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01/2016 journal articles

NURSING HOME RESEARCH INTERNATIONAL WORKING GROUP, 6-10 NOVEMBER, 2016 • BARCELONA, SPAIN

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CARDIOVASCULAR SECONDARY PREVENTION BY STATIN IN SOUTHERN FRENCH NURSING HOME

E. Gremeaux, M. Grino, C. Molines, C. Oliver, F. Retornaz

Jour Nursing Home Res 2016;2:1-6

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Objectives: To examine the prevalence of blood lipid monitoring and statin use in secondary prevention of residents in southern French nursing homes for dependent elderly people. Design, Setting and Participants: Observational study in 12 southern French nursing homes for dependent old persons with coronary heart disease, ischemic stroke, peripheral artery disease or diabetes. Measurements: Collection from medical charts of blood lipid monitoring, LDL-C levels, statin use and geriatric assessment among 965 residents. Results: 410/965 residents were eligible for secondary prevention of atherosclerotic complications. Blood lipid was measured in 195 residents and lipid-lowering drugs were given to 106 (statin in 101). The rate of statin use was significantly reduced with increasing age and dependence severity. One third of residents under statin were not monitored for blood lipid. Conclusion: Blood lipid monitoring and statin use were subnormal in nursing home residents under secondary prevention. There is a need for prospective studies in this population and precise recommendations taking into account geriatric assessment criteria.

CITATION:
E. Gremeaux ; M. Grino ; C. Molines ; C. Oliver ; F. Retornaz (2016): Cardiovascular secondary prevention by statin in southern French nursing home. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.1

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RECOMMENDATIONS ON PHYSICAL ACTIVITY AND EXERCISE FOR OLDER ADULTS LIVING IN LONG-TERM CARE FACILITIES: A TASKFORCE REPORT

P. de Souto Barreto, J.E. Morley, W. Chodzko-Zajko, K.H. Pitkala, E. Weening-Djiksterhuis, L. Rodriguez-Mañas, M. Barbagallo, E. Rosendahl, A. Sinclair, F. Landi, M. Izquierdo, B. Vellas, Y. Rolland, under the auspices of The International Association of Gerontology and Geriatrics – Global Aging Re

Jour Nursing Home Res 2016;2:7-20

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A taskforce, under the auspices of The International Association of Gerontology and Geriatrics – Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCF). Due to the high heterogeneity in terms of functional ability and cognitive function that characterizes older adults living in LTCFs, taskforce members established two sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. In order to promote a successful implementation of recommendations, taskforce experts highlighted the importance of promoting residents’ motivation and pleasure, the key factors that can be increased when taking into account residents’ desires, preferences, beliefs and attitudes toward physical activity and exercise. The importance of organizational factors related to LTCFs and healthcare systems were recognized by the experts. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCFs settings.

CITATION:
P. de Souto Barreto ; J.E. Morley ; W. Chodzko-Zajko ; K.H. Pitkala ; E. Weening-Djiksterhuis ; L. Rodriguez-Mañas ; M. Barbagallo ; E. Rosendahl ; A. Sinclair ; F. Landi ; M. Izquierdo ; B. Vellas ; Y. Rolland ; under the auspices of The International Association of Gerontology and Geriatrics – Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section (2016): Recommendations on physical activity and exercise for older adults living in long-term care facilities: a taskforce report. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.2

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ENTANGLED PRACTICES, ENTANGLED EPIDEMICS: ANTIBIOTIC PRACTICES AND HEALTHCARE ASSOCIATED INFECTIONS IN NURSING HOMES AND HOSPITALS

K.L. Lapane, C.E. Dubé, A.L. Pakyz

Jour Nursing Home Res 2016;2:21-26

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Each year ~388,000 deaths occur due to infections in nursing homes. The U.S. Department of Health and Human Services 2013 National Action Plan to Prevent Healthcare-Associated Infections ranked long-term care as the next priority setting in which to reduce healthcare-associated infections. The changing nature of U.S. nursing homes to increasingly post-acute, skilled nursing facilities has created a “revolving door” between hospitals and nursing homes which increases the potential for spread of healthcare-associated infections. We provide a review of what is known about antibiotic use and infections in both hospital and nursing home settings. A review of the extent of healthcare-associated infections in hospitals and nursing homes underscores the importance of the problem. Taken together, the information provided in this article highlights an acute and growing need for practical, foundational knowledge about transitions among healthcare settings across institutions within networks sharing care for vulnerable older adults. The interconnectedness of nursing homes and hospitals must be considered when devising sustainable strategies to reduce healthcare-associated infections in both settings.

CITATION:
K.L. Lapane ; C.E. Dubé ; A.L. Pakyz (2016): Entangled practices, entangled epidemics: Antibiotic practices and healthcare associated infections in nursing homes and hospitals. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.3

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NURSING HOME PROFESSIONALS OPINIONS ON DETERMINANTS OF MALNUTRITION – A QUALITATIVE STUDY

R.E. Roller, A. Morgner, D. Eglseer, G.H. Wirnsberger

Jour Nursing Home Res 2016;2:27-33

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Objectives: To assess the attitudes and knowledge of health care professionals, who work with long term nursing home residents, with respect to key factors that influence malnutrition. Methods: Based on the results of a comprehensive literature research, a qualitative study was carried out by conducting problem-centered and structured interviews with healthcare professionals (N=25) from different professions. Each individual qualitative interview consisted of 10 open and problem-centered questions. Specific areas of interest were problems experienced by nursing home residents, useful measures that could be taken in cases of malnutrition and the prevalence of malnutrition in the nursing homes. 80 items were extrapolated from the interviews, transferred to a 5-point Likert-like scale questionnaire and included in an electronic survey, which was sent out to the 25 experts who had already been interviewed. Raters were first asked to rate the items according to their professional opinion and, second, according to the current state of nursing homes in Austria. Results: 77% of the 80 factors that may influence the treatment of malnutrition were identified as important, having an arithmetic mean (Ø a.m.) = 4.15. The top five determinants were: two factors related to kitchen food (i.e., “age-adapted texture and portion size” and “quality, freshness, taste, appearance and smell”), further education of nursing staff, interdisciplinary cooperation and education of dietitians. The evaluation of the 80 factors in terms of their status quo resulted in an Ø a.m. of 2.94. No factor was rated higher than Ø a.m. 3.74 in terms of its status quo (i.e., according to guidelines). The status quo quality was evaluated critically especially with regard to financial support and education. Conclusion: A gap exists between the attitudes of health care professionals and the status quo (what is being done) in Austrian nursing homes.

CITATION:
R.E. Roller ; A. Morgner ; D. Eglseer ; G.H. Wirnsberger (2016): Nursing home professionals opinions on determinants of malnutrition – A qualitative study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.4

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RESIDENTS’ PERSPECTIVES ON LIVING WITH VISION IMPAIRMENT IN LONG TERM CARE: AN UNSEEN FACTOR IN QUALITY OF LIFE AND APPROPRIATENESS OF CARE

R. Meehan, R. Shura

Jour Nursing Home Res 2016;2:34-40

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Few qualitative studies have explored the day-to-day experiences of people with vision impairment living in assisted living. Long-term care residents with vision impairment are more likely to have problems with ADLs, like dressing and feeding themselves, and increased rates of depression, social isolation, and falls. To better understand how visual health may impact care and quality of life in long-term care, this qualitative study used semi-structured interviews to consider the direct experiences of vision impairment among residents of an assisted living facility within a continuing care retirement community (CCRC) in the United States (N=13). Results indicate that vision impairment may be an ‘unseen’ and often overlooked experience among institutionalized elders that is critical for appropriate care and improving quality of life. Residents’ reported impact of vision impairment on daily life and their reported coping strategies are discussed, yielding implications for adaptations of individuals, caregivers, and long-term care institutions and staff.

CITATION:
R. Meehan ; R. Shura ; (2016): Residents’ Perspectives on Living with Vision Impairment in Long Term Care: An Unseen Factor in Quality of Life and Appropriateness of Care. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.5

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HOW DO WORK HIERARCHIES AND STRICT DIVISIONS OF LABOUR IMPACT CARE WORKERS’ EXPERIENCES OF HEALTH AND SAFETY? CASE STUDIES OF LONG TERM CARE IN TORONTO

I. Syed, T. Daly, P. Armstrong, R. Lowndes, M. Chadoin, V. Naidoo

Jour Nursing Home Res 2016;2:41-49

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Background: According to the Canadian Health Care Association (1), there are 2,577 long-term care (“LTC”) facilities across Canada, with the largest proportion (33.4%) located in Ontario. Most studies focus on residents’ health, with less attention paid to the health and safety experiences of staff. Given that the work performed in Ontario LTC facilities is very gendered, increasingly racialized, task-oriented, and with strict divisions of labour, this paper explores in what ways some of these factors impact workers’ experiences of health and safety. Objectives: The study objectives included the following research question: How are work hierarchies and task orientation experienced by staff? Design and Setting: This paper draws on data from rapid team-based ethnographies of the shifting division of labour in LTC due to use of informal carers in six non-profit LTC facilities located in Toronto, Ontario. Methods: Our method involved conducting observations and key informant interviews (N=167) with registered nurses, registered practical nurses, personal support workers, dietary aides, recreation therapists, families, privately paid companions, students, and volunteers. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. For observations, researchers were paired and covered shifts between 7 a.m. and 11 p.m., as well as into the late night over six days, at each of the six sites. Detailed ethnographic field notes were written during and immediately following observational fieldwork. Results: Our results indicate that employee stress is linked to the experiences of care work hierarchies, task orientation, and strict divisions of labour between and among various staff designations. Conclusion: Findings from this project confirm and extend current research that demonstrates there are challenging working conditions in LTC, which can result in occupational health and safety problems, as well as stress for individual workers.

CITATION:
I. Syed ; T. Daly ; P. Armstrong ; R. Lowndes ; M. Chadoin ; V. Naidoo (2016): How Do Work Hierarchies and Strict Divisions of Labour Impact Care Workers’ Experiences of Health and Safety? Case Studies of Long Term Care in Toronto. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.6

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RAISE THE BAR: A PILOT EVALUATION OF THE EFFECT OF A RESIDENTIAL AGED CARE WORKFORCE DEVELOPMENT MODEL ON STAFF AND RESIDENTS

J. Williams, C. Stolp, G. Roberts, M. Fearn, C. Doyle

Jour Nursing Home Res 2016;2:50-56

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Background: A range of staff with different skills undertake care for older people in residential care. When older people in care become unwell, a transfer to hospital may be avoided if their illness is recognised early by staff, and assessed, monitored and treated. Objectives: To improve residential aged care workforce capacity and professionalism, by implementing a new pilot workforce model, and to evaluate the model’s impact on staff and residents, including provision of complex palliative care, confidence and hospital transfer rates. Design: Mixed methods, including staff semi-structured interviews, staff quality improvement surveys, and assessment of monitoring, interventions and resident transfers. Settings: Three aged care residences in Victoria, Australia. Participants: Staff (n=278) in all three aged care residences. Intervention: Implementation of a comprehensive care model, developed to decrease unnecessary transfers of older people to acute care from residential care, and to improve skills in staff. Measurements: Number of ‘Stop and Watch’ reports made, percentage of ‘Stop and Watch’ reports resulting in an intervention, average monthly hospital transfers of residents to acute care (baseline, implementation and post -implementation), percentage of End of life Care Pathways completed based on number of deaths, and staff confidence. Results: Staff reported more confidence in identifying and caring for unwell residents, their capability to provide palliative care was perceived to increase, teamwork with external services improved, and new interventions and a decrease in hospital transfers occurred. Conclusions: This project showed improvement in early detection of deterioration in residents’ health condition, reduction in hospital transfers and improvements in staff satisfaction and confidence. Limitations of the study were the lack of control group and the small sample.

CITATION:
J. Williams ; C. Stolp ; G. Roberts ; M. Fearn ; C. Doyle (2016): Raise the Bar: a pilot evaluation of the effect of a residential aged care workforce development model on staff and residents. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.7

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UNDERDIAGNOSIS AND UNDERTREATMENT OF NURSING HOME RESIDENTS AT HIGH RISK FOR FRAGILITY FRACTURES

C. Ruggiero, M. Baroni, E. Zengarini, G. Dell’Aquila, A. Cherubini, V. Boccardi, F. Lattanzio, P. Mecocci

Jour Nursing Home Res 2016;2:57-63

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Background: Identifying older individual at risk for fragility fractures is a priority among healthcare providers. However, the prevalence of osteoporosis, fragility fractures and the prescription of antifracture drugs among Nursing Home (NH) residents is almost ignored. The aim of this study is to describe the prevalence of osteoporosis and fragility fractures, and the main correlates of antifracture drug prescriptions among NH residents. Design: Observational multicentre prospective study. Setting: Nursing homes and assisted living facilities. Participants: 1995 NH residents aged 60 and older participating to the U.LI.S.S.E. (Un Link Informatico sui Servizi Sanitari Esistenti per l’Anziano) project were evaluated using a standardized comprehensive geriatric assessment instrument (Resident Assessment Instrument Minimum Data Set - RAI-MDS). Results: 256 (13%) persons (age 84.5±7.62 years) have diagnosis of osteoporosis without any fracture; 355 (17%) had previous fragility hip fracture with one out of three reporting a diagnosis of osteoporosis. An antifracture treatment is prescribed to 5.5% (n:111) of eligible persons: 18% of osteoporotic and 11% of hip fracture residents, respectively. Independent of age, gender, BMI and disability, subjects affected by osteoporosis are more likely to receive antifracture drugs (β=0.17, SE: 0.04; p: <0.0001),but not those with previous hip fracture. The probability to receive treatments decreases when dementia co-occurs (β=-0.07, SE: 0.03; p:0.05). Residents managed according with RAI-MDS show higher probability to receive appropriate antifracture treatment (β= 0.07, SE: 0.03; p: 0.01). Conclusion: NH residents at high risk for fragility fractures receive suboptimal care. Residents with a history of hip fracture or dementia are less likely to be treated, while those managed according to the geriatric comprehensive approach are more likely to receive adequate care.

CITATION:
C. Ruggiero ; M. Baroni ; E. Zengarini ; G. Dell’Aquila ; A. Cherubini ; V. Boccardi ; F. Lattanzio ; P. Mecocci (2016): Underdiagnosis and undertreatment of nursing home residents at high risk for fragility fractures. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.8

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VARIABILITY IN ONTARIO LONG-TERM CARE PRACTICES FOR SCREENING AND TREATMENT OF VITAMIN B12 DEFICIENCY

K.J. Pfisterer, M.T. Sharratt, G.G. Heckman, H.H. Keller

Jour Nursing Home Res 2016;2:64-70

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Background: Vitamin B12 deficiency is avoidable through screening and treatment. Deficiency in long-term care impacts ~35% of residents, yet it remains unclear as to what long-term care homes are doing to address this issue. Objective: For the first time, to describe the state of B12 screening and treatment protocols in Ontario long-term care homes, influence of geography and corporate structure on protocols, and the proportion of residents who are currently under treatment. Design: This cross-sectional study used stratified random sampling. Setting: Ontario long-term care homes. Participants: Forty-five standardized phone interviews were completed with the directors of nursing care. Measurements: The following measurements were collected: home demographics (geography, for-profit status etc.), protocols pertaining to vitamin B12 testing, treatment, the cut-point each home uses to define B12 deficiency, proportion of residents receiving B12 and the treatment method (intramuscular injection vs. oral). Results: Cut-off values for determination of B12 deficiency varied (31% <156 pmol/L). Admission and follow-up B12 testing were routinely conducted in 66% (30/45) and 88% (35/40) of long-term care homes respectively. On average 25 ± 16% of current residents received treatment (41/45 homes reporting). Conclusions: Variability in detection and treatment of B12 deficiency in LTC, potentially places residents at risk for undetected deficiency. Regular testing and monitoring beginning at admission may provide a solution, however, there is a need both for further studies targeted at addressing the effect of treatment on improved clinical outcomes as well as a formal cost-benefit analysis for screening and subsequent treatment.

CITATION:
K.J. Pfisterer ; M.T. Sharratt ; G.G. Heckman ; H.H. Keller ; (2016): Variability in Ontario long-term care practices for screening and treatment of vitamin B12 deficiency. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.9

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OBSERVATIONAL STUDY OF DRUG USE AMONG ELDERLY AT HOME AND IN NURSING HOMES IN FRANCE

L. Duco, C. Legendre, N. Cohen, C. Blochet, P. Demornandie, J.-F. Huon, B. Sabatier, O. Saint-Jean

Jour Nursing Home Res 2016;2:71-75

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Objective: Describe recent use of medication in France in the advanced in age who live at home or in nursing homes. Design: Observational study, data collected the fourth quarter 2011. Setting: Community dwelling older (≥70 years old) and elderly living in nursing homes (>70 years old). Participants: 72 556 patients living at home, covered by at least one of the three health insurance schemes in France (Echantillon Généraliste des Beneficiares) and 5867 patients in nursing homes. Measurement: The subjects aged 70 or over in the two databases are divided into 10-year ranges. For each of which, we determined the percentage use of medication, the number of drugs per person, and the percentage of users of each drug in the 74 categories according to the Anatomical Therapeutic and Chemical. Results: The patients living at home used 8.7 drugs on average, and 7.7 by patients from nursing homes. 87.4% of elderly patients living at home and 99.3% of elderly in institution were using medication during the study period. The drug classes most used were analgesics, psychotropic medications, cardiovascular and gastrointestinal drugs. Antidepressants such as serotonin reuptake inhibitors, anxiolytics, and antipsychotic medication were prescribed in respectively 27.9%, 38.8%, and 22.3% of patients in nursing homes versus 9.6%, 23.6%, and 4.4% of patients living at home. Renin-angiotensin system inhibitors and beta-blockers were prescribed more among patients living at home. Statin use was greater among elderly living at home than in nursing homes (35% versus 19%). Conclusion: Our data confirm that the elderly in France consume large amounts of medication, whether they live at home or in nursing homes. Extensive use of medication among the elderly and doubts regarding its misuse highlight the importance of reviewing prescriptions during a comprehensive geriatric assessment.

CITATION:
L. Duco ; C. Legendre ; N. Cohen ; C. Blochet ; P. Demornandie ; J.-F. Huon ; B. Sabatier ; O. Saint-Jean (2016): Observational study of drug use among elderly at home and in nursing homes in France. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.10

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UNDERNUTRITION IN INSTITUTIONALIZED ELDERLY PATIENTS WITH NEUROLOGICAL DISEASES: COMPARISON BETWEEN DIFFERENT DIAGNOSTIC CRITERIA

D. Miranda, R. Cardoso, R. Gomes, I. Guimarães, D. de Abreu, C. Godinho, P. Pereira, J. Domingos, N. Pona, J.J. Ferreira

Jour Nursing Home Res 2016;2:76-82

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Objectives: To determine and compare the frequency of undernutrition in institutionalized elderly patients with neurological diseases at admission using different nutritional assessment tools. Design: Cross-sectional observational study. Setting: One long-term care institution specialized in neurodegenerative diseases. Participants: 92 Elderly people (aged ≥ 65 years) with at least one neurological condition. Measurements: Mini Nutritional Assessment (MNA), body mass index (BMI), mid-arm (MAC) and calf circumferences (CC) were used for nutritional status assessment. Presence and severity of dysphagia, polypharmacy and feeding difficulties were also assessed. Results: According to MNA, 77.1% of the participants were undernourished at admission. BMI identified 46.8%, MAC identified 44.6% and CC identified 22.8% of undernourished participants. Undernutrition was more frequent in Alzheimer’s disease, stroke and dementia syndromes. 63% had dysphagia for at least one food consistence and most of these patients were malnourished. MNA revealed best concordance with BMI and MAC than with CC. BMI and feeding difficulties were the major risk factors for undernutrition. Conclusion: Undernutrition prevalence in institutionalized elderly with neurological diseases at admission is high. Nutritional assessment tools revealed low concordance between them.

CITATION:
D. Miranda ; R. Cardoso ; R. Gomes ; I. Guimarães ; D. de Abreu ; C. Godinho ; P. Pereira ; J. Domingos ; N. Pona ; J.J. Ferreira (2016): Undernutrition in institutionalized elderly patients with neurological diseases: comparison between different diagnostic criteria. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.11

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FALLS AND FEAR OF FALLING IN NURSING HOME RESIDENTS WITH HUNTINGTON’S DISEASE

K. Kalkers, J.C.L. Neyens, R. Wolterbeek, R.J.G. Halfens, J.M.G.A. Schols, R.A.C. Roos

Jour Nursing Home Res 2016;2:83-89

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Background: Almost half of nursing home residents with Huntington’s disease experience fall incidents. There is little knowledge about fear of falling in patients with Huntington’s disease. Objectives: To explore incidence of falling and the association with fear of falling in nursing home residents with Huntington’s disease compared to other nursing home residents. A secondary objective is to explore changes in incidence of falling and prevalence of fear of falling in a 24-month follow-up period in a subgroup of longitudinally followed HD-residents. Design: Cross-sectional multi-centre point prevalence study of relevant care problems including falls, known as the Dutch National Prevalence Measurement of Care Problems in 2012, 2013 and 2014. Setting: Eight Dutch nursing homes belonging to one organization. One of these nursing homes cares exclusively for Huntington residents. Participants: 57 Huntington residents and 404 non-Huntington residents were included over a two-year period; 30 Huntington residents participated in three consecutive measurements. Measurements: Residents’ characteristics, fall incidence and health problems after a fall were prospectively assessed for 30 days. Fear of falling and avoiding activities were measured by a single-item question. Results: The percentage of fallers among the Huntington residents (30%) was significantly higher (p<0.001) compared to the non-Huntington residents (10%). The percentage of Huntington residents expressing fear of falling was significantly lower (p<0.05, 14% versus 30%). Logistic regression analysis revealed that interaction between the Huntington and non-Huntington group and age was significant (odds ratio 0.91, p-value 0.02). Fewer Huntington residents than non-Huntington residents experienced fear of falling, a difference which increased with age. The percentages of avoiding activities did not differ between the two groups. Huntington residents were more care-dependent than non-Huntington residents. Huntington versus non-Huntington residents and care dependency were significant predictors for avoiding activities, after controlling for resident characteristics. A cohort of 30 Huntington residents followed longitudinally for 24 months showed significant changes in fear of falling: an increase in the first 12 months and a decrease in the second 12 months. Conclusions: Although fall incidents were more common in Huntington residents than in non-Huntington residents, Huntington residents were less fearful of falling. Possible explanatory factors are age and care dependency. Future research should include cognitive functioning and insight into deficits as factors possibly contributing to fear of falling.

CITATION:
K. Kalkers ; J.C.L. Neyens ; R. Wolterbeek ; R.J.G. Halfens ; J.M.G.A. Schols ; R.A.C. Roos (2016): Falls and Fear of Falling in Nursing Home Residents with Huntington’s Disease. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.12

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QUANTITY OF STAFF AND QUALITY OF CARE IN DUTCH NURSING HOMES: A CROSS-SECTIONAL STUDY

R. Backhaus, E. van Rossum, H. Verbeek, R.J.G. Halfens, F.E.S. Tan, E. Capezuti, J.P.H. Hamers

Jour Nursing Home Res 2016;2:90-93

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he general belief is that the number of total staff hours per resident day (HPRD) and the staff mix (% registered nurses/total staff) are associated with quality of care (QoC) in nursing homes. However, findings from studies examining these relationships are inconsistent. In this brief report, we present findings from a cross-sectional, observational study on the relationship between HPRD and clinical as well as staff-reported QoC indicators. Data were collected in 55 nursing home wards that participated in the Dutch Prevalence Measurement of Care Problems in April 2014. We conducted adjusted (multilevel) logistic regression analyses for clinical outcomes and multilevel linear regression analyses for staff perception of QoC. Overall, we were unable to demonstrate a relationship between HPRD and QoC. Our findings underscore that focusing on quantity of nursing care might not improve QoC in nursing homes. The quality of the team should be taken into consideration as well.

CITATION:
R. Backhaus ; E. van Rossum ; H. Verbeek ; R.J.G. Halfens ; F.E.S. Tan ; E. Capezuti ; J.P.H. Hamers (2016): QUANTITY OF STAFF AND QUALITY OF CARE IN DUTCH NURSING HOMES: A CROSS-SECTIONAL STUDY. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.13

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DAILY PHYSIOTHERAPEUTIC EXERCISE FOR NURSING HOME RESIDENTS WITH ACTUAL FALL RISK; FEASIBILITY AND EFFECT ON FALL FREQUENCY AND ENDURANCE. A MULTICENTER BEFORE-AFTER DESIGN

R.B. Veenhuizen, T. Hogeveen, L.W. van Buul, E.M. Wattel, C.M.P.M. Hertogh

Jour Nursing Home Res 2016;2:94-96

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In this study exercise is investigated as preventive action for falling. Frequently falling nursing home residents exercised for 2 months on a daily basis under the guidance of a physiotherapist, who measured endurance with the 6 minute walking test, and kept a track record of falling incidents and attendance to the exercise group. 15 Nursing homes participated in this study. A total of 63 residents with falls in the previous 2 months enrolled in the study. The number of falls decreased from 67 per month to 25 in the second month of the intervention and to 43 in the first month after cessation of the intervention. The majority of the patients had a significant increase in endurance. This study suggests that a moderately intensive exercise program may lead to a significant reduction of falls. Further research, involving a control group, is warranted to support these findings.

CITATION:
R.B. Veenhuizen ; T. Hogeveen ; L.W. van Buul ; E.M. Wattel ; C.M.P.M. Hertogh (2016): Daily physiotherapeutic exercise for nursing home residents with actual fall risk; feasibility and effect on fall frequency and endurance. A multicenter before-after design. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.14

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BODY-WEIGHT AND NUTRITIONAL-STATUS CHANGES IN SOUTH AUSTRALIAN NURSING-HOME RESIDENTS

T. Arjuna, N.D. Luscombe-Marshh, K. Lange, A.C. Kang, P. Hickman, C. Edwards, S. Reid, I. Chapman, S. Soenen

Jour Nursing Home Res 2016;2:97-103

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To characterize body weight and nutritional status of a cohort of elderly nursing home residents in Adelaide, South-Australia, and the factors associated with changes in these measures over 6-12 months. Design: Retrospective study. Setting: Nursing homes affiliated with a single provider of aged care. Participants: Residents aged 87±8years. Measurements: Age, gender, body weight and body mass index (BMI), pain, length of stay, and nutritional status assessed by malnutrition universal screening tool (MUST), were obtained from a data base. Changes in these parameters over 6 to 12 months were determined, as were factors associated with weight change. Results: 1,020 residents were in the 6-months retrospective analysis, and a subset of 752 residents in the 12-months sub-group. The average weight and BMI for the overall cohort were 66±16kg and 25±6kg/m2. Almost 30% of residents were at medium or high nutritional risk (14% and 16%). Body weight decreased 0.4±4.1kg (0.5±6.4%) over 6-months (P=0.006) and 0.9±5.2kg (1.3±7.8%) over 12-months (P<0.001). 46% of residents had marked weight change (≥ 5% loss or gain) over 12-months. Residents in the lowest BMI tertile (≤23kg/m2) were most likely to experience both marked weight change (52%) and weight reduction (30%). Weight loss was associated with higher pain scores (P=0.012) and greater length of stay in the nursing home (P=0.002). Conclusion: On average these older people lost weight, with high rates of both substantial weight loss and gain, particularly among those in the lowest BMI tertile. Almost a third in the lowest BMI tertile lost 5% or more body weight, putting them at increased risk of undernurition-related morbidity, suggesting greatest attention to prevent and treat such morbidity should be focused on that group.

CITATION:
T. Arjuna ; N.D. Luscombe-Marsh ; K. Lange ; A.C. Kang ; P. Hickman ; C. Edwards ; S. Reid ; I. Chapman ; S. Soenen (2016): Body-weight and nutritional-status changes in South Australian nursing-home residents. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.15

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RELATION OF STOP AND WATCH TOOL USE IN A SKILLED NURSING FACILITY TO 30-DAY HOSPITAL TRANSFER RATES

C.H. Lee, V. Gruss, M. Stuercke, C.J. Ryan

Jour Nursing Home Res 2016;2:104-109

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Background: Hospital readmissions in nursing home populations are rising every year. Little is known of how to prevent such hospital readmissions. The study’s purpose was to explore the relation of communication on 30-day readmission rates via the Stop and Watch (SW) Tool with Certified Nursing Assistants (CNAs) in the Interventions to Reduce Acute Care Transfers (INTERACT) program: a program implemented in skilled nursing facilities (SNFs). Objectives: The objectives were: describe the relation of the INTERACT SW Tool Use among admission/readmission patients and correlate outcomes on 30-day hospital readmission rates. Design: Quality improvement project. Setting: 234-bed skilled nursing facility in a large Chicago urban area in the United States; 3-unit facility with 91% occupancy. Participants: Licensed/registered nurses (N = 11) and CNAs (N = 21) on SNF unit with 80 residents. Intervention: INTERACT protocol, including identification of admission patients; CNAs’ daily monitoring of admission/readmission patients using the SW Tool; and licensed nurses’ review of SW Tool daily reports and follow-ups. Measurements: SW Tool use from each day, evening, and night shift; number of transfers to hospitals for readmission; and communication between CNAs and licensed nurses measured as SW Tool leading to a Situation, Background, Assessment, and Recommendation (SBAR) communication form. Results: For the four-month study period, 30-day readmission rates in the study unit decreased to 34% from over 50% at baseline. Readmission rates were associated with consistent SW Tool use (p = .007, Pearson Correlation = -0.304). Conclusions: 30-day transfer rates are reduced by CNAs’ consistent use of the SW Tool.

CITATION:
C.H. Lee ; V. Gruss ; M. Stuercke ; C.J. Ryan (2016): Relation of Stop and Watch Tool Use in a Skilled Nursing Facility to 30-Day Hospital Transfer Rates . The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.16

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WORKER INJURIES IN NURSING HOMES: IS SAFE PATIENT HANDLING LEGISLATION THE SOLUTION?

K.L. Lapane, C.E. Dubé, B.M. Jesdale

Jour Nursing Home Res 2016;2:110-117

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In 2012, nursing homes were considered the most dangerous workplaces in the United States. While other industries have guidelines that limit manual lifting of stable objects to ≤50 pounds, the same is not so in the nursing home industry where residents requiring physical assistance may weigh over 250 pounds and where the prevalence of obesity among residents is increasing. Safe patient handling legislation in nursing homes has been enacted in nine of the United States since 2005 (Hawaii, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, and Texas). This paper reviews the problem of worker injuries in nursing homes, describes the legislation passed to address the problem, and reviews the data available on the effectiveness of the legislation. No national studies evaluating the effectiveness of safe patient handling state policies on nursing home injuries exists, although the National Institute on Occupational Safety and Health has recently funded a national evaluation.

CITATION:
K.L. Lapane ; C.E. Dubé ; B.M. Jesdale (2016): WORKER INJURIES IN NURSING HOMES: IS SAFE PATIENT HANDLING LEGISLATION THE SOLUTION?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.17

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POOR NUTRITIONAL STATUS IS ASSOCIATED WITH WORSE ORAL HEALTH AND POORER QUALITY OF LIFE IN AGED CARE RESIDENTS

C. Hugo, N. Cockburn, P. Ford, S. March, E. Isenring

Jour Nursing Home Res 2016;2:118-122

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Objective: As previous studies have used a variety of outcome measures and assessment tools, the relationship between nutrition and oral health in residents of aged care facilities is unclear. The aim of this study was to investigate the association of oral health status and oral health-related quality of life (OHRQol) with nutritional status among residents of aged care facilities using validated assessment tools. Design: Prospective cross-sectional clinical investigation of 65 aged care residents (>65 years). Setting: Two residential aged care facilities from Southeast Queensland, Gold Coast region, Australia. Measurements: An aged care dietitian conducted nutritional assessments using the Subjective Global Assessment (SGA). An oral health therapist performed assessments using the Oral Health Assessment Tool (OHAT) and geriatric oral health assessment index (GOHAI). Results: Of the 65 older adults, almost two thirds (62%; n=38) were malnourished; (55%; n=34 moderately malnourished and 7%; n=4 severely malnourished). Using OHAT, 82% (n=41) needed a dental referral. Malnutrition was strongly associated with poor OHRQoL (p=0.007). Edentulous (no teeth) participants were more likely to limit their contact with others due to their dentures (p=0.025) and in turn, negatively impact OHRQoL. More people who had decayed or broken natural teeth (77%) (p=0.041) had trouble eating firm foods than those who had healthy natural teeth (23%). Modified diet texture was associated with poor nutritional status (p<0.001). Access to dentists in RACFs was an identified barrier to both optimal oral health and nutritional status. Conclusion: Both malnutrition and poor oral health were common in this sample of aged care residents which contributed to poor OHRQoL. Our findings show the SGA, OHAT and GOHAI instruments are appropriate and acceptable for assessing nutrition and oral health in this population. Further research needs to investigate if early and regular oral health assessments and treatments can improve or minimise deterioration in nutritional status in aged care residents. Recommendations for future practice include increasing training and education of RACFs in terms of oral health care and its connection with nutritional status and quality of life, increased access to dental professionals in RACFs and the importance of concurrent referrals to dietitians when dental issues are identified.

CITATION:
C. Hugo ; N. Cockburn ; P. Ford ; S. March ; E. Isenring (2016): Poor nutritional status is associated with worse oral health and poorer quality of life in aged care residents. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2016.18

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