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VandeVrede L, Ljubenkov PA, Rojas JC, Welch AE, Boxer AL. Four-Repeat Tauopathies: Current Management and Future Treatments. Neurotherapeutics 2020; 17:1563-1581. [PMID: 32676851 PMCID: PMC7851277 DOI: 10.1007/s13311-020-00888-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Four-repeat tauopathies are a neurodegenerative disease characterized by brain parenchymal accumulation of a specific isoform of the protein tau, which gives rise to a wide breadth of clinical syndromes encompassing diverse symptomatology, with the most common syndromes being progressive supranuclear palsy-Richardson's and corticobasal syndrome. Despite the lack of effective disease-modifying therapies, targeted treatment of symptoms can improve quality of life for patients with 4-repeat tauopathies. However, managing these symptoms can be a daunting task, even for those familiar with the diseases, as they span motor, sensory, cognitive, affective, autonomic, and behavioral domains. This review describes current approaches to symptomatic management of common clinical symptoms in 4-repeat tauopathies with a focus on practical patient management, including pharmacologic and nonpharmacologic strategies, and concludes with a discussion of the history and future of disease-modifying therapeutics and clinical trials in this population.
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Affiliation(s)
- Lawren VandeVrede
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA.
| | - Peter A Ljubenkov
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Julio C Rojas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Green C, Vandall-Walker V, Rysdale L, Stevens M, Feldmann H, Tymura S, Stojkovic K. You Can't Touch…or Can You? Dietitians' Perceptions of Expressive Touch in Client Encounters. CAN J DIET PRACT RES 2020; 81:112-119. [PMID: 32072833 DOI: 10.3148/cjdpr-2020-005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: We explored Registered Dietitians' (RDs') perceptions about expressive touch (ET) as a means to provide client-centred care, a practice unreported to date. For this study, ET is defined as relatively spontaneous, responsive, and affective contact by dietitians. Methods: This exploratory study used an explanatory sequential mixed-methods approach. RDs in Northern Ontario were surveyed (54% response, n = 135) and these results were further explored in interviews with a subset of participants (n = 17). Analysis included descriptive and association statistics and qualitative description. Results: Most RDs considered ET a useful tool for effective client communication (66%-77%), yet they were hesitant to enact the practice (81%). Analysis of interviews revealed ET to be "situationally beneficial" with uptake influenced by an interplay of factors, described as: perceived client openness to touch, the environment, and RD comfort with touch. Greater uptake was reported among RDs working with distressed clients and clients in ambulatory clinics and long-term care. ET practice was limited by personal safety concerns, unknown client customs, and client misinterpretation. Conclusion: ET was valued by many RDs as an enhancement to client-centred care. Selective use of ET is influenced by the context of dietetic practice and by perceived client and RD comfort with the use of ET.
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Affiliation(s)
- Cara Green
- Northern Ontario Dietetic Internship Program, Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, ON
| | | | - Lee Rysdale
- Northern Ontario Dietetic Internship Program, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON
| | - Michelle Stevens
- Northern Ontario Dietetic Internship Program, Northern Ontario School of Medicine, Thunder Bay, ON
| | - Heather Feldmann
- Northern Ontario Dietetic Internship Program, Northern Ontario School of Medicine, Thunder Bay, ON
| | - Stacey Tymura
- Northern Ontario Dietetic Internship Program, Northern Ontario School of Medicine, Thunder Bay, ON
| | - Kelsey Stojkovic
- Northern Ontario Dietetic Internship Program, Northern Ontario School of Medicine, Thunder Bay, ON
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Wells DL, Dawson P. A Framework for Developing Nursing Knowledge About the Effects of Dementia on Older Persons' Abilities. J Appl Gerontol 2016. [DOI: 10.1177/0733464802021001006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A dearth of nursing knowledge exists about the specific effects of the cognitive and other changes of dementia on older persons' abilities. Consequently, limited direction is available to guide nursing research and practice in this context. Thus, the authors designed a framework that directs the development of such knowledge. In this article, the assumptions and elements of the framework are detailed. An extensive illustration of the application of the framework is provided concerning ideational apraxia in dementia and self-care abilities related to feeding. It is shown how nurses can draw information from the scholarship of other disciplines and incorporate it into an understanding of the effects of dementia on abilities. The framework can be used to systematically focus research and practice concerning the care of people suffering fromdementia.
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Volkert D, Chourdakis M, Faxen-Irving G, Frühwald T, Landi F, Suominen MH, Vandewoude M, Wirth R, Schneider SM. ESPEN guidelines on nutrition in dementia. Clin Nutr 2015; 34:1052-73. [PMID: 26522922 DOI: 10.1016/j.clnu.2015.09.004] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/10/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified. OBJECTIVE It is the purpose of these guidelines to cover these issues with evidence-based recommendations. METHODS The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds and accepted in an online survey among ESPEN members. RESULTS 26 recommendations for nutritional care of older persons with dementia are given. In every person with dementia, screening for malnutrition and close monitoring of body weight are recommended. In all stages of the disease, oral nutrition may be supported by provision of adequate, attractive food in a pleasant environment, by adequate nursing support and elimination of potential causes of malnutrition. Supplementation of single nutrients is not recommended unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Artificial nutrition is suggested in patients with mild or moderate dementia for a limited period of time to overcome a crisis situation with markedly insufficient oral intake, if low nutritional intake is predominantly caused by a potentially reversible condition, but not in patients with severe dementia or in the terminal phase of life. CONCLUSION Nutritional care and support should be an integral part of dementia management. In all stages of the disease, the decision for or against nutritional interventions should be made on an individual basis after carefully balancing expected benefit and potential burden, taking the (assumed) patient will and general prognosis into account.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany.
| | - Michael Chourdakis
- Department of Medicine, Aristotle University of Thessaloniki (AUTH), Greece
| | - Gerd Faxen-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Krankenhaus Hietzing, Vienna, Austria
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Merja H Suominen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Maurits Vandewoude
- Department of Geriatrics, Medical School, University of Antwerp, Belgium
| | - Rainer Wirth
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany; St. Marien-Hospital Borken, Department for Internal Medicine and Geriatrics, Borken, Germany
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Nice, France
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Simmons SF, Sims N, Durkin DW, Shotwell MS, Erwin S, Schnelle JF. The Quality of Feeding Assistance Care Practices for Long-Term Care Veterans. J Appl Gerontol 2012; 32:669-86. [DOI: 10.1177/0733464811433487] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The primary purpose of this study was to determine the quality of feeding assistance care and identify areas in need of improvement for a sample of long-term care veterans. A secondary purpose was to compare these findings with the results of previous studies in community facilities to determine ways in which the VA sample might differ. A repeated measures observational study was conducted in two VA facilities with 200 long-stay residents. Research staff conducted standardized observations during and between meals for 3 months. There was a trend for better feeding assistance care quality during meals in the VA sample, but there were still multiple aspects of care in need of improvement both during and between meals. Higher licensed nurse staffing levels in the VA should enable effective supervision and management, but observation-based measures of care quality are necessary for accurate information about daily feeding assistance care provision.
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Affiliation(s)
- Sandra F. Simmons
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN
- Geriatric Research, Education and Clinical Center, VA Medical Center, Nashville, TN
| | - Nichole Sims
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN
| | - Daniel W. Durkin
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN
| | | | - Scott Erwin
- Tennessee Valley Healthcare System, Murfreesboro, TN
| | - John F. Schnelle
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN
- Geriatric Research, Education and Clinical Center, VA Medical Center, Nashville, TN
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Abstract
AIMS AND OBJECTIVES To use concept analysis to identify characteristics of feeding difficulty and its antecedents and consequences that provide direction for assessment and management. BACKGROUND Feeding difficulty is often recognised as a common problem for older adults and is associated with weight loss, poor nutrition and risk for aspiration pneumonia. The cognitive impairment found in persons with dementia impairs the ability of these adults to complete motor and perceptual tasks required for eating and often prevent the older adult from accepting help with feeding from caregivers. DESIGN Systematic review. METHODS In 2006, literature searches using keywords (feeding, eating, nutrition, malnutrition, feeding assessment, dementia, ageing and concept analysis, dementia and feeding and excluding enteral feeding, tube feedings, PEG and enteral nutrition) were done in Medline, CINHAL, AGELINE and Social Science Full Text. Seventy relevant articles in English were found. After a review of the relevant articles, concept analysis was used to develop a definition of feeding difficulty, its defining characteristics and to delineate feeding difficulty from its antecedents and consequences. RESULTS Feeding difficulties arise at the interface between the caregiver strategies to assist the older adult with getting food into the mouth and chewing and swallowing food. A model of feeding difficulty delineates the antecedents and consequences of feeding difficulties. CONCLUSIONS The conceptual model of feeding difficulties provides a strong and clear organising structure for research that can be used to developed evidence based guidelines for practice. RELEVANCE TO CLINICAL PRACTICE The conceptual model provides directions for assessment of feeding difficulties and their antecedents. The model can be used to identify interventions that address antecedents of feeding difficulty (risk factors) and different types of feeding difficulties.
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Abstract
Percutaneous endoscopic gastrostomy tubes are being placed with increasing frequency in the United States among elderly patients with dementia. Health care providers believe there may be long-term benefits for enteral feeding in this population, yet previous study of this topic has failed to yield any convincing evidence to support this hypothesis. In this study, we review the evidence regarding outcomes for artificial enteral feeding in older individuals with dementia. We found that there is a lack of evidence supporting artificial feeding in the specific outcomes of survival, pressure ulcers, nutrition, and aspiration pneumonia. A brief discussion regarding hand feeding is included. The data suggest that hand feeding may be a viable alternative to tube feeding in elderly patients with dementia, although a direct comparison trial of the 2 interventions is lacking.
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Ritchie CS, Wilcox CM, Kvale E. Ethical and medicolegal issues related to percutaneous endoscopic gastrostomy placement. Gastrointest Endosc Clin N Am 2007; 17:805-15. [PMID: 17967384 DOI: 10.1016/j.giec.2007.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Enteral nutrition, in many respects more than other medical interventions, has been in the limelight concerning the ethics of withdrawing or withholding nutritional support. This article describes the ethical and legal issues surrounding enteral nutrition, identifies the elements of informed consent for enteral nutrition, provides an overview of the endoscopic gastrostomy procedure, and offers recommendations for addressing ethicolegal issues in enteral nutrition.
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Affiliation(s)
- Christine S Ritchie
- Geriatric Research Education and Clinical Center at the Birmingham Veterans Affairs Medical Center, UAB Center for Palliative CareBirmingham, AL 35294, USA.
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Affiliation(s)
- Sara Stanner
- British Nutrition Foundation, 52–54 High Holborn, London WC1V 6RQ
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A Continuous Quality Improvement Pilot Study: Impact on Nutritional Care Quality. J Am Med Dir Assoc 2006; 7:480-5. [DOI: 10.1016/j.jamda.2006.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schnelle JF, Osterweil D, Simmons SF. Improving the quality of nursing home care and medical-record accuracy with direct observational technologies. THE GERONTOLOGIST 2006; 45:576-82. [PMID: 16199391 DOI: 10.1093/geront/45.5.576] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and ability of providers to identify areas for improvement. Observational protocols designed for use by survey and quality-assurance staff can provide the independent information necessary for improving both medical record accuracy and residents' quality of life. Unfortunately, observational protocols currently used in survey and quality-assurance activities are not designed in a manner that is consistent with the scientific principles that guide observational measurement. The purpose of this article is to describe the steps to develop a standardized and scientifically defensible observational system to assess nursing home care quality.
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Affiliation(s)
- John F Schnelle
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Health Care System, CA, USA.
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Chang CC, Wykle ML, Madigan EA. The Effect of A Feeding Skills Training Program for Nursing Assistants Who Feed Dementia Patients in Taiwanese Nursing Homes. Geriatr Nurs 2006; 27:229-37. [PMID: 16890104 DOI: 10.1016/j.gerinurse.2006.03.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A quasi-experimental 2-group repeated-measures design was used to test the impact of a feeding skills training program on 67 nursing assistants (treatment group n = 31; control group n = 36) regarding their knowledge, attitudes, perceived behavior control, intentions, and behaviors in feeding dementia patients. The treatment group received a feeding skills training program. Nursing assistants' knowledge, attitudes, perceived behavior control, and intentions were measured before (Pretest) and after the program (Posttest 1), and again 4 weeks later (Posttest 2). Nursing assistants (treatment group n = 20; control group n = 16) and the same number of dementia patients were measured on feeding behaviors during mealtimes before and after the training. The treatment group had significantly more knowledge (P < .001), greater intention to feed (P = .05), and better behaviors toward feeding dementia patients (P = .009) than the control group. There were no significant differences between the groups in attitude (P = .85), intention beliefs (P = .11) or perceived behavior control (P = .99). Thus, the intervention was effective at changing knowledge, intention, and behaviors among nursing assistants.
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Simmons SF, Walker KA, Osterweil D. The Effect of Megestrol Acetate on Oral Food and Fluid Intake in Nursing Home Residents: A Pilot Study. J Am Med Dir Assoc 2005; 6:S5-11. [PMID: 15890297 DOI: 10.1016/j.jamda.2005.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the effect of megestrol acetate (Megace OS; Bristol-Myers Squibb, Princeton, NJ) on the oral food and fluid intake of nursing home (NH) residents under two conditions: usual NH care and optimal mealtime feeding assistance. DESIGN AND SETTING We conducted a prospective, preliminary trial in four NHs. PARTICIPANTS Participants (n = 17) were recruited from a larger study designed to assess nutritional care quality. Eligibility for the Megace OS trial required participants to consistently eat less than 75% of most meals under both usual NH care and optimal feeding assistance conditions at baseline. INTERVENTION Megace OS, an oral liquid suspension of megestrol acetate, was given daily in a 400-mg dose for 63 days. MEASUREMENTS Each participant's oral food and fluid intake was monitored weekly for 1 day (three meals) during which research staff conducted direct observations of usual NH care (weeks 1, 3, and 5 and day 63) or provided optimal feeding assistance (weeks 2, 4, and 6). Average total percent intake was compared from baseline across the assessment weeks of the trial under the two mealtime care conditions. RESULTS Megace OS had a significant effect on oral food and fluid intake only under the optimal mealtime feeding assistance condition, in which average total percent eaten increased from 50% (+/-15%) at baseline to 63% (+/-14%) post-63 days of the trial. There was no change in participants' oral food and fluid intake under the usual NH care condition (average total percent intake at baseline 43% +/- 12% vs. 43% +/- 20% post-63 days). CONCLUSION The results of this preliminary study suggest that Megace OS is not an effective nutritional intervention to increase oral intake under usual NH care conditions, which is often characterized by inadequate feeding assistance. However, Megace OS in combination with optimal mealtime feeding assistance does significantly increase oral intake in a frail NH sample at high risk for weight loss.
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Gleeson M, Timmins F. A review of the use and clinical effectiveness of touch as a nursing intervention. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cein.2004.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
All cultures dictate the need to feed the hungry and create rituals for almost every life passage around the consumption of food and beverage. Yet, in old age and among those who cannot advocate for themselves, mealtime is medicalized and demoted to an insignificant event without dignity or regard for individualized needs. Attention must be paid to not only what people eat, but how they eat, and how they are supported in that process. Kayser-Jones summarized the extensive findings of several ethnographic studies in nursing homes by noting the multi-factorial issues involved in delivering excellent care to all residents, especially those lacking an advocate. Her findings exposed how lack of staff education, inadequate staffing and supervision, disregard for personal and cultural preferences, lack of assessment for comorbid health problems, intake of food and fluids, dysphagia, and oral health problems all contributed to malnutrition and dehydration among the residents studied. This seminal set of studies, along with Dr. Kayser-Jones' testimony in US Congressional hearings directly affected the design of federal regulatory protocols to address malnutrition and dehydration. In an attempt to increase the number of staff available to assist at meals, the Centers for Medicare and Medicaid issued a change in regulations on Sept. 26, 2003, allowing reimbursement for staff trained for a total of 8 hours to act as feeding assistants. This change is intended to, "provide more residents with help in eating and drinking and reduce the incidence of unplanned weight loss and dehydration". Although seen as answering some of the staffing ratio issues at meal times,this rule change has been criticized for not addressing the complexities of resident needs at meal times. Although offering food and fluid is time-consuming and requires special knowledge of physiological changes and empathy for persons whose behavior might be objectionable at times, it may be one of the few times during the day that the individual with dementia receives normalized social interaction. Thus, as in the care of all vulnerable persons with dementia, whether at home or in an institution, perhaps the greatest challenge and need is for nurses and other caregivers to provide a social environment that promotes individual dignity and comfort.
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Affiliation(s)
- Elaine J Amella
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Simmons SF, Walker KA, Osterweil D. The Effect of Megestrol Acetate on Oral Food and Fluid Intake in Nursing Home Residents: A Pilot Study. J Am Med Dir Assoc 2004. [DOI: 10.1016/s1525-8610(04)70040-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Simmons SF, Garcia ET, Cadogan MP, Al-Samarrai NR, Levy-Storms LF, Osterweil D, Schnelle JF. The Minimum Data Set Weight-Loss Quality Indicator: Does It Reflect Differences in Care Processes Related to Weight Loss? J Am Geriatr Soc 2003; 51:1410-8. [PMID: 14511161 DOI: 10.1046/j.1532-5415.2003.51459.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine whether nursing homes (NHs) that score differently on prevalence of weight loss, according to a Minimum Data Set (MDS) quality indicator, also provide different processes of care related to weight loss. DESIGN Cross-sectional. SETTING Sixteen skilled nursing facilities: 11 NHs in the lower (25th percentile-low prevalence) quartile and five NHs in the upper (75th percentile-high prevalence) quartile on the MDS weight-loss quality indicator. PARTICIPANTS Four hundred long-term residents. MEASUREMENTS Sixteen care processes related to weight loss were defined and operationalized into clinical indicators. Trained research staff conducted measurement of NH staff implementation of each care process during assessments on three consecutive 12-hour days (7 a.m. to 7 p.m.), which included direct observations during meals, resident interviews, and medical record abstraction using standardized protocols. RESULTS The prevalence of weight loss was significantly higher in the participants in the upper quartile NHs than in participants in the lower quartile NHs based on MDS and monthly weight data documented in the medical record. NHs with a higher prevalence of weight loss had a significantly larger proportion of residents with risk factors for weight loss, namely low oral food and fluid intake. There were few significant differences on care process measures between low- and high-weight-loss NHs. Staff in low-weight-loss NHs consistently provided verbal prompting and social interaction during meals to a greater proportion of residents, including those most at risk for weight loss. CONCLUSION The MDS weight-loss quality indicator reflects differences in the prevalence of weight loss between NHs. NHs with a lower prevalence of weight loss have fewer residents at risk for weight loss and staff who provide verbal prompting and social interaction to more residents during meals, but the adequacy and quality of feeding assistance care needs improvement in all NHs.
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Affiliation(s)
- Sandra F Simmons
- Department of Geriatrics, University of California at Los Angeles School of Medicine, Borun Center for Gerontological Research, Los Angeles, California 91335, USA.
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Paquet C, St-Arnaud-Mckenzie D, Ferland G, Dubé L. A blueprint-based case study analysis of nutrition services provided in a midterm care facility for the elderly. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2003; 103:363-8. [PMID: 12616261 DOI: 10.1053/jada.2003.50047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ensuring nutritionally adequate food intake in institutions is a complex and important challenge for dietitians. To tackle this problem, we argue that dietitians need to adopt a systematic, integrative, and patient-centered approach to identify and manage more effectively organizational determinants of the quality of food intake under their control. In this study, we introduce such an approach, the blueprint-based case study, that we applied in the context of a midterm care facility for elderly patients. Data gathered through interviews and field observations were used to develop, from the perspective of key patient encounters, detailed representations of the food, nutrition, and nursing activities necessary to ensure adequate food intake. These service "blueprints" were developed to illustrate all activities that might potentially impact on the nutritional, sensory, functional, and social quality of patients' meals. They were also used as roadmaps to develop a case study analysis in which critical areas were identified and opportunities for improvement put forth, while considering services' resources and priorities. By providing a precise, objective, yet comprehensive mapping of the service operations and management, the blueprint-based case study approach represents a valuable tool to determine the optimal allocation of resources to insure nutritionally adequate food intake to patients.
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Affiliation(s)
- Catherine Paquet
- Faculty of Management of McGill University, Montreal, Quebec, Canada
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Feldman PH, Kane RL. Strengthening research to improve the practice and management of long-term care. Milbank Q 2003; 81:179-220, 171. [PMID: 12841048 PMCID: PMC2690214 DOI: 10.1111/1468-0009.t01-1-00051] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Past investments in long-term care (LTC) research have improved the quality of care and the quality of life for LTC recipients by conceptualizing the goals and measuring the outcomes of care, designing practical assessment tools, testing clinical interventions, and evaluating new service delivery programs and models. To build a balanced portfolio of LTC research that will yield and sustain increased dividends in quality and outcomes will require (1) increasing investment in both basic and applied LTC research to ensure that critical service delivery issues are addressed in a rigorous and timely fashion, (2) fostering better communication between researchers and users to ensure research salience and credibility, and (3) dedicating more resources to identifying and implementing successful methods for translating LTC research into practice.
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Mihailidis A, Fernie GR, Barbenel JC. The use of artificial intelligence in the design of an intelligent cognitive orthosis for people with dementia. Assist Technol 2002; 13:23-39. [PMID: 12212434 DOI: 10.1080/10400435.2001.10132031] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Dementia often reduces a person's ability to perform activities of daily living because he or she becomes confused and cannot remember the sequence of steps to perform. The current solution is to have a caregiver continually supervise and assist the person using verbal reminders or cues. This loss of privacy and increased dependency may cause the affected person to become embarrassed and agitated. We propose that this situation might be improved by using a computerized device that monitors progress and provides the reminders needed. The COACH is a first prototype of such a device. It uses artificial intelligence to observe a user, learn from his or her actions, and issue prerecorded cues of varying detail. The device was developed using a personal computer and a video camera that unobtrusively tracked the user. Preliminary testing with subjects who simulated confused behavior as they washed their hands showed that the device was performing its functions with an efficacy of approximately 95%. More extensive clinical testing and evaluation has begun, and the results will be reported in future publications.
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Affiliation(s)
- A Mihailidis
- Centre for Studies in Aging, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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Remsburg RE, Luking A, Bara P, Radu C, Pineda D, Bennett RG, Tayback M. Impact of a buffet-style dining program on weight and biochemical indicators of nutritional status in nursing home residents: a pilot study. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2001; 101:1460-3. [PMID: 11762743 DOI: 10.1016/s0002-8223(01)00352-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R E Remsburg
- Johns Hopkins University School of Nursing, School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD 21205-2001, USA
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Abstract
Comfort touch as a holistic nursing intervention has gained considerable attention in the past decade. The purpose of this experimental study was to examine whether comfort touch improved the perceptions of self-esteem, well-being and social processes, health status, life satisfaction and self-actualization, and faith or belief and self-responsibility in 45 institutionalized elderly female residents. Results revealed that comfort touch significantly improved the perceptions of all elements. This article offers recommendations for practice, research, and education.
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Affiliation(s)
- J B Butts
- College of Nursing, University of Southern Mississippi, Hattiesburg, USA
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24
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Dufault MA. A Program of Research Evaluating the Effects of a Collaborative Research Utilization Model. Worldviews Evid Based Nurs 2001. [DOI: 10.1111/j.1524-475x.2001.00037.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Abstract
AIMS OF THE STUDY This study was conducted to clarify and to conceptualize the phenomena of physical touch in caring. BACKGROUND Physical touch occurs frequently in patient care situations and has specific meanings within the context of caring. However, the concept of physical touch in caring has not been well articulated in the literatures, although the phenomena of touch and physical touch have been studied in relation to comfort, sense of well-being and connectedness. DESIGN/METHOD The Hybrid Model of concept development was applied to develop a conceptual structure of physical touch in caring, which included a field study carried out in Seoul, South Korea using in-depth interviews with 39 adult subjects consisting of health-care professionals, in-patients, and healthy persons. RESULTS/FINDINGS The concept of physical touch in caring emerged as a complex phenomenon having meanings on several different dimensions which were encompassed several attributes and the conceptual structure of physical touch in caring centred around five aspects of goals for physical touch: promoting physical comfort, promoting emotional comfort, promoting mind-body comfort, performing social role, and sharing spirituality. CONCLUSIONS Physical touch in caring as a concept having the dimensions of physical, emotional, social, and spiritual significance needs to be treated in a holistic way and it is possible to enrich the meanings and methods of physical touch in nursing so that its application may have effects that have positive impacts on patients' well-being and comfort.
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Affiliation(s)
- S O Chang
- College of Nursing, Korea University, Seoul, Korea.
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26
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Cluskey M, Kim YK. Use and perceived effectiveness of strategies for enhancing food and nutrient intakes among elderly persons in long-term care. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2001; 101:111-4. [PMID: 11209576 DOI: 10.1016/s0002-8223(01)00025-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M Cluskey
- Department of Nutrition and Food Management, Oregon State University, Corvallis, USA
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27
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Abstract
In nursing contexts a distinction is made between two types of touch: physical touch and therapeutic touch. Physical touch may be experienced as therapeutic, but that is not its explicit purpose in the same way as with therapeutic touch. Most of the touch studies reviewed in this article are from the United States of America, Canada and the United Kingdom and thus represent the culture of modern western society. The area covered by these studies is far from coherent, and even the results are to some extent contradictory. It follows that it is difficult to draw any firm conclusions from this review of the concepts, methods and main results of touch studies.
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Affiliation(s)
- P Routasalo
- University of Turku, Department of Nursing, 20014 TURKU, Finland.
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28
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Cluskey M, Dunton N. Serving meals of reduced portion size did not improve appetite among elderly in a personal-care section of a long-term-care community. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1999; 99:733-5. [PMID: 10361539 DOI: 10.1016/s0002-8223(99)00177-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M Cluskey
- Nutrition and Food Management, Oregon State University, Corvallis, N., USA
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29
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Abstract
Refusal to eat by the elderly, and subsequent malnutrition, occurs in both institutional and community settings. Causes include physiologic changes associated with aging, mental disorders such as dementia and depression, and medical, social, and environmental factors. Treatment approaches call for management of these causes while considering the roles that medicine, ethics, and culture play in the process.
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Affiliation(s)
- E L Marcus
- Acute Geriatric Department, Sarah Herzog Memorial Hospital, Jerusalem, Israel
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30
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Affiliation(s)
- J Kayser-Jones
- Department of Physiological Nursing and Medical Anthropology Program, University of California, San Francisco, USA
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31
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Affiliation(s)
- M S Jamison
- ADP Integrated Medical Solutions, Inc., Bethesda, Maryland, USA
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32
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Abstract
Touching is an integral part of human behaviour; from the moment of birth until they die, people need to be touched and to touch others. Touching is an intimate action that implies an invasion of the individual's personal, private space. In ethical terms, the question of touching is closely related to the patient's right to integrity and inviolability. The purpose of this study was to describe touching as it is experienced by elderly patients and nurses in long-term care. Touching was approached as a form of communication and as an important part of nursing practice. The participants, 25 patients and 30 nurses, were interviewed using a semistructured schedule. The data were analysed using the method of content analysis. The patients experienced touching by nurses as gentle, comforting and important. The nurses, for their part, experienced touching by patients as easy and natural. The patients rarely touched nurses more than was necessary. In some cases, nurses had to cope with violent touching by patients. Some women nurses interpreted touches by male patients as having a sexual nature and as annoying. This had taught male patients to avoid touching nurses. On the other hand, friendly and grateful touches by patients were very important to nurses. When used for emotional purposes only, touching presupposed a good relationship between nurses and their patients. Although touching is extremely common in nursing practice, there has been very little research into its meaning. More work is therefore needed to explore the role and meaning of touching in nursing.
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