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Pillemer K, Teresi JA, Ramirez M, Eimicke J, Silver S, Boratgis G, Meador R, Schultz L, Kong J, Ocepek-Welikson K, Chang ES, Lachs MS. Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living. JAMA Netw Open 2024; 7:e249668. [PMID: 38700860 PMCID: PMC11069077 DOI: 10.1001/jamanetworkopen.2024.9668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/05/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Resident-to-resident aggression in assisted living facilities can result in physical and psychological harm, but its prevalence is unknown. Objective To estimate the prevalence of resident-to-resident aggression, including physical, verbal, and sexual, among residents in assisted living facilities. Design, Setting, and Participants This study used cross-sectional, observational data from a clinical trial, in which residents of assisted living facilities were monitored for events over a 1-month period. All residents of 14 large facilities randomly selected from 2 geographic locations (N = 1067), except those receiving hospice care (n = 11), were invited to participate; 93 died or moved prior to enrollment. There were 33 family and resident refusals; 930 residents were enrolled. Data were collected between May 30, 2018, and August 11, 2022. Main Outcomes and Measures The data are from a clinical trial testing the effectiveness of an intervention to reduce resident-to-resident aggression. In addition, the study was designed to assess prevalence using the Time 1 (baseline) data, using a probability sample of facilities to allow for this analysis. Resident-to-resident aggression was identified using a mixed-method, case-finding strategy involving 6 sources: (1) cognitively capable resident reports regarding 22 possible events, (2) direct care staff report, (3) staff member reports collected from event-reporting forms, (4) research assistant observation of events in real time, (5) facility accident or incident reports, and (6) resident records. Results The prevalence of resident-to-resident aggression among the 930 participants (mean [SD] age, 88.0 [7.2] years; 738 women [79.4%]) during the past month was estimated to be 15.2% (141 of 930 residents; 95% CI, 12.1%-18.8%). The most common forms of aggression included verbal (11.2% [104 of 930 residents; 95% CI, 8.8%-14.2%]), physical (41 of 930 residents; 4.4% [95% CI, 3.1%-6.3%]), sexual (0.8% [7 of 930 residents; 95% CI, 0.4%-1.6%]), and other (70 of 930 residents; 7.5% [95% CI, 5.5%-10.2%]). These categories are not mutually exclusive as residents could be involved with more than 1 type of aggressive behavior. Conclusions and Relevance In this cross-sectional, observational prevalence study, resident-to-resident aggression in assisted living facilities was highly prevalent. Verbal aggression was the most common form, and physical aggression also occurred frequently. The effects of resident-to-resident aggression can be both morbid and mortal; therefore, intervention research is needed to prevent it and to treat it when it occurs.
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Affiliation(s)
- Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute, New York
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Mildred Ramirez
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Joseph Eimicke
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Stephanie Silver
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Gabriel Boratgis
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Rhoda Meador
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York
| | - Leslie Schultz
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York
| | - Jian Kong
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Katja Ocepek-Welikson
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
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Hua CL, Patel S, Thomas KS, Jester DJ, Kosar CM, Peterson LJ, Dobbs D, Andel R, Dosa DM. Evacuation and Health Care Outcomes Among Assisted Living Residents After Hurricane Irma. JAMA Netw Open 2024; 7:e248572. [PMID: 38669016 PMCID: PMC11053374 DOI: 10.1001/jamanetworkopen.2024.8572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance Evacuation has been found to be associated with adverse outcomes among nursing home residents during hurricanes, but the outcomes for assisted living (AL) residents remain unknown. Objective To examine the association between evacuation and health care outcomes (ie, emergency department visits, hospitalizations, mortality, and nursing home visits) among Florida AL residents exposed to Hurricane Irma. Design, Setting, and Participants Retrospective cohort study using 2017 Medicare claims data. Participants were a cohort of Florida AL residents who were aged 65 years or older, enrolled in Medicare fee-for-service, and resided in 9-digit zip codes corresponding to US assisted living communities with 25 or more beds on September 10, 2017, the day of Hurricane Irma's landfall. Propensity score matching was used to match evacuated residents to those that sheltered-in-place based on resident and AL characteristics. Data were analyzed from September 2022 to February 2024. Exposure Whether the AL community evacuated or sheltered-in-place before Hurricane Irma made landfall. Main Outcomes and Measures Thirty- and 90-day emergency department visits, hospitalizations, mortality, and nursing home admissions. Results The study cohort included 25 130 Florida AL residents (mean [SD] age 81 [9] years); 3402 (13.5%) evacuated and 21 728 (86.5%) did not evacuate. The evacuated group had 2223 women (65.3%), and the group that sheltered-in-place had 14 556 women (67.0%). In the evacuated group, 42 residents (1.2%) were Black, 93 (2.7%) were Hispanic, and 3225 (94.8%) were White. In the group that sheltered in place, 490 residents (2.3%) were Black, 707 (3.3%) were Hispanic, and 20 212 (93.0%) were White. After 1:4 propensity score matching, when compared with sheltering-in-place, evacuation was associated with a 16% greater odds of emergency department visits (adjusted odds ratio [AOR], 1.16; 95% CI, 1.01-1.33; P = .04) and 51% greater odds of nursing home visits (AOR, 1.51; 95% CI, 1.14-2.00; P = .01) within 30 days of Hurricane Irma's landfall. Hospitalization and mortality did not vary significantly by evacuation status within 30 or 90 days after the landfall date. Conclusions and Relevance In this cohort study of Florida AL residents, there was an increased risk of nursing home and emergency department visits within 30 days of Hurricane Irma's landfall among residents from communities that evacuated before the storm when compared with residents from communities that sheltered-in-place. The stress and disruption caused by evacuation may yield poorer immediate health outcomes after a major storm for AL residents. Therefore, the potential benefits and harms of evacuating vs sheltering-in-place must be carefully considered when developing emergency planning and response.
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Affiliation(s)
- Cassandra L. Hua
- Department of Public Health, University of Massachusetts, Lowell
| | - Sweta Patel
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
| | - Kali S. Thomas
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Massachusetts
| | - Dylan J. Jester
- Women’s Operational Military Exposure Network Center of Excellence, VA Palo Alto Health Care System, Palo Alto, California
| | - Cyrus M. Kosar
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
| | - Lindsay J. Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Czech Republic
| | - David M. Dosa
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Mah J, Lieu A, Palayew M, Alipour P, Kong LY, Song S, Palayew A, Tutt-Guérette MA, Yang SS, Wilchesky M, Lipes J, Azoulay L, Greenaway C. Comparison of hospitalized patients with COVID-19 who did and did not live in residential care facilities in Montréal: a retrospective case series. CMAJ Open 2021; 9:E718-E727. [PMID: 34257090 PMCID: PMC8313094 DOI: 10.9778/cmajo.20200244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND As in other jurisdictions, the demographics of people infected with SARS-CoV-2 changed in Quebec over the course of the first COVID-19 pandemic wave, and affected those living in residential care facilities (RCFs) disproportionately. We evaluated the association between clinical characteristics and outcomes of hospitalized patients with COVID-19, comparing those did or did not live in RCFs. METHODS We conducted a retrospective case series of all consecutive adults (≥ 18 yr) admitted to the Jewish General Hospital in Montréal with laboratory-confirmed SARS-CoV-2 infection from Mar. 4 to June 30, 2020, with in-hospital follow-up until Aug. 6, 2020. We collected patient demographics, comorbidities and outcomes (i.e., admission to the intensive care unit, mechanical ventilation and death) from medical and laboratory records and compared patients who did or did not live in public and private RCFs. We evaluated factors associated with the risk of in-hospital death with a Cox proportional hazard model. RESULTS In total, 656 patients were hospitalized between March and June 2020, including 303 patients who lived in RCFs and 353 patients who did not. The mean age was 72.9 (standard deviation 18.3) years (range 21 to 106 yr); 349 (53.2%) were female and 118 (18.0%) were admitted to the intensive care unit. The overall mortality rate was 23.8% (156/656), but was higher among patients living in RCFs (36.6% [111/303]) compared with those not living in RCFs (12.7% [45/353]). Increased risk of death was associated with age 80 years and older (hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.35-4.24), male sex (HR 1.74, 95% CI 1.25-2.41), the presence of 4 or more comorbidities (HR 2.01, 95% CI 1.18-3.42) and living in an RCF (HR 1.62, 95% CI 1.09-2.39). INTERPRETATION During the first wave of the COVID-19 epidemic in Montréal, more than one-third of RCF residents hospitalized with SARS-CoV-2 infection died during hospitalization. Policies and practices that prevent future outbreaks of SARS-CoV-2 infection in this setting must be implemented to prevent high mortality in this vulnerable population.
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Affiliation(s)
- Jordan Mah
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Anthony Lieu
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Mark Palayew
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Pouria Alipour
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Ling Yuan Kong
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Sunny Song
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Adam Palayew
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Marc Antoine Tutt-Guérette
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Stephen Su Yang
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Machelle Wilchesky
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Jed Lipes
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Laurent Azoulay
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Christina Greenaway
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que.
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Abstract
This cohort study examines rates of mortality among US assisted living residents during the COVID-19 pandemic in comparison with the same period in 2019.
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Affiliation(s)
- Kali S. Thomas
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Center for Long-Term Services and Support, US Department of Veterans Affairs Medical Center, Providence, Rhode Island
| | - Wenhan Zhang
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - David M. Dosa
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Center for Long-Term Services and Support, US Department of Veterans Affairs Medical Center, Providence, Rhode Island
| | - Paula Carder
- Institute on Aging, Portland State University, Portland, Oregon
| | - Philip Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
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Wang J, Ying M, Temkin-Greener H, Caprio TV, Yu F, Simning A, Conwell Y, Li Y. Care-Partner Support and Hospitalization in Assisted Living During Transitional Home Health Care. J Am Geriatr Soc 2021; 69:1231-1239. [PMID: 33394506 PMCID: PMC8127345 DOI: 10.1111/jgs.17005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Care-partner support affects outcomes among assisted living (AL) residents. Yet, little is known about care-partner support and its effects on hospitalization during post-acute care transitions. This study examined the variation in care-partner support and its impact on hospitalizations among AL residents receiving Medicare home health (HH) services. DESIGN Analysis of national data from the Outcome and Assessment Information Set, Medicare claims, Area Health Resources File, and the Social Deprivation Index File. SETTING AL facilities and Medicare HH agencies in the United States. PARTICIPANTS 741,926 Medicare HH admissions of AL residents in 2017. MEASUREMENTS Care-partner support during the HH admission was measured based on the type and frequency of assistance from AL staff in seven domains (i.e., activities of daily living (ADL), instrumental ADLs, medication administration, treatment, medical equipment, home safety, and transportation). Care-partner support in each domain was measured as "assistance not needed" (reference group), "Care-partner currently provides assistance," "care-partner need additional training/support to provide assistance" (i.e., inadequate care-partner support), and "care-partner unavailable/unlikely to provide assistance" (i.e., unavailable care-partner support). Outcome was time-to-hospitalization during the HH admission. RESULTS Among the 741,926 Medicare HH admissions of AL residents, inadequate care-partner support was identified for all seven domains that ranged from 13.1% (for transportation) to 49.8% (for treatment), and care-partner support was unavailable from 0.9% (for transportation) to 11.0% (for treatment). In Cox proportional hazard models adjusted for patient covariates and geography, compared with "assistance not needed", having inadequate and unavailable care-partner support was related to increased risk of hospitalization by 8.9% (treatment (hazard ratio (HR) =1.089, P < .001)) to 41.3% (medication administration (HR =1.413, P < .001)). CONCLUSION For AL residents receiving HH services, having less care-partner support was related to increased risk of hospitalization, particularly regarding medication administration, medical equipment, and transportation/advocacy.
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Affiliation(s)
| | - Meiling Ying
- University of Rochester, Department of Public Health Sciences, NY
| | | | - Thomas V. Caprio
- University of Rochester Medical Center, Department of Medicine, NY
- University of Rochester Medical Home Care, NY
- Finger Lakes Geriatric Education Center, NY
| | - Fang Yu
- Arizona State University, College of Nursing and Health Innovation, AZ
| | - Adam Simning
- University of Rochester, Department of Public Health Sciences, NY
- University of Rochester Medical Center, Department of Psychiatry, NY
| | - Yeates Conwell
- University of Rochester Medical Center, Department of Psychiatry, NY
| | - Yue Li
- University of Rochester, Department of Public Health Sciences, NY
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Feaster M, Goh YY. High Proportion of Asymptomatic SARS-CoV-2 Infections in 9 Long-Term Care Facilities, Pasadena, California, USA, April 2020. Emerg Infect Dis 2020; 26:2416-2419. [PMID: 32614768 PMCID: PMC7510707 DOI: 10.3201/eid2610.202694] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Our analysis of coronavirus disease prevalence in 9 long-term care facilities demonstrated a high proportion (40.7%) of asymptomatic infections among residents and staff members. Infection control measures in congregate settings should include mass testing–based strategies in concert with symptom screening for greater effectiveness in preventing the spread of severe acute respiratory syndrome coronavirus 2.
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Thomas KS, Zhang W, Cornell PY, Smith L, Kaskie B, Carder PC. State Variability in the Prevalence and Healthcare Utilization of Assisted Living Residents with Dementia. J Am Geriatr Soc 2020; 68:1504-1511. [PMID: 32175594 PMCID: PMC7363564 DOI: 10.1111/jgs.16410] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Almost 1 million older and disabled adults who require long-term care reside in assisted living (AL), approximately 40% of whom have a diagnosis of Alzheimer's disease and related dementias (ADRD). States vary in their regulations specific to dementia care that may influence the presence of residents with ADRD in AL and their outcomes. The objectives of this study were to describe the state variability in the prevalence of ADRD among Medicare beneficiaries residing in larger (25+ bed) ALs and their healthcare utilization. DESIGN Retrospective observational national study. PARTICIPANTS National cohort of 293,336 Medicare fee-for-service enrollees residing in larger (25+ bed) ALs in 2016 and 2017 including 88,867 (30.3%) residents with ADRD. We compared this cohort's characteristics and healthcare utilization with that of individuals with ADRD who resided in nursing homes (NHs; n = 602,521) and the community (n = 2,074,420). METHODS Medicare enrollment data, claims, and the NH Minimum Data Set were used to describe differences among ADRD patients in AL, NHs, and the community. We present rates of NH admission and hospitalization, by state, adjusting for age, sex, race, dual eligibility, and chronic conditions. RESULTS The prevalence of ADRD among AL residents varied by state, ranging from 24% to 47%. In 2017, AL residents with ADRD had higher rates of NH admission than their community-dwelling counterparts (adjusted national average = 24%, ranging from 14% to 35% among states). AL residents with ADRD had higher rates of hospitalization (38%) than populations in either NHs (29%) or the community (34%), and ranged from 29% to 45% of residents among states. CONCLUSION These findings have implications for states as they regulate AL and for healthcare professionals whose patients reside in AL. Future work is needed to understand specific elements of states' regulatory environments and local markets that may impact access and outcomes for this vulnerable population of residents with ADRD. J Am Geriatr Soc 68:1504-1511, 2020.
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Affiliation(s)
- Kali S. Thomas
- Brown University School of Public Health, U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island
| | - Wenhan Zhang
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Portia Y. Cornell
- Brown University School of Public Health, U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island
| | - Lindsey Smith
- Institute on Aging, Portland State University, Portland, Oregon
| | - Brian Kaskie
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa
| | - Paula C. Carder
- Institute on Aging, Portland State University, Portland, Oregon
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Zimmerman S, Sloane PD, Katz PR, Kunze M, O'Neil K, Resnick B. The Need to Include Assisted Living in Responding to the COVID-19 Pandemic. J Am Med Dir Assoc 2020; 21:572-575. [PMID: 32334770 PMCID: PMC7175842 DOI: 10.1016/j.jamda.2020.03.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, NC.
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Paul R Katz
- Florida State University College of Medicine, Tallahassee, FL
| | - Margo Kunze
- American Assisted Living Nursing Association, Belmar, NJ
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Bridges LC, Christie AB, Awad HH, Sigman EJ, Christie DB, Ackermann RJ. Geriatric Trauma Screening Tool: Preinjury Functional Status Dictates Intensive Care Unit Discharge Disposition. Am Surg 2019; 85:800-805. [PMID: 32051066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Older adults account for an increasing percentage of trauma patients and have worse outcomes when compared with younger populations. Simple prediction tools are needed to designate risk categories among these patients. The Geriatric Trauma Screening Tool (GTST) was developed to risk stratify older adults admitted to the ICU at a Level 1 trauma center. One hundred fifty patients aged ≥ 65 years were prospectively screened for high-risk (HR) injuries, comorbidities, and prehospital function using the GTST. Patients who screened for HR were more likely to have an unfavorable disposition than non-HR patients. HR patients had significantly longer ICU and hospital length of stays when compared with non-HR patients. In addition, patients with prior functional impairment were at higher risk for an unfavorable discharge disposition than their counterparts. Implementation of the GTST predicted discharge disposition in geriatric trauma patients admitted to the ICU. Pre-injury functional status was a better predictor of discharge disposition than either the types of HR injuries or the presence of comorbidities. Risk stratification of geriatric trauma patients allows for early engagement of patients and caregivers regarding transitions of care as well as more efficient utilization of hospital resources.
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Choi MJ, Noh JY, Cheong HJ, Kim WJ, Kim MJ, Jang YS, Lee SN, Choi EH, Lee HJ, Song JY. Spread of ceftriaxone non-susceptible pneumococci in South Korea: Long-term care facilities as a potential reservoir. PLoS One 2019; 14:e0210520. [PMID: 30699137 PMCID: PMC6353129 DOI: 10.1371/journal.pone.0210520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022] Open
Abstract
Despite the availability of a pneumococcal National Immunization Program, which provides free PPSV23 vaccination for older adults aged ≥65 years in South Korea, pneumococcal pneumonia remains one of the most common respiratory infections, with increasing antimicrobial resistance. From January to December in 2015, all pneumococcal isolates were collected from a 1,050-bed teaching hospital in South Korea. All isolates were analyzed for serotype, genotype, and antimicrobial susceptibility. Demographic, clinical and microbiological data were compared between ceftriaxone susceptible and non-susceptible cases. Among 92 microbiologically identified pneumococcal isolates, ceftriaxone non-susceptible pneumococci (CNSP) accounted for 32 cases (34.8%). Some of these cases also showed levofloxacin resistance (25%, 8/32 isolates) and all CNSP cases were multidrug resistant. Compared to patients with ceftriaxone susceptible pneumococci (CSP), long-term care facility residents (odds ratio [OR] 7.0, 95% confidence interval [CI] 0.8-62.1) and patients with chronic lung (OR 4.1, 95% CI 1.1-15.0) and renal diseases (OR 9.1, 95% CI 1.2-70.5) were more common among those with CNSP on multivariate analysis. PPSV23-unique serotypes not included in PCV13 were more common in CNSP than in CSP (34.4% versus 13.3%, p = 0.02). Regarding genotypes, ST320 (10 cases), ST166 (7 cases) and ST8279 (3 cases) were dominant in CNSP, and ST8279 was only detected in previous long-term care facility residents. Clonal expansion and spread of CNSP strains should be monitored among patients with chronic lung/renal diseases and residents of long-term care facilities.
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Affiliation(s)
- Min Joo Choi
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ye Seul Jang
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Saem Na Lee
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Abstract
IMPORTANCE End-of-life care costs are high and decedents often experience poor quality of care. Numerous factors influence changes in site of death, health care transitions, and burdensome patterns of care. OBJECTIVE To describe changes in site of death and patterns of care among Medicare decedents. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study among a 20% random sample of 1 361 870 decedents who had Medicare fee-for-service (2000, 2005, 2009, 2011, and 2015) and a 100% sample of 871 845 decedents who had Medicare Advantage (2011 and 2015) and received care at an acute care hospital, at home or in the community, at a hospice inpatient care unit, or at a nursing home. EXPOSURES Secular changes between 2000 and 2015. MAIN OUTCOMES AND MEASURES Medicare administrative data were used to determine site of death, place of care, health care transitions, which are changes in location of care, and burdensome patterns of care. Burdensome patterns of care were based on health care transitions during the last 3 days of life and multiple hospitalizations for infections or dehydration during the last 120 days of life. RESULTS The site of death and patterns of care were studied among 1 361 870 decedents who had Medicare fee-for-service (mean [SD] age, 82.8 [8.4] years; 58.7% female) and 871 845 decedents who had Medicare Advantage (mean [SD] age, 82.1 [8.5] years; 54.0% female). Among Medicare fee-for-service decedents, the proportion of deaths that occurred in an acute care hospital decreased from 32.6% (95% CI, 32.4%-32.8%) in 2000 to 19.8% (95% CI, 19.6%-20.0%) in 2015, and deaths in a home or community setting that included assisted living facilities increased from 30.7% (95% CI, 30.6%-30.9%) in 2000 to 40.1% (95% CI, 39.9%-30.3% ) in 2015. Use of the intensive care unit during the last 30 days of life among Medicare fee-for-service decedents increased from 24.3% (95% CI, 24.1%-24.4%) in 2000 and then stabilized between 2009 and 2015 at 29.0% (95% CI, 28.8%-29.2%). Among Medicare fee-for-service decedents, health care transitions during the last 3 days of life increased from 10.3% (95% CI, 10.1%-10.4%) in 2000 to a high of 14.2% (95% CI, 14.0%-14.3%) in 2009 and then decreased to 10.8% (95% CI, 10.6%-10.9%) in 2015. The number of decedents enrolled in Medicare Advantage during the last 90 days of life increased from 358 600 in 2011 to 513 245 in 2015. Among decedents with Medicare Advantage, similar patterns in the rates for site of death, place of care, and health care transitions were observed. CONCLUSIONS AND RELEVANCE Among Medicare fee-for-service beneficiaries who died in 2015 compared with 2000, there was a lower likelihood of dying in an acute care hospital, an increase and then stabilization of intensive care unit use during the last month of life, and an increase and then decline in health care transitions during the last 3 days of life.
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Affiliation(s)
- Joan M. Teno
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - Pedro Gozalo
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
| | - Amal N. Trivedi
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
| | - Jennifer Bunker
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - Julie Lima
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Jessica Ogarek
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
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12
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Resnick B, Galik E, Boltz M, Holmes S, Fix S, Vigne E, Zhu S, Lewis R. Polypharmacy in Assisted Living and Impact on Clinical Outcomes. Consult Pharm 2018; 33:321-330. [PMID: 29880094 PMCID: PMC6311411 DOI: 10.4140/tcp.n.2018.321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The purpose of this study was to describe medication use and polypharmacy in assisted living settings. We hypothesized that: 1) age, gender, race, setting, multi-morbidity, and cognitive status would influence polypharmacy; and 2) polypharmacy would be associated with falls, emergency room visits, and hospitalizations. DESIGN This was a descriptive study using data from a larger study testing the Dissemination and Implementation of Function Focused Care for Assisted Living (FFC-AL-EIT). SETTING Participants were recruited from 26 assisted living settings. PARTICIPANTS A total of 242 individuals for cohort 1 consented and completed baseline data collection. INTERVENTIONS Data were obtained from participant medical records, observations, and input from staff. MAIN OUTCOME MEASURE(S) Age, gender, race, ethnicity, comorbidities, cognitive status, medications, falls, emergency room visits, hospitalizations, function based on the Barthel Index and physical activity using the MotionWatch 8. RESULTS Participants had a mean age of 86.86 (standard deviation [SD] = 7.0), the majority were women (n = 179, 74%) and white (n = 233, 96%), with five (SD = 2) diagnoses. The mean number of drugs was seven (SD = 3.56), and 51% were exposed to polypharmacy. The mean Barthel Index score was 63.06 (SD = 20.20), and they engaged in 111,353 (SD = 87,262) counts of activity daily. Fifty-eight residents fell at least once (24%), 22 were sent to the hospital (9%), and 32 (13%) to the emergency room. Neither hypothesis was supported. CONCLUSION Continued research is needed to explore the factors that influence polypharmacy. Identification of these factors will help guide deprescribing so that medication management does not harm older adults physically or cause unnecessary financial burden.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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13
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Garner R, Tanuseputro P, Manuel DG, Sanmartin C. Transitions to long-term and residential care among older Canadians. Health Rep 2018; 29:13-23. [PMID: 29852053] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The aging of the Canadian population has increased attention on the future need for nursing home beds. Although current projections rely primarily on age and sex, other factors also contribute to the need for long-term care. This study seeks to identify additional factors to age and sex that contribute to Canadians transitioning from living at home to living in a seniors' residence or nursing home. DATA AND METHODS As part of a larger record linkage project, three cycles of the Canadian Community Health Survey (CCHS) were linked to the 2011 Census of Population: Cycle 3.1 (2005/2006), Cycle 4.1 (2007/2008), and CCHS-Healthy Aging (2008/2009). The sample was limited to successfully linked CCHS respondents who were aged 60 years or older as of Census Day 2011 (May 10, 2011; n=81,411). Sex-specific generalized multinomial logistic regression models were conducted to examine the association between each respondent's characteristics and dwelling location (private dwelling, private dwelling with additional family, nursing home, or seniors' residence) on Census Day. RESULTS On Census Day, 1.4% of the study sample were living in a nursing home, 1.2% in a seniors' residence, 7.1% in a private dwelling with additional family, and 90.3% in a private dwelling. Women were more likely than men to be living in a nursing home (1.8% of women vs. 0.9% of men) or seniors' residence (1.7% of women vs. 0.7% of men). Regression models showed that, aside from age, there were increased odds of living in a nursing home or seniors' residence among individuals who lost their spouse or who were not married, who did not own their dwelling, who had poor self-rated health, or who had been diagnosed with dementia. The association of other factors with dwelling place differed according to sex and type of dwelling. DISCUSSION Although age is strongly associated with living in a nursing home or seniors' residence, other demographic and health factors affect the likelihood of an individual transitioning to an institutional dwelling. Such factors could be considered when planning for the future housing and care needs of the Canadian population.
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Affiliation(s)
- Rochelle Garner
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | | | - Douglas G Manuel
- Health Analysis Division, Statistics Canada, Ottawa Hospital Research Institute
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14
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Abstract
OBJECTIVES To describe differences in perceived quality of hospice care for individuals living at home or in a nursing home (NH) or assisted living facility (ALF) through analysis of after-death surveys of family members. DESIGN Retrospective cohort study using hospice medical record data and Family Evaluation of Hospice Care (FEHC) survey data. SETTING Large, national hospice provider. PARTICIPANTS Individuals who died while receiving routine hospice care and family caregivers who completed after-death quality-of-care surveys. MEASUREMENTS Survey results for 7,510 individuals were analyzed using analysis of variance and chi-square tests. Logistic regression was used to assess relationship between location of care and overall service quality. RESULTS The overall survey response rate was 27%; 34.5% of families of individuals in ALFs in hospice, 27.4% of those at home, and 22.9% of those in NHs returned the survey (P < .001). Differences in return rate according to primary diagnosis were significant, although differences were not large. Most (84.3%) respondents reported that hospice referral had occurred at the right time, and 63.4% rated service quality as excellent. Hospice care in the NH was less likely to be perceived as excellent. CONCLUSION There were significant differences in characteristics of individuals whose family members did and did not return surveys, which has implications for use of after-death surveys to evaluate hospice quality. Lower perceived quality of hospice care in NHs may be related to general dissatisfaction with receiving care in this setting. Survey results have the potential to set priorities for quality improvement, choice of provider, and potentially reimbursement. Underlying causes of differences of perceived quality in different settings of care should be examined.
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Affiliation(s)
- Kathleen T. Unroe
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Timothy E. Stump
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shannon Effler
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Wanzhu Tu
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher M. Callahan
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Caffrey C, Sengupta M. Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2016. NCHS Data Brief 2018:1-8. [PMID: 29442991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Residents of residential care communities are persons who cannot live independently but generally do not require the skilled care provided by nursing homes. On any given day in 2016, an estimated 811,500 residents were in residential care communities (1,2). As the population ages, the numbers in residential care communities will likely increase, creating a sizeable group within the long-term care population. This report presents national estimates of selected characteristics of residential care community residents in 2016 and compares them by community size. State-level estimates are available from:
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Stock KJ, Hogan DB, Lapane K, Amuah JE, Tyas SL, Bronskill SE, Morris AM, Bell CM, Jeffs L, Maxwell CJ. Antipsychotic Use and Hospitalization Among Older Assisted Living Residents: Does Risk Vary by Frailty Status? Am J Geriatr Psychiatry 2017; 25:779-790. [PMID: 28302438 DOI: 10.1016/j.jagp.2017.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/19/2017] [Accepted: 02/10/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine associations between baseline frailty measures, antipsychotic use, and hospitalization over 1 year and whether hospitalization risk associated with antipsychotic use varies by frailty level. METHODS In this prospective cohort study of 1,066 residents (mean age: 85 years; 77% women) from the Alberta Continuing Care Epidemiological Studies, trained research nurses conducted comprehensive resident assessments at baseline (2006-2007) for sociodemographic characteristics, health conditions, frailty status, behavioral problems, and all medications consumed during the past 3 days. Two separate measures of frailty were assessed, the Cardiovascular Health Study (CHS) phenotype and an 86-item Frailty Index (FI). Time to first hospitalization during follow-up was determined via linkage with the Alberta Inpatient Discharge Abstract Database. RESULTS Baseline frailty status (both measures), but not antipsychotic use, was significantly associated with hospitalization over 1 year. When stratified by frailty, FI-defined frail residents using antipsychotics showed a significantly increased risk for hospitalization (adjusted HR: 1.54; 95% CI: 1.01-2.36) compared with frail nonusers. CHS-defined frail antipsychotic users versus frail nonusers also showed an elevated risk (adjusted HR: 1.67; 95% CI: 0.96-2.88). Nonfrail residents using antipsychotics were significantly less likely to be hospitalized compared with nonfrail nonusers whether defined by the FI (adjusted HR: 0.62; 95% CI: 0.39-0.99) or CHS criteria (adjusted HR: 0.62; 95% CI: 0.40-0.96). CONCLUSION Frailty measures may be helpful in identifying those who are particularly vulnerable to adverse effects and those who may experience benefit with treatment.
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Affiliation(s)
- Kathryn J Stock
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - David B Hogan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kate Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Joseph E Amuah
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Suzanne L Tyas
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew M Morris
- Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Lianne Jeffs
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Colleen J Maxwell
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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17
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Abstract
Despite the prevalence of dementia among residents in assisted living (AL), few researchers have focused on the length of stay (LOS) in AL among this population. Little is known about the factors that may contribute to LOS in these settings, particularly for residents with dementia. In the current study, a sub-set of AL residents with dementia (n = 112) was utilized to examine whether marital status was associated with LOS in AL as this has received sparse attention in previous research despite studies suggesting that marital status influences LOS in other health-care and long-term care settings. The Andersen-Newman behavioral model was used as a conceptual framework for the basis of this study of LOS, marital status, and dementia in AL. We hypothesized that persons with dementia who were married would have longer LOS than unmarried persons with dementia in AL. Cox regression was used to examine the association between marital status and LOS in AL of residents with dementia and whether activities of daily living were related to discharge from AL settings among married and unmarried residents with dementia. Main effects for marital status and the interaction between marital status and mobility with LOS were examined. Study findings provide information related to the psychosocial needs of AL residents with dementia and offer implications for assessing the on-going needs of vulnerable AL residents.
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Affiliation(s)
- Noelle L. Fields
- School of Social Work, The University of Texas at Arlington, Arlington, TX, USA
| | | | - Donna Schuman
- School of Social Work, The University of Texas at Arlington, Arlington, TX, USA
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18
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Suskind AM, Jin C, Cooperberg MR, Finlayson E, Boscardin WJ, Sen S, Walter LC. Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity. Urology 2016; 97:25-32. [PMID: 27392651 PMCID: PMC5477056 DOI: 10.1016/j.urology.2016.03.073] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the association between frailty and postoperative discharge destination after different types of commonly performed urologic procedures in older patients. MATERIALS AND METHODS Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2011 to 2013, we identified commonly performed inpatient urologic procedures among patients aged 65 and older. We then assessed the effect of frailty, measured by the NSQIP Frailty Index (NSQIP-FI), on discharge to a skilled or assisted living facility using logistic regression and assessed the heterogeneity of this effect across procedures using 2-level random effects modeling. RESULTS Overall, 1144 out of 20,794 (5.5%) urologic cases, representing 19 different procedures, resulted in discharge to a skilled or assisted living facility. Cystectomy and large transurethral resection of bladder tumor had the highest percentage (16.3%). Twenty-five percent of patients undergoing urology procedures were frail (NSQIP-FI 0.18+), including 9.8% of patients discharged to a facility. Even after adjustment for year, age, race, type of anesthesia, smoking status, recent weight loss, and whether or not the procedure was elective, frailty was strongly associated with discharge to a facility (adjusted odds ratio 3.1 [96% confidence interval 2.5, 3.8] for NSQIP-FI 0.18+ compared to NSQIP FI 0). This finding was consistent across most procedures of varying complexity with an overall effect of odds ratio 1.6 (95% confidence interval 1.5, 2.0). CONCLUSION Increasing frailty is associated with discharge to a skilled or assisted living facility across most inpatient urologic procedures evaluated, regardless of complexity. This information is important for preoperative counseling with patients undergoing urologic surgery.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, CA.
| | - Chengshi Jin
- Division of Geriatrics, University of California, San Francisco, CA
| | | | - Emily Finlayson
- Department of General Surgery, University of California, San Francisco, CA
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Saunak Sen
- Department of Preventative Medicine, University of Tennessee Health Science Center
| | - Louise C Walter
- Division of Geriatrics, University of California, San Francisco, CA
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McClive-Reed KP, Gellis ZD. Psychological Distress and Help-Seeking by Residents of a Neighborhood Naturally Occurring Retirement Community (NNORC). J Gerontol Soc Work 2016; 59:572-586. [PMID: 27585987 DOI: 10.1080/01634372.2016.1222474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article presents findings from an annual program survey of residents of a horizontal neighborhood naturally occurring retirement community (NNORC). The study explored the relationship between several factors (age, co-residents, number of chronic illnesses, self-reported health, loneliness, sense of mastery, locus of control, pain, and psychological distress) and their ability to predict general health, level of psychological distress, and the quantity and type of help-seeking behaviors. Although residents generally reported moderate to high levels of chronic disease, pain, loneliness, and concerns about life issues, 25% of them sought no help from any of the listed resources, and 65% sought help from only one of seven resources. The most common source of help for most (70%) was a primary care physician (PCP), and comparatively few respondents sought help from other sources. Older adults, especially those with chronic illness, generally consider their PCP to be the first, and perhaps only, source to consult. However, research indicates that the most effective health promotional programs for older adults are social and educational group activities, rather than individual health-focused interventions. Possible means of redirecting residents toward NNORC services include more vigorous outreach and creating collaborative partnerships between local PCPs serving older populations and the NNORC.
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Affiliation(s)
- Kimberly P McClive-Reed
- a Center for Mental Health & Aging, School of Social Policy and Practice , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Zvi D Gellis
- a Center for Mental Health & Aging, School of Social Policy and Practice , University of Pennsylvania , Philadelphia , Pennsylvania , USA
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Abstract
This study explored to what extent personal and environmental factors, as defined by the ecological model of aging, help us to understand length of stay in assisted living (AL). A convenience sample (N = 218) of administrative records of AL residents admitted between the years 2006 and 2011 was collected and included AL residents' demographic and healthcare information as well as dates of admission and discharge. Cox regression was used to determine which personal and environmental factors influenced length of stay in three AL programs. Number of medical diagnoses, level of care score, and facility were found to be significant predictors of length of stay. The analyses identified a median survival time of 32 months as well as critical periods for discharge from AL. Implications for future research and social work practice are presented.
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Affiliation(s)
- Noelle L Fields
- a School of Social Work , University of Texas at Arlington , Arlington , Texas , USA
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21
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Myers B. Here Come The Boomers. Provider 2016; 42:18-26. [PMID: 27209664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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22
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Hyde J, Perez R, Doyle PJ, Forester BP, Whitfield TH. The Impact of Enhanced Programming on Aging in Place for People With Dementia in Assisted Living. Am J Alzheimers Dis Other Demen 2015; 30:733-7. [PMID: 24509611 PMCID: PMC10852683 DOI: 10.1177/1533317513520212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Assisted living (AL) is a growing and operationally diverse option in our nation's long-term care system. Many consumers view AL communities as a viable option to receive needed services and age in place. However, little is known about the factors that influence residents' ability to age in place when experiencing cognitive decline. OBJECTIVE To estimate the association of resident and site characteristics to length of stay, reason for leaving and destination for residents with dementia in assisted living. In particular, this study sought to assess the impact of an 'Enhanced' Program intended to facilitate aging in place. METHOD Data were gathered from a retrospective evaluation of residents' clinical records (N=312) in five dementia-specific ALs (3 with robust enhanced programs) in the Northeastern United States. RESULTS The time to 50% survival for the full cohort (N=312) was 20.2 months. Both age at move-in and gender were statistically significant predictors of length of stay. Sites with robust support for aging in place exhibited a statistically significant longer length of stay compared to sites with limited support. Of the residents who left or died (N=165) nearly one quarter (24%) were able to stay until the end of their lives, while 52% moved to a nursing home, primarily because of family, financial, or medical concerns. Few residents left these settings because of behavioral problems. CONCLUSION AL sites with a more robust commitment to an aging in place model and a willingness to provide palliative care demonstrated a significantly longer length of stay.
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Affiliation(s)
- Joan Hyde
- Gerontology Institute, University of Massachusetts Boston, Boston, MA, USA
| | - Rosa Perez
- Center for Aging Studies, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Patrick J Doyle
- Assistant Professor of Gerontology Department of Human Services Bowling Green State University Bowling Green, OH, USA
| | - Brent P Forester
- Director, Geriatric Mood Disorders Research Program McLean Hospital, Belmont, MA, USA Assistant Professor of Psychiatry, Harvard Medical School, Cambridge, MA, USA
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Caffrey C, Harris-Kojetin L, Sengupta M. Variation in Operating Characteristics of Residential Care Communities, by Size of Community: United States, 2014. NCHS Data Brief 2015:1-8. [PMID: 26633699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Assisted living and similar residential care communities provide services to individuals who cannot live independently but generally do not require the skilled level of care provided by nursing homes. In 2014, there were 30,200 residential care communities nationwide (1). This report presents the most current national estimates of residential care community operating characteristics and compares these characteristics by community bed size. State-level estimates for the characteristics presented in this report are available from http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.
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Caffrey C, Harris-Kojetin L, Sengupta M. Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2014. NCHS Data Brief 2015:1-8. [PMID: 26633827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Residents of residential care communities are persons who cannot live independently but generally do not require the skilled care provided by nursing homes. There were 835,200 current residents in residential care communities in 2014 (1,2). "Current residents" refers to those who were living in the community on the day of data collection (as opposed to the total number of residents who lived in the community at some time during the calendar year). This report presents national estimates of selected characteristics of current residents in 2014 and compares these characteristics by community bed size. State-level estimates for these characteristics are available online at: http:// www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.
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Abstract
OBJECTIVES We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. METHODS Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. RESULTS Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. CONCLUSIONS LTC may be an important point of engagement in suicide prevention.
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Affiliation(s)
- Briana Mezuk
- At the time of the study, Briana Mezuk and Matthew Lohman were with the Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond. Briana Mezuk is also with the Institute for Social Research, University of Michigan, Ann Arbor. Marc Leslie and Virginia Powell are with the Office of the Chief Medical Examiner, Virginia Department of Health, Richmond
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26
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Oberst J. 2015 Year Of The Mergers. Provider 2015; 41:51-54. [PMID: 26263747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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27
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Amirgaliyev YR. [The quality of life of elderly citizens in Kazakhstan (by the example of Astana)]. Adv Gerontol 2015; 28:586-588. [PMID: 28509501] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The article presents the results of the study of self-assessment of quality of life of older Kazakhstan citizens. The differences between the self-assessment of quality of life of older people living in institutional care in the hospital and outside the hospital are discussed. The results show that elderly people who live in institutional care in a hospital, assess the quality of life is better than older people living independently.
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Affiliation(s)
- Y R Amirgaliyev
- Academy of Public Administration under the President of the Republic of Kazakhstan, Astana, 010000, the Republic of Kazakhstan;
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28
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Startseva ON. [The study of general satisfaction in stationary social institutions (Yaroslavl Regional Gerontology Center)]. Adv Gerontol 2015; 28:780-782. [PMID: 28509471] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The article analyzes the satisfaction with social environment of patients of older age groups living in the Yaroslavl Regional Gerontology Center. On the basis of a survey of 118 patients of older age groups the satisfaction with the living conditions in the institution, the provision of socio-medical assistance, catering, leisure activities and social environment were assessed. 92,4 % of patients reported of their satisfaction, in general, with the stay. The obtained information confirms necessity of creation of qualitative therapeutic environment in a hospital of social service.
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Affiliation(s)
- O N Startseva
- Yaroslavl Region Gerontology Center, Yaroslavl, 150007, Russian Federation;
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29
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Mijnarends DM, Schols JMGA, Meijers JMM, Tan FES, Verlaan S, Luiking YC, Morley JE, Halfens RJG. Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies. J Am Med Dir Assoc 2014; 16:301-8. [PMID: 25530211 DOI: 10.1016/j.jamda.2014.11.011] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Both sarcopenia and physical frailty are geriatric syndromes causing loss of functionality and independence. This study explored the association between sarcopenia and physical frailty and the overlap of their criteria in older people living in different community (care) settings. Moreover, it investigated the concurrent validity of the FRAIL scale to assess physical frailty, by comparison with the widely used Fried criteria. DESIGN Data were retrieved from the cross-sectional Maastricht Sarcopenia Study (MaSS). SETTING The study was undertaken in different community care settings in an urban area (Maastricht) in the south of the Netherlands. PARTICIPANTS Participants were 65 years or older, gave written informed consent, were able to understand Dutch language, and were not wheelchair bound or bedridden. INTERVENTION Not applicable. MEASUREMENTS Sarcopenia was identified using the algorithm of the European Working Group on Sarcopenia in Older People. Physical frailty was assessed by the Fried criteria and by the FRAIL scale. Logistic regression was performed to assess the association between sarcopenia and physical frailty measured by the Fried criteria. Spearman correlation was performed to assess the concurrent validity of the FRAIL scale compared with the Fried criteria. RESULTS Data from 227 participants, mean age 74.9 years, were analyzed. Sarcopenia was identified in 23.3% of the participants, when using the cutoff levels for moderate sarcopenia. Physical frailty was identified in 8.4% (≥3 Fried criteria) and 9.3% (≥3 FRAIL scale criteria) of the study population. Sarcopenia and physical frailty were significantly associated (P = .022). Frail older people were more likely to be sarcopenic than those who were not frail. In older people who were not frail, the risk of having sarcopenia increased with age. Next to poor grip strength (78.9%) and slow gait speed (89.5%), poor performance in other functional tests was common in frail older people. The 2 physical frailty scales were significantly correlated (r = 0.617, P < .001). CONCLUSION Sarcopenia and physical frailty were associated and partly overlap, especially on parameters of impaired physical function. Some evidence for concurrent validity between the FRAIL scale and Fried criteria was found. Future research should elicit the value of combining sarcopenia and frailty measures in preventing disability and other negative health outcomes.
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Affiliation(s)
- Donja M Mijnarends
- Department of Health Services Research, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | - Jos M G A Schols
- Department of Health Services Research, School CAPHRI, Maastricht University, Maastricht, The Netherlands; Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Judith M M Meijers
- Department of Health Services Research, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Frans E S Tan
- Department of Methodology and Statistics, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Sjors Verlaan
- Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Yvette C Luiking
- Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University, St Louis, MO
| | - Ruud J G Halfens
- Department of Health Services Research, School CAPHRI, Maastricht University, Maastricht, The Netherlands
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Caffrey C, Harris-Kojetin L, Rome V, Sengupta M. Characteristics of residents living in residential care communities, by community bed size: United States, 2012. NCHS Data Brief 2014:1-8. [PMID: 25411919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In 2012, there was a higher percentage of older, female residents in communities with more than 25 beds compared with communities with 4–25 beds. Residents in communities with 4–25 beds were more racially diverse than residents in larger communities. The percentage of Medicaid beneficiaries was higher in communities with 4–25 beds than it was in communities with 26–50 and more than 50 beds. A higher percentage of residents living in communities with 4–25 beds had a diagnosis of Alzheimer’s disease or other dementias compared with residents in larger communities. Need for assistance with each of the activities of daily living (ADLs) examined (except walking or locomotion) was substantially higher among residents in communities with 4–25 beds, compared with residents in larger communities. Emergency department visits and discharges from an overnight hospital stay in a 90-day period did not vary across residents by community bed size. This report presents national estimates of residents living in residential care, using data from the first wave of NSLTCP. This brief profile of residential care residents provides useful information to policymakers, providers, researchers, and consumer advocates as they plan to meet the needs of an aging population. The findings also highlight the diversity of residents across the different sizes of residential care communities. Corresponding state estimates and their standard errors for the national figures in this data brief can be found on the NSLTCP website, available from: http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm. These national and state estimates establish a baseline for monitoring trends among residents living in residential care.
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Ligons FM, Mello-Thoms C, Handler SM, Romagnoli KM, Hochheiser H. Assessing the impact of cognitive impairment on the usability of an electronic medication delivery unit in an assisted living population. Int J Med Inform 2014; 83:841-8. [PMID: 25153770 DOI: 10.1016/j.ijmedinf.2014.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/04/2014] [Accepted: 07/16/2014] [Indexed: 01/13/2023]
Abstract
PURPOSE To examine the relationship between cognitive status and the usability of an integrated medication delivery unit (MDU) in older adults who reside in an Assisted Living Facility (ALF). METHODS Subjects were recruited from a single ALF in Pittsburgh, PA. Usability testing sessions required subjects to execute tasks essential to using EMMA(®) (Electronic Medication Management Assistant), a Class II Federal Drug Administration (FDA) approved integrated MDU. Video coding allowed for quantification of usability errors observed during the testing sessions. Each subject's cognitive status was assessed using the Mini Mental State Exam (MMSE(®)) with scores <24 indicating cognitive impairment. Functional status was assessed using the Lawton Instrumental Activities of Daily Living (IADL) questionnaire, and a global assessment of subjective usability was assessed by completing the System Usability Scale (SUS). Non-parametric statistics and correlation analysis were used to determine whether significant differences existed between cognitively impaired and non-impaired subjects. RESULTS Nineteen subjects were recruited and completed the protocol. The subject pool was primarily white, female, 80+ and in possession of above average education. There was a significant relationship between MMSE(®) scores and the percentage of task success (z=-2.03, p=0.04). Subjects with MMSE(®) scores of 24+ (no cognitive impairment) successfully completed an average of 69.0% of tasks vs. the 34.7% performance for those in the cognitively impaired group (<24). Six of the unimpaired group also succeeded at meeting the 85% (6 out of 7 correct) threshold. No subject with cognitive impairments (<24 MMSE(®)) completed more than 5/7 (71.4%) of their tasks. Two of the impaired subjects failed all of the tasks. Three of the MMSE(®)'s subsections (Date, Location and Spell 'world' backwards) were found to be significantly related (p<0.05) to the percentage of task success. Tasks success rates were related with IADL scores (z=-3.826, p<0.0001), and SUS scores (r=0.467, p=0.0429). CONCLUSIONS Medication delivery units like EMMA(®) have the potential to improve medication management by combining reminder systems with telemedical monitoring and control capabilities. However, subjects judged to be "cognitively impaired" (<24 MMSE(®)) scored a significantly smaller percentage of task success than the "unimpaired" (>=24), suggesting that cognitive screening of patients prior to the use of EMMA(®) may be advisable. Further studies are needed to test the use of EMMA(®) amongst ALF residents without cognitive impairment to see if this technology can improve medication adherence.
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Affiliation(s)
- Frank M Ligons
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States; Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA, United States
| | - Claudia Mello-Thoms
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States; Medical Radiation Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Steven M Handler
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States; Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA, United States; Division of Geriatric Medicine, University of Pittsburgh School of Medicine, United States
| | - Katrina M Romagnoli
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States; Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA, United States
| | - Harry Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States; Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA, United States; Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, United States.
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LaPorte M. Steady stream of variety. Provider 2014; 40:51-54. [PMID: 25061659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Gluckstern L. Study reveals varying characteristics of assisted living residents. Provider 2014; 40:40. [PMID: 24660525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
This descriptive study examined the relationship between volunteer activities, depressive symptoms, and feelings of usefulness among older adults using path analysis. Survey data was collected via interview from residents of a continuing care retirement community. Neither feelings of usefulness nor volunteering were directly associated with depressive symptoms. Volunteering was directly associated with feelings of usefulness and indirectly associated with depressive symptoms through total physical activity. Age, fear of falling, pain, physical activity, and physical resilience explained 31% of the variance in depressive symptoms. Engaging in volunteer work may be beneficial for increasing feelings of usefulness and indirectly improving depressive symptoms among older adults.
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35
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Park-Lee E, Sengupta M, Harris-Kojetin LD. Dementia special care units in residential care communities: United States, 2010. NCHS Data Brief 2013:1-8. [PMID: 24314070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In 2010, 17% of residential care communities had dementia special care units. Beds in dementia special care units accounted for 13% of all residential care beds. Residential care communities with dementia special care units were more likely than those without to have more beds, be chain-affiliated, and be purposely built as a residential care community, and less likely to be certified or registered to participate in Medicaid. Residential care communities with dementia special care units were more likely than those without to be located in the Northeast and in a metropolitan statistical area, and less likely to be in the West. Assisted living and similar residential care communities provide an alternative to nursing homes for individuals with dementia who can no longer live independently. In 2010, about 42% of individuals living in residential care communities had Alzheimer's disease or other dementia. Individuals with dementia can live in residential care communities that have dementia special care units, or in a more traditional setting where these residents are integrated with residents without dementia. Many states require residential care communities with dementia special care units to have certain physical features (e.g., locked door) and specially trained staff to care for residents with dementia. This report compares residential care communities with and without dementia special care units.
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Abstract
OBJECTIVE To determine the prevalence and relationship of frailty and health-related quality of life (HRQOL) among residents of long-term care [nursing homes (NH) and assisted living (AL)] facilities. METHODS Residents of NH and AL facilities in La Crosse County, Wisconsin, were recruited 1/2009-6/2010 and assessed for frailty (gait speed, unintended weight loss, grip strength), comorbidity (Charlson index), and HRQOL [Short Form (SF)-36]. RESULTS Among 137 participants, 85% were frail. Frail residents were older, had more comorbidities (2.0 vs. 0, p < .001) and lower mean SF-36 Physical Component Score (PCS, 32 vs. 48, p < .001). Following adjustments for age, sex, and comorbidities, compared to nonfrail residents, frail residents had lower SF-36 PCS (mean difference -14.7, 95% CI. -19.3,-10.1, p < .001). Frailty, comorbidity, and HRQOL did not differ between NH and AL facilities. DISCUSSION Frail residents had lower HRQOL, suggesting that preventing frailty may lead to better HRQOL among residents of long-term care facilities.
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Affiliation(s)
| | - Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan Lennon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Véronique L. Roger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Zimmerman S, Cohen LW, Reed D, Gwyther LP, Washington T, Cagle JG, Beeber AS, Sloane PD. Comparing families and staff in nursing homes and assisted living: implications for social work practice. J Gerontol Soc Work 2013; 56:535-53. [PMID: 23869592 PMCID: PMC3772131 DOI: 10.1080/01634372.2013.811145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Nursing homes and residential care/assisted living settings provide care to 2.4 million individuals. Few studies compare the experience of, and relationships between, family and staff in these settings, despite ongoing family involvement and evidence that relationships are problematic. Data from 488 families and 397 staff members in 24 settings examined family involvement and family and staff burden, depressive symptoms, and perceptions; and staff absenteeism and turnover. There were few differences across setting types. Although conflict rarely occurred, there was room for improvement in family-staff relations; this area, and preparing family for their caregiving roles, are appropriate targets for social work intervention.
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Affiliation(s)
- Sheryl Zimmerman
- School of Social Work and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Abstract
OBJECTIVE To analyze the effect of market-level changes in assisted living supply on nursing home utilization and resident acuity. DATA SOURCES Primary data on the supply of assisted living over time were collected from 13 states from 1993 through 2007 and merged with nursing home-level data from the Online Survey Certification and Reporting System and market-level information from the Area Resource File. STUDY DESIGN Least squares regression specification incorporating market and time-fixed effects. PRINCIPAL FINDINGS A 10 percent increase in assisted living capacity led to a 1.4 percent decline in private-pay nursing home occupancy and a 0.2-0.6 percent increase in patient acuity. CONCLUSIONS Assisted living serves as a potential substitute for nursing home care for some healthier individuals with greater financial resources, suggesting implications for policy makers, providers, and consumers.
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Affiliation(s)
- David C Grabowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899, USA.
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Abbott KM, Bettger JP, Hampton K, Kohler HP. Exploring the use of social network analysis to measure social integration among older adults in assisted living. Fam Community Health 2012; 35:322-333. [PMID: 22929378 DOI: 10.1097/fch.0b013e318266669f] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Social integration is measured by a variety of social network indicators each with limitations in its ability to produce a complete picture of the variety and scope of interactions of older adults receiving long-term services and supports. The purpose of this study was to develop and evaluate the feasibility of collecting sociocentric (whole network) data among older adults in one assisted living neighborhood. The sociocentric approach is required to conduct social network analysis. Applying social network analysis is an innovative way to measure different facets of social integration among residents. Sociocentric data are presented for 12 residents. Network visualization or sociograms are used to illustrate the level of social integration among residents and between residents and staff. Measures of network centrality are reported to illustrate the number of personal connections and cohesion. The use of resident photographs helped residents with cognitive impairment to nominate individuals with whom they interacted. The sociocentric approach to data collection is feasible and allows researchers to measure levels and different aspects of social integration in assisted living environments. Residents with mild to moderate cognitive impairment were able to participate with the aid of resident and staff photographs. This approach is sensitive to capturing routine day-to-day interactions between residents and assisted living staff members that are often not reported in person-centered networks. This study contributes to the foundation for larger more representative studies of entire assisted living organizations that could in the future inform interventions aimed at improving social integration and cohesion among recipients of long-term services and supports.
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Affiliation(s)
- Katherine M Abbott
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19104, USA.
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Zuidgeest M, Delnoij DMJ, Luijkx KG, de Boer D, Westert GP. Patients' experiences of the quality of long-term care among the elderly: comparing scores over time. BMC Health Serv Res 2012; 12:26. [PMID: 22293109 PMCID: PMC3305532 DOI: 10.1186/1472-6963-12-26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 01/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Every two years, long-term care organizations for the elderly are obliged to evaluate and publish the experiences of residents, representatives of psychogeriatric patients, and/or assisted-living clients with regard to quality of care. Our hypotheses are that publication of this quality information leads to improved performance, and that organizations with substandard performance will improve more than those whose performance is relatively good. METHODS The analyses included organizational units that measured experiences twice between 2007 (t(0)) and 2009 (t(1)). Experiences with quality of care were measured with Consumer Quality Index (CQI) questionnaires. Besides descriptive analyses (i.e. mean, 5(th) and 95(th) percentile, and 90% central range) of the 19 CQI indicators and change scores of these indicators were calculated. Differences across five performance groups (ranging from 'worst' to 'best') were tested using an ANOVA test and effect sizes were measured with omega squared (ω(2)). RESULTS At t0 experiences of residents, representatives, and assisted-living clients were positive on all indicators. Nevertheless, most CQI indicators had improved scores (up to 0.37 change score) at t(1). Only three indicators showed a minor decline (up to -0.08 change score). Change scores varied between indicators and questionnaires, e.g. they were more profound for the face-to-face interview questionnaire for residents in nursing homes than for the other two mail questionnaires (0.15 vs. 0.05 and 0.04, respectively), possibly due to more variation between nursing homes on the first measurement, perhaps indicating more potential for improvement. A negative relationship was found between prior performance and change, particularly with respect to the experiences of residents (ω(2) = 0.16) and assisted-living clients (ω(2) = 0.15). However, the relation between prior performance and improvement could also be demonstrated with respect to the experiences reported by representatives of psychogeriatric patients and by assisted-living clients. For representatives of psychogeriatric patients, the performance groups 1 and 2 ([much] below average) improved significantly more than the other three groups (ω(2) = 0.05). CONCLUSIONS Both hypotheses were confirmed: almost all indicator scores improved over time and long-term care organizations for the elderly with substandard performance improved more than those with a performance which was already relatively good.
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Affiliation(s)
- Marloes Zuidgeest
- TRANZO, Scientific Centre for care and welfare, Faculty of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Diana MJ Delnoij
- TRANZO, Scientific Centre for care and welfare, Faculty of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
- Centre for Consumer Experience in Healthcare, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Katrien G Luijkx
- TRANZO, Scientific Centre for care and welfare, Faculty of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Dolf de Boer
- Centre for Consumer Experience in Healthcare, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Gert P Westert
- TRANZO, Scientific Centre for care and welfare, Faculty of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
- IQ Healthcare, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114, 6500 HB Nijmegen, the Netherlands
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Abbott KM, Bettger JP, Hanlon A, Hirschman KB. Factors associated with health discussion network size and composition among elderly recipients of long-term services and supports. Health Commun 2012; 27:784-93. [PMID: 22292979 PMCID: PMC4627608 DOI: 10.1080/10410236.2011.640975] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Social networks play an important role in helping older adults monitor symptoms and manage chronic conditions. People use verbal discussions to make sense of symptoms, determine their seriousness, and decide whether to seek medical care. In this study, problem-specific social networks called health discussion networks (HDNs) are examined over time among older adults receiving long-term services and supports (LTSS). Data were gathered from older adults who had recently moved into a nursing home (NH) or assisted-living facility (ALF) or who had started to receive home- and community-based services (H&CBS). LTSS recipients identified people with whom they discussed symptoms or disease information, talked over what their physician said, and considered consulting other health-care providers. Data were analyzed for 216 adults with Mini Mental State Examination (MMSE) baseline scores of 20 or higher, and these individuals were interviewed quarterly over a 12-month period. Generalized estimated equations (GEE) were used to model repeated measures of HDN size and composition as a function of baseline age, gender, race, ethnicity, marital status, education, quality of life, setting, number of adult children, and cognitive status. GEE modeling demonstrated that HDN size decreased over time (p = .01) and that the probability of mentioning formal care providers as part of that network increased over time (p = .003). Multivariate predictors of increased HDN size were lower ratings of quality of life (p = .001), having more adult children (p = .04), and higher MMSE scores (p < .0001) after controlling for covariates. Older adults new to receiving LTSS had relatively small HDNs that were mixed networks including family, friends, and formal care providers. This suggests an opportunity for interventions aimed at maintaining and enhancing the HDNs of older adults beyond family members.
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Affiliation(s)
- Katherine M Abbott
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19001, USA.
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Jakobsson U, Rahm Hallberg I, Westergren A. Pain management in elderly persons who require assistance with activities of daily living: a comparison of those living at home with those in special accommodations. Eur J Pain 2012; 8:335-44. [PMID: 15207514 DOI: 10.1016/j.ejpain.2003.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 10/23/2003] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To describe and compare the methods of pain management used by elderly individuals with chronic pain and requiring assistance with activities of daily living, depending on whether they live alone, with someone, at home or in special accommodations. METHODS This study comprised 294 people aged 76-100 years, identified as having chronic pain and requiring assistance with activities of daily living. Pain and pain management methods were compared using the Multidimensional Pain Inventory, Swedish version, and the Pain Management Inventory. RESULTS Those living in special accommodations reported more pain than those living at home. Those living with someone reported more pain and interference in daily life than those living alone, despite using more pain-relief methods and having greater social support. The median number of pain-relieving methods used was 3.0 (75th-25th percentile: 5-2). Some (3.8%) did not use any method to relieve their pain. The most frequently used methods were prescribed medicine (20%), rest (20%) and distraction (15%). The methods rated most effective were using cold, exercise, hot bath/shower and consuming alcohol. CONCLUSION Participants had only a small repertoire of pain management methods and these were mostly conventional in nature. Few non-pharmacological methods were used. The findings suggest the importance of thorough assessment, and the need to fully discuss pain management options with the elderly.
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Affiliation(s)
- Ulf Jakobsson
- Department of Nursing, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden.
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Park-Lee E, Caffrey C, Sengupta M, Moss AJ, Rosenoff E, Harris-Kojetin LD. Residential care facilities: a key sector in the spectrum of long-term care providers in the United States. NCHS Data Brief 2011:1-8. [PMID: 22617275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
RCFs in the United States totaled 31,100 in 2010, with 971,900 state-licensed, certified, or registered residential care beds. About one-half of RCFs were small facilities which served one-tenth of all RCF residents. The remaining RCFs were medium-sized facilities (16%) which served about one-tenth of all RCF residents, large facilities (28%) which served about one-half of all RCF residents, and extra large facilities (7%) which housed about three-tenths of all RCF residents. RCFs were predominantly for profit (82%), not part of a chain (62%), and located in an MSA (81%). Small RCFs were more likely to be for profit than larger RCFs. The proportion of chain-affiliated RCFs grew with increasing facility size. Small and extra large RCFs were most likely to be located in an MSA, while medium RCFs were least likely to be in an MSA. RCFs were most commonly located in the West. The mix of facility sizes varied by region. The West had almost twice as many residential care beds per 1,000 persons aged 85 and over as the Northeast (245 to 131). Comparing the supply of RCF beds with nursing home beds (data compiled by Centers for Medicare & Medicaid Services) shows that the supply of RCF beds (245) and nursing home beds (203) per 1,000 persons aged 85 and over was relatively comparable in the West, but nursing home beds far outnumbered RCF beds in all other regions. There were about twice as many nursing home beds as RCF beds per 1,000 persons aged 85 and over in the South (325 to 164), Midwest (390 to 177), and Northeast (303 to 131). More research is needed to identify and examine factors that may explain these regional differences in both the supply of residential care beds, including variations in state regulation and financing of different types of LTC providers, and in consumer preferences for different kinds of long-term services and support. RCFs serve primarily a private-pay adult population (6). However, the use of Medicaid financing for services in residential care settings has gradually increased in recent years (7). About 4 out of 10 RCFs had at least one resident who had some or all of their LTC services paid by Medicaid. The percentage of facilities having residents who received LTC services paid by Medicaid varied by facility size. Although nearly all RCFs provided basic health monitoring (96%) and incontinence care (93%), larger RCFs were more likely than smaller RCFs to offer occupational and physical therapy. Larger RCFs were also more likely than small RCFs to provide social services counseling and case management. The provision of skilled nursing services did not vary by facility size. This report presents national estimates of RCFs using data from the first-ever national probability sample survey of RCFs with four or more beds. Findings on differences in selected characteristics and services offered by facility size and on regional variations in the supply of beds provide useful information to policymakers, LTC providers, and consumer advocates as they plan to meet the needs of an aging population. Moreover, these findings establish baseline national estimates as researchers continue to track growth and changes in the residential care industry.
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Affiliation(s)
- Eunice Park-Lee
- Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road, Hyattsville, Maryland 20782, USA
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Gelhaus L. Top 40 assisted living chains. 2010: a bright spot. Provider 2010; 36:61-64. [PMID: 20590049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
Today, long-term care facilities are composed of independent, assisted living, and skilled nursing facilities along with many variations of those themes in between. The clientele for these various types of facilities differ because of the level of care the facility provides as well as the amenities long-term care consumers are looking for. However, there many similarities and common approaches to how reaching the target audience through effective marketing activities. Knowing who the target audience is, how to reach them, and how to communicate with them will serve any facility well in this competitive market. Developing marketing strategies for long-term care settings is as important as understanding what elements of care can be marketed individually as a niche market. Determining the market base for a facility is equally crucial since the target populations differ among the three types of facilities. By reviewing current marketing articles and applying marketing practices, we have crafted some general principles for which each facility type can learn from. Finally, we will discuss the types of marketing and how they related to the spectrum of long-term care facilities.
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Affiliation(s)
- J Nathan Laurence
- Department of Health Policy and Administration, School of Rural Public Health, Texas A&M University Health Science Center, College Station, Texas 77843, USA.
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Cruthird-Rudd T, Yu Q, McNabney MK. Geographic distribution of assisted living facilities in Baltimore, Maryland. J Am Geriatr Soc 2010; 57:2366-8. [PMID: 20121996 DOI: 10.1111/j.1532-5415.2009.02590.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gelhaus L. 2009. Assisted living feels pinch. Provider 2009; 35:53-56. [PMID: 19579522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, Masica AL. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med 2009; 4:211-8. [PMID: 19388074 DOI: 10.1002/jhm.427] [Citation(s) in RCA: 259] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
RATIONALE Care coordination has shown inconsistent results as a mechanism to reduce hospital readmission and postdischarge emergency department (ED) visit rates. OBJECTIVE To assess the impact of a supplemental care bundle targeting high-risk elderly inpatients implemented by hospital-based staff compared to usual care on a composite outcome of hospital readmission and/or ED visitation at 30 and 60 days following discharge. PATIENTS/METHODS Randomized controlled pilot study in 41 medical inpatients predisposed to unplanned readmission or postdischarge ED visitation, conducted at Baylor University Medical Center. The intervention group care bundle consisted of medication counseling/reconciliation by a clinical pharmacist (CP), condition specific education/enhanced discharge planning by a care coordinator (CC), and phone follow-up. RESULTS Groups had similar baseline characteristics. Intervention group readmission/ED visit rates were reduced at 30 days compared to the control group (10.0% versus 38.1%, P = 0.04), but not at 60 days (30.0% versus 42.9%, P = 0.52). For those patients who had a readmission/postdischarge ED visit, the time interval to this event was longer in the intervention group compared to usual care (36.2 versus 15.7 days, P = 0.05). Study power was insufficient to reliably compare the effects of the intervention on lengths of index hospital stay between groups. CONCLUSIONS A targeted care bundle delivered to high-risk elderly inpatients decreased unplanned acute health care utilization up to 30 days following discharge. Dissipation of this effect by 60 days postdischarge defines reasonable expectations for analogous hospital-based educational interventions. Further research is needed regarding the impacts of similar care bundles in larger populations across a variety of inpatient settings.
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Affiliation(s)
- Bruce E Koehler
- Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 North Central Expressway, Dallas, TX 75206, USA
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Abstract
Our study examined the process of transitioning residents of assisted living facilities (ALFs) who have Alzheimer's disease or a related disorder to memory care units (MCUs). In-depth surveys with 10 ALF administrators in South Carolina were conducted. Grounded theory identified major themes; thematic analysis organized content. Most administrators used a preadmission screening process to assess cognitive status. About half reported that they discussed the possibility of future transfer to another level of care with the family at admission. Most administrators said that their facilities had transfer policies in place; of these, only two-thirds discussed their policies with families on admission. Transfer triggers included leaving the facility without anyone's knowledge, disturbing behaviors, and increased care needs. Challenges included family resistance and greater costs of MCUs. Assisted living facilities that were part of continuing care retirement communities used more multidisciplinary transfer decision-making than free-standing ALFs. Suggested improvements stressed educating families about dementia and MCUs.
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Affiliation(s)
- Susan G Kelsey
- Department of Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208, USA.
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Young HM, Gray SL, McCormick WC, Sikma SK, Reinhard S, Johnson Trippett L, Christlieb C, Allen T. Types, prevalence, and potential clinical significance of medication administration errors in assisted living. J Am Geriatr Soc 2008; 56:1199-205. [PMID: 18482296 PMCID: PMC2633588 DOI: 10.1111/j.1532-5415.2008.01754.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the types and potential clinical significance of medication administration errors in assisted living (AL). DESIGN Cross-sectional observational study. SETTING This study was conducted in 12 AL settings in three states (Oregon, Washington, and New Jersey). PARTICIPANTS Participants included 29 unlicensed assistive personnel and 510 AL residents. MEASUREMENTS Medication administration observations, chart review, and determination of rates, types, and potential clinical significance of errors using standardized methodology. RESULTS Of 4,866 observations, 1,373 errors were observed (28.2% error rate). Of these, 70.8% were wrong time, 12.9% wrong dose, 11.1% omitted dose, 3.5% extra dose, 1.5% unauthorized drug, and 0.2% wrong drug. Excluding wrong time, the overall error rate dropped to 8.2%. Of the 1,373 errors, three were rated as having potential clinical significance. CONCLUSION A high number of daily medications are given in AL. Wrong time accounted for the majority of the errors. The bulk of the medications are low risk and routine; to promote optimal care delivery, clinicians need to focus on high-risk medications and residents with complex health problems.
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Affiliation(s)
- Heather M Young
- School of Nursing, Oregon Health and Science University Ashland, Oregon 97520, USA.
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