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JNHR, Volume 4, 2018

 

NURSING HOME RESEARCH INTERNATIONAL WORKING GROUP, 13-14 SEPTEMBER, 2018 •ROME, ITALY

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Abstracts (2018): NURSING HOME RESEARCH INTERNATIONAL WORKING GROUP, 13-14 SEPTEMBER, 2018 •ROME, ITALY. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.7

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STAY OR GO: NURSING HOMES’ NATURAL DISASTER RESPONSE IN A CHANGING CLIMATE

D.A. Harris, G.A. Wellenius

Jour Nursing Home Res 2018;4:64-66

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The Centers for Medicare & Medicaid Services (CMS) reported 15,634 certified nursing homes in the United States in 2014. Approximately 1.4 million older adults reside in nursing homes due to a variety of clinical and social factors. Older adults who transition into nursing home care tend to have a greater prevalence of cognitive and physical morbidities, such as cognitive impairment and chronic obstructive pulmonary disease. Given their clinical vulnerabilities, nursing home residents are at an increased risk of adverse events due to climate change. Major hurricane systems over the past several decades have contributed to significant and avoidable loss of life among nursing homes residents. Currently, evidence from both the qualitative and quantitative literatures consistently suggest that the evacuation of nursing homes residents leads to greater morbidity and mortality compared to sheltering in place due to a host of clinical and environmental factors. However, as extreme weather events intensify due to climate change, policy makers, health officials, and nursing homes will need to reassess their disaster plans amidst the increasing risk of facility damage and need for evacuation from worsening storm systems. In this commentary we review the evidence regarding the risks of sheltering in place versus evacuation during extreme weather events and propose that climate-change projections be integrated into the conversation and development of nursing home disaster preparation.

CITATION:
D.A. Harris ; G.A. Wellenius (2018): Stay or Go: Nursing homes’ natural disaster response in a changing climate. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.12

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FOOD SERVICES IN LONG-TERM CARE HOMES ARE ASSOCIATED WITH RESIDENTS’ FOOD INTAKE

C. Lagacé, N. Carrier, L. Villalon, C. Lengyel, S.E. Slaughter, J.M. Morrison, H. Keller

Jour Nursing Home Res 2018;4:56-63

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Background: Food and nutrient intake of Canadian long-term care residents is commonly inadequate. Factors influencing resident food intake and nutritional quality of menus are numerous and those related to food service are often poorly investigated. Objective: To: a) describe food service characteristics of diverse Canadian long-term care homes, b) determine if there are provincial differences in these characteristics, c) determine the association between these characteristics and food intake of residents, and d) determine the association between these characteristics and the nutritional quality of the menus. Design: A cross-sectional study. Setting: Thirty-two long-term care homes in four Canadian provinces (Alberta, Manitoba, New Brunswick and Ontario). Participants: 639 residents. Measurements: Food service operations were reported by home administrators using a standardized questionnaire and summarized by province for analysis. Resident food intake was assessed by weighing and observing intake over three non-consecutive days including one weekend day. Absolute mean energy and protein intake per resident was used in analyses, as well as the nutritional quality of the diet (iMAR). Menus (regular and pureed) were analyzed for nutrient content and compared to the Dietary Reference Intakes to determine the menu Mean Adequacy Ratio (mMAR), a score that summarizes the nutrient quality. Results: Daily energy and protein intake as well as iMAR were not significantly different across provinces. The timing of the biggest meal of the day, the proportion of commercially prepared food and the mMAR score were the only food service variables significantly different between provinces. Homes who reviewed their menus in the past six months (72%), was positively associated with participant’s energy (β=23.0; p=0.02) and protein intake (β=3.1; p=0.03). Food production system was associated with pureed menu mMAR score (F=5.46; p=0.01). Supper as the biggest meal of the day (67.7 %), was negatively associated with participants’ protein intake (β=-16.73; p=0.02) while the pureed menu mMAR score was positively associated with the iMAR score (β=0.61; p=0.01). Conclusion: To promote sufficient intake, effort is needed to ensure menus meet dietary requirements. Most homes provided the largest meal of the day in the evening and this practice appears to lead to lower protein intake. Relatively few food service variables analysed were associated with resident intake, suggesting that others factors (i.e., resident attributes, mealtime environment, etc.) should also be considered.

CITATION:
C. Lagacé ; N. Carrier ; L. Villalon ; C. Lengyel ; S.E. Slaughter ; J.M. Morrison ; H. Keller (2018): Food services in long-term care homes are associated with residents’ food intake. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.11

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IS MALNUTRITION A RISK FACTOR FOR INCIDENT URINARY TRACT INFECTION AMONG OLDER PEOPLE IN RESIDENTIAL CARE FACILITIES?

M. Burman, C. Hörnsten, M. Carlsson, E. Rosendahl, P. Nordström, B. Olofsson, Y. Gustafson

Jour Nursing Home Res 2018;4:49-55

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Background: Malnutrition and urinary tract infections (UTI) are common among older people living in residential care facilities. Objectives: To determine whether malnutrition is a risk factor for incident urinary tract infection in people aged ≥65 years living in residential care facilities. Design, Setting, and Participants: A prospective cohort study of people living in residential care facilities in northern Sweden (N=373). Data from the Frail Older People-Activity and Nutrition and Umeå Dementia and Exercise studies were used. Measurements: Malnutrition was assessed using the Mini Nutritional Assessment (MNA). Risk factors for UTI were explored using univariate and multivariate Cox proportional hazard regression analyses. Maximum follow-up time was 9 months. Results: The incidence of UTI was 460/1000 person-years; 85/276=30.8% of women and 16/97=16.5% of men contracted UTIs. History of UTI (hazard ratio [HR] 2.804, 95% confidence interval [CI] 1.824–4.311), heart failure (HR 2.101, 95% CI 1.368–3.225), hypertension (HR 1.656, 95% CI 1.095–2.504), and low Mini-Mental State Examination (MMSE) score (HR 0.937, 95% CI 0.892–0.985) were associated independently with higher risk of incident UTI in multivariate analyses. Malnutrition was not associated with UTI in the whole sample or in women; MNA score was associated with UTI in men in univariate analysis (HR 0.841, 95% CI 0.750–0.944). Conclusion: The incidence of UTI was high in residential care facilities and individuals with histories of UTI, heart failure, hypertension, or cognitive impairment were more likely to be affected. Malnutrition was not a risk factor for UTI in the whole sample or in women, but may constitute a risk for UTI among men.

CITATION:
M. Burman ; C. Hörnsten ; M. Carlsson ; E. Rosendahl ; P. Nordström ; B. Olofsson ; Y. Gustafson (2018): IS MALNUTRITION A RISK FACTOR FOR INCIDENT URINARY TRACT INFECTION AMONG OLDER PEOPLE IN RESIDENTIAL CARE FACILITIES?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.10

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IMPLEMENTATION OF THE MONTESSORI PROGRAM IN ASSISTED LIVING: POSITIVE OUTCOMES AND CHALLENGES

J. Brush, N. Douglas, M. Bourgeois

Jour Nursing Home Res 2018;4:42-48

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The purpose of this study was to evaluate the impact of the implementation of the Association Montessori Internationale (AMI) Montessori for Dementia and Aging (1) (MDA) program in a memory care Assisted Living community. A pre-post quasi experimental descriptive study was conducted with 29 elders in an assisted living community. The AMI MDA program1 was implemented over the course of one year; adoption of program features was documented pre- and post-implementation. Outcomes for elders included number of neuropsychiatric symptoms due to dementia (Cohen-Mansfield Agitation Inventory (2)), falls, medications and hospitalizations; attitude, attention and engagement (Observational Measure of Engagement (3)), affect (Observed Emotion Rating Scale (4)); and the Dementia Quality of Life Scale (5). The Benjamin Rose Nurse Assistant Job Satisfaction Scale (6) was used to measure employee job satisfaction before and after implementation of the program. After 1 year, the community had adopted 68% of program features compared to 28% at study start. Elders displayed significantly more positive emotions, affect, and feelings of self-esteem and belonging after the intervention; positive trends were documented for increased engagement. Overall, employee job satisfaction was higher after the implementation of the program; barriers to full implementation, however, were identified.

CITATION:
J. Brush ; N. Douglas ; M. Bourgeois (2018): Implementation of the Montessori Program in Assisted Living: Positive Outcomes and Challenges. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.9

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EVALUATING THE IMPACT OF SAFE PATIENT HANDLING AND MOVEMENT LAWS ON NURSING HOME WORKER INJURIES

B.M. Jesdale, S.A. Chrysanthopoulou, C.E. Dubé, Kate L. Lapane

Jour Nursing Home Res 2018;4:36-41

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Objectives: We estimated the impact of safe patient handling legislative efforts to reduce nursing home worker injuries, and examined potential impacts among specific nursing home types. Design: Difference-in-difference analysis. Setting: 2,034 nursing homes in 8 states enacting safe patient handling and movement legislation from 2004 to 2007 and 5,901 nursing homes in 36 comparator states. Measures: Reductions in reported work-related injuries and illnesses resulting in Days Away from work, Restricted job activities, or Transfer (DART) rates per 100 full time equivalents (FTE’s). Facility characteristics included size, profit orientation, chain membership, nursing staffing measures, and location (urbanicity). Results: Among nursing homes in 8 states that enacted legislation, there was a 23.5% decrease in mean DART rate from 7.53 per 100 FTE’s in the pre-enactment period (2002-2003) to 5.76 per 100 FTE’s in the post-enactment period (2008-2010) whereas in 36 comparator states, there was a 24.4% decrease in the mean DART rate, from 8.54 to 6.46 per 100 FTE’s. After adjustment for nursing home and aggregated resident characteristics, a difference-in-difference model showed that DART rates were similar in states with and without legislation (adjusted estimate: 1.03; 95% confidence interval: 0.96 to 1.11), with estimates similar across a range of nursing homes characteristics. Conclusions: The promise of enacting safe patient handling and movement legislation to reduce nursing home worker injuries has yet to be realized. In a context of rapidly declining injury rates, substantial financial incentives, other forms of assistance, and/or enforcement activities may be needed to improve the effectiveness of legislative initiatives.

CITATION:
B.M. Jesdale ; S.A. Chrysanthopoulou ; C.E. Dubé ; Kate L. Lapane (2018): Evaluating the Impact of Safe Patient Handling and Movement Laws on Nursing Home Worker Injuries. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.8

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REHABILITATION CARE AFTER HIP FRACTURE IN OLDER PATIENTS WITH COGNITIVE IMPAIRMENT: SYSTEMATIC REVIEW

T. Krams, C. Lafont, T. Voisin, A. Castex, M. Houles, Y. Rolland

Jour Nursing Home Res 2018;4:27-35

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Background/Objectives: Hip fractures (HF) are frequent in older adults. A substantial number of cognitively impaired patients are admitted to rehabilitation units, where they will receive the same care program as non-impaired patients. The aims of this literature review are to describe the results of short-, medium- and long-term rehabilitation for cognitively impaired patients. Methods: We conducted a systematic review of French and English articles of human studies in MEDLINE via PubMED with the key words “hip fracture“ AND “rehabilitation” AND “dementia“. In a second step, the references of selected articles were analyzed and a complementary search on Google Scholar was conduct for an exhaustive literature search. We extracted data on the author name, the journal, year of publication, study design, total number of patients and number of cognitively impaired patients, mean patient age, time and modality of the cognitive assessment, inclusion and exclusion criteria, rehabilitation program, and primary endpoint. Results: The initial literature search retrieved 147 articles. 16 reports of studies representing 2,255 patients were selected. Our study reveal that multidisciplinary rehabilitation is possible and permits functional gain that persists in the long-term. The intensity of rehabilitation can be as high as for subjects without cognitive impairment. Characteristics of dementia are prognostic factors of rehabilitation (severity of dementia, profile of dementia). Other accessible factors are malnutrition, depression, family. Conclusion: Concerning patients with cognitive impairment, although our data do not permit establishing recommendations for rehabilitation after HF, some important elements emerged from this review. Additional studies are needed to better define rehabilitation programs adapted to the specificities of the different types of dementia.

CITATION:
T. Krams ; C. Lafont ; T. Voisin ; A. Castex ; M. Houles ; Y. Rolland (2018): Rehabilitation care after hip fracture in older patients with cognitive impairment: systematic review. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.6

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THE CAPACITY OF FOOD SERVICE PROVIDERS AS NUTRITION CHANGE AGENTS IN NURSING HOMES

L. Matwiejczyk, O. Farrer, J. Hamilton, M. Miller

Jour Nursing Home Res 2018;4:20-26

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Background: Despite the correlation between the food provided and nursing home residents’ food satisfaction, Quality of Life and health, the capacity of food service providers to enact positive nutrition-related changes is unknown. Objectives: Researchers explored (1) the experiences and perceptions of senior-level food service providers from nursing homes (NH) to elicit change prompted by participation in a national educational intervention (2) the barriers and enablers to eliciting change and (3) practice implications. Design: Using qualitative methodology, individual semi-structured interviews were conducted four months after the intervention and thematically analyzed. Participants: Participants were 23 senior-level food service providers from 21 NH in Victoria, Australia. Results: Participants started with the necessary confidence, knowledge and skills for food provision and three themes that best represent food service providers’ perceived capacity and experience to affect food service changes included: (1) participants’ motivations as change agents (2) empowerment facilitated by external factors (organizational, external and ongoing peer-support) and (3) constraints to enacting change (local and system-wide). Conclusion: Understanding the motivations and experiences of senior food service providers to enact change provides important information on the barriers and enablers which can be used to augment intervention planning and reduce the implementation gap between evidence-based recommendations and practice. A number of underlying mechanisms were identified and recommendations for system-wide changes made. Improvement in food and dining experiences may help to improve residents’ satisfaction with food which has been correlated with improved life satisfaction, health and well-being.

CITATION:
L. Matwiejczyk ; O. Farrer ; J. Hamilton ; M. Miller (2018): Intake rate survey and cooking methods of a novel texture-modified chicken designed for a soft diet. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.5

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TREATMENT OF ATRIAL FIBRILLATION IN NURSING HOMES: A PLACE FOR DIRECT ACTING ORAL ANTICOAGULANTS?

M. Alcusky, K.L. Lapane

Jour Nursing Home Res 2018;4:15-19

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Atrial fibrillation affects ~1 in 6 long-term nursing home residents. After an ischemic stroke hospitalization, ~2/3 of nursing home residents receive skilled nursing care and functional independence continues to decline, a process often complicated by rehospitalization and stroke recurrence. Due to advanced age and multimorbidity, anticoagulation is indicated for essentially all nursing home residents with atrial fibrillation. Yet as the severity of cognitive and/or functional deficits increases, the net clinical benefit of anticoagulation becomes less certain. Therefore, nursing home residents are most likely to be in need of supportive clinical evidence regarding anticoagulation, but least likely to have risk/benefit information from trials. Approximately half of US nursing home residents with atrial fibrillation have been treated with warfarin historically. Trial evidence in ambulatory older adults supports a large relative risk reduction (~50%) for stroke with warfarin versus aspirin and generally comparable bleeding risk. However, nursing home residents have a complex confluence of multimorbidity and polypharmacy that distinguishes them from healthier, non-institutionalized trial populations. Exemplifying this distinction, maintaining nursing home residents treated with warfarin within the therapeutic range has been a challenge historically, increasing the risk of adverse events. The direct acting oral anticoagulants may be a preferred therapeutic option for an indeterminate fraction of nursing home residents with atrial fibrillation. A review of the literature on anticoagulant use in nursing homes underscores the need for evidence on the effectiveness and safety of the direct acting oral anticoagulants specific to clinically complex older adults.

CITATION:
M. Alcusky ; K.L. Lapane (2018): Treatment of atrial fibrillation in nursing homes: A place for direct acting oral anticoagulants?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.4

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INTAKE RATE SURVEY AND COOKING METHODS OF A NOVEL TEXTURE-MODIFIED CHICKEN DESIGNED FOR A SOFT DIET

E. Watanabe, M. Maeno, M. Kamon, J. Kayashita, K. Miyamoto, M. Kogirima

Jour Nursing Home Res 2018;4:10-14

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Objectives: The elderly generally experience low occlusal force, which leads to decreased food intake. In this population, a soft diet with high protein content is necessary to avoid undernutrition. Here, we developed a novel texture-modified chicken using yogurt, with a hardness lower than 40,000 N/m2. Design: We applied a crossover design. Setting: Nursing home (long-term care health facility) in Kyoto, Japan from 12 to 24 June 2016. Participants: A total of 34 participants (mean age 89.7 years old, 82% female). Measurements: The proportions of minced chicken, yogurt, water, and potato starch in the texture-modified chicken were measured. The hardness and intake rate of teriyaki chicken using texture-modified chicken and conventional chicken thighs were also measured. Results: The amount of minced chicken, yogurt, water, and potato starch in the texture-modified chicken provided in the nursing home was 49.0 g, 16.2 g, 2.4 g, 2.4 g, respectively. The hardness was approximately 30,000 N/m2, which was lower than that of teriyaki chicken using conventional chicken thigh (> 63,000 N/m2). The intake rates of teriyaki chicken using texture-modified chicken and conventional chicken thigh were 75.3% and 60.0%, respectively. Conclusions: We developed a novel texture-modified chicken for a soft diet using yogurt. The texture-modified chicken had both softness and high nutrient content. Continuance of efforts such as that described in this study will lead to the prevention of undernutrition in the elderly.

CITATION:
E. Watanabe ; M. Maeno ; M. Kamon ; J. Kayashita ; K. Miyamoto ; M. Kogirima (2018): Intake rate survey and cooking methods of a novel texture-modified chicken designed for a soft diet. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.3

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NURSING HOMES CHARACTERISTICS ACCORDING TO THE RATE OF EMERGENCY DEPARTMENT TRANSFER: A RETROSPECTIVE STUDY

K. El Haddad , X. Dubusc, C. Cool, F. Nourhashémi, P. De Souto Barreto, Y. Rolland

Jour Nursing Home Res 2018;4:5-9

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Background: Despite comparable clinical characteristics of nursing home residents, the rate of emergency department transfer is highly variable from one nursing home to another, suggesting that structural characteristic and organizational factors may influence the rate of nursing home resident’s transfer to the emergency department. Objectives: To identify structural characteristics and medical care organization of nursing homes according to the rate of emergency department transfers of nursing home residents. Design: We conducted a cross-sectional analysis using the baseline data of the IQUARE study (Impact of a QUAlity improvement initiative on nursing practices and functional decline in NH REsidents), a non-randomized controlled multicenter trial with 175 nursing homes in south-western, France. Participants: 5926 nursing home residents. Measurement: Data on nursing home structural characteristics and medical care organization were collected by questionnaires between May and July 2011. Data concerning hospital admissions and emergency department transfers during the past year were retrieved from the residents’ medical files. Results: The rate of emergency department transfer in the last 12 months was 18.9% (±11.5): 7.4%, 18.4% and 31.4% for the low, medium and high tertile groups, respectively. Compared to the low transfer group, the high transfer group had less special care unit (RRR: 0.31, 95%CI 0.19-0.83, P: 0.018). The location of the high transfer group tends to be more urban than rural when compared to the low transfer group (RRR: 0.37, 95%CI 0.14-0.99, P: 0.047). Compared to the low transfer group, the high transfer group has less pharmacy for internal use (RRR: 0.10, 95%CI 0.03-0.38, P < 0.001). Conclusion: Our results suggest that implementing special care unit and pharmacy for internal use in nursing homes may reduce the rate of nursing home residents’ transfer to the emergency department. Geographic location seems to dissuade or encourage nursing home to transfer residents to the emergency department. Long-term interventions are needed to reduce the risk of inappropriate emergency department transfers, thus the risk and cost associated with hospitalization.

CITATION:
K. El Haddad ; X. Dubusc ; C. Cool ; F. Nourhashémi ; P. De Souto Barreto ; Y. Rolland (2018): Nursing homes characteristics according to the rate of emergency department transfer: a retrospective study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.2

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USING ENVIRONMENTAL LIGHT THERAPY TO IMPROVE SLEEP AND NEUROPSYCHIATRIC SYMPTOMS IN ALZHEIMER SPECIAL CARE UNIT

S. Gonfrier, S. Al Rifai, L. Benattar, S. Bernabé, O. Guérin

Jour Nursing Home Res 2018;4:1-4

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No study has been able to definitively demonstrate that it is effective at improving the behavior of patients with ADRS. The main objective of our study was to assess the influence of environmental light therapy (from 5 am to 10 pm) on nocturnal sleep patterns of individuals with ADRS. Secondary objectives were to study the time spent sleeping during the day, the level of anxiety based on the COVI scale, and the extent of behavioral disorders based on the NPI scale.Twelve nursing home residents were studied who were exposed to integrated light therapy in common areas. The residents were equipped with a wrist or ankle actimeter for 42 days. This time period was divided into three periods of 14 days, with standard lighting in period 1 and 3, and light therapy during period 2. Their sleep time was determined using Cole-Kripke algorithms. Neuropsychiatric symptoms were assessed based on the COVI scale for anxiety and the neuropsychiatric inventory (NPI).Duration of nocturnal sleep was significantly higher with light therapy by 15.8 minutes on average, the total sleep time during period 2 was significantly increased by 55.1 minutes compared to period 1. The COVI scale measurements indicated that there was a significant decrease of 0.7 points and the NPI scale decreased significantly by 4.9 points between periods 1 and 2. The use of environmental light therapy resulted in a significant increase in the nocturnal sleep and total sleep times, as well as improvement of the level of anxiety and in terms of behavior.

CITATION:
S. Gonfrier ; S. Al Rifai ; L. Benattar ; S. Bernabé ; O. Guérin (2018): Using environmental light therapy to improve sleep and neuropsychiatric symptoms in Alzheimer special care unit. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2018.1

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