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JNHR, Volume 6, 2020

 

ELECTROLYTE IMBALANCES IN NURSING HOME RESIDENTS: A REVIEW OF PREVALENCE, MANAGEMENT AND CONSIDERATIONS

L. Pickenhan, C. Rungg, N. Schiefermeier-Mach

Jour Nursing Home Res 2020;6:14-19

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Background: Electrolyte imbalances strongly impact on morbidity and mortality rate in elderly adults. In particular, residents of long-term care facilities may develop life-threatening conditions as a result of altered serum electrolyte concentration. European nursing homes have restricted availability of general practitioner, therefore the role of nurses in medical care, prevention practices, early symptoms identification and communication with physicians is indispensable. Many of the risk factors associated with electrolyte imbalances are modifiable or preventable and have to be adequately recognized and managed by health professionals in nursing home settings. Objective: The aim of this review is to discuss prevalence and management of electrolyte imbalances in long-term care facilities with focus on nursing homes. Design: Narrative literature review. Methods: Search was performed in MEDLINE/PubMed and CINAHL databases. Key search terms associated with electrolyte imbalances including hyper- and hypo-states of sodium, potassium and magnesium were utilized in the subject search in combination with nursing homes, long-term care and older adults. Results and Conclusions: Published research studies reported higher prevalence of electrolyte imbalances and related mortality rate in nursing home residents when compared to older community adults. Serum sodium imbalances, hyponatremia and hypernatremia, were the most commonly identified. High incidence was also documented for hypomagnesemia and associated hypokalemia. Risk factors strongly associated with electrolyte imbalances included nursing home resident’s dietary/ hydration status, presence of comorbidities and type of prescribed medications. In this review we also summarise early signs of electrolyte imbalances and assessments that can be performed locally by nursing personnel. Strengthening awareness for electrolyte imbalances is an important quality-improvement effort from the perspective of nursing home residents and their families that might lower unnecessary hospital transfers, EI complication rates and residents’ mortality.

CITATION:
L. Pickenhan ; C. Rungg ; N. Schiefermeier-Mach (2020): Electrolyte Imbalances in Nursing Home Residents: a Review of Prevalence, Management and Considerations. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.3

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DO PHYSICAL FUNCTION IN NURSING HOME RESIDENTS CHANGE DURING THEIR STAY?

L. Yong, P. Upendranatha Reddy, J. Tan, D. Avers, P.-H. Ong, W.-P. Wong

Jour Nursing Home Res 2020;6:6-13

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Background: Decline in physical function is associated with increased frailty and hospitalization, resulting in decline of mental status and loss of functional independence. Nursing homes engage residents with variable intensity and frequency of physical activities to reduce functional decline. However the extent to which the physical function of nursing home residents change (that is, improve, maintain or decline) remains unknown. Objectives: The aims of this study were to document the change in physical function and functional category among 222 nursing home residents over a period of 9 months; and to identify the factors associated with changes in their physical function. Design: This is a longitudinal and multi-site study, with outcomes measured at point of recruitment and measurements repeated every three months for nine months. Setting: Three nursing homes in Singapore. Participants: A total of 222 residents (59% male and 41% female) with a mean age of 77.4 years, and an average length of stay of 64 days, participated in the study. Participants did not differ significantly from the 698 total residents in terms of age, number of medical comorbidities and physical function. The key exclusion criteria preventing participation in the study were cognitive status (MMSE < 11) and being placed on cardiac and pulmonary precautions. Measurements: Physical function was measured using the following outcome measures: sit and reach for flexibility, single leg stance for balance, 5 times chair-stand for overall lower extremity muscle strength, 10-meter walk tests for gait speed, and Modified Barthel Index (MBI) for activities of daily living (ADL). Participants were categorised into functional categories (“Fun”, “Functional”, “Frail”, “Failure”) for each test. Factors that are potentially associated with changes in physical function such as number and type of physiotherapy sessions received, number of hospitalisations, age, and length of stay, Charlson Comorbidity Index, and baseline Geriatric Depression Scale were also recorded. Results: There were significant improvements between baseline to 3rd month in flexibility (sit and reach distance from toe in centimeters) [2.69; 95% confidence interval [CI] = 1.05, 4.34; p = .001], balance (single leg stance in seconds) [8.46; 95% CI = 6.81, 10.12; p < .001), MBI [5.06; 95% CI = 2.61, 7.51; p < .001] but not strength and gait speed. Improvements were maintained until 9th month except on flexibility test. Gait speed significantly improved between baseline and 9th month [0.13, 95% CI = .009, .242; p = .035]. The group that improved the most were those who were in the “Failure” group at baseline. Number and type of physiotherapy sessions as well as number of hospitalisations was found to be associated with the extent of improvement in physical function. Conclusions: The study suggests that current rehabilitation framework at these nursing homes has the potential to enhance the physical function of residents who are in the earlier stage of their nursing home stay. Modifiable variables such as number and types of physiotherapy sessions appear to be significant factors associated with these outcomes. Hence, further studies examine the optimum frequency and type of physiotherapy sessions for this population.

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ORAL HEALTH IN NURSING HOMES: WHAT WE KNOW AND WHAT WE NEED TO KNOW

A.M. Foiles Sifuentes, K.L. Lapane

Jour Nursing Home Res 2020;6:1-5

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A “silent epidemic» of oral diseases is afflicting older adults. Older adults develop coronal caries at “approximately one new cavity per year”. Despite the rapidly growing older adult population, no recent data exist for adults aged ≥ 75 years. Oral disease impacts physical, psychological, and social well-being through pain, diminished function, and reduced quality of life. People of color disproportionately experience oral disease, yet little is known about racial/ethnic disparities in older adults. In the United States, the Health and Human Services Oral Health Strategic Framework proposed concrete steps to eliminate oral health disparities. Notably absent from this strategic plan is explicit consideration of nursing home residents. In the United States, federal regulations require nursing homes to evaluate oral health needs and facilitate access to dental care. Compliance to the regulations is unknown. Data are urgently required to provide essential information for program planning and evaluation on “racial and ethnic minorities, rural populations, and the frail elderly”.

CITATION:
A.M. Foiles Sifuentes ; K.L. Lapane (2020): ORAL HEALTH IN NURSING HOMES: WHAT WE KNOW AND WHAT WE NEED TO KNOW. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.1

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