537464 DOI: 10.1186/s12913-023-10041-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Pain in nursing home (NH) residents with dementia is commonly reported and may affect Quality of Life (QoL) negatively. Few longitudinal studies have explored how pain and QoL develop in NH residents with dementia starting from their admission to the NH. AIM The aim was to explore pain, QoL, and the association between pain and QoL over time in persons with dementia admitted to a NH. METHODS A convenience sample, drawn from 68 non-profit NHs, included a total of 996 Norwegian NH residents with dementia (mean age 84.5 years, SD 7.6, 36.1% men) at NH admission (A1), with annual follow-ups for two years (A2 and A3). Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively, at all assessments. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the prescription of psychotropic drugs and analgesics (opioids and/or paracetamol) were also assessed at all assessments. RESULTS Mean (SD) MOBID-2 pain intensity scores were 2.1 (2.1), 2.2 (2.2), and 2.4 (2.1) at A1, A2, and A3, respectively. Participants who were prescribed analgesics had higher pain intensity scores at all assessments than participants not prescribed analgesics. The mean (SD) QUALID scores at each assessment were 19.8 (7.1), 20.8 (7.2), and 22.1 (7.5) at A1, A2, and A3, respectively. In the adjusted linear mixed model, higher pain intensity score, prescription of opioids, and prescription of paracetamol were associated with poorer QoL (higher QUALID total score and higher scores in the QoL dimensions of sadness and tension) when assessed simultaneously. No time trend in QoL was found in these adjusted analyses. CONCLUSION NH residents with dementia who have higher pain intensity scores or are prescribed analgesics are more likely to have poorer QoL. Clinicians, NH administrators, and national healthcare authorities need to look into strategies and actions for pharmacological and non-pharmacological pain treatment to reduce pain intensity while simultaneously avoiding negative side effects of pain treatment that hamper QoL.
Collapse
Affiliation(s)
- Anne-S Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway, Box 8905, NO-7491 Trondheim.
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tom Borza
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Bettina Husebø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, Neuro-SysMed, University of Bergen, Bergen, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway, Box 8905, NO-7491 Trondheim
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
7
|
Lund SB, Skolbekken JA, Mosqueda L, Malmedal WK. Legitimizing neglect - a qualitative study among nursing home staff in Norway. BMC Health Serv Res 2023; 23:212. [PMID: 36879261 PMCID: PMC9990246 DOI: 10.1186/s12913-023-09185-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Residents in nursing homes do not always get qualitatively good nursing care, and research shows that residents' basic care needs are sometimes neglected. Neglect in nursing homes is a challenging and complex issue, yet a preventable one. Nursing home staff are at the frontline of detecting and preventing neglect but may also be the ones causing it. It is essential to understand why and how neglect happens in order to recognize, expose, and prevent its occurrence. Our aim was to generate new knowledge on the processes leading to and allowing neglect to continue in Norwegian nursing homes, by studying how nursing home staff perceive and reflect on when nursing home residents are neglected in their daily practice. METHODS A qualitative exploratory design was used. The study was based on five focus group discussions (20 participants, total) and ten individual interviews with nursing home staff from 17 different nursing homes in Norway. The interviews were analysed according to Charmaz constructivist grounded theory. RESULTS In order to make neglect an acceptable practice, nursing home staff apply different strategies. These strategies were identified as when the staff legitimize neglect by neglecting neglect, when the staff are not recognizing their own behaviour as neglectful, as expressed in their actions and language, and normalizing missed care when resources are lacking and nursing staff are rationing care. CONCLUSIONS The gradual shift between judging actions as neglectful or not are made possible when nursing home staff legitimize neglect by not recognizing their practice as neglective, thus neglecting neglect or when they are normalizing missed care. Increased awareness and reflections on these processes may be a way of reducing the risk of and preventing neglect in nursing homes.
Collapse
Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway.
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway
| | - Laura Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Wenche K Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway
| |
Collapse
|
8
|
Eikelboom WS, Koch J, Beattie E, Lautenschlager NT, Doyle C, van den Berg E, Papma JM, Anstey KJ, Mortby ME. Residential aged care staff perceptions and responses towards neuropsychiatric symptoms: a mixed methods analysis of electronic healthcare records. Aging Ment Health 2023; 27:243-250. [PMID: 35100918 DOI: 10.1080/13607863.2022.2032597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate electronic care notes to better understand reporting and management of neuropsychiatric symptoms (NPS) by residential aged care (RAC) staff. METHODS We examined semi-structured care notes from electronic healthcare notes of 77 residents (67% female; aged 67-101; 79% with formal dementia diagnosis) across three RAC facilities. As part of standard clinical practice, staff documented the NPS presentation and subsequent management amongst residents. Using a mixed-method approach, we analyzed the type of NPS reported and explored care staff responses to NPS using inductive thematic analysis. RESULTS 465 electronic care notes were recorded during the 18-month period. Agitation-related behaviors were most frequently reported across residents (48.1%), while psychosis (15.6%), affective symptoms (14.3%), and apathy (1.3%) were less often reported. Only 27.5% of the notes contained information on potential causes underlying NPS. When faced with NPS, care staff responded by either providing emotional support, meeting resident's needs, removing identified triggers, or distracting. CONCLUSION Results suggest that RAC staff primarily detected and responded to those NPS they perceived as distressing. Findings highlight a potential under-recognition of specific NPS types, and lack of routine examination of NPS causes or systematic assessment and management of NPS. These observations are needed to inform the development and implementation of non-pharmacological interventions and care programs targeting NPS in RAC. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2032597 .
Collapse
Affiliation(s)
- Willem S Eikelboom
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jana Koch
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Colleen Doyle
- National Aging Research Institute, Parkville, VIC, Australia
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kaarin J Anstey
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Moyra E Mortby
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| |
Collapse
|
9
|
Abstract
Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses' ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses' own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner.
Collapse
Affiliation(s)
- Hillestad AH
- Lovisenberg Diaconal University College, Oslo, Norway
| |
Collapse
|
10
|
Helvik AS, Bergh S, Kabukcuoğlu K, Šaltytė Benth J, Lichtwarck B, Husebø B, Tevik K. Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home - A longitudinal study. PLoS One 2022; 17:e0279909. [PMID: 36584218 PMCID: PMC9803316 DOI: 10.1371/journal.pone.0279909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/18/2022] [Indexed: 01/01/2023] Open
Abstract
The overall aim was to explore the prevalence and persistent regular prescription of opioids and paracetamol among nursing home (NH) residents with dementia at admission and over time. A total of 996 residents with dementia, mean (SD) age 84.5 (7.6) years and (36.1% men), were included at admission (A1). Yearly assessments were performed for two years (A2 and A3) or until death. Pain was assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale. Information regarding prescription of analgesics, general physical health, personal activities of daily living, severity of dementia, neuropsychiatric symptoms, and prescription of psychotropic drugs was collected. A generalized linear mixed model was used to explore whether pain severity was associated with persistent and persistent prescription of opioids and/or paracetamol across timepoints. At A1, 495 of 996 (49.7%) NH residents were prescribed analgesics and prevalence increased at the follow-ups (A2: n = 630, 65.1%; A3: n = 382, 71.2%). Paracetamol was the most frequently prescribed analgesic at all assessments (A1: 45.5%; A2: 59.5%; A3: 67.1%). Opioid prescriptions were quite prevalent (A1: 18.1%; A2: 25.1%; A3: 28.3%), with odds approximately 13 times (OR = 13.3, 95% CI 6.8-26.0) and 9 times (OR = 8.6, 95% CI 3.7-20.3) higher for prescription at follow-up A2 and A3, respectively, relative to prescription at A1. In adjusted analyses, higher pain intensity and poor physical health were associated with prescription and persistent prescription of opioids and paracetamol. In conclusion, prevalence and persistent prescription of analgesics were high in NH residents with dementia. The odds for the prescription of opioids at follow-up were high if prescribed at baseline. Interdisciplinary collaboration, routine assessment of pain at admission and regularly thereafter, and systematic drug reviews are essential to adequately assess and treat pain in NH residents with dementia.
Collapse
Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- * E-mail:
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Kamile Kabukcuoğlu
- Faculty of Nursing, Akdeniz University, Campus Antalya, Antalya, Türkiye
| | - Jūratė Šaltytė Benth
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Lichtwarck
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Bettina Husebø
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
11
|
Sandmoe A, Myhre J, Iversen MH, Eriksen S, Lichtwarck B. Vold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon:Begrepsbruk i en norsk sykehjemskontekst. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
12
|
Helvik AS, Bergh S, Šaltytė Benth J, Selbaek G, Husebo BS, Tevik K. Pain in nursing home residents with dementia and its association to quality of life. Aging Ment Health 2022; 26:1787-1797. [PMID: 34251936 DOI: 10.1080/13607863.2021.1947968] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We aimed to describe pain, use of analgesics and quality of life (QoL) in people with dementia admitted to a Norwegian nursing home (NH), and to explore if and how pain was associated with their QoL when adjusting for sociodemographic characteristics, other health conditions and use of analgesics. METHOD A total of 953 Norwegian NH residents with dementia (mean age 84.0, SD 7.5 years, 35.8% men) were included at admission to the NH. Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the use of psychotropic drugs and analgesics were assessed. RESULTS In total, 36% of the participants had clinically relevant pain intensity (MOBID-2 ≥ 3) and 52% received analgesics. Paracetamol was most frequently prescribed (45%). In an adjusted linear mixed model, more severe pain was associated with higher QUALID total scores, indicating poorer QoL (regression coefficient 0.52, 95% CI 0.36-0.69). CONCLUSION Pain prevalence at NH admission was high in residents with dementia; half used analgesics, particularly paracetamol. More severe pain was associated with poorer QoL when adjusting for sociodemographic characteristics, other health conditions, and use of analgesics. The routine assessment of pain at NH admission can uncover undiagnosed and untreated pain and allow for adequate non-pharmacological and pharmacological pain management and likely increased QoL.
Collapse
Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Vestfold Hospital Trust, Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
| | - Sverre Bergh
- Vestfold Hospital Trust, Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway.,The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė Benth
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbaek
- Vestfold Hospital Trust, Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Vestfold Hospital Trust, Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
| |
Collapse
|
13
|
Affiliation(s)
- Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Gary Mitchell
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| |
Collapse
|
14
|
Mortality in nursing home residents stratified according to subtype of dementia: a longitudinal study over three years. BMC Geriatr 2022; 22:282. [PMID: 35382759 PMCID: PMC8985279 DOI: 10.1186/s12877-022-02994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background There are several subtypes of dementia caused by different pathophysiology and with different clinical characteristics. Irrespective subtype, the disease is progressive, eventually leading to the need for care and supervision on a 24/7 basis, often provided in nursing homes (NH). The progression rate and course of the disease might vary according to subtype. The aim of this study was to explore whether the mortality rate for NH residents varied according to the subtype of dementia. Methods NH residents were followed from admission to NH over a period of 36 months or until death with annual follow-up examinations. Demographic and clinical data were collected. The diagnosis of dementia and its subtype at baseline (BL) were set according to international accepted criteria. Kaplan-Meier analysis was performed to estimate median survival time. A Cox regression model was estimated to assess the impact of dementia diagnosis and demographic and clinical variables on mortality. Results A total of 1349 participants were included. When compared to persons with Alzheimer’s disease (AD), persons with frontotemporal dementia (FTD) and dementia with Lewy bodies or Parkinson’s disease dementia (DLB/PDD) were younger and had more neuropsychiatric symptoms. Median survival for the total sample was 2.3 years (95% confidence interval: 2.2–2.5). When compared to persons with AD, having no dementia or unspecified dementia was associated with higher mortality, while we found similar mortality in other subtypes of dementia. Higher age, male gender, poorer general health, higher dependency in activities of daily living, and more affective symptoms were associated with higher mortality. Conclusion Mortality did not differ across the subtypes of dementia, except in persons with unspecified dementia or without dementia, where we found a higher mortality. With a median survival of 2.3 years, NH residents are in the last stage of their lives and care and medical follow-up should focus on a palliative approach. However, identifying the subtype of dementia might help carers to better understand and address neuropsychiatric symptoms and to customize medical treatment.
Collapse
|
15
|
Grossman HT, Sano M, Aloysi A, Elder GA, Neugroschl J, Schimming C, Soleimani L, Zhu CW. Prevalent, persistent, and impairing: Longitudinal course and impact of apathy in Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 13:e12169. [PMID: 35141391 PMCID: PMC8817116 DOI: 10.1002/dad2.12169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Understanding of the natural history of apathy and its impact on patient function is limited. This study examines, in a large, national sample of Alzheimer's disease (AD) patients with long follow-ups: (1) prevalence, incidence, and persistence of apathy, and (2) impact of apathy on function across dementia severity. METHODS A longitudinal study of 9823 well-characterized AD patients in the National Alzheimer's Coordinating Center Uniform Data Set. RESULTS Apathy was highly prevalent across disease severity with cumulative prevalence of 48%, 74%, and 82% in Clinical Dementia Rating (CDR) 0.5, 1.0, and 2.0, respectively. Persistence of apathy from clinician judgment varied from visit to visit at earlier disease stages but remained high at moderate dementia. Independent of cognition, persistent apathy was strongly associated with accelerated rate of functional decline. DISCUSSION Findings point to important targets for the treatment and management of apathy, include functional outcomes, and study designs that account for variable persistence of the apathy syndrome.
Collapse
Affiliation(s)
- Hillel T. Grossman
- James J. Peters VA Medical CenterBronxNew YorkUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Mary Sano
- James J. Peters VA Medical CenterBronxNew YorkUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Amy Aloysi
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
- Department of NeurologyIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Gregory A. Elder
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
- Department of NeurologyIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Judith Neugroschl
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Corbett Schimming
- James J. Peters VA Medical CenterBronxNew YorkUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Laili Soleimani
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Carolyn W. Zhu
- James J. Peters VA Medical CenterBronxNew YorkUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
- Brookdale Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| |
Collapse
|
16
|
Shaughnessy L, Brunton S, Chepke C, Farmer JG, Rosenzweig AS, Grossberg G. Using Telemedicine to Assess and Manage Psychosis in Neurodegenerative Diseases in Long-Term Care. J Am Med Dir Assoc 2022; 23:1145-1152. [PMID: 35032454 PMCID: PMC8752392 DOI: 10.1016/j.jamda.2021.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/29/2021] [Accepted: 12/11/2021] [Indexed: 11/04/2022]
Abstract
The coronavirus disease 2019 (COVID-19) epidemic has forced a sudden global implementation of telemedicine strategies, including in long-term care (LTC) facilities where many people with dementia and Parkinson disease (PD) reside. Telemedicine offers a unique set of advantages for residents in LTC facilities if effectively supported and implemented, including expanded access to specialists in rural or underserved areas or for people with dementia who cannot travel for off-site visits. Many medical and psychiatric organizations have recently issued new or updated guidelines on the use of telemedicine. On October 22, 2020, a multidisciplinary consensus panel was convened to collate a list of best practices for LTC facilities and specialists when conducting telemedicine with residents with dementia-related psychosis or PD-related psychosis (PDP). A collaborative effort between specialists, facility administrators, and facility staff is essential for the success of telemedicine in the LTC setting. Telemedicine in LTC facilities comes with increased administrative and technical challenges that fall heavily on the shoulders of the LTC facility administrators and staff. Specialists can ease this burden by maintaining flexibility and ensuring expression of empathy and thanks to the staff who are facilitating the visits. LTC staff can provide specialists with valuable information about their patients to aid in evaluation and diagnosis. Specialists can facilitate this exchange of information by speaking to staff who work closely with the resident about any signs of hallucinations or delusions they may have observed. Educational efforts can increase staff understanding of dementia and PDP and empower them to engage with, and facilitate the resident's treatment plan. Using these strategies to take advantage of the benefits of telemedicine, specialists and LTC staff can together expand and improve care for LTC facility residents with dementia-related psychosis or PDP.
Collapse
Affiliation(s)
- Lynn Shaughnessy
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Stephen Brunton
- Primary Care Education Consortium, Winnsboro, SC, USA; Touro University, Vallejo, CA, USA
| | - Craig Chepke
- Excel Psychiatric Associates and University of North Carolina School of Medicine, Huntersville, NC, USA
| | - Jill G Farmer
- Parkinson's Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA; Drexel College of Medicine, Philadelphia, PA, USA
| | | | | |
Collapse
|
17
|
Gisladottir S, Sigurdardottir AK, Hjaltadottir I. Use of psychiatric medication in three Arctic nursing homes: association with dementia and psychiatric symptoms. Int J Circumpolar Health 2021; 80:1920252. [PMID: 33899700 PMCID: PMC8079027 DOI: 10.1080/22423982.2021.1920252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
Abstract
As more people reaches advanced age, more people experience cognitive impairment and dementia. Dementia is a degenerative disease in which behavioural and psychological symptoms frequently occur, resulting in admissions to nursing homes (NHs), where the most common treatment has been medical treatment. The aim was to compare three rural Arctic NHs in Iceland in their use of psychiatric medication, type of dementia among residents, level of cognitive impairment and selected quality indicators, as well as considering national data, for the period 2016-2018. Data from the interRAI-MDS 2.0 evaluation were used. Residents with severe cognitive impairment used more antipsychotic medications, and residents with mild and severe cognitive impairment used more antidepressants than residents with no cognitive impairment did. Diagnoses of Alzheimer's Disease and Related Dementias (ADRD) are more common in the capital area and the national average than they are in the rural NHs. This indicates need for diagnostic assessments of ADRD to be conducted in rural areas. Benchmarking is beneficial for local and national regulatory bodies to find areas for improvement. The NHs did not have a lower quality of care compared with the whole country, but areas for improvement were identified. One of the NHs has already started this process.
Collapse
Affiliation(s)
- Sigurveig Gisladottir
- Fossahlid Nursing Home, Health Care Institution of Eastern Iceland
- University of Akureyri, School of Health Sciences, Akureyri, Iceland
| | - Arun K. Sigurdardottir
- University of Akureyri, School of Health Sciences, Akureyri, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - Ingibjörg Hjaltadottir
- Faculty of Nursing, University of Iceland
- Division of Clinical Services Landspítali, National University Hospital, Reykjavik, Iceland
| |
Collapse
|
18
|
Callegari E, Šaltytė Benth J, Selbæk G, Grønnerød C, Bergh S. Do prescription rates of psychotropic drugs change over three years from nursing home admission? BMC Geriatr 2021; 21:496. [PMID: 34530728 PMCID: PMC8447606 DOI: 10.1186/s12877-021-02437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription. METHODS We used data from the Resource Use and Disease Course in Dementia - Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period. RESULTS PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%-42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92-0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85-0.94, p < 0.001). CONCLUSIONS PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01920100 .
Collapse
Affiliation(s)
- Enrico Callegari
- grid.412938.50000 0004 0627 3923Østfold Hospital Trust, Sykehuset Østfold HF, postboks 300, 1714 Grålum, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway ,grid.412929.50000 0004 0627 386XResearch Centre for Age-related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway ,grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbæk
- grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway ,grid.417292.b0000 0004 0627 3659Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway ,grid.55325.340000 0004 0389 8485Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Cato Grønnerød
- grid.412938.50000 0004 0627 3923Østfold Hospital Trust, Sykehuset Østfold HF, postboks 300, 1714 Grålum, Norway ,grid.5510.10000 0004 1936 8921Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- grid.412929.50000 0004 0627 386XResearch Centre for Age-related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway ,grid.417292.b0000 0004 0627 3659Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
19
|
Palmdorf S, Stark AL, Nadolny S, Eliaß G, Karlheim C, Kreisel SH, Gruschka T, Trompetter E, Dockweiler C. Technology-Assisted Home Care for People With Dementia and Their Relatives: Scoping Review. JMIR Aging 2021; 4:e25307. [PMID: 33470935 PMCID: PMC7857954 DOI: 10.2196/25307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 12/30/2022] Open
Abstract
Background Assistive technologies for people with dementia and their relatives have the potential to ensure, improve, and facilitate home care and thereby enhance the health of the people caring or being cared for. The number and diversity of technologies and research have continuously increased over the past few decades. As a result, the research field has become complex. Objective The goal of this scoping review was to provide an overview of the research on technology-assisted home care for people with dementia and their relatives in order to guide further research and technology development. Methods A scoping review was conducted following a published framework and by searching 4 databases (MEDLINE, CINAHL, PsycInfo, and CENTRAL) for studies published between 2013 and 2018. We included qualitative and quantitative studies in English or German focusing on technologies that support people with dementia or their informal carers in the home care setting. Studies that targeted exclusively people with mild cognitive impairment, delirium, or health professionals were excluded as well as studies that solely consisted of assessments without implication for the people with dementia or their relatives and prototype developments. We mapped the research field regarding study design, study aim, setting, sample size, technology type, and technology aim, and we report relative and absolute frequencies. Results From an initial 5328 records, we included 175 studies. We identified a variety of technology types including computers, telephones, smartphones, televisions, gaming consoles, monitoring devices, ambient assisted living, and robots. Assistive technologies were most commonly used by people with dementia (77/175, 44.0%), followed by relatives (68/175, 38.9%), and both target groups (30/175, 17.1%). Their most frequent goals were to enable or improve care, provide therapy, or positively influence symptoms of people with dementia (eg, disorientation). The greatest proportions of studies were case studies and case series (72/175, 41.1%) and randomized controlled trials (44/175, 25.1%). The majority of studies reported small sample sizes of between 1 and 50 participants (122/175, 69.7%). Furthermore, most of the studies analyzed the effectiveness (85/233, 36.5%) of the technology, while others targeted feasibility or usability or were explorative. Conclusions This review demonstrated the variety of technologies that support people with dementia and their relatives in the home care setting. Whereas this diversity provides the opportunity for needs-oriented technical solutions that fit individual care arrangements, it complicates the choice of the right technology. Therefore, research on the users’ informational needs is required. Moreover, there is a need for larger studies on the technologies’ effectiveness that could contribute to a higher acceptance and thus to a transition of technologies from research into the daily lives of people with dementia and their relatives.
Collapse
Affiliation(s)
- Sarah Palmdorf
- Institute for Educational and Health-care Research in the Health Sector, Bielefeld University of Applied Sciences, Bielefeld, Germany
| | - Anna Lea Stark
- Centre for ePublic Health Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany.,Nursing Science Staff Unit, Franziskus-Hospital Harderberg, Niels-Stensen-Kliniken, Georgsmarienhütte, Germany
| | - Gerrit Eliaß
- Innovation & Research, Executive Department, Evangelisches Klinikum Bethel, University Hospital OWL - Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Christoph Karlheim
- Innovation & Research, Executive Department, Evangelisches Klinikum Bethel, University Hospital OWL - Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Stefan H Kreisel
- Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL - Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Tristan Gruschka
- Faculty of Social Studies, Bielefeld University of Applied Sciences, Bielefeld, Germany
| | - Eva Trompetter
- Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL - Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Christoph Dockweiler
- Centre for ePublic Health Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
20
|
de Boer B, Bozdemir B, Jansen J, Hermans M, Hamers JPH, Verbeek H. The Homestead: Developing a Conceptual Framework through Co-Creation for Innovating Long-Term Dementia Care Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E57. [PMID: 33374761 PMCID: PMC7795205 DOI: 10.3390/ijerph18010057] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 12/22/2022]
Abstract
Alternative care environments for regular nursing homes are highly warranted to promote health and well-being of residents with dementia that are part of an age-friendly and dementia-friendly city and society. Insight is lacking on how to translate evidence-based knowledge from theory into a congruent conceptual model for innovation in current practice. This study reports on the co-creation of an alternative nursing home model in the Netherlands. A participatory research approach was used to co-create a conceptual framework with researchers, practitioners and older people following an iterative process. Results indicate that achieving positive outcomes for people with dementia, (in)formal caregivers, and the community is dependent on how well the physical, social and organizational environment are congruently designed. The theoretical underpinnings of the conceptual model have been translated into "the homestead," which is conceptualized around three main pillars: activation, freedom and relationships. The Homestead Care Model is an illustrative example of how residential care facilities can support the development of age-friendly communities that take into consideration the needs and requirements of older citizens. However, challenges remain to implement radical changes within residential care. More research is needed into the actual implementation of the Homestead Care Model.
Collapse
Affiliation(s)
- Bram de Boer
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Living Lab in Ageing and Long-Term Care, 6229 GT Maastricht, The Netherlands; (B.B.); (J.J.); (M.H.)
| | - Belkis Bozdemir
- Living Lab in Ageing and Long-Term Care, 6229 GT Maastricht, The Netherlands; (B.B.); (J.J.); (M.H.)
- MeanderGroep Zuid Limburg, 6372 PP Landgraaf, The Netherlands
| | - Jack Jansen
- Living Lab in Ageing and Long-Term Care, 6229 GT Maastricht, The Netherlands; (B.B.); (J.J.); (M.H.)
- MeanderGroep Zuid Limburg, 6372 PP Landgraaf, The Netherlands
| | - Monique Hermans
- Living Lab in Ageing and Long-Term Care, 6229 GT Maastricht, The Netherlands; (B.B.); (J.J.); (M.H.)
- MeanderGroep Zuid Limburg, 6372 PP Landgraaf, The Netherlands
| | - Jan P. H. Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Living Lab in Ageing and Long-Term Care, 6229 GT Maastricht, The Netherlands; (B.B.); (J.J.); (M.H.)
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Living Lab in Ageing and Long-Term Care, 6229 GT Maastricht, The Netherlands; (B.B.); (J.J.); (M.H.)
| |
Collapse
|
21
|
Myhre J, Saga S, Malmedal W, Ostaszkiewicz J, Nakrem S. React and act: a qualitative study of how nursing home leaders follow up on staff-to-resident abuse. BMC Health Serv Res 2020; 20:1111. [PMID: 33261610 PMCID: PMC7709220 DOI: 10.1186/s12913-020-05969-x] [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] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Elder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse. METHODS A qualitative explorative design was used. The sample comprised 43 participants from two levels of nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews were conducted with 28 care managers, and individual interviews took place with 15 nursing home directors. The constant comparative method was used for the analyses. RESULTS Nursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows: 1) on an individual level, leaders performed investigations and meetings, guidance, supervision, and occasionally relocated staff members; 2) on a group level, feedback, openness, and reflection for shared understanding were strategies leaders used; and 3) on an organisational level, the main solutions were to adjust to available resources, training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that were taken. CONCLUSIONS Nursing home leaders need to be clear about how they should follow up incidents of elder abuse on different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that acknowledge that incidents of elder abuse in patient care arise not only from the actions of individuals but also from the complex everyday life of which they are a part and in which they operate.
Collapse
Affiliation(s)
- Janne Myhre
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, Australia
- National Ageing Research Institute, Parkville, VIC, 3052, Australia
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
22
|
Pinazo-Clapés C, Pinazo-Hernandis S, Sales A. Effects of an Educational Program for Professional Caregivers on Behavioral Alterations in Nursing Home Residents: Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8845. [PMID: 33260699 PMCID: PMC7731200 DOI: 10.3390/ijerph17238845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
This pilot study aims to analyze the effectiveness of a type of non-pharmacological intervention such as the educating and training of professional caregivers on behavioral alterations and prescription of psychotropic drugs of older adults in nursing homes. One hundred and forty-five people from two nursing homes were randomized to either treatment (educational training program for healthcare professionals) or a no-treatment group. Twenty-two professional caregivers in the experimental group received 20 h of a training program. Five data collection points were collected (pre and post, and three follow-ups, all six months apart). Intervention consisted of the behavioral alterations and psychopharmacological treatment. The analysis of variance for repeated measures showed significant differences in the time-group interaction for the educational program's effectiveness in reducing behavior alterations and psycho-pharmaceuticals' record. The results show that an improvement in the educating and training of professional caregivers can reduce behavioral alterations (F3,407 = 9.29, p < 0.001, η2= 0.063) and prescription of psychotropic drugs (F2,10 = 18.90, p < 0.001, η2 = 0.117). In addition, these effects are maintained over time. Educating health professionals on ways to care for residents who present behavioral alterations may be one alternative for improving the quality of care that residents receive. Non-pharmacological interventions, besides being individualized and adapted to the needs and experiences of individuals, achieve effects that last longer at low cost. An educational program shows new alternatives to pharmacological intervention, achieving a reduction in behavioral alterations without the costs and effects that psychopharmaceuticals entail.
Collapse
Affiliation(s)
| | | | - Alicia Sales
- Department of Developmental Psychology, Faculty of Psychology, University of Valencia, 46010 Valencia, Spain
| |
Collapse
|
23
|
Johansen RH, Olsen K, Bergh S, Benth JŠ, Selbæk G, Helvik AS. Course of activities of daily living in nursing home residents with dementia from admission to 36-month follow-up. BMC Geriatr 2020; 20:488. [PMID: 33218298 PMCID: PMC7678321 DOI: 10.1186/s12877-020-01877-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 11/09/2020] [Indexed: 02/02/2023] Open
Abstract
Background Dementia is affecting both the person with the disease and the family members. It is associated with nursing home admission, and a reduced ability to perform personal activities of daily living (P-ADL). The aim of this study was to examine the association between the severity of dementia and P-ADL function, and to study if additional factors such as neuropsychiatric symptoms, type of nursing home unit, and use of medication were associated with P-ADL function. Methods A total of 582 nursing home residents with dementia, included at admission to the nursing home, were followed with biannual assessments for 36 months. P-ADL was assessed using the Physical Self-Maintenance scale, and severity of dementia was measured with the Clinical Dementia Rating scale. In addition, neuropsychiatric symptoms, general physical health, and use of medications were assessed at the same time points. Demographic information was collected at baseline. Linear mixed models were estimated. Results There was a significant (p < 0.05) non-linear decline in P-ADL function over time in analysis not adjusting for any characteristics. More severe dementia at baseline and at the follow-up assessments was associated with lower P-ADL function (p < 0.001), with the association being stable over time. A higher level of neuropsychiatric symptoms, not using anti-dementia medication, being in a regular care unit as compared to a special care unit and having poor/fair general physical health as compared to good/excellent, were associated with a lower P-ADL function. Conclusion The association between more severe dementia and lower P-ADL function was stable over a 36-month follow-up period of nursing home residents with dementia. Health care planners and clinicians should be aware of this when planning for and treating nursing home residents.
Collapse
Affiliation(s)
- Reidun Haarr Johansen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Karoline Olsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,General Practice Research unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
24
|
Ito E, Berge LI, Husebo BS, Nouchi R, Sandvik RK. The Negative Impact of Psychotropic Drug Use on Quality of Life in Nursing Home Patients at Different Stages of Dementia: Cross-Sectional Analyses from the COSMOS Trial. J Am Med Dir Assoc 2020; 21:1623-1628. [DOI: 10.1016/j.jamda.2020.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/27/2020] [Accepted: 03/29/2020] [Indexed: 11/27/2022]
|
25
|
Callegari E, Benth JŠ, Selbæk G, Grønnerød C, Bergh S. Does Psychotropic Drug Prescription Change in Nursing Home Patients the First 6 Months After Admission? J Am Med Dir Assoc 2020; 22:101-108.e1. [PMID: 33077352 DOI: 10.1016/j.jamda.2020.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/25/2020] [Accepted: 08/24/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To explore the course of psychotropic drug (PTD) prescription from admission (BL) to 6-month follow-up (6m) in Norwegian nursing homes (NHs). To examine how clinical variables, such as neuropsychiatric symptoms (NPS), cognition, physical health, and NH characteristics at BL are associated with prescription rates at 6 months. DESIGN An observational longitudinal cohort study (data from the Resource Use and Disease Course in Dementia-Nursing Home study) designed to examine the course of dementia, psychiatric and somatic diseases, and drug prescriptions in NH patients during the first 6 months after admission. SETTING AND PARTICIPANTS We included 696 patients at admission to 47 representative Norwegian NHs. METHODS Demographic and clinical characteristics at BL and 6m are presented. Dementia severity was assessed by the Clinical Dementia Rating scale and the Functional Assessment Staging of Alzheimer's Disease scale. Final diagnosis was made by 2 of the authors (G.S. and S.B.) according to ICD-10 criteria. Prevalence, incidence, and persistence rates of PTD prescriptions for people with dementia are presented. Generalized mixed models were used to identify possible predictors for the course of PTD prescription from BL to 6m. RESULTS Prescription rates of antidepressants, antipsychotics, anxiolytics, sedatives, and hypnotics increased in people with dementia from BL (67.5% received at least 1 PTD) to 6m (74.0% received at least 1 PTD). Younger age and higher Neuropsychiatric Inventory-affective subsyndrome score at BL were associated with higher odds of antidepressant prescription, whereas patients with higher comorbidity at BL had lower odds of receiving antidepressants, both at BL and 6m. Higher Neuropsychiatric Inventory-affective subsyndrome scores at BL were associated with higher odds of sedative and hypnotic prescription at both assessment points. CONCLUSIONS AND IMPLICATIONS PTD prescription rates increase from BL to 6m. Medication appropriateness should be frequently evaluated after admission to optimize PTD prescriptions.
Collapse
Affiliation(s)
- Enrico Callegari
- Østfold Hospital Trust, Grålum, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway; Research Centre for age related functional decline and diseases, Innlandet Hospital Trust, Ottestad, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbæk
- Faculty of Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Faculty of Medicine, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Cato Grønnerød
- Østfold Hospital Trust, Grålum, Norway; Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- Research Centre for age related functional decline and diseases, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
26
|
Badcock JC, Larøi F, Kamp K, Kelsall-Foreman I, Bucks RS, Weinborn M, Begemann M, Taylor JP, Collerton D, O’Brien JT, El Haj M, Ffytche D, Sommer IE. Hallucinations in Older Adults: A Practical Review. Schizophr Bull 2020; 46:1382-1395. [PMID: 32638012 PMCID: PMC7707075 DOI: 10.1093/schbul/sbaa073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Older adults experience hallucinations in a variety of social, physical, and mental health contexts. Not everyone is open about these experiences, as hallucinations are surrounded with stigma. Hence, hallucinatory experiences in older individuals are often under-recognized. They are also commonly misunderstood by service providers, suggesting that there is significant scope for improvement in the training and practice of professionals working with this age group. The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management guidelines. We conclude with a brief summary including suggestions for service and training providers and future research.
Collapse
Affiliation(s)
- Johanna C Badcock
- School of Psychological Science, University of Western Australia, Perth, Australia
- Perth Voices Clinic, Murdoch, Australia
- To whom correspondence should be addressed; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, 6009; tel: 0423123665, fax: 61864881006, e-mail:
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liege, Liege, Belgium
- Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Karina Kamp
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus C, Denmark
| | | | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Marieke Begemann
- Department of Biomedical Sciences of Cells and Systems, University Medical Center, Rijks Universiteit Groningen (RUG), Groningen, The Netherlands
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Collerton
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mohamad El Haj
- Laboratoire de Psychologie des Pays de la Loire (LPPL-EA 4638), Nantes Université, Univ Angers, Nantes, France
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Iris E Sommer
- Rijks Universiteit Groningen (RUG), Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, The Netherlands
| |
Collapse
|
27
|
Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
|
28
|
Abrahamsen JF, Monsen ALB, Ranhoff AH, Nilsen RM, Engtrø E, Rekdal M, Kruger K. No association between subnormal serum vitamin B12 and anemia in older nursing home patients. Eur Geriatr Med 2020; 11:247-254. [PMID: 32297187 DOI: 10.1007/s41999-019-00269-y] [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: 09/06/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Since evidence of an association between vitamin B12 (B12) deficiency and anemia in older people is limited and inconclusive, we wanted to investigate this association in old, frail nursing home patients. METHODS The study includes patients admitted to short-term, post-acute care (n = 765) and residents in long-term care (LTC) (n = 1665), in the municipality of Bergen. Anemia was defined according to the WHO criteria: Hb < 13 g/dL in men and < 12 g/dL in women, and as Hb < 11 g/dL, in both sex (moderate/severe anemia). The presence of anemia was analyzed in patients with subnormal (< 250 pmol/L), normal (250-650 pmol/L) and high (> 650 pmol/L) B12, and the association between anemia and clinical parameters, and including B12, was analyzed using logistic regression models. The use of B12 supplementation was investigated in the LTC patients. RESULTS Mean age of the 2430 patients was 86 ± 7 years. WHO-defined anemia was seen in 1023 (42%), and moderate/severe anemia in 384 (16%) of the patients. In multiple logistic regression analyses, we found no statistically significant associations of subnormal B12 with WHO-defined anemia or moderate/severe anemia. Renal insufficiency, iron deficiency and CRP > 10 mg/L were significantly associated with both types of anemia, (p < 0.001). Among the LTC residents, 405 (24%) received B12 supplements, 112 (7%) of them had elevated B12 > 650 pmol/L. CONCLUSION In older nursing home patients, no association was observed between subnormal B12 and anemia. Older patients in Western societies with mild/moderate anemia should not be treated with B12 supplements without further investigation.
Collapse
Affiliation(s)
- Jenny Foss Abrahamsen
- Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway. .,Kavli Research Centre, Haraldsplass Deaconess Hospital, Bergen, Norway.
| | | | | | - Roy M Nilsen
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | | | - Kjell Kruger
- Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway.,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| |
Collapse
|
29
|
Myhre J, Saga S, Malmedal W, Ostaszkiewicz J, Nakrem S. Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders' perceptions of elder abuse and neglect. BMC Health Serv Res 2020; 20:199. [PMID: 32164695 PMCID: PMC7069163 DOI: 10.1186/s12913-020-5047-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/26/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The definition and understanding of elder abuse and neglect in nursing homes can vary in different jurisdictions as well as among health care staff, researchers, family members and residents themselves. Different understandings of what constitutes abuse and its severity make it difficult to compare findings in the literature on elder abuse in nursing homes and complicate identification, reporting, and managing the problem. Knowledge about nursing home leaders' perceptions of elder abuse and neglect is of particular interest since their understanding of the phenomenon will affect what they signal to staff as important to report and how they investigate adverse events to ensure residents' safety. The aim of the study was to explore nursing home leaders' perceptions of elder abuse and neglect. METHODS A qualitative exploratory study with six focus group interviews with 28 nursing home leaders in the role of care managers was conducted. Nursing home leaders' perceptions of different types of abuse within different situations were explored. The constant comparative method was used to analyse the data. RESULTS The results of this study indicate that elder abuse and neglect are an overlooked patient safety issue. Three analytical categories emerged from the analyses: 1) Abuse from co-residents: 'A normal part of nursing home life'; resident-to-resident aggression appeared to be so commonplace that care leaders perceived it as normal and had no strategy for handling it; 2) Abuse from relatives: 'A private affair'; relatives with abusive behaviour visiting nursing homes residents was described as difficult and something that should be kept between the resident and the relatives; 3) Abuse from direct-care staff: 'An unthinkable event'; staff-to-resident abuse was considered to be difficult to talk about and viewed as not being in accordance with the leaders' trust in their employees. CONCLUSIONS Findings in the present study show that care managers lack awareness of elder abuse and neglect, and that elder abuse is an overlooked patient safety issue. The consequence is that nursing home residents are at risk of being harmed and distressed. Care managers lack knowledge and strategies to identify and adequately manage abuse and neglect in nursing homes.
Collapse
Affiliation(s)
- Janne Myhre
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Susan Saga
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research- Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, Australia
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| |
Collapse
|
30
|
Severity of both neuropsychiatric symptoms and dementia is associated with quality of life in nursing home residents. Eur Geriatr Med 2019; 10:793-800. [PMID: 34652697 DOI: 10.1007/s41999-019-00213-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The primary focus in long-term care is to maintain quality of life. The aim of this study was to investigate the association of severity of neuropsychiatric symptoms (NPS) and health-related quality of life (HRQoL) and their interaction with dementia severity among institutionalized older people with dementia. METHODS 352 long-term care residents aged 65 years or over with dementia participated in this cross-sectional study. NPS were measured with Neuropsychiatric Inventory (NPI). HRQoL was measured with 15D. Dementia severity was measured with Clinical Dementia Rating (CDR). RESULTS The severity of NPS was significantly associated with better HRQoL in 15D. Residents with severe dementia (CDR 3) had worse HRQoL than residents with mild-moderate dementia (CDR < 3). There was a significant interaction between NPI and CDR (p = 0.037 for NPI, p < 0.001 for CDR, p < 0.001 for interaction). HRQoL correlated positively with all NPS subgroups in residents with severe dementia, but in residents with mild-moderate dementia, no significant correlation existed. In severe dementia, higher NPI correlated positively with such dimensions of 15D as mobility, vision, eating, speech, excretion, usual activities, mental functions, and vitality, whereas in residents with mild-moderate dementia only with mobility. In mild-moderate dementia, NPI correlated negatively with depression, distress and vitality. CONCLUSION Dementia severity and NPS burden are important determining factors of HRQoL in long-term care. NPS have a distinct impact on HRQoL at different stages of dementia. In severe dementia, higher NPS and better HRQoL indicate better functioning and higher vitality.
Collapse
|
31
|
Helvik AS, Selbæk G, Šaltytė Benth J, Røen I, Bergh S. Correction: The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up. PLoS One 2018; 13:e0209875. [PMID: 30571720 PMCID: PMC6301691 DOI: 10.1371/journal.pone.0209875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0206147.].
Collapse
|