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Yan L, Pu H, Shi X, Yu Q, Wang Z, Hu Y, Zhang Y, Zhang X. Construction of key quality indicators for aged care facilities in China: A two-tier Delphi study: Key aged care quality indicators in ACF by Delphi method. J Clin Nurs 2024; 33:752-767. [PMID: 37994245 DOI: 10.1111/jocn.16917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/24/2023]
Abstract
AIM To construct key quality indicators for aged care facilities in China. BACKGROUND Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self-supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China. DESIGN AND METHOD This two-tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two-round Delphi study. This study followed the SQUIRE 2.0 guidelines. RESULTS The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively). CONCLUSIONS Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement. RELEVANCE TO CLINICAL PRACTICE Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self-supervision for aged care facilities. ELDERLY OR PUBLIC CONTRIBUTION No elderly or public contribution.
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Affiliation(s)
- Lichun Yan
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Haixu Pu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoyin Shi
- Zhangjiajie College of Jishou University, Zhangjiajie, China
| | - Qian Yu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Zhiyi Wang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yajing Hu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yinhua Zhang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- Affiliated Changde Hospital of Hunan University of Chinese Medicine, Changde, China
| | - Xiaoqin Zhang
- School of Marxism, Hunan University of Chinese Medicine, Changsha, China
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Young AM, Tanaka MM, Yuwono C, Wehrhahn MC, Zhang L. Clinical Setting Comparative Analysis of Uropathogens and Antibiotic Resistance: A Retrospective Study Spanning the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2024; 11:ofad676. [PMID: 38333882 PMCID: PMC10853000 DOI: 10.1093/ofid/ofad676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
Background Antimicrobial resistance (AMR) in uropathogens has been increasing in Australia. Many nations observed heightened AMR during the coronavirus disease 2019 (COVID-19) pandemic, but it is not known how this may vary across clinical settings and in nations with lower infection rates. Methods We investigated the uropathogen composition and corresponding antibiotic resistance of 775 559 Australian isolates from the community, hospitals, and aged care facilities before (2016-2019) and during (2020-2022) the COVID-19 pandemic. A mathematical model was developed to predict the likelihood of resistance to currently recommended antibiotics for treating urinary tract infections (UTIs). Results Among uropathogens originating from the community, hospitals, and aged care facilities, Escherichia coli accounted for 71.4%, 57.6%, and 65.2%, respectively. During the COVID-19 pandemic period, there was an increase in UTIs caused by E coli across all settings. Uropathogens from aged care and hospitals frequently showed higher resistance to antibiotics compared to those isolated from the community. Interestingly, AMR among uropathogens showed a declining trend during the COVID-19 pandemic. Based on the resistance patterns of the past 3 years, our modeling predicted that 30%, 42.6%, and 38.8% of UTIs in the community, hospitals, and aged care facilities, respectively, would exhibit resistance to trimethoprim treatment as empirical therapy. In contrast, resistance to nitrofurantoin was predicted to be 14.6%, 26%, and 24.1% from these 3 respective settings. Conclusions Empirical therapy of UTIs in Australia with trimethoprim requires evaluation due to high rates of resistance observed across clinical settings.
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Affiliation(s)
- Alexandra M Young
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark M Tanaka
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Yuwono
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C Wehrhahn
- Douglass Hanly Moir Pathology, a Sonic Healthcare Australia Pathology Practice, Macquarie Park, New South Wales, Australia
| | - Li Zhang
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Malouh MA, Sefidani Forough A, Cichero JAY, Lau ETL, Nissen LM, Steadman KJ. The prevalence and perceived effectiveness of using a medication-swallowing lubricant in aged care facilities across Australia. Aging Med (Milton) 2023; 6:239-244. [PMID: 37711253 PMCID: PMC10498827 DOI: 10.1002/agm2.12261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 09/16/2023] Open
Abstract
Objective To explore the extent of use and perceived effectiveness of using a medication lubricant that is specifically designed to help people who struggle to swallow their solid medications whole. Method Health care workers of varying professional levels in aged care facilities (ACFs) across Australia who are involved in medication administration were invited to participate in a structured online survey. Results Of the 355 health care workers who completed the survey, 48% had used the medication lubricant to aid administration of whole and/or crushed solid oral dosage forms, and of these 89% agreed with the statement that "it is effective method to facilitate medication swallowing in residents." The main benefits of using the medication lubricant were considered to be easier medication administration to residents (49%), reduction in need for crushing of medications (34%), and better adherence with medications (33%). Conclusions This study showed that using a medication lubricant for aged care residents may facilitate the process of medication administration for health care workers, which they perceive to improve residents' adherence with medications. Serious complications associated with solid dosage form modification may also be decreased by using a medication lubricant, as the need for modifying medications is reduced. Therapeutic Goods Administration (TGA)-approved medication lubricants could therefore be a valuable tool to aid the medication administration for patients who have difficulties swallowing medications. Future research may consider the clinical efficacy and acceptability of medication lubricants specifically for people with swallowing difficulties.
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Affiliation(s)
- Marwa A. Malouh
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
| | - Aida Sefidani Forough
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Julie A. Y. Cichero
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Esther T. L. Lau
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Lisa M. Nissen
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Kathryn J. Steadman
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
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Udesen SEJ, Rasmussen CH, Mikkelsen S, Andersen N, Brabrand M, Lassen AT. Mobile emergency department care to nursing home residents: a novel outreach service. Age Ageing 2023; 52:7066942. [PMID: 36861182 PMCID: PMC9978309 DOI: 10.1093/ageing/afad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Every month, 6% of Danish nursing home residents are admitted to hospital. However, these admissions might have limited benefits and are associated with an increased risk of complications. We initiated a new mobile service comprising consultants performing emergency care in nursing homes. OBJECTIVE Describe the new service, the recipients of this service, hospital admission patterns and 90-day mortality. DESIGN A descriptive observational study. MODEL When an ambulance is requested to a nursing home, the emergency medical dispatch centre simultaneously dispatches a consultant from the emergency department who will provide an emergency evaluation and decisions regarding treatment at the scene in collaboration with municipal acute care nurses. METHOD We describe the characteristics of all nursing home contacts from 1st November 2020 to 31st December 2021. The outcome measures were hospital admissions and 90-day mortality. Data were extracted from the patients' electronic hospital records and prospectively registered data. RESULTS We identified 638 contacts (495 individuals). The new service had a median of two (interquartile range: 2-3) new contacts per day. The most frequent diagnoses were related to infections, unspecific symptoms, falls, trauma and neurologic disease. Seven out of eight residents remained at home following treatment, 20% had an unplanned hospital admission within 30 days and 90-day mortality was 36.4%. CONCLUSION Transitioning emergency care from hospitals to nursing homes could present an opportunity for providing optimised care to a vulnerable population and limiting unnecessary transfers and admissions to hospitals.
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Affiliation(s)
- Stine Emilie Junker Udesen
- Emergency Medicine Research Unit, University of Southern Denmark and Odense University Hospital, Odense 5000, Denmark
| | | | - Søren Mikkelsen
- The Prehospital Research Unit, the Department of Regional Health Research, University of Southern Denmark, Odense 5000, Denmark
| | - Nina Andersen
- The Department of the Elderly and Disabled, Odense 5000, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense 5000, Denmark
| | - Annmarie Touborg Lassen
- Address correspondence to: Annmarie Touborg Lassen, Department of Emergency Medicine and Emergency Medicine Research Unit, University of Southern Denmark, and Odense University Hospital, Odense 5000, Denmark. Tel: +45 65405048.
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Pu H, Zhang X, Luo L, Yu Q, Feng X, Yan L, Zhang Y. Use of physical restraints and its associated risk factors in the aged care facilities: A multicentre cross-sectional study. J Clin Nurs 2022. [PMID: 35718889 DOI: 10.1111/jocn.16406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/04/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To investigate the use of physical restraints in aged care facilities(ACFs)and analyse its associated risk factors. BACKGROUND Physical restraints have been widely used in ACFs worldwide, but they can cause physical and mental harm to older people. It is important to regulate the use of physical restraint. DESIGN A cross-sectional observational and correlational multicentre study. METHODS By convenience sampling method, we selected eight ACFs in four representative regions of Hunan province, China, for this study. The ACF-related information was obtained by interviewing the managers and reviewing records. We conducted investigation and observation on the elderly in the ACFs to understand the use of physical restraints at three different times: 9:30-11:30, 16:00-18:00 and 19:30-21:30 on a working day. The STROBE checklist was followed for this cross-sectional study. RESULTS This study found that the utilisation rate of physical restraints was 23.2%. The critical risk factors affecting the use of physical restrains include the following: (1) the ratio of nursing staff to the elderly residents; (2)whether there is a dementia care unit at the facility; (3) the number of elderly residents in each room; (4) the elderly residents' age, degree of education, marital status, care dependence and cognitive impairment; (5) whether the elderly has suffered from a stroke or senile dementia; (6) whether the elderly carries medical catheters. CONCLUSION There is a lack of standardisation in the use of physical restraints in ACFs of central China. Chinese ACFs should develop guidelines and reduction measures to standardise the use of physical restraints, basing on the key factors affecting the use of physical restraints. RELEVANCE TO CLINICAL PRACTICE The use of physical restraints in ACFs is threatening the safety of the elderly residents. Understanding the implementation of physical restraint in ACFs can provide reference for reducing the use of physical restraint.
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Affiliation(s)
- Haixu Pu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoqin Zhang
- School of Marxism, Hunan University of Chinese Medicine, Changsha, China
| | - Liangchu Luo
- Clinical School of Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Qian Yu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaolin Feng
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Lichun Yan
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yinhua Zhang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
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Dronavalli M, Lord H, Alexander K, Boonwaat L, Pal N, Fletcher-Lartey SM. Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care. J Epidemiol Glob Health 2021; 10:184-189. [PMID: 32538036 PMCID: PMC7310780 DOI: 10.2991/jegh.k.200402.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/20/2020] [Indexed: 11/25/2022] Open
Abstract
Influenza outbreaks in Aged Care Facilities (ACFs) can lead to hospitalizations and deaths. Influenza can spread rapidly through ACFs if precautionary measures are not taken. Along with influenza vaccination and precautionary hygiene measures, Oseltamivir Prophylaxis (OP) may be effective in reducing the attack rate of influenza by preventing new cases. A cohort study was carried out to investigate the effectiveness of OP use during influenza outbreaks in ACFs located within South Western Sydney Local Health District from 1 January 2015 to 31 December 2018. The main outcome assessed was the rate of OP failure (new cases of influenza in patients treated with OP) among ACF residents. Subgroups and various predictors of OP failure were investigated including presence of a dementia ward, high care ward, and days to Public Health Unit (PHU) notification. The cohort consisted of 86 ACF outbreaks involving 10,064 residents. OP prevented 90% of influenza cases during influenza outbreaks [0.1 RR (95% confidence interval (CI): 0.08–0.12); P < 0.0001]. ACFs with dementia wards had a 44% (0.56 relative risk (RR) (95% CI: 0.34–0.93); P < 0.05) lower OP failure rate. ACFs with high level care had an 87% (0.13 RR (95% CI: 0.05–0.38); P < 0.05) lower OP failure rate. OP is highly effective in preventing new cases of influenza during outbreaks in ACFs, especially in ACFs with dementia or high care wards. Mandatory reporting of influenza outbreaks to PHUs would ensure that ACFs are supported throughout the outbreak, which will facilitate reductions in hospitalizations and mortality.
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Affiliation(s)
- Mithilesh Dronavalli
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Heidi Lord
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre for Excellence, Wollongong, NSW, Australia
| | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Leng Boonwaat
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Narugopal Pal
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Usher K, Durkin J, Gyamfi N, Warsini S, Jackson D. Preparedness for viral respiratory infection pandemic in residential aged care facilities: A review of the literature to inform post-COVID-19 response. J Clin Nurs 2021:10.1111/jocn.15863. [PMID: 34021650 PMCID: PMC8242770 DOI: 10.1111/jocn.15863] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 05/04/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine what was known about disaster preparedness in residential care and to consider this in the light of the current COVID-19 pandemic. BACKGROUND Care homes provide long-term care to vulnerable, frail older people, as well as to young people with profound disabilities. The COVID-19 pandemic has shown that the residential care sector has been seriously affected in many parts of the world and has exposed major flaws and vulnerabilities in infection control and other processes that have resulted in considerable loss of life of residents of these facilities. DESIGN Discursive paper informed by a systematic literature. Review was carried out in line with PRISMA reporting guidelines. The review protocol was registered with PROSPERO on 2020 [CRD42020211847]. RESULTS The review identified six papers meeting inclusion criteria across care residential facilities in different countries. Several prevention and mitigation strategies were identified to manage and reduce the spread and severity of viral respiratory infection pandemics. These strategies include isolation, restriction of movement, personal protective and hygienic measures, health education and information sharing, monitoring and coordination, and screening and treatment. Preparedness strategies identified were contingency planning such as reporting/communication, leadership, human resource, insurance, occupational health and resource availability. The prevention/mitigation and preparedness strategies helped to achieve decline in disease severity, reduced prevalence, reduced spread of the disease, improved readiness criteria, resource usefulness and increased intervention acceptability. This paper presents a conceptual framework exploring the interconnectedness of preparedness and prevention/ mitigation strategies and associated outcomes. We discuss areas of concern in the context of workforce employment patterns in the sector. Concerns related to the unintended consequences of strategies placed on aged care facilities, which may worsen mental health outcomes for residents, are discussed. CONCLUSIONS Persons in residential care settings are at greater risk of infection during a pandemic, and therefore, strict measures to protect their safety are warranted. However, they are also a group who already experience social isolation and so any measures involving restrictions to visiting and social interaction, particularly over the longer term, must be accompanied by strategies to mitigate potential loneliness and mental health sequelae arising from long-term pandemic restrictions. RELEVANCE TO CLINICAL PRACTICE Though there was evidence of activity in preparedness for disasters within the residential care sector, various contextual factors affecting the sector were clearly not adequately considered or addressed in pre-pandemic disaster planning, particularly in the areas of staff movements between care homes and the length of time that social isolation and restriction measures would need to be in place. Future pandemic planning should consider the nature of the workforce model in the care home sector, and factor in strategies to better support the mobile and highly casualised workforce.
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Affiliation(s)
- Kim Usher
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
| | - Joanne Durkin
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
| | - Naomi Gyamfi
- School of HealthUniversity of New EnglandArmidaleNSWAustralia
| | | | - Debra Jackson
- Susan Wakil School of NursingUniversity of SydneySydneyNSWAustralia
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Wang X, Shen J, Chen Q. How PARO can help older people in elderly care facilities: A systematic review of RCT. Int J Nurs Knowl 2021; 33:29-39. [PMID: 33960698 PMCID: PMC9292779 DOI: 10.1111/2047-3095.12327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 12/24/2022]
Abstract
Purpose This review aims to systematically evaluate the effects of Paro on older adults and provide a stronger basis for the rational application of Paro in aged care facilities. Methods Articles published between January 2003 and January 2020 via five databases (PubMed, Web of Science, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Chinese database SinoMed) were searched. The Cochrane collaboration tool for randomized controlled trials was used to assess the quality of all included studies. Results Nine articles were included in this systematic review. All articles were summarized according to three themes: quality of life, and biopsychological conditions, and drug usage. Conclusions The review demonstrated that interaction with Paro can be beneficial for improving quality of life (QOL), biopsychological conditions, and reducing psychotropic and pain medical usage. Since the differences of the study design and low to moderate quality of these studies, however, we should be cautious to make positive comments on the role of Paro. Implications of nursing practice The implications of Paro in aged care facilities have positive effects on nursing outcomes. This review helps caregivers understand the advantages and disadvantages of care robots, and promotes the integration of intelligent technology and manual services in nursing practice.
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Affiliation(s)
- Xinxia Wang
- Nursing Department, the First Affiliated Hospital of Chongqing Medical University, Yuzhong district, #1 Youyi road, Chongqing, 400014, China
| | - Jun Shen
- Nursing Department, the First Affiliated Hospital of Chongqing Medical University, Yuzhong district, #1 Youyi road, Chongqing, 400014, China
| | - Qiu Chen
- Nursing Department, the First Affiliated Hospital of Chongqing Medical University, Yuzhong district, #1 Youyi road, Chongqing, 400014, China
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Qasim H, Simpson M, Guisard Y, de Courten B. A Comprehensive Evaluation of Studies on the Adverse Effects of Medications in Australian Aged care Facilities: A Scoping Review. Pharmacy (Basel) 2020; 8:E56. [PMID: 32244394 PMCID: PMC7356156 DOI: 10.3390/pharmacy8020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
Aim: this scoping review was designed to identify studies that assess adverse drug reactions (ADRs) for older people in Australian aged care facilities. This review critically evaluates each published study to identify the risk of, or actual, adverse drug events in older people. Inclusion criteria: this review considered any clinical studies that examined the adverse effects of medications in older people who were living in aged care facilities. This review considered qualitative studies, analytical studies, randomized controlled trials (RCTs), descriptive cross-sectional studies, and analytic observational studies that explored the use of medications and their adverse effects on older people in clinical settings (including aged care facilities). Methods: an initial search of the PubMed (United State National Library of Medicine), OvidSP, EBSCOHost, ScienceDirect, Wiley Online, SAGE, and SCOPUS databases, with full text was performed, followed by an analysis of the article's title and abstract. Additionally, MeSH (Medical Subject Headings) was used to describe the article. The initial round of the database search was based on inclusion criteria from studies that assessed tools or protocols aiming to identify the adverse effects of medications on the elderly population suffering chronic conditions or multiple co-morbidities. Two reviewers screened the retrieved papers for inclusion. The data presented in this review are in tabular forms and accompanied by a narrative summary which aligns with the review's objectives. Results: seven studies were identified, and the extracted data from these studies were grouped according their characteristics and the auditing results of each study. Conclusion: it would be beneficial to design a comprehensive or broadly adverse drug reaction assessment tool derived from Australian data that has been used on the elderly in an Australian healthcare setting.
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Affiliation(s)
- Haider Qasim
- School of Biomedical Science, Charles Sturt University, Orange 2800, NSW, Australia;
| | - Maree Simpson
- School of Biomedical Science, Charles Sturt University, Orange 2800, NSW, Australia;
| | - Yann Guisard
- Faculty of Science, Charles Sturt University, Orange 2800, NSW, Australia;
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Abstract
Objective: Optimal pain management in residents requires an understanding of prescribing and administration of opioid analgesics. This study aimed to describe opioid administration for elderly residents in a selection of aged care facilities. Methods: A cross-sectional audit of analgesics administration was conducted for all 458 residents of three-aged care facilities on May 1, 2017. The facilities (each ~160 beds) represented a geographically diverse area in Perth, Australia, and varying service levels by nurse practitioners. Data were accessed using the iCare® platform and transcribed into a customized database. Data were reported descriptively, with relationships between categorical variables examined using the Chi-square analysis. Main outcome measures in the study were the prevalence of administration of opioids compared to that of nonopioid analgesics and no analgesics on the audit date, and characteristics of the opioid prescriptions (the type of prescriber and nursing/care staff involved in the dose administration). Findings: Of 458 residents, 95 (20.7%) received an opioid analgesic on the audit date; 231 had also received a nonopioid analgesic. The most common opioid (34 residents) was a brand of oxycodone hydrochloride and naloxone hydrochloride as 10/5 mg tablets. There was no significant tendency for opioid prescribing by classification of the prescriber, nor for any category of nursing/care staff to administer the particular types of analgesics. Conclusion: The tendency for prescribing of opioids showed no significant among the prescribers. Finally, the administration of opioids was predominantly by caregivers. This represents the first step in a program of activity to ensure the quality use of potent analgesics in an aged care provider network.
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Affiliation(s)
- Areej Numan Hussein
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia
| | - Lynne Emmerton
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia
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Tao Y, Lau SSY, Gou Z, Fu J, Jiang B, Chen X. Privacy and Well-Being in Aged Care Facilities with a Crowded Living Environment: Case Study of Hong Kong Care and Attention Homes. Int J Environ Res Public Health 2018; 15:ijerph15102157. [PMID: 30275374 PMCID: PMC6209900 DOI: 10.3390/ijerph15102157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 11/16/2022]
Abstract
This study aims to understand the relationship between bedroom privacy and well-being of the elderly in aged care facilities with a compact living situation. A majority of studies on this topic were carried out in a low-density population context. The crowded living situation might compromise the well-being of residents. This study proposed five architectural parameters to measure bedroom privacy in aged care facilities: total open surface per unit, openness/solid ratio per bed, height of partition wall, number of people per unit, and personal control over bedroom privacy. SF-12 v.2 Health Survey was used to collect information on physical and mental health status. The study surveyed nine Care & Attention homes and their 213 residents in Hong Kong. The total open surface per unit and the openness/solid ratio per bed were positively associated with the physical health of residents. The height of partition walls was associated negatively with their physical and mental health conditions, and the number of people per unit was negatively associated with their physical health. More than half of respondents preferred a single unit with high partition walls; however, 40% of respondents preferred low partition walls. The provision of privacy for the elderly should be balanced with their needs for social interactions; total open surface per unit, openness/solid ratio per bed and height of partition wall should be taken into consideration. The study provides evidence and design guidelines for improving privacy in aged care facilities with a compact living environment.
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Affiliation(s)
- Yiqi Tao
- Department of Architecture, National University of Singapore, Singapore 117566, Singapore.
| | - Stephen Siu Yu Lau
- Department of Architecture, National University of Singapore, Singapore 117566, Singapore.
| | - Zhonghua Gou
- School of Engineering and Built Environment, Griffith University, Gold Coast, QLD 4215, Australia.
| | - Jiayan Fu
- Department of Architecture, College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310000, China.
| | - Boya Jiang
- School of Architecture, Nanjing Tech University, Nanjing 211816, China.
| | - Xiaowei Chen
- School of Public Affairs, Zhejiang University, Hangzhou 310000, China.
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Goto T, Nakagami G, Takehara K, Nakamura T, Kawashima M, Tsunemi Y, Sanada H. Examining the accuracy of visual diagnosis of tinea pedis and tinea unguium in aged care facilities. J Wound Care 2017; 26:179-183. [PMID: 28379097 DOI: 10.12968/jowc.2017.26.4.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to examine the accuracy of visual diagnosis of tinea pedis (Athlete's foot) and tinea unguium (fungal nail infection), as well as to provide information on skin abnormalities that could help identify these diseases in aged care facilities (long-term care facilities (LTCFs) and nursing homes). METHOD A multicentre, cross-sectional observational study was conducted in a LTCF and two nursing homes. A dermatologist observed the skin abnormalities in the participants' interdigital and plantar areas, to screen for tinea pedis, and in the participants' toenails, to screen for tinea unguium. If abnormalities were noted, samples such as scales or toenails were collected and examined using direct microscopy. The accuracy of the macroscopic observation for each skin abnormality was examined. RESULTS A total of 173 residents were recruited. The accuracy of clinical diagnosis using macroscopic observation was relatively low. The sensitivities and specificities for clinical diagnosis were 0.37 and 0.95 for tinea pedis in the interdigital areas, 0.47 and 0.94 for tinea pedis in the plantar areas, and 0.80 and 0.61 for tinea unguium in toenails, respectively. Scales in the plantar areas and discoloration of the toenails were more frequently observed in residents with tinea pedis and tinea unguium than in those without them. CONCLUSION Several skin abnormalities were observed in the residents recruited in this study, but there was insufficient correlation with tinea pedis and tinea unguium to be used for screening.
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Affiliation(s)
- T Goto
- PhD student, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Global Leadership Initiative for an Age-Friendly Society, The University of Tokyo, Tokyo, Japan
| | - G Nakagami
- Lecturer, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Takehara
- Lecturer, Department of Advanced Clinical Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Nakamura
- Physician, Shukokai Medical Corporation, Tokyo, Japan
| | - M Kawashima
- Professor, Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Tsunemi
- Associate Professor, Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Sanada
- Professor, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sposito G, Barbosa A, Figueiredo D, Yassuda MS, Marques A. Effects of multisensory and motor stimulation on the behavior of people with dementia. Dementia (London) 2016; 16:344-359. [PMID: 26112166 DOI: 10.1177/1471301215592080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A quasi-experimental study using a pre-posttest design was conducted in four aged care facilities to assess the effects of a person-centred care (PCC) multisensory stimulation (MSS) and motor stimulation (MS) program, implemented by direct care workers, on the behaviors of residents with dementia. Data were collected at baseline and after the intervention through video recordings of morning care routines. Forty-five residents with moderate and severe dementia participated in the study. A total of 266 morning care routines were recorded. The frequency and duration of a list of behaviors were analyzed. The frequency of engagement in task decreased significantly ( p = .002) however, its duration increased ( p = .039). The duration of gaze directed at direct care workers improved significantly ( p = .014) and the frequency of closed eyes decreased ( p = .046). There was a significant decrease in the frequency of the expression of sadness. These results support the implementation of PCC-MSS and MS programs as they may stimulate residents' behaviors.
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Affiliation(s)
- Giovana Sposito
- School of Medical Sciences, State University of Campinas (Unicamp), Campinas-SP, Brazil
| | - Ana Barbosa
- Department of Health Sciences, University of Aveiro, Portugal
| | - Daniela Figueiredo
- School of Health Sciences, University of Aveiro, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), University of Aveiro, Portugal
| | - Mônica Sanches Yassuda
- School of Arts, Sciences and Humanities, University of São Paulo (USP), São Paulo-SP, Brazil
| | - Alda Marques
- School of Health Sciences, University of Aveiro, Portugal.,CINTESIS, University of Aveiro, Portugal
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Abstract
BACKGROUND There is gap in the literature regarding the current practice of diabetes management of the elderly in Australia and its compliance with available Australian diabetes practice guidelines. AIMS The aims of this study were to describe the pharmacological management of elderly residents with diabetes living in aged care facilities and to identify areas for improvement in the current management as recommended by the current diabetes management guidelines in Australia. METHOD Residents with diabetes from three rural aged care facilities were identified by nursing staff. A cross-sectional medical record audit was carried out to obtain data of residents diagnosed with diabetes. Thirty-four medical records were audited from three aged care facilities.Data including demographics, medical histories and medications were collected and analysed. RESULTS This study had two key findings; Firstly, it showed that about a third of residents with type 2 diabetes are managed with diet only. Secondly, of the residents who are managed with medications, less than half of those audited (41%) were managed according to the current diabetes guidelines in terms of pharmacological treatment which included anti- hypertensive, lipid lowering and anti- platelet therapies. Of those patients with a history of CVD, all were receiving an antihypertensive medication, 71% were not managed for their lipids and 20% were not on any prophylactic anti- platelet therapy. CONCLUSION Management of patients with diabetes living in rural aged care facilities is inconsistent with the current management guidelines. Educational interventions targeting health professionals and patients might be beneficial to increase compliance with the current diabetes guidelines.
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Affiliation(s)
- H Khalil
- Monash University, Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Department of Rural and Indigenous Health, Australia
| | - L Tan
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Australia
| | - J George
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Australia
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Silvester W, Fullam RS, Parslow RA, Lewis VJ, Sjanta R, Jackson L, White V, Gilchrist J. Quality of advance care planning policy and practice in residential aged care facilities in Australia. BMJ Support Palliat Care 2012; 3:349-57. [PMID: 24644755 PMCID: PMC3756507 DOI: 10.1136/bmjspcare-2012-000262] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess existing advance care planning (ACP) practices in residential aged care facilities (RACFs) in Victoria, Australia before a systematic intervention; to assess RACF staff experience, understanding of and attitudes towards ACP. DESIGN Surveys of participating organisations concerning ACP-related policies and procedures, review of existing ACP-related documentation, and pre-intervention survey of RACF staff covering their role, experiences and attitudes towards ACP-related procedures. SETTING 19 selected RACFs in Victoria. PARTICIPANTS 12 aged care organisations (representing 19 RACFs) who provided existing ACP-related documentation for review, 12 RACFs who completed an organisational survey and 45 staff (from 19 RACFs) who completed a pre-intervention survey of knowledge, attitudes and behaviour. RESULTS Findings suggested that some ACP-related practices were already occurring in RACFs; however, these activities were inconsistent and variable in quality. Six of the 12 responding RACFs had written policies and procedures for ACP; however, none of the ACP-related documents submitted covered all information required to meet ACP best practice. Surveyed staff had limited experience of ACP, and discrepancies between self reported comfort, and levels of knowledge and confidence to undertake ACP-related activities, indicated a need for training and ongoing organisational support. CONCLUSIONS Surveyed organisations â policies and procedures related to ACP were limited and the quality of existing documentation was poor. RACF staff had relatively limited experience in developing advance care plans with facility residents, although attitudes were positive. A systematic approach to the implementation of ACP in residential aged care settings is required to ensure best practice is implemented and sustained.
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Affiliation(s)
- William Silvester
- Respecting Patient Choices, Austin Health, Heidelberg, Victoria, Australia
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Wilson N, Hilmer S, March L, Cameron I, Lord S, Mason R, Sambrook P. Physical functioning measures and risk of falling in older people living in residential aged care facilities. Ther Adv Musculoskelet Dis 2012; 3:9-15. [PMID: 22870462 DOI: 10.1177/1759720x10389848] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Frail older individuals living in residential aged care facilities (RACFs) have impaired physical function compared with to older people living in the community. In residents of RACFs, we aimed to produce sex-specific means and empirical norms of objective physical function measures to ascertain whether these measures are predictors of falls. METHODS Data were extracted from a large cohort study investigating fall and fracture rates in RACFs in the Northern Sydney Health Area, Australia. RESULTS Study participants (n = 602, 70.9% female) were recruited from 51 RACFs. Cohort means (±standard deviation) for females were for grip strength (GS) 16.8±5.3 kg, simple reaction time (RT) 384±154 ms, walking speed (WS) 0.56 ±0.20 ms(-1), balance category (B) 3.8±1.1 and sit to stand category (STS) 3.6±0.5. For males, means were for GS 28.8±7.8 kg, RT 335±150 ms, WS 0.62±0.22 ms(-1), B 4.1±1.1 and STS 3.7±0.5. Means of B and STS decreased significantly over the 1-year study period for males and females (p < 0.001). Individual multivariate negative binomial regression models for each functional outcome showed having a WS <0.6 ms(-1) (IRR = 1.37, 95% Cl = 1.03-1.84), a STS score of 3 (IRR = 1.39, 95% Cl = 1.09-1.79) and B category of 3 or 5 (IRR = 1.69, 95% CI = 1.29-2.22) were significantly associated with an increased fall rate. CONCLUSIONS This study establishes normative values for physical function tests in mobile residents of RACFs and demonstrates that walking speed, balance and sit to stand impairments are associated with falls in this group.
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Affiliation(s)
- Nicholas Wilson
- University of Sydney, Departments of Clinical Pharmacology and Aged Care, Sydney, Australia
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