Ahead of print articles
JNHR, Volume 3, 2017
NURSING HOME RESEARCH INTERNATIONAL WORKING GROUP, 13-15 OCTOBER, 2017 • SAINT-LOUIS, USA
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UNDERSTANDING THE LINKS OF ACTIVITY, ENVIRONMENT, AND SOCIAL NETWORKS TO HEALTH FOR NEWLY RELOCATED SKILLED NURSING FACILITY RESIDENTS
Jour Nursing Home Res 2017;3:1-9Show summaryHide summary
Background: Admission into a skilled nursing facility can pose many challenges for new residents. Many residents possess adverse health conditions and body function and structure impairments which limit their daily activity performance and participation. Little is known about the relationships between activity, social networks, environment, and health of skilled nursing facility residents. Objectives: This study aimed to examine activity, environmental, and social network factors that significantly relate to the physical and mental health states of newly relocated skilled nursing facility residents. Design: A pre-post non-experimental correlational research design was employed during the first and second months of newly relocating to a skilled nursing facility. Setting: Eight skilled nursing facilities from the Greater Los Angeles area were used in this study. Participants: Ninety-four residents answered interviewee-administered questionnaires during their first month of stay and fifty of these residents were available to complete the questionnaire battery during their second month. Measurements: A battery of questionnaires were used to measure the residents’ perceived activity participation, importance, and performance; environmental influence; social networks; and perceived health. Results: The most importantly defined activities for residents during the first and change of first to second month were activities of daily living. Sixteen statistically significant activity and environmental predictors to both positive and negative mental and physical health were found. Conclusion: The statistically significant findings from this study can inform geriatric healthcare provider care, activity programming, and rehabilitation as to which activities and environmental elements positively and negatively relate to resident mental and physical health.
T. Mernar (2017): Understanding the Links of Activity, Environment, and Social Networks to Health for Newly Relocated Skilled Nursing Facility Residents. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.1
PREVENTION OF FUNCTIONAL DECLINE BY REFRAMING THE ROLE OF NURSING HOMES?
C. Laffon de Mazières, J.E. Morley, C. Levy, F. Agenes, M. Barbagallo, M. Cesari, P. De Souto Barreto, L.M. Donini, L.M. Donini, J. Fitten, A. Franco, M. Izquierdo, R.A. Kane, F.C. Martin, G. Onder, J. Ouslander, K. Pitkälä, D. Saliba, A. Sinclair, L. Rodriguez Manas, B. Vellas, Y. Rolland
Jour Nursing Home Res 2017;3:10-15Show summaryHide summary
Institutionalization is generally a consequence of functional decline driven by physical limitations, cognitive impairments, and/or loss of social supports. At this stage, intervention to reverse functional losses is often too late. To be more effective, geriatric medicine must evolve to intervene at an earlier stage of the disability process. Could nursing homes (NHs) transform from settings in which many residents dwell to settings in which the NH residents and those living in neighboring communities benefit from staff expertise to enhance quality of life and maintain or slow functional decline? A task force of clinical researchers met in Toulouse on December 2, 2015, to address some of these challenges: how to prevent or slow functional decline and disabilities for NH residents and how NHs may promote the prevention of functional decline in community-dwelling frail elderly. The present article reports the main results of the Task Force discussions to generate a new paradigm.
C. Laffon de Mazières ; J.E. Morley ; C. Levy ; F. Agenes ; M. Barbagallo ; M. Cesari ; P. De Souto Barreto ; L.M. Donini ; J. Fitten ; A. Franco ; M. Izquierdo ; R.A. Kane ; F.C. Martin ; G. Onder ; J. Ouslander ; K. Pitkälä ; D. Saliba ; A. Sinclair ; L. Rodriguez Manas ; B. Vellas ; Y. Rolland (2017): Prevention of Functional Decline by Reframing the Role of Nursing Homes?. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.2
WHAT IS THE “RIGHT” NUMBER OF NURSING HOME BEDS FOR POPULATION NEEDS? AN INDICATOR DEVELOPMENT PROJECT
D.M. Wilson, R.R. Brow, R. Playfair
Jour Nursing Home Res 2017;3:16-21Show summaryHide summary
The need for nursing homes is increasing rapidly now with accelerating population aging and other socio-demographic developments. No indicators currently exist to specify the number of nursing home beds that should be available to meet population requirements. To meet this gap, descriptive-comparative information was gathered on the number of nursing home beds that exist in 10 Canadian provinces and 15 high-income countries and other relevant information. Major differences were found in bed numbers relative to population age structures, with a set of three median indicators (109.4, 17.5, and 4.5) developed to identify the mid-range number of citizens of all ages per nursing home bed, citizens aged 65+ per nursing home bed, and citizens aged 80+ per nursing home bed. Indicators such as these enable comparisons of actual to optimal. The devised set of three indicators should raise nursing attention to nursing home bed accessibility, and further policy and planning for the nursing home expansion required with population aging.
D.M. Wilson ; R.R. Brow ; R. Playfair ; (2017): What is the “Right” Number of Nursing Home Beds for Population Needs? An Indicator Development Project. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.3
COSTS OF A STAFF COMMUNICATION INTERVENTION TO REDUCE DEMENTIA BEHAVIORS IN NURSING HOME CARE
K.N. Williams, P. Ayyagari, Y. Perkhounkova, M.J. Bott, R. Herman, A. Bossen
Jour Nursing Home Res 2017;3:22-27Show summaryHide summary
Context: Persons with Alzheimer’s disease and other dementias experience behavioral symptoms that frequently result in nursing home (NH) placement. Managing behavioral symptoms in the NH increases staff time required to complete care, and adds to staff stress and turnover, with estimated cost increases of 30%. The Changing Talk to Reduce Resistivenes to Dementia Care (CHAT) study found that an intervention that improved staff communication by reducing elderspeak led to reduced behavioral symptoms of dementia or resistiveness to care (RTC). Objective: This analysis evaluates the cost-effectiveness of the CHAT intervention to reduce elderspeak communication by staff and RTC behaviors of NH residents with dementia. Design: Costs to provide the intervention were determined in eleven NHs that participated in the CHAT study during 2011-2013 using process-based costing. Each NH provided data on staff wages for the quarter before and for two quarters after the CHAT intervention. An incremental cost-effectiveness analysis was completed. Analysis: An average cost per participant was calculated based on the number and type of staff attending the CHAT training, plus materials and interventionist time. Regression estimates from the parent study then were applied to determine costs per unit reduction in staff elderspeak communication and resident RTC. Results: A one percentage point reduction in elderspeak costs $6.75 per staff member with average baseline elderspeak usage. Assuming that each staff cares for 2 residents with RTC, a one percentage point reduction in RTC costs $4.31 per resident using average baseline RTC. Conclusions: Costs to reduce elderspeak and RTC depend on baseline levels of elderspeak and RTC, as well as the number of staff participating in CHAT training and numbers of residents with dementia-related behaviors. Overall, the 3-session CHAT training program is a cost-effective intervention for reducing RTC behaviors in dementia care. Clinical Trials.gov Identifier NCT01324219
K.N. Williams ; P. Ayyagari ; Y. Perkhounkova ; M.J. Bott ; R. Herman ; A. Bossen (2017): Costs of a Staff Communication Intervention to Reduce Dementia Behaviors in Nursing Home Care. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.4
NURSING HOME RESIDENTS IN EMERGENCY DEPARTMENT: RISK FACTORS OF INAPPROPRIATE OR POTENTIALLY AVOIDABLE TRANSFERS. RESULTS OF FINE PILOT STUDY
I. Binot, N. Tavassoli, E. Berard, A. Perrin, S. Bismuth, E. Giovanni, A. Lafourcade, B. Vellas, Y. Rolland
Jour Nursing Home Res 2017;3:28-37Show summaryHide summary
Background: Transfer of residents from nursing home (NH) to emergency department (ED) can be inappropriate or potentially avoidable. Objectives: To determine the rate of inappropriate (IT) or potentially avoidable (PAT) transfers of NH residents to ED and to identify the factors associated with these transfers. Setting: Two emergency departments of Toulouse University Hospital, France. Design: All residents arriving at the ED during one week were included. Data were collected, the day of the resident’s transfer, by face to face interviews with the ED’s practitioner and by phone call to the general practitioner (GP) or the health professional in the NH who decided the transfer. An independent panel of experts in geriatrics, pharmacy, emergency and family medicine assessed the appropriateness and potentially avoidable profile of transfers. Results: Fifty-four residents were included. 43% (n=23) considered as IT and 48% (n=26) as PAT. The main factors associated with IT was a low score on basic ADL (Activities of Daily Living) (p=0.03), the need of physician to be reassured about the resident’s pathology (p=0.03) and a lack of technical support in the NH (p=0.03). Iatrogenic medication was found in 44% of the resident with PAT. Before the transfer to ED and after the return in NH, there was a significant increase in diagnosis of dementia (p=0.01) and a non-significant decline in residents’ functional status (ADL score) (p=0.05). Conclusion: This pilot study suggested that factors associated with IT and PAT are related to the clinical characteristics of the residents, the isolation of the NH and the poor quality of prescription. Some factors seem accessible to improvement.
I. Binot ; N. Tavassoli ; E. Berard ; A. Perrin ; S. Bismuth ; E. Giovanni ; A. Lafourcade ; B. Vellas ; Y. Rolland (2017): Nursing Home residents in emergency department: risk factors of inappropriate or potentially avoidable transfers. Results of FINE pilot study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.5
PHASE ANGLE IN INSTITUTIONALIZED ELDERLY BRAZILIANS
A.J. Fortes Ferreira, M. Eickemberg, A.K. Carneiro Roriz, J.M. Barreto Medeiros, L. Barbosa Ramos
Jour Nursing Home Res 2017;3:38-42Show summaryHide summary
Objective: Evaluate the phase angle and the factors associated with their values in institutionalized Brazilians elderly. Design: cross-sectional study. Participants and Settings: Study with 213 subjects aged ≥ 60 years, of both sexes, residents in long-term care facilities for the elderly. Measurements: The phase angle was determined by examining the bioelectrical impedance. Body mass index was used to evaluate the anthropometric nutritional status and skeletal muscle mass index to estimate skeletal muscle mass reserve. To examine the factors related to the phase angle was used Poisson regression with robust variance. Results: More than half of the elderly (50.7 %) presented phase angle below normal values, with higher prevalence among females (60.9 %). Men showed median values of phase angle and phase angle percentiles superior to women. Low phase angle values were associated with sex (PR: 2.08; 95% CI: 1.06 to 4.07 ), longevity (PR: 1.92 ; 95% CI: 1.04 to 3.52 ) and sarcopenia severe (PR: 1.26 ; 95% CI: 1.05 to 1.50). Conclusion: The occurrence of PA below normal values was high, especially among women and was associated with sex, severe sarcopenia and longevity, demonstrating the possible role of PA as elderly identification tool with impaired skeletal muscle mass reserve.
A.J. Fortes Ferreira ; M. Eickemberg ; A.K. Carneiro Roriz ; J.M. Barreto Medeiros ; L. Barbosa Ramos (2017): Phase angle in institutionalized elderly Brazilians. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.6
LONELINESS IN NURSING HOMES AND ASSISTED LIVING FACILITIES: PREVALENCE, ASSOCIATED FACTORS AND PROGNOSIS
A.H. Jansson, S. Muurinen, N. Savikko, H. Soini, M.M. Suominen, H. Kautiainen, K.H. Pitkälä
Jour Nursing Home Res 2017;3:43-49Show summaryHide summary
Background: Loneliness is common among older people and implies poor prognosis. Still only few studies have explored loneliness, its prevalence and associates in nursing homes and assisted living facilities. Objectives: The purpose of this study was to examine the prevalence, associated factors and prognosis of loneliness among older people in institutional settings. Design and settings: A cross-sectional study with 3.6-year follow-up for mortality was conducted in nursing homes and assisted living facilities (N = 61) in Helsinki, Finland in 2011. Participants: Participants of the study were all residents (N = 4966) in nursing homes and assisted living facilities. The original participation rate was 72%. We excluded residents with dementia diagnoses, with severe dementia on the Clinical Dementia Rating Scale (CDR), non-responders and participants with no reliable information on mortality. The total number of participants in this analysis was 2072. Measurements: We asked the residents about loneliness with the question “Do you suffer from loneliness?” Respondents evaluated their own health (self-rated health; SRH). The CDR, Psychological well-being Score (PWB) and Mini-Nutritional Assessment (MNA) served to assess the residents. We collected the mortality data from central registers. Results: Of the residents, 9% stated that they suffered from loneliness often or always, and 26%, sometimes. Loneliness was associated with poor SRH, disability, mobility problems, higher cognitive function, depression and poor PWB. The risk for mortality was significantly higher among the “sometimes lonely” (HR 1.19; 95% CI 1.05 to 1.35) and for the “always lonely” (HR 1.28; 95% CI 1.06 to 1.55) than among the “not lonely” residents (p for linearity < 0.001 adjusted for age, sex and comorbidities). Conclusions: Loneliness has severe consequences in institutional settings and therefore deserves more attention in nursing home care and research. Developing interventions to alleviate residents’ loneliness in order to improve their general well-being is important.
A.H. Jansson ; S. Muurinen ; N. Savikko ; H. Soini ; M.M. Suominen ; H. Kautiainen ; K.H. Pitkälä (2017): Loneliness in nursing homes and assisted living facilities: prevalence, associated factors and prognosis. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.7
THE ‘DIABETIC DIET’: A WEB BASED SURVEY FOR DETERMINING THE INCIDENCE, RATIONALE, COMPOSITION AND IMPLICATIONS IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES
O. Farrer, A. Yaxley, K. Walton, R. Milte, M. Miller
Jour Nursing Home Res 2017;3:50-53Show summaryHide summary
Background: Historically, diabetic diets are typically limited in carbohydrate, energy and food choices and may limit overall oral intake in older adults with diabetes. Objective: This study aims to evaluate the extent to which Australian residential aged care facilities still offer a diabetic diet, the rationale for providing and composition of this diet, and with consideration for implications this may have for residents with diabetes. Design: A web-based survey about current food service practices, menu design and specifically about meal provision for residents with diabetes was emailed to participants. Participation was voluntary. Setting: Web based survey to Australian residential aged care facilities. Participants: 2075 food service managers or staff of similar responsibility within the organisation. Results: More than half of the respondents (n=121, 59%) still provide a diabetic diet because it has historically always been offered or as advised by their dietitian. Respondents frequently offered a menu comprising food restriction rather than the liberalised diet promoted by current recommendations. Conclusions: Findings from this study demonstrate that there is inconsistency in practices. Dietary restriction is still a feature of diabetes management which may increase risk of malnutrition and affect resident quality of life. There does appear to be a need for widely endorsed aged care specific guidelines for best practice.
O. Farrer ; A. Yaxley ; K. Walton ; R. Milte ; M. Miller (2017): The ‘diabetic diet’: a web based survey for determining the incidence, rationale, composition and implications in Australian residential aged care facilities. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.8
RESIDENT CHARACTERISTICS IN AN AUSTRALIAN PSYCHOGERIATRIC RESIDENTIAL FACILITY AND THEIR RELATIONSHIP WITH HOSPITAL ADMISSIONS
D. Koder, C. Kamath
Jour Nursing Home Res 2017;3:54-60Show summaryHide summary
Background: There is a dearth of research in the area of residential care for psychiatric elderly patients, despite their complex needs and the high prevalence rate of mental health problems in nursing homes. There are few accommodation alternatives specific to the needs of residents with both physical and mental health presentations. Objectives and method: A cross-sectional epidemiological study aimed to describe the characteristics of 84 residents from a residential facility caring for psychogeriatric patients via a retrospective file audit. Risk factors associated with residents being admitted to hospital were also of interest in order to assess severity of presentations and to direct resource planning. Data related to medical and psychiatric diagnoses, treatment, estimates of cognitive functioning, depression, verbal and physical aggressive behaviours, pain and falls risk were collected. Results: Based on descriptive statistics from the available data base of resident records, the profile of the average resident of this facility is aged 71, with a diagnosis of schizophrenia being treated via atypical antipsychotics, having at least one medical co-morbidity such as osteoarthritis and hypertension and has lived in the facility for six years. A significant relationship was noted between behavioural issues and both cognitive functioning and depression. There was a relatively low rate of psychiatric admission to hospital, with falls risk predicting admission to hospital, based on logistic regression analysis. Conclusion: Falls prevention programs are needed to positively impact on hospital admissions. The influence of poor cognition and depression on behavioural problems suggests there is a need to address cognitive limitations in future planning of environments and programs for older residents with mental health issues. Exercise programs may also improve mood, as well as mobility, in these residents. Attention is needed in reliably measuring aspects of care via subjective self-reports in this population.
D. Koder ; C. Kamath (2017): Resident characteristics in an Australian psychogeriatric residential facility and their relationship with hospital admissions. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.9
IDENTIFYING PRIORITY AREAS FOR IMPROVING FOOD AND FLUID INTAKE IN LONG-TERM CARE: MULTI-PROFESSIONAL VIEWS
S. Slaughter, C. Ickert, N. Carrier, C. Lengyel, H. Keller
Jour Nursing Home Res 2017;3:61-63Show summaryHide summary
Objective: Poor food intake, which is preventable and treatable, is the primary cause of malnutrition among residents living in long-term care (LTC). The purpose of this study was to identify the perspective of a multi-professional group of LTC stakeholders on areas to target for intervention research in LTC to improve food and fluid intake of residents. Design: Descriptive survey design. Setting: long term care. Participants: A cross-provincial group of dietitians, administrators, food service managers, practice leads, policy makers, nurses, and physicians attended four symposiums and three presentations on a nutrition study. Attendees self-selected to participate. Measurements: Participants were asked to rank from 1 (first priority) to 10 (last priority) a list of potential determinants of resident food and fluid intake, which were previously prioritized by the International-Dining in Nursing home Experts (I-DINE) Consortium. Results: In total, 132 participants completed the ranking. Top ranked areas for intervention research were: adequate time to eat/availability of staff to assist; sensory properties of food; and choice and variety in the dining experience. Conversely, the I-DINE consortium highly ranked social interaction of residents; self-feeding ability; and dining environment. Conclusion: Perceptions of the priorities for targeting interventions to improve food and fluid intake may be divergent between expert groups and clinicians. Understanding priorities of local stakeholders is essential to developing effective interventions for the LTC context. The results of this study will inform future intervention development for improving food intake in LTC residents.
S. Slaughter ; C. Ickert ; N. Carrier ; C. Lengyel ; H. Keller (2017): Resident characteristics in an Australian psychogeriatric residential facility and their relationship with hospital admissions. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.10
THE EFFECT OF A STRUCTURED NUTRITIONAL CARE PROGRAMME IN SWEDISH NURSING HOMES
C. Lannering, L. Johansson, M. Ernsth Bravell
Jour Nursing Home Res 2017;3:64-70Show summaryHide summary
Objective: Malnutrition with consequent weight loss is a well-known problem among older frail persons living in nursing homes. The objective of this study was to examine the effect of a structured preventive care programme including an individualized nutrition plan. Design: A retrospective study, based on already collected data from two different nursing home populations. One population constituted a group of nursing home residents receiving the nutritional care programme (ncp-group), including individually performed nutritions actions. The ncp-group (N=135) was registered in the national quality registry Senior Alert (SA), a platform for following of this preventive care process. The other population constituted a group of nursing home residents receiving “care as usual” (n=186), ie not using the nutritional care programme, collected from the study SHADES. The two populations was compared by a quasi-experimental pre-posttest design with a follow-up time of 5–7 months. Settings: Nursing homes in Sweden. Participants: Two populations of nursing home residents assessed to be at risk for malnutrition, or to be already malnourished, according to the short form of the Mini Nutritional Assessment (MNA-SF). Intervention: The ncp-group received a structured, individually targeted care programme including risk assessments, team-based decisions on actions, and evaluation of results. Measurements: Body weight and weight changes were monitored over time. Additionally, nutritional status was described using the MNA-SF scores and body mass index (BMI). Results: No statistically significant differences in body weight, MNA-SF or BMI between the groups were found at follow-up. However, within-group analyses in the group followed in SA showed improved outcomes. Conclusion: This suggest small differences in nutritional care provided at nursing homes working with SA and “care as usual” in nursing homes, not working with SA.
C. Lannering ; L. Johansson ; M. Ernsth Bravell (2017): The effect of a structured nutritional care programme in Swedish nursing homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.11
LITERATURE REVIEW: COMPARISON OF THE TREATMENT OF INSTITUTIONALIZED PATIENTS EXHIBITING A DEGENERATIVE DEMENTIA IN SPECIALIZED CARE UNITS AND IN CONVENTIONAL EXTENDED STAY CARE UNITS BETWEEN 2006 AND 2016
M.A. SANCHEZ, P. DENORMANDIE, A. LETTY, L. JOSSERAN, S. SANCHEZ
Jour Nursing Home Res 2017;3:71-80Show summaryHide summary
Introduction : The number of individuals living in designated lodgings for elderly individuals (DLEI) in France continues to increase, amounting to close to 9% of the individuals over the age of 75 in 2012. The aim of our work was hence to provide a review of the recent literature from 2006 to February 2016 regarding the treatment of institutionalized patients exhibiting a neurodegenerative illness in specialized care units compared to conventional care units, according to specific criteria for quality of life, maintenance of higher functions, and in terms of behavioral changes or loss of autonomy. Methods: This involved a selective literature review carried out by a digitally-assisted search. The selected studies had to be less than 10 years old at the time of the data collection. The articles had to be published in English, or in French so as to include published studies that specifically addressed features relating to the French care system. Only studies addressing differences in treatments between special (SCU) and non-Special (n-SCU) units were considered, the others being excluded. Results: To compare treatment in SCUs and in n-SCUs, the studies used validated current indicators for assessing quality of life, cognition, behavioral issues, as well as autonomy in each of the units. Use of medicinal therapeutics, hospitalization rates, and physical restraints were also often investigated. Our work focused on recent studies taking into account the latest measures put in place in DLEIs comprising SCUs. A literature review carried out in 2013 that took into account historical studies did not find that SCUs were generally better in regard to providing care for patients with dementias. Conclusion: In conclusion, by specifically considering only the more recent studies, this work has allowed knowledge of the merits of development of specialized units to be updated, particularly in terms of the treatment of dementias.
M.A. SANCHEZ ; P. DENORMANDIE ; A. LETTY ; L. JOSSERAN ; S. SANCHEZ (2017): Literature review: comparison of the treatment of institutionalized patients exhibiting a degenerative dementia in specialized care units and in conventional extended stay care units between 2006 and 2016. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.12
GAIT SPEED AND ADVERSE EVENTS IN NURSING HOME RESIDENTS: A PROSPECTIVE COHORT STUDY
S. Fien, M. Climstein, T. Henwood, E. Rathbone, J.W.L. Keogh
Jour Nursing Home Res 2017;3:81-87Show summaryHide summary
Background: Falls, wounds and hospitalisation are serious adverse events that may result in reduced independence and quality of life, and contribute to higher risks of disability and death in nursing homes. Objectives: To quantify the incidence of events (falls, hospital admissions and wounds) in nursing home residents and to determine if gait speed thresholds can predict falls. Design: A prospective cohort design was used to estimate the incidence and types of adverse events. Setting: Three nursing homes on the Gold Coast/Northern New South Wales, Australia. Participants: 100 nursing home adults consented to participate in this project. Measurements: The primary outcome included the number of adverse events (falls, wounds and hospital admissions) accessed through the nursing homes records. We used negative binomial regression models adjusted for potential confounders to examine associations between gait speed group and falls suffered by residents in nursing home settings, and we reported incidence rate ratios (IRRs) with 95% CIs and the actual P-value. Results: During the six months, there were a total of 226 falls, 243 wounds, 65 hospital admissions and 29 deaths with 12% of the residents having a fall(s), wound, admitted to hospital and dying in the 6-month period. Gait speed was not a statistically significant factor that impacted adverse events. However, for every additional hospital admission there was a 28% increased rate of falling, for every additional wound there was a 7.8% increased rate of falling and for every kilogram increase in handgrip strength there was a 4.4% increase rate of falling. Residents were also found to have an increased rate of falling if they were female (65.5%) and a decreased rate of falling with a positive impairment Mini-Cog score residents were likely to have a 52% decrease in their rate of falling when compared with negative cognitive impairment. Conclusion: The incidence of adverse events in Australian nursing homes is high, suggesting that continual refinement of assessment, education, awareness and management processes are required to improve resident outcomes. In particular, falls reduction interventions appear important, as they would likely reduce the number of hospital admissions and wounds in the nursing home setting.
S. Fien ; M. Climstein ; T. Henwood ; E. Rathbone ; J.W.L. Keogh (2017): Gait Speed and Adverse Events in Nursing Home Residents: A Prospective Cohort Study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.13
REVIEW AND ANALYSIS OF INDICATORS IN NUTRITION SCREENING TOOLS THAT IDENTIFY MALNUTRITION AMONG LONG TERM CARE RESIDENTS
S. Johnson, A. Siddique, K. Hyer
Jour Nursing Home Res 2017;3:88-98Show summaryHide summary
Background: Malnutrition is common among nursing home residents and it occurs when the nutrient intake is not sufficient, precipitated by a complex array of physiological, psychosocial and other factors. The importance of addressing malnutrition as early as possible in an efficient and effective manner has resulted in the development of several nutrition screening tools (NSTs) to identify those at risk for malnutrition. However, a recent systematic review of the NSTs concluded that «none performs better than «fair» in assessing nutritional status or in predicting outcomes.» Objectives: Thus, the purpose of this systematic review is to identify and review the indicators included in NSTs that identify malnutrition among LTC residents. Methods: For this systematic review, relevant publications were identified using a comprehensive search of electronic databases based on pre-established search criteria. A final list of 17 articles were reviewed and relevant data pertinent to the NSTs and the specific indicators used were extracted and entered into an excel spreadsheet for further analysis. The indicators were grouped as anthropometric measurements, biochemical, clinical factors, dietary assessment, psychological, social and physical factors, and then the individual indicators within each of the groupings were examined. Results: This paper shows that NSTs rely heavily on anthropometric measurements (93%) especially on body mass or weight based indicators (BMI, weight loss). Only 12% of NSTs include any biochemical indicator. Heavy reliance on certain indicators could compromise the effectiveness of NSTs in identifying individuals with malnutrition or in predicting outcomes. Conclusions NSTs, encompassing combinations of varied indicators, provides an alternate choice, however the optimal and best combination of these indicators has yet to be determined.
S. Johnson ; A. Siddique ; K. Hyer (2017): Review and Analysis of Indicators in Nutrition Screening Tools that Identify Malnutrition Among Long Term Care Residents. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.14
IDENTIFYING PUBLISHED STUDIES OF CARE HOME RESEARCH: AN INTERNATIONAL SURVEY OF RESEARCHERS
J.K. Burton, T.J. Quinn, A.L. Gordon, A.M.J. MacLullich, E.L. Reynish, S.D. Shenkin
Jour Nursing Home Res 2017;3:99-102Show summaryHide summary
Collating the published research around institutional, long term care is confounded by the differing terminologies used to describe this health-care setting. We aimed to collate the descriptors used by researchers to inform the future development of a ‘search filter’ (a collection of search terms to help identify relevant records from electronic literature databases). We surveyed international researchers via the Nursing Home Research International Working Group, European Geriatric Medicine Society and published reviewers, achieving at 38% response rate across 21 countries. Our findings identified variation in terminology used by researchers to describe long-term care settings in their country of practice. Nursing home was the most accepted term (96%). ‘Homes for the Aged’ was selected by 48% of respondents. A range of terms are likely to be necessary to identify all relevant research and these may not be intuitive. We will use these data to help inform development of a search filter.
J.K. Burton ; T.J. Quinn ; A.L. Gordon ; A.M.J. MacLullich ; E.L. Reynish ; S.D. Shenkin (2017): Identifying published studies of care home research: an international survey of researchers. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.15
POSTSTROKE ADL PERFORMANCES: A COMPARISON BETWEEN VA COMMUNITY LIVING CENTERS AND VA-CONTRACTED COMMUNITY NURSING HOMES
H. Jia, Q. Pei, C.T. Sullivan, D.C. Cowper Ripley, S.S. Wu, W.B. Vogel, X. Wang, J. Hale Gallardo, B.E. Bates
Jour Nursing Home Res 2017;3:103-109Show summaryHide summary
Background: Department of Veterans Affairs (VA) community living centers (CLCs) and community nursing homes (CNHs) are the two major sources of institutional postacute care for Veterans with stroke. However, information about Veterans’ functional outcomes in these facilities is limited. Objectives: This study was to evaluate the activities of daily living (ADL) performances between Veterans at CLCs and Veterans at VA-contracted CNHs by comparing the change in ADL scores between baseline and various follow-up time points. Design: This is a retrospective, observational study. Setting: The study included all Veterans diagnosed with stroke, admitted to CLCs or VA-contracted CNHs during the study period, and had at least 2 ADL assessments completed post-admission. Measurements: ADL change score was the ADL scale sum score difference between the baseline and 3-month, 6-month, 9-month and 12-month follow-up time points. Statistical Analysis: Generalized linear mixed model with repeated ADL change scores were fitted to assess the effects of time-dependent facility type adjusting for propensity score, rehabilitation utilization, and regional districts. Results: Our pared comparison results showed that CLC (vs. CNH) Veterans had significantly better ADL performance at 3 month, but significantly worse ADL performance at 9 month and 12 month. Our risk-adjusted longitudinal analysis results demonstrated that at the 12-month follow-up CLC Veterans had developed better ADL performance (Coefficient±SD: -0.71±0.18, p<0.001) than the CNH Veterans. Conclusions: Significant differences in the changes of ADL score within the 12-month follow-up time were observed between the CLC Veterans and CNH Veterans. These longitudinal analytical findings suggest that the CLC Veterans experienced more positive changes in their ADL score compared with their counterpart CNH Veterans, even after adjusting for potential risk factors. As CNHs are more likely to provide longer term care of older Veterans, further investigation is warranted to compare other related outcomes between the two types of facilities.
H. Jia ; Q. Pei ; C.T. Sullivan ; D.C. Cowper Ripley ; S.S. Wu ; W.B. Vogel ; X. Wang ; J. Hale Gallardo ; B.E. Bates (2017): Poststroke ADL performances: A comparison between VA community living centers and VA-contracted community nursing homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.16
ASSOCIATIONS BETWEEN RESIDENT, FACILITY AND COMMUNITY CHARACTERISTICS AND USE OF ANTIPSYCHOTIC MEDICATIONS IN RHODE ISLAND NURSING HOMES
D.A. Harris, R. Youssef, K.D. Pelland, N. Silva-Odom, A.J. DaCunha, L. McNicoll
Jour Nursing Home Res 2017;3:110-115Show summaryHide summary
Background: Antipsychotic medications (APMs) have been used to treat mood and behavior dysregulation associated with dementia. However, APMs are associated with several adverse health outcomes. Federal initiatives have successfully reduced the use of APMs in nursing homes nationally; however, from 2014 to 2017, the use of APMs in Rhode Island (RI) has increased. Objective: Delineate resident, facility and community characteristics associated with APM use in RI. Design: Cross-sectional. Setting: RI, USA. Participants: RI nursing homes (N=84). Measurements: Data for RI nursing homes were obtained from the Certification and Survey Provider Enhanced Reporting (CASPER) system. The main dependent variable was a facility’s APM use. Resident, facility and community characteristics were included in the analysis. Logit-binomial regression identified which independent variables were associated with APM prevalence. Results: APM use was at an average of 18.8% (SD: 13.0%) for residents in RI’s nursing homes. After adjustment for confounding variables, the use of antianxiety and antidepressant medications, psychiatric diagnoses, and behavioral symptoms were positively associated with APM use. Dementia and behavioral care plans were associated with lower APM use (β = -1.38 [95%CI= -2.21, -0.55]; β = -0.59 [95%CI= -0.86, -0.32], respectively). Compared to non-profit facilities, for-profit facilities had greater use of APMs (β = 0.81 [95%CI= 0.39, 1.24]). Compared to nursing homes in low-income communities, homes in middle- and high-income communities were associated with less use of APMs (β = -0.67 [95%CI= -1.30, -0.25]; β = -0.75 [95%CI= -1.30, -0.20], respectively). Conclusions: Findings assist quality improvement by identifying which nursing home characteristics are associated with APM use.
D.A. Harris ; R. Youssef ; K.D. Pelland ; N. Silva-Odom ; A.J. DaCunha ; L. McNicoll (2017): Associations between Resident, Facility and Community Characteristics and Use of Antipsychotic Medications in Rhode Island Nursing Homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2017.17