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01/2015 journal articles

NURSING HOME RESEARCH INTERNATIONAL WORKING GROUP WEDNESDAY 2ND & THURSDAY 3RD, DECEMBER, 2015 • TOULOUSE FRANCE

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PROFILE OF USE OF VITAMIN AND MINERAL SUPPLEMENTS AMONG ELDERLY INSTITUTIONALIZED ADULTS: A SYSTEMATIC REVIEW

S. Goorang, L. Ausman, R. Houser, S.J. Whiting

Jour Nursing Home Res 2015;1:1-5

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Background: Although studies have evaluated the use of vitamin and mineral supplements in the general population and community-dwelling older adults, little is known about the use of these products among long-term care (LTC) facility residents. These individuals, who tend to take more medications and are particularly at risk of undernutrition and micronutrient deficiencies, may benefit from using vitamin and/or mineral supplements. Alternatively, getting too much of these nutrients may increase risk of excessive intake or drug-supplement interactions. Thus, it is important to document supplement use among elders living in institutions. Objective: To examine the prevalence of use of different types of vitamin and mineral supplements among institutionalized elderly people in nursing homes and assisted living facilities. Design: A systematic review was conducted in July 2013 of Medline and Embase databases using key terms for LTC facilities and vitamin-mineral supplements. Filters used to narrow down the results included publication year after 1997, English language, human studies, and adult/aged population. Results: Of the 1825 publications identified, 892 were excluded after applying filters. After eliminating duplicates, 676 records were screened by either title or abstract, excluding 617. Full text of the remaining 59 articles was reviewed and 5 studies were selected. Conclusions: Very few studies have provided comprehensive information about the use of vitamin and mineral supplements among institutionalized elderly people. There appears to be some challenges associated with conducting research among this vulnerable population who have advanced age and multiple chronic diseases, and further studies are warranted.

CITATION:
S. Goorang ; L. Ausman ; R. Houser ; S.J. Whiting (2015): Profile OF USE of vitamin and mineral supplements among elderly institutionalized adults: A systematic review. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.1

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OBESITY IN NURSING HOME RESIDENTS: A CROSS-SECTIONAL STUDY

P. de Souto Barreto, V. Zanandrea, M. Lapeyre-Mestre, M. Cesari, B. Vellas, Y. Rolland

Jour Nursing Home Res 2015;1:6-10

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Background: Obesity in older people is a growing health problem in developed countries including among nursing home (NH) patients. However, little is known about the characteristics of obese NH residents and the specific organization of care devoted for these patients. Methods: Data are from 4168 patients recruited among the 175 NHs from Midi-Pyrénées, South-Western, France. Patient’s characteristics (e.g., demographics, weight changes, comorbidities, treatments, diet) are explored according to the body mass index (BMI) groups and NH specificities (e.g., ownership, number of beds, number of NH staff). Results: About 18.5% of NH residents were obese. Obese patients were significantly younger and less disabled than non-obese. They had a significantly higher prevalence of hypertension, diabetes, peripheral vascular disease, psychiatric diseases and pain than non-obese residents, and had a lower prevalence of dementia and stroke. No weight change and weight gain in the past two months were significantly more prevalent in the obese group than in the non-obese one, despite of the higher rate of low salt, diabetic and hypo-caloric diet among obese people. Higher prevalence of obesity was found in NHs who less often had both dietitian and physical activity professional as a member of the staff. Conclusions: Very old and obese people living in NHs are a particular population, with specific care needs. Further studies are needed in order to define the optimal management of obesity in the NH resident.

CITATION:
P. de Souto Barreto ; V. Zanandrea ; M. Lapeyre-Mestre ; M. Cesari ; B. Vellas ; Y. Rolland (2015): Obesity in nursing home residents: a cross-sectional study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.2

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HYDRATION STATUS OF LONG TERM CARE RESIDENTS REHOSPITALIZED WITHIN 30 DAYS OF HOSPITAL DISCHARGE

J. Robles-Suarez, L.D. Sinvani, L. Rosen, C.N. Nouryan, G. Wolf-Klein

Jour Nursing Home Res 2015;1:11-14

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Background: Today, up to 90% of rehospitalizations from long term care (LTC) facilities appear to be unplanned. Studies have found laboratory values indicating low levels of hydration in as many as 48% to 60% of subjects in both hospitalized and community-dwelling older adults. Objectives: This study's objective was to identify the prevalence of low hydration, a potentially treatable condition, in patients who were rehospitalized from a LTC facility. Design: This was a retrospective chart review of patients rehospitalized within 30 days of LTC facility admission. For this study, low hydration was defined as a Serum Na >145 mg/dl or a blood urea nitrogen to creatinine (BUN:Cr) ratio of > 20:1. Setting: A hospital and a nearby LTC facility in the metropolitan New York area. Participants: Any patient over age 65 who was sent back to the hospital for any reason within 30 days of entering the LTC facility. Measurements: demographics, admission diagnosis, co-morbid conditions, electrolyte changes (Na, BUN, and Cr), and reason for transfer. Results: There were 261 subjects rehospitalized during the six-month study period. Average age was 79 years, and 42% were male. The principal diagnoses at LTC admission were: cardiovascular (34%), infection (20%), neurological (14%), gastrointestinal (13%), gynecological (4%), pulmonary (3%), fall (2%), electrolyte abnormality (including documented dehydration, 2%), hematology (1%) and other (6%). For these subjects, the prevalence of low hydration at time of LTC facility admission was 60.5% (95% CI: 54.3% to 66.5%), at time of rehospitalization, low hydration prevalence had increased to 67.4% (95% CI: 61.4% to 73.1%). Conclusion: Low hydration appears to be an unrecognized clinical issue for older adults requiring LTC and hospital readmission. Increasing awareness of this condition might assist in improving the patient's fluid status prior to discharge from the hospital thereby potentially preventing avoidable readmissions.

CITATION:
J. Robles-Suarez ; L.D. Sinvani ; L. Rosen ; C.N. Nouryan ; G. Wolf-Klein (2015): Hydration Status of Long Term Care Residents Rehospitalized Within 30 Days of Hospital Discharge. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.3

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EDITORIAL TREATMENT OF AGITATION IN NURSING HOME: IS THERE ANOTHER SOLUTION THAN ANTIPSYCHOTICS?

P. SAIDLITZ, T. VOISIN

Jour Nursing Home Res 2015;1:15-17

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CITATION:
P. Saidlitz ; T. Voisin (2015): Treatment of agitation in nursing home: is there another solution than antipsychotics?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.4

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NOTHING VENTURED, NOTHING GAINED: ACCEPTABILITY TESTING OF MICRONUTRIENT FORTIFICATION IN LONG-TERM CARE

I.T.Y. Lam, H.H. Keller, L.M. Duizer, K.D. Stark, A.M. Duncan

Jour Nursing Home Res 2015;1:18-27

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Background: Purpose: Malnutrition is common in long-term care (LTC) residents, yet limited research exists on micronutrient deficiencies. Objective: This study used qualitative methods to explore the acceptability of a food-first micronutrient fortification strategy for LTC and further develop this strategy. Design & participants: Qualitative cross-sectional data collection based on eleven staff focus groups (n=45), ten expert key informant interviews, and five family/resident focus groups (n=71) were conducted. Data were triangulated during content analysis, completed by two coders. Results: Stakeholders provided insight into benefits, concerns and potential solutions to minimize barriers and promote adherence to the strategy. Suggested solutions included development of outsourced/pre-made fortified products, mandatory training and clear protocols. Stakeholders can envision food fortification as a strategy to improve micronutrient status if products are easy to access and incorporate into current production systems. Yet, residents and families wish to be informed and have the potential to ‘opt out’. Safety and efficacy also needs to be demonstrated before it is incorporated into standard practice. Conclusion: This work provides a strong foundation for developing a proof-of-concept micronutrient food fortification study for the prevention of deficiencies in LTC.

CITATION:
I.T.Y. Lam ; H.H. Keller ; L.M. Duizer ; K.D. Stark ; A.M. Duncan ; (2015): NOTHING VENTURED, NOTHING GAINED: ACCEPTABILITY TESTING OF MICRONUTRIENT FORTIFICATION IN LONG-TERM CARE. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.5

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PREDICTORS OF CAREGIVERS’ CONSIDERATION FOR INSTITUTIONALIZATION OF ELDERLY CARE RECIPIENTS WITH ALZHEIMER’S DISEASE AMONG THREE DIFFERENT ETHNICITIES

H.J. Shim

Jour Nursing Home Res 2015;1:33-40

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The increasing number of older adults in the US suggests accordingly increasing older populations with Alzheimer’s Disease (AD). As some studies found a higher prevalence of AD among ethnic minority older adults, understanding different needs of ethnic minority caregivers is an important task. Using the REACH II data, the current study analyzed what caregivers’ and care recipients’ characteristics contribute to predicting caregivers’ consideration about institutionalization, and whether such difference was associated with caregivers’ ethnicity/race. A binary logistic regression was done to evaluate how these characteristics were associated with caregivers’ having consideration/no consideration about institutionalization. The final model was significant (χ2 (12) = 741.37, p <.001), with caregivers’ ethnicity and perceived burden about caregiving as strong predictors.

CITATION:
H.J. Shim (2015): Predictors of Caregivers’ Consideration for Institutionalization of Elderly Care Recipients with Alzheimer’s Disease Among Three Different Ethnicities. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.7

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LEGIONNAIRES’ DISEASE IN NURSING HOMES AND LONG-TERM CARE FACILITIES: AN EMERGING CATASTROPHE

Y.E. Lin, V.L. Yu

Jour Nursing Home Res 2015;1:28-32

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Outbreaks of Legionnaires’ diseases in nursing homes and longterm care facilities have become increasingly cited in newspaper and television reports especially when deaths are involved. News reports can lead to unsubstantiated rumors and widespread disruption of services. A sense of panic can lead to adoption by the facility of expensive, short-term measures that are unscientific and expensive. The worst case scenario is that the measures will also be found to be useless. We present an evidence-based approach that has been successful and cost-effective in longterm care facilities. Environmental cultures of the drinking water for Legionella within the nursing home and longterm care facility is a necessary first step. Infection control personnel should make the key decisions in management of the outbreak. Healthcare facility managers and outside water treatment consultants often make costly and expensive recommendations that will be proven ineffective over time.

CITATION:
Y.E. Lin ; V.L. Yu (2015): Legionnaires’ Disease in Nursing Homes and Long-Term Care Facilities: An Emerging Catastrophe. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.6

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POST ORDERS-WHAT’S THE IMPACT ON STAFF, HOSPITAL ADMISSIONS AND HOSPICE?

V. Armstrong, M. Renaud

Jour Nursing Home Res 2015;1:41-46

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Objectives: The objective of this study was to evaluate the effect of Physician Order for Scope of Treatment (POST) orders on interdisciplinary staff caregiver satisfaction, hospital admissions and hospice enrollment. POST is a program that provides a vehicle for clear communication of an individual’s desires for EOLC care in a physician order to be honored across the continuum of care. The effect of POST orders on staff caregiver satisfaction, hospital admissions and hospice enrollment has not been published. Design: This study used a quasi-experimental pre-test/post-test design for a single group of participants to measure staff caregiver satisfaction change. Retrospective chart reviews for data collection for comparison to historical data for change of hospice enrollment and hospital admission. Setting: The study was conducted in nine nursing homes in Southeastern Virginia from August 1, 2013 to December 31, 2013. Participants: Participants were the interdisciplinary staff caregivers who cared for residents with POST orders. Intervention: Implementation of POST orders. Measurements: Pre and post POST order surveys that were completed by staff and retrospective chart reviews for evidence of hospice enrollment and hospital admission. Results: There was no demonstrated change in staff caregiver satisfaction (p=0.05). 86 charts with POST orders were reviewed. Hospice enrollment for residents with POST orders was 16.2% compared to 2.10% in 2013 and 1.68% in 2012 of nursing home residents without POST orders. Hospital admissions were 0% as compared to 2012 and 2013 hospital admission rates of 4.8% and 6.2% respectively. Conclusion: POST orders did not change staff caregiver satisfaction with EOLC, however there were significant changes in the rate of hospital admissions and utilization of hospice services. These results may provide basis for further examination and possibly dedication of resources for further development of Advance Care Planning Facilitator training. The ability to identify and communicate individual wishes for EOLC beneficially impacts the patient, family, caregivers and society; continued efforts in this arena are imperative.

CITATION:
V. Armstrong ; M. Renaud (2015): POST Orders-What’s the Impact on Staff, Hospital Admissions and Hospice?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.8

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PREVALENCE OF RISK OF MALNUTRITION AND ASSOCIATED FACTORS IN HOME CARE CLIENTS

T. Kaipainen, M. Tiihonen, S. Hartikainen, I. Nykänen

Jour Nursing Home Res 2015;1:47-51

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Objectives: To describe nutritional status and to detect factors associated with it in home care clients aged 75 years or older. Design: A cross-sectional study with a population-based sample. Setting: Home care.Participants: The study included 267 home care clients in three cities in Finland. Measurements: The outcomes were nutritional status (Mini Nutritional Assessment, MNA), body mass index (BMI), functional ability (Barthel Index, Instrumental Activities of Daily Living, IADL), cognitive function (Mini Mental State Examination, MMSE), depression (Geriatric Depression Scale, GDS-15), comorbidity (Functional Comorbidity Index, FCI), Vitamin D and drug use and levels of blood albumin and haemoglobin. Chewing problems and dry mouth were assessed by using a structured interview. Results: According to the MNA, a majority (86%, n = 229) of all home care clients were at risk of malnutrition or were malnourished. Persons at risk of malnutrition or who were malnourished used more drugs and had a higher depressive score and lower Barthel Index, IADL and MMSE scores than well-nourished participants. Multivariate analysis showed that excessive polypharmacy (OR 3.63, 95% CI:1.51–8.74), a lower MMSE score (OR 1.29, 95% CI:1.12–1.48) and a higher GDS-15 score (OR 1.32, 95% CI:1.07–1.63) appeared to be independently connected to malnutrition or a risk of malnutrition. Conclusions: Malnutrition or a risk of malnutrition is a common problem among home care clients. Excessive polypharmacy, cognitive impairment and depressive symptoms increase malnutrition or the risk of malnutrition. To prevent a further decline in their health status, home care clients should be screened for malnutrition and the risk of malnutrition.

CITATION:
T. Kaipainen ; M. Tiihonen ; S. Hartikainen ; I. Nykänen (2015): PREVALENCE OF RISK OF MALNUTRITION AND ASSOCIATED FACTORS IN HOME CARE CLIENTS. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.9

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EDITORIAL: NON-PHARMACOLOGICAL INTERVENTIONS IN THE NURSING HOME SETTING: DOES IT MAKE ANY SENSE TO STRUGGLE AGAINST SEDENTARY BEHAVIOR AMONG RESIDENTS?

P. de Souto Barreto

Jour Nursing Home Res 2015;1:52-54

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CITATION:
P. de Souto Barreto (2015): Non-pharmacological interventions in the nursing home setting: Does it make any sense to struggle against sedentary behavior among residents? . The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.10

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TASTE OF TEN DRUGS FREQUENTLY PRESCRIBED IN NURSING HOMES CRUSHED AND MIXED IN FOOD: OBSERVATIONAL STUDY IN 16 HEALTHY VOLUNTEERS

J. Lamure, P. Brocker, S.M. Schneider, R. Collomp, F. Bertin-Hugault, P. Denormandie, I. Prêcheur

Jour Nursing Home Res 2015;1:55-61

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Background & Aims: Many frail elderly patients are polymedicated. Whether they suffer from dysphagia (due to stroke, Parkinson’s disease, etc.) or cognitive troubles (due to Alzheimer’s disease, etc.), they are often given blended food, with drugs crushed and mixed into the food. Health Authorities recommend to crush and to administrate crushed drugs separately, for pharmacologic reasons, but the drugs are usually mixed together to facilitate ease of case by nursing staff. Crushed drugs can have a bad taste, leading to drug / food refusal, worsening malnutrition, but this qualitative aspect has been scarcely studied in geriatric populations. The present study aimed to evaluate the taste of the ten drugs most frequently prescribed in nursing homes, in order to determine which drugs are acceptable or not when crushed and mixed into food. Methods: This one-step observational study was designed like a food or wine tasting. A jury of healthy volunteers was recruited among medical staff (8 volunteers) and other people involved in food and gastronomy (8 volunteers, including a starred Chef). Every tablet or capsule was mixed into 100 mL of berry-flavored jelly or apple sauce. It was a blind tasting of 24 verrines, containing the ten drugs randomly distributed, a control without drug and a combination of the 6 top-list drugs. Twelve jelly verrines were followed by 12 apple sauce verrines. Tasters spat the spoonful content out after they had assessed its taste. Each verrine was scored from 0 (bad taste) to 10 (good). Qualitative and free comments were also recorded. Results: The lowest scores were attributed to the combination of paracetamol, alprazolam, furosemide, levothyroxine sodium, memantine and zopiclone (1.5 + 1.6; 0 to 5), followed by zopiclone (1.9 + 2.3; 0 to 8), clopidogrel (4.3 + 2.1; 1 to 7) and paracetamol (4.6 + 1.8; 1 to 8). All these drugs had a long-lasting bitterness. Zopiclone mixed and alone was qualified as unbearable and one participant exhibited nausea by taking it. Five participants did not take lunch after the study for lack of hunger (5/16: 31.3 %). Drug-free jelly and apple sauce were scored 6.7 + 1.4 (4 to 9) and 7.1 + 1.1 (5-9.5), respectively. Other scores ranged from 6.1 to 7.9, for alprazolam, ramipril, oxazepam, levothyroxine sodium, donezepil and furosemide. Conclusions: The taste of some drugs may be unbearable when they are crushed and mixed into food, and caregivers should avoid mixing a bad-tasting drug with the other drugs. There are wide differences of taste acceptability from one person to another. Thus, during workshops, every patient could taste once separately any single drug in his prescription list. If a bad taste leads to drug refusal, caregivers should inform physicians and pharmacists, who in turn should seek alternative medical solutions (drug discontinuation or substitution). Caregivers could also seek alternative food or administration conditions. On a mid-term basis, pharmaceutical companies should also develop specific pharmaceutical forms, as they do for children.

CITATION:
J. Lamure ; P. Brocker ; S.M. Schneider ; R. Collomp ; F. Bertin-Hugault ; P. Denormandie ; I. Prêcheur (2015): TASTE OF TEN DRUGS FREQUENTLY PRESCRIBED IN NURSING HOMES CRUSHED AND MIXED IN FOOD: OBSERVATIONAL STUDY IN 16 HEALTHY VOLUNTEERS. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.12

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EFFECTIVENESS OF A HEALTH CARE AIDE EDUCATIONAL INTERVENTION TO IMPROVE RECOGNITION OF URINARY TRACT INFECTION AND NURSING HOME ACQUIRED PNEUMONIA SYMPTOMS IN LONG-TERM CARE FACILITIES: A PRE-POST INTERVENTION TRIAL

P. Quail, S.a. Ahmed, M. Shaw, S. Parry, M. Hofmeister, N. Drummond

Jour Nursing Home Res 2015;1:62-65

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Objectives: To implement and evaluate a targeted training initiative for care aides with the aim of improving recognition and reporting of early symptoms of Nursing Home Acquired Pneumonia (NHAP) and Urinary Tract Infection (UTI). Design: Pre-post, non-randomized, intervention trial design with care aides and residents. Setting: Three long-term care facilities: one site implemented the intervention and two maintained normal practices and procedures. Intervention: A nurse-led educational intervention and tool kit were delivered to health care aides to improve recognition and reporting of subtle behavioral or physiological changes in residents, which may be indicative of NHAP and UTI. Measurements: Paired t-tests were used to compare scores on questionnaires completed by care aides at baseline, immediately post-intervention and 3 months later, to identify their knowledge of UTI and NHAP symptoms, their perceptions of the professional relationships between care aides and members of other professions, and on workload. Resident charts were also reviewed. Results: Significant changes in NHAP symptom recognition were found for the intervention group between baseline (M = 2.45, SD = 1.18) and the three month follow-up (M = 2.94, SD = 1.34); t(31) = -2.05, p = .049. There was a significant increase in UTI symptom recognition scores for the intervention group between baseline (M = 2.20, SD = 1.18), immediately post-intervention (M = 2.80, SD = 1.05); t(35) = -3.34, p = .002 and after three months (M = 3.88, SD = 1.83); t(25) = -3.73, p = .001. Conclusion: A simple and inexpensive educational intervention among care aides may improve their recognition of UTI symptoms in residents in LTC.

CITATION:
P. Quail ; S.a. Ahmed ; M. Shaw ; S. Parry ; M. Hofmeister ; N. Drummond (2015): Effectiveness of a health care aide educational intervention to improve recognition of urinary tract infection and nursing home acquired pneumonia symptoms in Long-Term Care Facilities: A pre-post intervention trial. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.11

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PERSONAL AND HEALTH-RELATED FACTORS ASSOCIATED WITH RECREATIONAL ACTIVITY PREFERENCES AMONG NURSING HOME RESIDENTS

S. Jung, V.R. Cimarolli

Jour Nursing Home Res 2015;1:66-72

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Background: Recreational activities have the potential to improve nursing home residents’ quality of life, but little is known about the factors that are associated with the preferences that residents may voice regarding specific types of activities. Objectives: To identify personal, and health-related factors associated with recreational activity preferences in nursing home residents. Design: Cross-sectional study. Setting: An urban nursing home facility in the United States. Participants: Newly admitted, long-stay nursing home residents (N = 123). Measurements: Data obtained from residents’ admission Minimum Data Set (MDS) 3.0, including age, gender, race/ethnicity, marital status, subjective vision and hearing impairment ratings, cognitive functioning, depressive symptoms, and pain presence were examined as predictors of eight activity preferences items (i.e., having books, listening to music, participating in religious services) using multivariate logistic analyses. Results: In general, nursing home residents reported high preferences for most recreational activities. Vision and hearing impairments were significantly associated with vision-specific (reading) and hearing-specific activities (listening to music), respectively. Racial/ethnic minority residents were more likely to prefer group activities, keeping up with news, and religious practices, when compared to non-minority residents. Conclusions: Understanding activity preferences is a necessary first step in establishing and designing recreational programs that meet the needs of diverse populations in nursing homes.

CITATION:
S. Jung ; V.R. Cimarolli (2015): Personal and Health-Related Factors Associated with Recreational Activity Preferences Among Nursing Home Residents. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.13

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GENERAL PRACTITIONERS ARE NOT INFORM CONCERNING MEDICINE CRUSHING IN NURSING HOMES

N. Boussier, M-E. Rougé-Bugat, J. Dupouy, A. Stillmunkès, S. Bismuth, Y. Rolland, B. Vellas, S. Oustric

Jour Nursing Home Res 2015;1:73-76

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Background: Behavioural disorders or swallowing difficulties result in delivery of medication in crushed form for more than 30% of older people living in the community and 23% in the nursing home (NH). This practice can results in poor efficacy of the treatment. Based on the recommendations from the French National Authority for Health, general practitioners (GP) should be informed when their patient’s pills are crushed by the nurses. Our aim was to assess knowledge of general practitioner on medication delivered in crushed form to their patients in NH settings. Materials and method: A survey of practice was send in January and February 2013 to 63 coordinating physicians (CPs) working in 63 NH in the south of France. Self-administered questionnaire were sent. The subject of the questionnaire was information given to general practitioners (GPs) and medicine-crushing practices in NH. Results: Sixteen CPs (25.4%) agree to participate. Nine of them (56.3%) reported that they did not tell GPs about medicine crushing. Only one CP reported that his NH had a written protocol of information for GPs. However, no CP reported having a written protocol on medicine crushing. Only one CP reported that the reason for crushing medicine was systematically reported by the nurses of the NH in the charts. Conclusion: Despite national guidance, CPs reported that they did not frequently inform attending GPs when medicines were crushed.

CITATION:
N. Boussier ; M-E. Rougé-Bugat ; J. Dupouy ; A. Stillmunkès ; S. Bismuth ; Y. Rolland ; B. Vellas ; S. Oustric (2015): General practitioners are not inform concerning medicine crushing in nursing homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.14

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CONCURRENT USE OF DIETARY SUPPLEMENTS AND MEDICATIONS IN LONG-TERM CARE FACILITY RESIDENTS WITH ADVANCED DEMENTIA

S. Goorang, L.U. Thorpe, A. Baillod, S.J. Whiting

Jour Nursing Home Res 2015;1:77-80

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Seniors residing in long-term care (LTC) facilities may suffer from nutrient deficiencies, yet supplementation may increase burden with little benefit, especially in advanced dementia with reduced life expectancy. A multidisciplinary team examined the clinical context and prescription of medications and dietary supplements to 29 LTC residents in the latest stages of dementia. All except one had problems with oral intake, and almost half had problems taking medications/supplements. The mean likelihood of death at 6 months was estimated to be 30%. Vitamin D and calcium were prescribed in 19 and 12 residents respectively. The mean (range) oral medication and supplement burden was 8.2 (0-20.5) and 1.4 (0-5) units per day, respectively, with clinical data frequently suggestive of potentially adverse outcomes. We recommend increased acquisition of knowledge and clinical expertise in the practical use of dietary supplementation in frail seniors, especially those in the latest stages of dementia.

CITATION:
S. Goorang ; L.U. Thorpe ; A. Baillod ; S.J. Whiting (2015): Concurrent use of dietary supplements and medications in long-term care facility residents with advanced dementia. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.15

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CAN RESIDENT LIFE STORIES HELP NURSING AIDES LEARN ABOUT RESIDENTS? A PILOT STUDY

M.C. Smith, C.M. Kreklewetz

Jour Nursing Home Res 2015;1:81-83

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This research investigated the use of resident life stories to help nursing aides learn about nursing home residents. Forty-one nursing aides from seven nursing homes viewed an intake form, read a story about the resident’s background, and watched a video about the resident’s background. Dependent measures included how absorbed/transported they were into the information, how distracted they were while taking in the information, the usefulness and relevance of the information to them in their jobs, and the overall usefulness of each mode of communication. In many cases, the story or video was superior to the regular information form used by nursing homes. Few empirical studies have examined the role of resident life stories to assist nursing aides in caring for residents. Results provide evidence that resident life stories are a useful method for delivering information about the residents to this target group.

CITATION:
M.C. Smith ; C.M. Kreklewetz (2015): CAN RESIDENT LIFE STORIES HELP NURSING AIDES LEARN ABOUT RESIDENTS? A PILOT STUDY. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.16

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SAFETY EVALUATION OF FLAXSEED LIGNAN SUPPLEMENTATION IN OLDER ADULTS RESIDING IN LONG-TERM CARE HOMES

N. Viveky, L. Thorpe, J. Alcorn, T. Hadjistavropoulos, S.J Whiting

Jour Nursing Home Res 2015;1:84-88

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The anti-inflammatory and anti-oxidant properties of flaxseed lignans could benefit age-related chronic conditions. We aimed to examine the safety of supplementation of the major flaxseed lignan, secoisolariciresinol diglucoside (SDG) in frail older adults residing in long-term care (LTC) homes. Twenty-six older adults (60-80 years of age) met the inclusion criteria and were enrolled in a double blind randomized control trial of SDG supplementation at 300 mg/day for six months. Adverse events were recorded every week along with other blood and functionality tests. Participants in the treatment group demonstrated no evidence of hypoglycemia and hypotension or other adverse events. We conclude that SDG supplementation (300 mg/day) in a frail, complex patient population causes no significant adverse outcomes.

CITATION:
N. Viveky ; L. Thorpe ; J. Alcorn ; T. Hadjistavropoulos ; S.J Whiting (2015): Safety evaluation of flaxseed lignan supplementation in older adults residing in long-term care homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.17

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IMPROVING NURSING HOME RESIDENT OUTCOMES: TIME TO FOCUS ON MORE THAN STAFFING?

L.D. Kimmey, S.C. Stearns

Jour Nursing Home Res 2015;1:89-95

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Background: Nursing home staffing characteristics have long been hypothesized to affect quality of care and resident outcomes. The current literature lacks a solid understanding of the magnitude of the effects that sufficient staff, low turnover, and good nursing oversight can have on outcomes that are important to residents and payers. Knowledge of the magnitudes of these effects is essential to evaluating future directions for long-term care research and policy. Objectives: This study estimates the effects of staffing components on the following resident outcomes: pain, pressure ulcers, and restraint use; falls; and emergency department use and hospitalizations. Design: Prior estimates of the relationship between staffing components and resident outcomes suffer from limitations including small samples and use of facility rather than resident-level data. This study allows for joint and non-linear effects of staffing characteristics on undesirable outcomes. We allowed for non-linear relationships by including squared measures of staffing hours per resident day and interactions between staffing levels and retention by type of staff. Our final models used logistic regression with sample weights calculated by the National Center for Health Statistics. Setting: Residents and facilities participating in the 2004 National Nursing Home Survey. Participants: The 2004 National Nursing Home Survey sampled 14,017 residents at 1,500 of the 16,628 nursing homes in the United States; facility and resident response rates were 81% and 96%, respectively. Exclusions for various criteria and missing data result in an analysis sample of 10,043 residents at 954 facilities. Measurements: We assessed three dichotomous outcome measures. The first measure combined reports of pain in the week prior to the survey, pressure sores at the time of the survey, or whether restraints were ever used for the resident. The second measure was a report of any fall in the 30 days prior to the survey, and third was any emergency department visits or hospital admissions in the previous 90 days. Key explanatory variables reflected staffing levels (ratios of staff hours per patient day and registered nurse bedside hours), retention (proportion of staff employed at least one year) and mix (ratio of registered nurses to licensed practical nurses and certified nursing assistants). Results: Moving from very poor to very good staffing improves predicted outcomes in plausible ways: pain, pressure sores or restraint use decline with higher certified nursing assistant hours and retention, 30-day fall rates decline with greater registered nurse oversight, and emergency department /hospital use decline with more registered nurse bedside hours. Conclusions: Both the absolute and relative effects of moving from very poor to very good staffing are limited in magnitude, demonstrating that broader approaches to improving nursing home quality are needed to ensure satisfactory outcomes for nursing home residents. Additional research is needed to better understand what components of facility administration and operation are most strongly associated with resident outcomes.

CITATION:
L.D. Kimmey ; S.C. Stearns (2015): IMPROVING NURSING HOME RESIDENT OUTCOMES: TIME TO FOCUS ON MORE THAN STAFFING?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.18

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IS EARLY HOSPITAL DISCHARGE AFTER STROKE COMBINED WITH ASSESSMENT IN THE NURSING HOME SAFE AND ACCEPTABLE?

R.W.H. Heijnen, T.D.E.M. Van der Weijden, S.M.A.A. Evers, M. Limburg, B. Winkens, J.M.G.A. Schols

Jour Nursing Home Res 2015;1:96-103

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Background: A new stroke care model has been developed aiming at the early hospital discharge of stroke patients to a nursing home for systematic assessment with subsequent planning for rehabilitation. Our hypothesis was that this new model for stroke care improves the delivery of care without affecting quality of life, functional outcomes and satisfaction with care. Design: A non-randomised comparative trial. Setting: Two Dutch stroke services in the regions of Maastricht and Eindhoven. Participants: Acute stroke patients, over 18 years of age. Intervention: Hospital discharge of stroke patient within 5 days to a nursing home, followed by a systematic multidisciplinary assessment in a specialised nursing home assessment unit to determine the optimal rehabilitation track. Usual care consists of an average of 10 days of hospital care, followed by less extensive assessment. Measurements: The primary outcome measures were quality of life and activities of daily living. The primary and secondary outcomes - impairment, cognitive functioning, instrumental activities of daily life, mood, satisfaction with care, caregivers’ strain, length of stay, and medical complications - were assessed using validated instruments. Results: 239 acute stroke patients participated in this study: 122 in the intervention and 117 in the control group. We did not succeed in implementing early discharge from hospital, although the systematic assessment in the nursing home was accomplished. No clinically relevant differences were found between the groups for functional outcomes, quality of life or satisfaction with care. In comparison with the control group, a trend towards reduction in length of nursing home stay was found in the intervention group. Conclusion: Although the new care model failed to implement early discharge, more stroke patients in the intervention group were assessed by a multidisciplinary team in a nursing home in comparison with the usual care group, where more patients were discharged home after their initial hospital stay.

CITATION:
R.W.H. Heijnen ; T.D.E.M. Van der Weijden ; S.M.A.A. Evers ; M. Limburg ; B. Winkens ; J.M.G.A. Schols (2015): Is early hospital discharge after stroke combined with assessment in the nursing home safe and acceptable?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.19

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PREDICTORS OF PRESSURE ULCER DEVELOPMENT IN NURSING HOME RESIDENTS: A STUDY FROM UNITED STATES NATIONAL NURSING HOME SURVEY 2004

P. Patel, A. Aranha, L. Cardozo

Jour Nursing Home Res 2015;1:104-107

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Background: Pressure Ulcers (PU) have grown into a significant clinical and economic problem; as a consequence there is a need for a better understanding of predictors for PU development in Nursing Home (NH) Residents (NHR). Objective: To analyze the prevalence and predictors of PU among United States NHR population. Methods: The Center of Disease Control National Nursing Home Survey 2004 comprising 13,507 NHR from 1,152 United States NH facilities. Among them, 11,870 NHR, above age 65, having or not having Stage 1-4 PU, were analyzed. Results: NHR mean age was 84.2 years, 74.4% female, 89.4% white, 5.2% behavioral problems, 5.6% dementia and 10.3% stages 1-4 PU. Age of cohort was directly related to Activities of Daily Living (ADL) dependencies (p=0.001) and inversely to number of medications taken (p=0.001). Overall, the NHR with PU were slightly younger (p=0.021) with a shorter Length of Stay (LOS) (p=0.001), had skin wounds present (p=0.001), a higher ADL dependency (p=0.001), and number of medications taken (p=0.001). NHR without behavioral problems had a greater likelihood (p=0.021) of having PU. Conclusion: Age, Gender, Ethnicity, LOS at NH, presence of skin wounds, number of ADL dependencies and Medications taken were found to be good predictors of PU among NHR.

CITATION:
P. Patel ; A. Aranha ; L. Cardozo (2015): Predictors of Pressure Ulcer Development in Nursing Home Residents: A Study from United States National Nursing Home Survey 2004. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.20

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