Ahead of print articles
JNHR, Volume 6, 2020
EFFECTS OF RESISTIVE INSPIRATORY EXERCISE ON ACTIVITY PARTICIPATION, FATIGUE, AND RESPIRATORY INFECTIONS IN PERSONS WITH ADVANCED MULTIPLE SCLEROSIS LIVING IN A LONG-TERM CARE FACILITY
M.H. Huang, A. Burnham, L. Doyle, D. Fry, L. Wiske, M. Kolanda, E. Khitrik, J. Goode, H. Smith, K. Shea, N. Houston
Jour Nursing Home Res 2020;6:78-81Show summaryHide summary
This study examined the outcomes of 10-week daily resistive inspiratory exercise in 34 adults with advanced multiple sclerosis (MS) in a long-term care facility. Respiratory muscle strength (maximum inspiratory [MIP] and expiratory pressure [MEP]) and fatigue (Modified Fatigue Impact Scale-5) were measured at pre-test, post-test, and 8-week retention. Activity participation (days/week attending group social activities) and respiratory infections were analysed during the baseline, exercise, and retention. Participants were aged 60.0±8.5 years and non-ambulatory (Expanded Disability Status Scale = 8.5±0.4). MIP (p=0.02) and activity participation (p=0.019) differed significantly by time. Bonferroni post-hoc analysis revealed that MIP was greater at post-test (41.6%±23.9%) than pre-test (35.6%±22.0%) (p=0.004), and participants attended more social activities during exercise phase (5.0±3.4 days/week) than baseline (4.0±2.1 days/week) (p=0.043). Fatigue did not change by time. Among the participants, 18%, 6%, and 9% had respiratory infections during baseline, exercise, and retention, respectively. Resistive inspiratory exercise improved activity participation without worsening fatigue during the course of exercise in persons with advanced MS.
M.H. Huang ; A. Burnham ; L. Doyle ; D. Fry ; L. Wiske ; M. Kolanda ; E. Khitrik ; J. Goode ; H. Smith ; K. Shea ; N. Houston (2020): Health Information Technology Use Among Nursing Assistants in Long Term Care: A User Study of a Touch Screen Point of Care System. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.21
HEALTH INFORMATION TECHNOLOGY USE AMONG NURSING ASSISTANTS IN LONG TERM CARE: A USER STUDY OF A TOUCH SCREEN POINT OF CARE SYSTEM
Jour Nursing Home Res 2020;6:73-77Show summaryHide summary
Background: As health information technology (IT) sophistication evolves in long term care (LTC) facilities, it is critical to understand the user experience of health IT among all LTC caregivers to support their roles in providing quality care. Objectives: To examine the end user’s (nursing assistants) experience of a newly implemented wall-mounted, touch screen point-of-care (POC) system in a LTC facility in the mid-western United States. Design: This study used a descriptive qualitative method to conduct a user experience study. Setting: The study site was a chain-affiliated, non-profit continuing care retirement community in the Midwest United States, with 79 skilled nursing facility beds licensed for LTC and 29 beds licensed for rehabilitation. Participants: This purposive sample included state tested nursing assistants (NA) (n=25), representing all three work shifts (day, afternoon, and night). Measurements: Measures included a semi-structured one-on-one interview and a short questionnaire using both closed ended and open ended questions to examine the user experience of the new health IT in terms of 1) usability, (2) overall evaluation (what is working, what is not, what can be improved), and (3) whether the POC has helped staff members to provide better care. Results: Nursing assistants reported satisfaction with the system, ease of use, and a more effective data capture experience than compared to using a paper chart. Most respondents agreed that the POC helped staff to provide better care. Respondents voiced concerns in areas of how best to configure the POC system and best practices on how to use the system more effectively going forward. Conclusions: Optimizing the user experience of health IT among NA staff can affect clinical outcomes for LTC residents. Recommendations for improvements include improved usability to ensure data is captured efficiently, enhanced and more frequent training for accuracy, ergonomic adjustments for reaching the screen and entering data without injury, and modifications to protect resident health information privacy.
R. Meehan ; (2020): Health Information Technology Use Among Nursing Assistants in Long Term Care: A User Study of a Touch Screen Point of Care System. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.20
IMPACT OF EVACUATING SKILLED NURSING HOME RESIDENTS TESTING POSITIVE FOR COVID-19 TO AN INPATIENT ACUTE CARE SETTING
Jour Nursing Home Res 2020;6:69-72Show summaryHide summary
We report a case series of 38 patients infected with coronavirus disease 2019 (COVID-19) evacuated to Mann-Grandstaff Veterans Affairs Medical Center (MGVAMC) in Spokane, Washington following disease outbreak in a skilled nursing home (SNH). Range of symptoms were none to mild on transfer. Patients were admitted to stem the outbreak, provide enhanced medical care and improve clinical outcome. The nursing home outbreak was arrested within two weeks of the initial patient transfer and mortality in this cohort was 13.2%.
R.J. Fischer ; (2020): Impact of Evacuating Skilled Nursing Home Residents Testing Positive for COVID-19 to an Inpatient Acute Care Setting. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.19
PREVALENCE AND PREDICTORS OF POOR SLEEP QUALITY AMONG INSTITUTIONALIZED ELDERS
M.H. Itani, G. Hamadeh, S. Mroueh, N. Naja, O. Kolokotroni
Jour Nursing Home Res 2020;6:61-68Show summaryHide summary
Objectives: Sleep problems are common in institutionalized elders and are associated with increased mortality and morbidity. Our study evaluates the prevalence of poor sleep quality in a chronic care philanthropic institution and their possible predictors in that setting. Methods: The study involved 192 participants. The Pittsburgh Sleep Quality Index (PSQI) scale was used as an assessment tool for poor sleep quality. Participants with a global PSQI score of 5 or more were classified as poor sleepers. Bivariate analysis was used to study statistical correlation between high PSQI scores and the independent variables of demographic data and lifestyle habits, coexisting chronic medical conditions and current medications. Results: Poor sleep quality was present in 75% of the participants. Decreased ambulatory activity, poor performance on memory tests and Alzheimer disease had positive association with poor sleep quality [OR 2.85 (95% CI, 1.41-5.68), OR 4.21 (95% CI, 1.90-9.33) and OR 2.28 (95% CI, 1.05-4.94) respectively]. Schizophrenia had a negative association [OR 0.46 (95% CI, 0.23-0.92)], while proton pump inhibitors approached statistical significance [OR 1.85 (95% CI, 0.96-3.59)]. Conclusion: Our study showed high prevalence of poor sleep quality in institutionalized elders. Physicians must use a standardized tool for assessment of sleep in that setting and not rely on a single question about sleep quality. The activity of moving the elders out of the bed during the day is a simple intervention that may help in improving their sleep at night. The association between poor sleep and Alzheimer disease and impaired memory reflects the importance of early identification of these problems and early management. Overuse of proton pump inhibitors in institutionalized elders may be associated with poor sleep quality.
M.H. Itani ; G. Hamadeh ; S. Mroueh ; N. Naja ; O. Kolokotroni (2020): Prevalence and Predictors of Poor Sleep Quality among Institutionalized Elders . The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.18
THE COVID-19 PANDEMIC IN UK CARE HOMES – REVEALING THE CRACKS IN THE SYSTEM
R. Devi, K. Hinsliff-Smith, C. Goodman, A.L Gordon
Jour Nursing Home Res 2020;6:58-60Show summaryHide summary
R. Devi ; K. Hinsliff-Smith ; C. Goodman ; A.L Gordon (2020): The COVID-19 pandemic in UK Care Homes – Revealing the Cracks in the System. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.17
COVID-19 EPIDEMIC IN THE NURSING HOME – THE GERMAN EXPERIENCE
S. Grund, M. Gosch, T. Laurentius, C. Bollheimer, C. Becker, J.M. Bauer
Jour Nursing Home Res 2020;6:55-57Show summaryHide summary
S. Grund ; M. Gosch ; T. Laurentius ; C. Bollheimer ; C. Becker ; J.M. Bauer (2020): Covid-19 epidemic in the nursing home – The German experience. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.16
STRATEGY FOR RESIDENTS OF NURSING HOMES FACING THE SARS-COV2 EPIDEMIC IN FRANCE
S. Vienne-Noyes, L. Andre, Y. Rolland
Jour Nursing Home Res 2020;6:53-54Show summaryHide summary
S. Vienne-Noyes ; L. Andre ; Y. Rolland (2020): Strategy for residents of nursing homes facing the SARS-Cov2 epidemic in France. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.15
NURSING HOME CARE IN AUSTRIA DURING SARS-COVID-19 PANDEMIA 2020
R. Roller-Wirnsberger, S. Lindner, A. Matijevic, E. Stolz, G. Wirnsberger
Jour Nursing Home Res 2020;6:50-52Show summaryHide summary
R. Roller-Wirnsberger ; S. Lindner ; A. Matijevic ; E. Stolz ; G. Wirnsberger (2020): Nursing Home Care in Austria during SARS-COVID-19 Pandemia 2020 . The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.14
THE EXPERIENCE OF MANAGING COVID-19 IN IRISH NURSING HOMES IN 2020
D.W. Molloy, C. O’Sullivan, R. O’Caoimh, E. Duggan, K. Mcgrath, M. Nolan, J. Hennessy, G. O’Keeffe, K. O’Connor
Jour Nursing Home Res 2020;6:47-49Show summaryHide summary
D.W. Molloy ; C. O’Sullivan ; R. O’Caoimh ; E. Duggan ; K. Mcgrath ; M. Nolan ; J. Hennessy ; G. O’Keeffe ; K. O’Connor (2020): The experience of managing COVID-19 in Irish Nursing Homes in 2020. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.13
COVID-19 IN LTC – REFLECTIONS FROM ONTARIO CANADA
A. Moser, P. Pariser, A. Verma, F. Razak, B. Wong, L. Pus, S. Feldman
Jour Nursing Home Res 2020;6:45-46Show summaryHide summary
A. Moser ; P. Pariser ; A. Verma ; F. Razak ; B. Wong ; L. Pus ; S. Feldman (2020): COVID-19 in LTC – Reflections from Ontario Canada. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.12
STRUGGLING WITH COVID19 PANDEMIC IN NURSING HOMES: THE CASE OF SPAIN
Jour Nursing Home Res 2020;6:43-44Show summaryHide summary
L. Rodríguez-Mañas ; (2020): Struggling with covid19 pandemic in Nursing Homes: the case of Spain. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.11
COVID-19 EPIDEMIC IN THE NURSING HOMES IN BELGIUM
S. Gillain, J.-L. Belche, J.-F. Moreau
Jour Nursing Home Res 2020;6:40-42Show summaryHide summary
S. Gillain ; J.-L. Belche ; J.-F. Moreau (2020): COVID-19 epidemic in the Nursing Homes in Belgium. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.10
NEW ZEALAND NURSING HOMES (AGED RESIDENTIAL CARE FACILITIES) AND COVID-19 PANDEMIC
X.J. Walker, D.L. Waters, N. Millar
Jour Nursing Home Res 2020;6:38-39Show summaryHide summary
X.J. Walker ; D.L. Waters ; N. Millar (2020): New Zealand Nursing Homes (Aged Residential Care Facilities) and COVID-19 Pandemic. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.9
COVID-19: PREVENTION AND OUTBREAK MANAGEMENT IN NURSING HOMES: EXPERIENCES FROM THE NURSING HOMES OF THE CITY OF ZURICH
H. Geschwindner, G. Bieri-Brüning
Jour Nursing Home Res 2020;6:35-37Show summaryHide summary
H. Geschwindner ; G. Bieri-Brüning (2020): COVID-19: Prevention and Outbreak Management in Nursing Homes: Experiences from the Nursing Homes of the City of Zurich. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.8
DEALING WITH COVID-19 IN DUTCH NURSING HOMES
J.M.G.A. Schols, E.P. Poot, N.M. Nieuwenhuizen, W.P. Achterberg
Jour Nursing Home Res 2020;6:30-34Show summaryHide summary
It is absolutely no surprise that the Dutch nursing home sector with a total of 125.000 residents would be affected by COVID-19. Before the first case in the Netherlands was registered, alarming signals had already arrived from other countries, indicating that the frail and disabled, multimorbid nursing home population is an easy prey for this virus. In the meantime, despite a visitor lockdown since mid-March, a considerable amount of residents and staff have been infected and around 1700 residents have died from COVID-19 (mid-May). The future will learn what the long-term consequences of this crisis will be for residents and staff and what finally will be the main lessons learnt. This article shows that it is clear that we have some way to go, to ensure that the Dutch nursing home sector, despite its good infrastructure, will be sustainably and proactively recognized, resourced and equipped to fulfil its unique role in long-term care. Moreover the sector has to find its way in preparing itself for the temporary future 1,5 meter society.
J.M.G.A. Schols ; E.P. Poot ; N.M. Nieuwenhuizen ; W.P. Achterberg (2020): Dealing with COVID-19 in Dutch nursing homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.7
AN ASPIRATIONAL APPROACH TO NURSING HOME OPERATIONS DURING THE COVID-19 PANDEMIC
M. Wasserman, A.G. Wolk, A. Lam
Jour Nursing Home Res 2020;6:24-29Show summaryHide summary
COVID-19 has infected nearly half of all nursing homes in the United States. Tens of thousands of residents have lost their lives, and many more have been hospitalized. Emerging data suggest that few nursing facilities have the organizational structure, training, resources, physical plant, and operational capability to keep the COVID-19 infection completely out of a facility. Key infection prevention strategies (such as cohorting, universal masking of patients/staff, focused ventilation, point-prevalence testing, and preventing movement of healthcare workers between facilities) have been inconsistently and haphazardly applied. With these challenges in mind, the California Association of Long Term Care Medicine (CALTCM) proposed a model for a virtual centralized Support and Guidance Center that develops and disseminates real-time expert-driven recommendations to the traditional organizational structure of a nursing facility. We recommended that all senior congregate facilities transition to an incident command management structure. This would allow local leadership teams to focus on day to day management, transferring the responsibility of training, PPE procurement, engineering, testing, and real-time expert-driven recommendations to a centralized entity. Clinical and operational aspects of this model are based on emergency preparedness principles. While this approach is aspirational, the principles delineated in this document can be used to guide policy decisions as we work to mitigate the impact of this virus.
M. Wasserman ; A.G. Wolk ; A. Lam (2020): An Aspirational Approach to Nursing Home Operations During the COVID-19 Pandemic. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.6
COVID-19 IN ITALIAN NURSING HOMES: FROM GUIDELINES TO PRACTICE
G. Pezzoni, C. Luchetti, M. Cesari
Jour Nursing Home Res 2020;6:22-23Show summaryHide summary
he COVID-19 pandemic has pushed the world at urgently elaborating new strategies to cope with the many healthcare issues raising from such unprecedent and complex situation. This article is focused on the many problems faced by Italian nursing homes. In particular, it is described which countermeasures were suggested in the guidelines, and the obstacles encountered in their implementation. It is then explained the importance of reshaping the current “hospital-centered” healthcare system into a more modern model, giving more value to the centrality of the person.
G. Pezzoni ; C. Luchetti ; M. Cesari (2020): COVID-19 in Italian Nursing Homes: from guidelines to practice. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.5
COVID 19 AND RESIDENTIAL CARE HOMES IN HONG KONG
Jour Nursing Home Res 2020;6:20-21Show summaryHide summary
J. Woo (2020): Covid 19 and Residential Care Homes in Hong Kong. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2020.4
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;6:14-19Show summaryHide summary
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.
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
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;6:6-13Show summaryHide summary
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.
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;6:1-5Show summaryHide summary
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”.
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