Ahead of print articles
JNHR, Volume 5, 2019
POOR DENTAL HEALTH AND CRUSHED DRUGS IN NURSING HOME RESIDENTS
S. Pasqualini, A.M. Barisic, M. Serris, C. Rio, I. Prêcheur
Jour Nursing Home Res 2019;5:76-79Show summaryHide summary
Some older adults with a poor dental state, but not suffering from swallowing disorders (dysphagia), could be given crushed drugs unnecessarily, just because they are given texture modified food. Thirty-nine residents were included in this analysis of nursing home practices: mainly women (28/39); mean age 86.8 +/-7.7; Groupe Iso-Ressource (GIR) 1.7 +/- 0.6; Mini Mental State (MMS) 16.5 +/- 6.0; crushed drugs 26/38; swallowing disorders 14/39; mixed and mashed food 25/38. Crushed drugs were associated with mixed and mashed food (P = 0.001), male gender (P = 0.008) and lower mastication ability (P = 0.015), but not with swallowing disorders (P = 1). Seventeen patients not recorded as having swallowing disorders were given crushed drugs. In conclusion, a poor dental health is frequently but not systematically related to swallowing disorders. This is not an indication for crushing drugs, because tablets and capsules don’t have to be chewed before being swallowed.
S. Pasqualini ; A.M. Barisic ; M. Serris ; C. Rio ; I. Prêcheur (2019): POOR DENTAL HEALTH AND CRUSHED DRUGS IN NURSING HOME RESIDENTS. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.13
FEAR OF CHOKING AND FEAR OF FALLING IN HUNTINGTON’S DISEASE: STUDY PROTOCOL FOR A MULTI-CENTER OBSERVATIONAL CROSS-SECTIONAL STUDY
K. Kalkers, J.M.G.A Schols, J.C.L. Neyens, R.A.C. Roos
Jour Nursing Home Res 2019;5:68-75Show summaryHide summary
Background: Dysphagia and accidental falls are common in patients with Huntington’s disease; they can have serious consequences and may, therefore lead to fear of choking and fear of falling. Objectives: In this article, a protocol is described to explore the prevalence of fear of choking and fear of falling in patients with Huntington’s disease, to identify the relationship between fear of choking and fear of falling and, respectively, anxiety, awareness and cognitive functioning and to define the care demands with regard to fear of choking and fear of falling. In addition, the related problems encountered by their (in)formal caregivers are investigated. Design: This study protocol describes a multi-center observational cross-sectional study. Participants: Our aim is to include 150 patients with Huntington’s Disease living in or attending day care in Dutch nursing homes specialized in Huntington’s Disease and their (in)formal caregivers. Setting: Dutch nursing homes, specialized in long-term care for patients with Huntington’s Disease. Measurements: The patients will be assessed by means of questionnaires enquiring about mobility, swallowing and their feelings and experiences related to these topics, a mobility task, a cognitive screening and a neurological examination. Other patient information will be derived from regular patient files, registered by formal caregivers. Data about fear of choking and fear of falling from the formal and informal caregiver’s perspective will be obtained by means of self–administered questionnaires. Conclusions: This study may contribute to improving insight into the cognitive, emotional and behavioral functioning of patients with Huntington’s disease. The findings may lead to relevant interventions for patients or support advice for caregivers, with regard to adequate coping strategies for risk-taking behavior.
K. Kalkers ; J.M.G.A Schols ; J.C.L. Neyens ; R.A.C. Roos (2019): Fear of choking and fear of falling in Huntington’s disease: study protocol for a multi-center observational cross-sectional study . The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.12
PREDICTING 30-DAY MORTALITY AND 30-DAY RE-HOSPITALIZATION RISKS IN MEDICARE PATIENTS WITH HEART FAILURE DISCHARGED TO SKILLED NURSING FACILITIES: DEVELOPMENT AND VALIDATION OF MODELS USING ADMINISTRATIVE DATA
L. Li, J. Baek, B.M. Jesdale, A.L. Hume, G. Gambassi, R.J. Goldberg, K.L. Lapane
Jour Nursing Home Res 2019;5:60-67Show summaryHide summary
Background: Despite the growing importance of skilled nursing facility care for Medicare patients hospitalized with heart failure, no risk prediction models for these patients. Objectives: To develop and validate separate predictive models for 30-day all-cause mortality and 30-day exist all-cause re-hospitalization. Design: Retrospective cohort study using nationwide Medicare claims data cross-linked with Minimum Data Set 3.0. Setting: 11,529 skilled nursing facilities in the United States (2011-2013). Participants: 77,670 hospitalized heart failure patients discharged to skilled nursing facilities (randomly split into development (2/3) and validation (1/3) cohorts). Measurements: Using data on patient sociodemographic and clinical characteristics, health service use, functional status, and facility-level factors, we developed separate prediction models for 30-day mortality and 30-day re-hospitalization using logistic regression models in the development cohort. Results: Within 30 days, 6.8% died and 24.2% were re-hospitalized. Thirteen patient-level factors remained in the final model for 30-day mortality and 10 patient-level factors for re-hospitalization with good calibration. The area under receiver operating characteristic curves were 0.71 for 30-day mortality and 0.63 for re-hospitalization in the validation cohort. Conclusions: Among Medicare patients with heart failure discharged to skilled nursing facilities, our predictive model based on administrative data may be used to identify those at risk for dying within 30 days, which could aid clinicians and family members in improving care for patients with heart failure during this vulnerable period. Further work identifying factors for re-hospitalization remains needed.
L. Li ; J. Baek ; B.M. Jesdale ; A.L. Hume ; G. Gambassi ; R.J. Goldberg ; K.L. Lapane (2019): Predicting 30-day mortality and 30-day re-hospitalization risks in Medicare patients with heart failure discharged to skilled nursing facilities: development and validation of models using administrative data. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.11
DERMATOLOGICAL CONSULTATIONS IN A NURSING HOME
M.S. Klapwijk, S.T.P. Kouwenhoven, W.P. Achterberg, M.H. Vermeer
Jour Nursing Home Res 2019;5:56-59Show summaryHide summary
Skin diseases are predominantly non-lethal, but can have a significant impact on quality of life in older people living in a nursing home. This short report shows the results of consultations of a dermatologist visiting people in a nursing home. The frequency of the visits was 3-4 times a year, from June 2013 to December 2016. This is the description of all consultations of fifty residents, seen during eleven visits, 53 treatment plans were made. Sixty percent of consults were on suspected oncological conditions and treatment decisions were often more reticent due to impairment in mobility, life expectancy and comorbidities. The model (visiting dermatologist in nursing home) was evaluated as very valuable complementary care alongside normal dermatological care provided by the physician in the nursing home and the possibility of telemedicine. This type of palliative dermatological care in cooperation between a hospital and a nursing home is worth being studied.
M.S. Klapwijk ; S.T.P. Kouwenhoven ; W.P. Achterberg ; M.H. Vermeer (2019): Dermatological consultations in a nursing home. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.10
MEDICAL DIAGNOSIS DOES NOT INFLUENCE FOOD INTAKE IN FRAIL LONG-TERM CARE RESIDENTS
W.S. Barkema, G.A. Heckman, S.E. Slaughter, N. Carrier, C.O. Lengyel, H.H. Keller
Jour Nursing Home Res 2019;5:49-55Show summaryHide summary
Background: Frailty is common in long-term care (LTC) and leads to decreased survival. Certain diagnoses (asthma, heart failure (HF)), Chronic Obstructive Pulmonary Disease (COPD), depressive symptoms and chronic renal failure) are associated with frailty. Objective: This study investigated food and fluid intake of residents with certain diagnoses and if the conditions were independently associated with food intake. Design & participants: Cross-sectional study with 633 participants’ where three days of weighed food and fluid intake were observed. T-tests and multiple linear regression were used to analyze associations between energy, protein, fluid and Mean Adequacy Ratio (MAR) and diagnoses and their multi-morbidity. Covariates included age, BMI, sex, cognition, eating challenges, therapeutic diets, total medications, modified diet texture, malnutrition, oral health status affecting food intake and dysphagia risk. Results: Diet quality was moderate (MAR = 0.78-0.80) and mean daily energy, protein and fluid were 1554 (±295) kcal, 57.4 (±13.0) grams, and 1102 (±383) ml respectively. Diagnoses were not associated with energy, protein or fluid intake or MAR after adjusting for covariates. However, significantly higher fluid intake was seen in residents with HF (p=0.014) and multiple selected diagnoses (p =0.011) as compared to those without. Conclusion: Diagnoses were found to be irrelevant for explaining food and fluid intake of LTC residents. Other covariates, potential symptoms of the condition (e.g., dysphagia), were associated with intake, suggesting that the stage of frailty may be more relevant than the diagnoses leading to frailty with respect to food intake.
W.S. Barkema ; G.A. Heckman ; S.E. Slaughter ; N. Carrier ; C.O. Lengyel ; H.H. Keller (2019): MEDICAL DIAGNOSIS DOES NOT INFLUENCE FOOD INTAKE IN FRAIL LONG-TERM CARE RESIDENTS. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.9
DEPRESSION, ANXIETY, AND PAIN AMONG NEWLY ADMITTED NURSING HOME RESIDENTS
C.M. Ulbricht, J.N. Hunnicutt, A.L. Hume, K.L. Lapane
Jour Nursing Home Res 2019;5:40-48Show summaryHide summary
Background: Depression, anxiety, and pain are commonly experienced by older adults living in nursing homes. Objectives: To describe the prevalence of depression, anxiety disorders, and pain among newly admitted nursing home residents in the United States and to describe the treatment of these disorders. Design: Cross-sectional study of newly admitted residents. Setting: Residents able to complete a pain assessment (n=783,826) living in Medicare- and Medicaid-certified nursing homes in the United States in 2011-2012. Measures: Measures of sociodemographic, mood and behavior, pain, diagnoses, and functioning items from the Minimum Data Set (MDS) version 3.0. Results: Approximately 36% of residents had a diagnosis of depression (other than bipolar disorder) and/or an anxiety disorder (n = 272,311). Of these residents, 25.2% had both depression and an anxiety disorder (95% CI = 25.0-25.4%), 54.3% (95% CI = 54.1-54.5%) had depression without an anxiety disorder, and 20.5% had an anxiety disorder without depression (95% CI = 20.3-20.6%). Fifteen percent had the triad of depression, anxiety, and pain at admission (95% CI = 9.3-23.3%). Depressive symptoms were more commonly reported by residents with pain than by those without pain. Receipt of psychological therapy (range: 0.9%-2.0%) or any psychiatric medication was lacking (range: 35.3%-48.5%), regardless of pain status. Participants reporting pain received a combination of scheduled, pro re nata (PRN)/as-needed, and non-medication pain interventions (range: 59.8% depression without anxiety to 62.9% depression and anxiety disorder). Conclusion: Residents often suffer from combinations of depression, anxiety, and pain at admission to nursing home. While treatment of pain is more common than treatment of psychiatric treatments, both psychiatric treatment and pain management may be suboptimal in nursing homes.
C.M. Ulbricht ; J.N. Hunnicutt ; A.L. Hume ; K.L. Lapane (2019): Depression, Anxiety, and Pain among Newly Admitted Nursing Home Residents. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.8
FACTORS INFLUENCING AUTONOMY OF NURSING HOME RESIDENTS WITH DEMENTIA: THE PERCEPTION OF FAMILY CAREGIVERS
L.J.M Hoek, J.C.M. van Haastregt, E. de Vries, R. Backhaus, J.P.H. Hamers, H. Verbeek
Jour Nursing Home Res 2019;5:33-39Show summaryHide summary
Background: Being able to live the life you want to live within a nursing home might be challenging for residents with dementia, as they become dependent on others in achieving autonomy. However, little is known about which factors support or impede resident autonomy within nursing homes. Objectives: The purpose of this study was to gain insight into factors that support or impede autonomy for nursing home residents with dementia, from the perspective of their family caregivers. Design: A qualitative study was conducted. Setting: Five psychogeriatric nursing home wards within three care organizations in the Netherlands. Participants: 30 family caregivers. Measurements: Semi-structured interviews were held and a qualitative thematic approach was used. Findings: This study identified several factors that seemed to influence resident autonomy within six themes: activities; personal approach; visits from family and friends; being part of a group; physical environment; and organization of care. Within these themes, factors were mentioned that could either support or impede resident autonomy. For example, being socially engaged with family and fellow residents and participation in meaningful activities were supporting factors. The inability to go outside when wished or having inadequate private space were impeding factors. Overall, daily life was mostly organized from a communal and task-centered perspective instead of adaptation to individual preferences. Conclusions: The current study suggests that in order to improve the support of resident autonomy, nursing homes should focus on flexibility in providing care, finding ways to offer meaningful activities, and stimulating resident’s social environment to continue social traditions.
L.J.M Hoek ; J.C.M. van Haastregt ; E. de Vries ; R. Backhaus ; J.P.H. Hamers ; H. Verbeek (2019): Factors Influencing Autonomy of Nursing Home Residents with Dementia : The perception of Family Caregivers. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.7
DEVELOPMENT OF A NEW DEVICE FOR IDENTIFICATION OF NUTRITIONAL NEEDS OF DYSPHAGIC INPATIENTS
F. Bortolazzi, A. Calabrò, M. Pesce, U. Tortorolo, T.F. Piccinno, M. Masini, C. Chiorri
Jour Nursing Home Res 2019;5:27-32Show summaryHide summary
Objectives: Dysphagia in elderly patients can cause serious health problems. The aim of this study was to investigate the effects of a new method for the identification of the elderly dysphagic patient. We hypothesized that a simple identification device could reduce errors in providing food and therefore reduce negative outcomes. Design: Two group of participants were enrolled (experimental and control). Each patient received a diagnosis of the severity of his/her own dysphagia disorder on a scale ranging from 1 (no swallowing problem) to 5 (unable to swallow). Inpatients of the experimental group only worn a bracelet with a specific color code for each level of the dysphagia disorder. Operators were trained to check the bracelet color and provide the corresponding diet to the patients. Participants were tested three times over a two months period. Setting: The participants were hospitalized in three nursing homes of the same institute. The colored bracelet method was adopted in two of these nursing homes. Participants: Fifty-five participants were enrolled for the study (44 in the experimental group, 78% female, mean age = 88.9±6.6 years). Forty-two operators (86% female, 64% of age between 36 and 55)) filled in an evaluation questionnaire. Measurements: Several measures of nutrition, hydration, and clinical condition were collected. Results: The method significantly improved hydration (p = .002) and BMI (p = .010) and reduced the risk of bedsore (p < .001) of the patients. Conclusion: The colored bracelet method is an effective instrument for managing the diet of elderly dysphagic inpatients.
F. Bortolazzi ; A. Calabrò ; M. Pesce ; U. Tortorolo ; T.F. Piccinno ; M. Masini ; C. Chiorri (2019): Development of a new device for identification of nutritional needs of dysphagic inpatients. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.6
RISE IN ASSISTED LIVING LAWSUITS INDICATES THE NEED FOR A CONSUMER-CENTERED MODEL OF CARE
M. Fetterolf, P. Kao, N. Castle
Jour Nursing Home Res 2019;5:24-26Show summaryHide summary
Across the United States, 60% of Assisted Living administrators noticed an increase in legal claims; meanwhile nearly 75% noticed an increase in lawsuits and 71% noticed an increase in settlements. This article asks whether or not the rise in legal pressure may be attributed to a higher proportion of residents with moderate to severe cognitive impairment in Assisted Living. More broadly, the findings indicate that there is a lack of consumer choice and solutions for the elderly in need of long-term services. As a short-term option to mitigate the rise in legal pressure, long-term facilities could explore ways to work with residents in defining various thresholds of care that are safe, sustainable and economically sound whilst preserving certain aspects of residents’ desired lifestyles. Over the long term, the United States needs to develop innovative options for the provision of long-term care services with a focus on redesigning care for older adults with their input. The consequences of such a positive change are examined.
M. Fetterolf ; P. Kao ; N. Castle (2019): Rise in assisted living lawsuits indicates the need for a consumer-centered model of care. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.5
PROFIT MAXIMIZATION AND NURSE STAFFING STANDARDS/LEVELS IN FOR-PROFIT AND NOT-FOR-PROFIT NURSING HOMES
O.O. Omotowa, L.C. Hussey
Jour Nursing Home Res 2019;5:21-23Show summaryHide summary
Profit maximization is a significant factor affecting adherence to adequate staffing standards and actual staffing levels of nursing staff in many nursing homes in the United States. Studies have shown that inadequate nurse staffing is worse in the for-profit than not-for-profit nursing homes and, is adversely affecting resident care outcomes. The purpose of this report is to examine the literature and establish the impact of profit maximization on nurse staffing with a focus on the differences between for-profit, not-for-profit, and religious-based nursing homes in the United States. Databases such as CINAHL Plus, Business Source Complete, Medline Complete, Academic Search Complete, ProQuest Nursing, Allied Health Source, and Google Scholar were used as sources for information collection. Compared to other types of nursing homes, findings showed that for-profit nursing homes are doing better financially but worse on care outcomes. It is important that nursing homes regulators enforce strict adherence to staffing standards for optimal quality of care outcomes.
O.O. Omotowa, ; L.C. Hussey (2019): Profit Maximization and Nurse Staffing Standards/Levels in For-Profit and Not-For-Profit Nursing Homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.4
GER-E-TEC: TELEMONITORING PROJECT FOR ELDERLY RESIDENTS IN NURSING HOMES
A.A. Zulfiqar, A. Hajjam, B. Gény, S. Talha, M. Hajjam, J. Hajjam, S. Ervé, D. Letourneau, E. Andrès
Jour Nursing Home Res 2019;5:20Show summaryHide summary
A.A. Zulfiqar ; A. Hajjam ; B. Gény ; S. Talha ; M. Hajjam ; J. Hajjam ; S. Ervé ; D. Letourneau ; E. Andrès (2019): GER-e-TEC: Telemonitoring project for elderly residents in nursing homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.3
EXPLORING THE TRAJECTORIES OF QUALITY OF LIFE AND ITS COVARIATES IN NURSING HOME RESIDENTS: A LONGITUDINAL STUDY
I. Røen, J. Šaltyté Benth, Ø. Kirkevold, I. Testad, G. Selbæk, K. Engedal, S. Bergh
Jour Nursing Home Res 2019;5:8-19Show summaryHide summary
Background: There is no cure for dementia and appropriate care should be offered to improve or maintain quality of life for those living with dementia. Objectives: To identify groups of residents following similar trajectories of quality of life after nursing home admission, to examine which resident, staff, and organizational characteristics at baseline differ between the identified groups, and to assess the associations between the trend in quality of life and the same characteristics measured at baseline and over the study period. Design: A prospective, observational, longitudinal cohort design over 30 months. Setting: Nursing homes in Norway. Participants: Residents admitted to nursing homes. Measurements: Resident data on quality of life, dementia, pain, activities of daily living, physical health, neuropsychiatric symptoms, medication, and demographic characteristics were obtained by interviews. Unit characteristics and the staff data on person-centered care, psychosocial factors, and job satisfaction were obtained by questionnaires and interviews. The physical environment of the unit was assessed by structured observation. Results: 694 residents admitted to a nursing home and 1161 staff from 175 nursing home units participated. Three resident groups following similar trajectories in quality of life were identified by growth mixture model; good quality of life (53.6%), moderate quality of life (32.9%), and poor quality of life (13.4%). All groups’ quality of life decreased over time. More pain, more severe dementia, and more affective symptoms at baseline were associated with belonging to the poor quality of life group. Overall decline in quality of life was associated with more severe dementia, more pain, poorer function in activities of daily living, more severe neuropsychiatric symptoms among residents, and poorer job satisfaction among staff. Conclusion: Reducing pain, reducing NPS, improving activities of daily living for the residents, and improving the staff’s job satisfaction may be factors of importance to improve the residents’ quality of life.
I. Røen1 ; J. Šaltytė Benth ; Ø. Kirkevold ; I. Testad ; G. Selbæk ; K. Engedal ; S. Bergh (2019): Exploring the trajectories of Quality of Life and its covariates in nursing home residents: A longitudinal study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.2
THE MEANING OF THE DEATH AND DYING OF TAIWANESE NURSING HOME RESIDENTS: THE NURSING STAFF’S VIEW
S.L. Tsai, J.F. Stocker, C.H. Tsai, S.H. Yeh
Jour Nursing Home Res 2019;5:1-7Show summaryHide summary
Background: The number of people living in long-term care (LTC) facilities has been rising in many parts of the world, and most current residents will end their lives in LTC facilities. The perceptions of residential care and practices in most current research of nursing homes (NHs) in Taiwan are based on evidence from an ego-centric rather than socio-cultural-centric model. Objectives: This study was designed to address the overlooked cultural aspect in NHs research and thereby advance understanding of how the NH staff in an East Asian setting perceive NH resident death and dying. Design: A qualitative study was designed in line with the hermeneutic phenomenological method. Data were collected via in-depth semi-structured interviews. Setting: The research was conducted in five hospital affiliated nursing homes and seven independent nursing homes in central and southern Taiwan. Participants: Through purposive sampling, twenty-five participants were recruited for interview, twelve registered nurses (RNs) and thirteen nursing aides (NAs). Measurements: An interview guide was used to produce the digitally-recorded contents, which was then transcribed verbatim and translated. The hermeneutic phenomenological analysis was conducted such that authors went back and forth through every interview text (parts) and the research questions (whole) until they reached a comprehensive understanding of the subject matter in terms of reduced, emerging themes. Results: Four themes were identified in the data analysis. They were ‘impact of a resident’s death,’ ‘reflections on entangled feelings,’ ‘insufficiencies.’ and ‘tremendous pressure of informing death.’ Conclusion: This qualitative study confirmed previous findings of non-Asian studies about the significance of ‘assessment of dying’ and ‘family communication’ in quality NH care. In addition, NH nurses were in need of palliative training in dying care. The nurses’ felt pressure due to family requests to send residents home for their ‘last breath,’ which was both the nurses’ most challenging work of care and the most culturally grounded aspect of it.
S.L. Tsai ; J.F. Stocker ; C.H. Tsai ; S.H. Yeh (2019): The meaning of the death and dying of Taiwanese nursing home residents: the nursing staff’s view. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2019.1