Journal articles on the topic 'Nursing homes Admission Case studies'
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1
Toot, Sandeep, Tom Swinson, Mike Devine, David Challis, and Martin Orrell. "Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis." International Psychogeriatrics 29, no. 2 (November 3, 2016): 195–208. http://dx.doi.org/10.1017/s1041610216001654.
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ABSTRACTBackground:Up to half of people with dementia in high income countries live in nursing homes and more than two-thirds of care home residents have dementia. Fewer than half of these residents report good quality of life and most older people are anxious about the prospect of moving into a nursing home. Robust evidence is needed as to the causes of admission to nursing homes, particularly where these risk factors are modifiable.Methods:We conducted a systematic literature search to identify controlled comparison studies in which the primary outcome was admission to nursing home of older adults with dementia. Identified studies were assessed for validity and 26 (17 cohort and 9 case-control) were included. Qualitative and quantitative analyses were conducted, including meta-analysis of 15 studies.Results:Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of our meta-analyses demonstrated impairments in activities of daily living as a significant risk. The effects of community support services were unclear, with both high and low levels of service use leading to nursing home placement. There was an association between caregiver burden and risk of institutionalization, but findings with regard to caregiver depression varied, as did physical health associations, with some studies showing an increased risk of nursing home placement following hip fracture, reduced mobility, and multiple comorbidities.Conclusion:We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.
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Gaugler, Joseph, Rachel Zmora, Colleen Peterson, Lauren Mitchell, Robyn Birkeland, Eric Jutkowitz, and Sue Duval. "What Keeps Older People out of Nursing Homes? A Meta-Analysis." Innovation in Aging 5, Supplement_1 (December 1, 2021): 508. http://dx.doi.org/10.1093/geroni/igab046.1963.
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Abstract Perhaps one of the most examined, and costly, health transitions older people experience is nursing home admission. In addition to the financial costs nursing home admission poses to older people, their families, and other payers (e.g., the public), institutionalization is linked with a range of negative outcomes and represents a loss of independence and quality of life to many older persons. The current meta-analysis attempted to synthesize all available randomized controlled trials available to ascertain which intervention approaches appeared to prevent nursing home entry for older adults. The MEDLINE, PsycInfo, CINAHL, Cochrane, and EMBASE databases were searched to August, 2020. Abstracts were screened (N = 28,120) to identify randomized controlled trials of interventions to prevent or delay nursing home admission as well as systematic reviews. Identified studies were cross-referenced until the point of saturation, resulting in 1,786 studies for additional inclusion/exclusion screening. Following a consensus-based review among the authors that included risk of bias, 323 randomized controlled trials were included in the meta analysis. Although several intervention modalities appeared protective against nursing home admission and approached statistical significance, preliminary results suggest that comprehensive geriatrics assessment (pooled OR = .69, 95% CI: .50, .95) and specialized, inpatient geriatrics care (pooled OR: .77, 95% CI: .59, .99) were most consistent in helping to prevent institutionalization among older persons. The findings emphasize the importance of geriatrics when delivering optimal care to older persons. Integrating such approaches more effectively into a largely fee-for-service healthcare paradigm remain a critical challenge.
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Cooney, Eamonn, Christina Donnellan, and Binish Baburaj. "291 The Impact of a Frailty Team Liaison Service on Nursing Home Attendances in an Emergency Department." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.185.
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Abstract Background Up to 50% of referrals from nursing homes to emergency departments (ED) are considered inappropriate. Interventions such as the introduction of advanced practice registered nurses to nursing homes, and community matrons in other jurisdictions have reduced inappropriate referrals. Methods A liaison service with nursing homes was initiated by a candidate Advanced Nurse Practitioner (cANP) supported by the frailty multidisciplinary team in January 2019. It focused on nursing home residents aged 70 years and older. A single point of contact was provided. ED presentations were assessed if possible, and telephone consultations were also available. A database was maintained and the data from the first 3 months of this service was analysed. Results The service provided from 7th January and 31st March 2019 was studied. Referrals of patients aged 70 years and over from nursing homes to ED for this period in 2018 were 100. In 2019 it was 73, representing a 27% decrease in referrals. The total number of patients referred in 2019 was 51. Twenty one (41%) patients had an assessment by the cANP. Interventions by the cANP and team included rapid access to other specialties, medication reconciliation, and prescription of antibiotics, diagnostics and referral to the Community Intervention Team (CIT). Telephone liaison from nursing homes resulted in referrals to the palliative care service in 2 cases, prescription of antibiotic in another, rapid access comprehensive geriatric assessment in another case and rapid access to ED for catheter change in another, hence admission avoidance's in all of these cases. Conclusion The early experience of this service is that it facilitated more nursing home residents to receive care and support within their care setting. It contributed to reduced referrals of this vulnerable cohort of the population to ED, and also resulted in admission avoidance in some cases.
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Gohil, Shruti K., Annabelle De St Maurice, Deborah S. Yokoe, Deborah S. Yokoe, Stuart H. Cohen, Francesca J. Torriani, Jonathan Grein, et al. "41. Assessing Past vs Present COVID-19 Infection: A Survey of Criteria for Discontinuing Precautions in Asymptomatic Patients." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S29—S31. http://dx.doi.org/10.1093/ofid/ofab466.041.
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Abstract Background COVID-19 patients can remain positive by PCR-testing for several months. Pre-admission or pre-procedure testing can identify recovered asymptomatic patients who may no longer be contagious but would require precautions according to current CDC recommendations (10 days). This can result in unintended consequences, including procedure delays or transfer to appropriate care (e.g., psychiatric or post-trauma patients requiring admission to COVID-19 units instead of psychiatric or rehabilitation facilities, respectively). Methods We conducted a structured survey of healthcare epidemiologists and infection prevention experts from the SHEA Research Network between March-April, 2021. The 14-question survey, presented a series of COVID-19 PCR+ asymptomatic patient case scenarios and asked respondents if (1) they would consider the case recovered and not infectious, (2) if they have cleared precautions in such cases, and if so, (3) how many transmission events occurred after discontinuing precautions. The survey used one or a combination of 5 criteria: history of COVID-19 symptoms, history of exposure to a household member with COVID-19, COVID-19 PCR cycle threshold (CT), and IgG serology. Percentages were calculated among respondents for each question. Results Among 60 respondents, 56 (93%) were physicians, 51 (86%) were hospital epidemiologists, and 46 (77%) had >10y infection prevention experience. They represented facilities that cumulatively cared for >29,000 COVID-19 cases; 46 (77%) were academic, and 42 (69%) were large ( >400 beds). One-third to one-half would consider an incidentally found PCR+ case as recovered based on solo criteria, particularly those with two consecutive high CTs or COVID IgG positivity recovered (53-55%) (Table 1). When combining two criteria, half to four-fifths of respondents deemed PCR+ cases to be recovered (Table 2). Half of those had used those criteria to clear precautions (45-64%) and few to none experienced a subsequent transmission event resulting from clearance. Conclusion The majority of healthcare epidemiologists consider a combination of clinical and diagnostic criteria as recovered and many have used these to clear precautions without high numbers of transmission. Disclosures Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Deborah S. Yokoe, MD, MPH, Nothing to disclose Stuart H. Cohen, MD, Seres (Research Grant or Support) Jonathan Grein, MD, Gilead (Other Financial or Material Support, Speakers fees) Richard Platt, MD, MSc, Medline (Research Grant or Support, Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)
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Cornell, Portia, Emily Corneau, Kate Magid, Patience Moyo, James Rudolph, Cari Levy, and Vincent Mor. "Are Nursing Home Preferred Networks Good for Patients' Outcomes? Evidence From the Veterans Health Administration." Innovation in Aging 5, Supplement_1 (December 1, 2021): 21. http://dx.doi.org/10.1093/geroni/igab046.074.
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Abstract In the Veterans’ Administration (VA), medical centers contract with community nursing homes to provide care to Veterans. As a purchaser, the VA could pursue a strategy of selecting a high-quality network; alternatively, it could focus resources on oversight by its nursing-home coordinators. The question of whether narrow networks are good for Veterans’ outcomes, conditional on quality, therefore, needs empirical investigation. We examined the effect of network concentration on hospital admissions, conditional on Veterans’ clinical acuity. We operationalized network concentration as the number of Veterans already in residence at the time of admission, and controlled for publicly reported quality measure (star rating). We identified 93,805 VA-paid admissions to nursing homes between 2013 to 2016. To address selectin bias, we estimated effects using a distance- based instrumental variable (IV) for each measure, with the log of distance to the nearest nursing home with a specified number of Veterans at the facility in the previous month (1-4, 5-9, and 10-13, and 14+ Veterans). Going to a facility with 10-13 or 14+ Veterans had a higher hospitalization probability (6.2 and 3.3 percentage points higher, respectively), than going to a facility with 1-4 Veterans. If quality rating improves outcomes, then broader networks are beneficial if consumers (Veterans) choose based on quality, given a broader choice set. Conditional on quality, concentrated networks do not seem to lead to fewer hospital admissions. Our results suggest that the VA could do more in its oversight role to work with these nursing homes to decrease hospital admissions.
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Caldwell, Lauren, Lee-Fay Low, and Henry Brodaty. "Caregivers' experience of the decision-making process for placing a person with dementia into a nursing home: comparing caregivers from Chinese ethnic minority with those from English-speaking backgrounds." International Psychogeriatrics 26, no. 3 (November 22, 2013): 413–24. http://dx.doi.org/10.1017/s1041610213002020.
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ABSTRACTBackground:The experience of care transitions for people with dementia from ethnic minority groups has been poorly researched. Few studies have examined the decision to put someone on a waiting list for a nursing home and then actually accept a place. Many nursing homes have long waiting lists, but sometimes offers of a place are declined. Our aims were to investigate the decision-making process for placing a person with dementia on a waiting list for a nursing home, why offers of a place are accepted or declined, and the influence of cultural factors, comparing caregivers from Chinese and English-speaking backgrounds.Methods:Semi-structured interviews with 27 caregivers of people with dementia on waiting lists or living in nursing homes (20 Chinese background and seven English-speaking background) were conducted, with thematic analysis of factors affecting caregivers’ decision-making.Results:Caregivers were at different stages of decision-making when they applied for a waiting list – some were ready for placement, others applied “just in case,” and for some there was no waiting time because of an urgent need for placement. Caregivers’ decisions were influenced by their emotions and expectations of nursing homes. The decision-making process was similar for both cultural groups, but Chinese caregivers spoke more about their sense of duty, the need for a Chinese specific facility, and declining a place because of family disagreement.Conclusions:Understanding cultural issues, including stereotypes and concerns about nursing homes, and providing better information about admission processes may help caregivers by allaying their anxiety about nursing home placement.
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Ferrah, Noha, Joseph Elias Ibrahim, Chebiwot Kipsaina, and Lyndal Bugeja. "Death Following Recent Admission Into Nursing Home From Community Living: A Systematic Review Into the Transition Process." Journal of Aging and Health 30, no. 4 (February 5, 2017): 584–604. http://dx.doi.org/10.1177/0898264316686575.
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Objective: This study examines the impact of the transition process on the mortality of elderly individuals following their first admission to nursing home from the community at 1, 3, and 6 months postadmission, and causes and risk factors for death. Method: A systematic review of relevant studies published between 2000 and 2015 was conducted using key search terms: first admission, death, and nursing homes. Results: Eleven cohort studies met the inclusion criteria. Mortality within the first 6 month postadmission varied from 0% to 34% (median = 20.2). Causes of deaths were not reported. Heightened mortality was not wholly explained by intrinsic resident factors. Only two studies investigated the influence of facility factors, and found an increased risk in facilities with high antipsychotics use. Discussion: Mortality in the immediate period following admission may not simply be due to an individual’s health status. Transition processes and facility characteristics are potentially independent and modifiable risk factors.
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Cornell, Portia, Cassandra Hua, Momotazur Rahman, Gauri Gadkari, and Kali Thomas. "STRUCTURAL INEQUITIES IN OUTCOMES FOR DUAL-ELIGIBLE RESIDENTS IN ASSISTED LIVING." Innovation in Aging 6, Supplement_1 (November 1, 2022): 421. http://dx.doi.org/10.1093/geroni/igac059.1654.
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Abstract We examined the association of AL residents’ dual-eligibility and the concentration of dually eligible residents in AL communities with residents’ risk of hospitalization and long-term nursing home admission. The exposure was dual status interacted with AL concentration: no-duals, minority-duals [<=50%] (reference group), and majority-duals [>50%]. We found that duals in AL have higher risk of hospitalization and nursing home admission than non-duals. For both duals and non-duals, moving to an AL with a high concentration of duals conferred excess risk of hospitalization. Among duals, however, lower concentration of duals in ALs increases risk of long-term nursing home admission for duals, whereas it is protective for non-duals. The association of higher hospitalization with concentration of duals suggests that quality may be a concern in communities that specialize in care for duals. However, majority-duals ALs may be better equipped to provide more comprehensive care as an alternative to nursing homes.
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Moyo, Patience, Emily Corneau, Portia Cornell, Amy Mochel, Kate Magid, Cari Levy, and Vincent Mor. "Antipsychotic Prescribing in VA-Contracted Community Nursing Homes and Incident Use Among Veterans." Innovation in Aging 5, Supplement_1 (December 1, 2021): 331. http://dx.doi.org/10.1093/geroni/igab046.1287.
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Abstract The Veterans Health Administration (VA) is increasingly purchasing long-term care for eligible Veterans from non-VA, community nursing homes (CNHs). Antipsychotics present safety risks for older adults, but it is unknown how the prevalent use of antipsychotics at CNHs influences whether newly admitted Veterans will initiate antipsychotic therapy. This study used 2013-2016 VA data, Medicare claims, Nursing Home Compare, and Minimum Data Set (MDS) assessments. We identified 10,531 long-stay CNH episodes for Veterans not prescribed antipsychotics 6 months before CNH admission. We categorized Veterans by whether, 12 months before admission, they were diagnosed with FDA-approved indications (including schizophrenia, Tourette’s syndrome, Huntington’s disease) for antipsychotic use. The exposure was the proportion of all CNH residents prescribed antipsychotics in the quarter preceding a Veteran’s admission. Using adjusted logistic regression, we analyzed two outcomes measured using MDS assessments collected ~100 days after CNH admission: 1) new antipsychotic use, and 2) new diagnosis for an FDA-approved indication among Veterans without these conditions at admission. Among antipsychotic-naïve Veterans admitted to CNHs, 7,924 (75.2%) lacked an antipsychotic indication. Prevalent antipsychotic use in CNHs ranged 0%-10.9% (quintile 1) and 25.7%-91.4% (quintile 5). The odds of initiating antipsychotic use increased with higher CNH antipsychotic use rates (OR=2.52, 95% CI:2.05-3.10, quintile 5 vs. 1), as did the odds of acquiring a new indication (OR=2.08, 95% CI:1.27-3.40, quintile 5 vs. 1). Provider practices may be influencing new diagnoses indicating antipsychotic use at CNHs with high antipsychotic use. It may be important for VA to consider antipsychotic use when contracting with CNHs.
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Parry, Laura. "Can patient and carers’ experiences shape services?" BMJ Supportive & Palliative Care 9, no. 3 (October 5, 2018): 287–90. http://dx.doi.org/10.1136/bmjspcare-2018-001618.
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Dementia is an increasingly recognised medical condition which, towards its later stages, leads to the manifestation of symptoms that often require palliation. Hospice admission for patients with dementia has been shown to increase caregiver satisfaction. Yet, admission can be harmful for the patient. This feature follows the case of one patient, Mr Smith, who was admitted to Royal Trinity Hospice (RTH) for symptom control, along with providing respite for his carers. Shortly into Mr Smith’s admission, he became increasingly agitated and was ultimately discharged home. After investigating the cause of early discharge, it was concluded that the newly built, modernised private rooms were in fact very dissimilar to the homes of patients with dementia. Adapting the clinical environment to improve patient and carer satisfaction has been explored in numerous studies. Significant amendments used by hospices and care homes include bold signs and natural lighting to facilitate way-finding, in addition to vintage furnishings to create a sense of familiarity. Taking recent evidence into consideration, RTH designed a new dementia-friendly bay situated on the ground floor of its inpatient unit. Since then, many other patients with dementia have been admitted to the hospice, one being Mr Thomas. Unlike Mr Smith, Mr Thomas was much more relaxed during his admission and his wife commented on how pleased she was with his care. This feature demonstrates the importance of being receptive to feedback and identifying the need for change.
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O'Connor, Daniel W., Joanne Griffith, and Kate McSweeney. "Changes to psychotropic medications in the six months after admission to nursing homes in Melbourne, Australia." International Psychogeriatrics 22, no. 7 (March 4, 2010): 1149–53. http://dx.doi.org/10.1017/s1041610210000165.
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ABSTRACTBackground: Nursing home residents are often prescribed large numbers of psychotropic medications. Previous studies suggest that antipsychotic medications are often unnecessary and can be withdrawn without ill effects. Depression, in contrast, is believed to be under-recognized and under-treated.Method: A six-month audit was carried out of the antipsychotic, antidepressant, anxiolytic and hypnotic medications prescribed to 166 newly admitted residents of a convenience sample of seven nursing homes in Melbourne, Australia.Results: Over the six-month period, antidepressants were started in 6% of all cases and stopped in 2% of treated cases. Antipsychotics were added in 5% of all cases and stopped in 15% of treated cases. Residents were switched from one antidepressant to another in 5% of treated cases and from one antipsychotic to another in 4%. Benzodiazepine use was relatively modest.Conclusions: Judging from epidemiological data, treatment revisions were almost certainly insufficient to address residents’ mental health needs. We discuss ways of harnessing existing nursing and pharmacy resources to ensure better care for aged residents.
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Miller, Loren G., James A. McKinnell, Raveena Singh, Gabrielle Gussin, Ken Kleinman, Raheeb Saavedra, Job Mendez, et al. "5. The PROTECT Trial: A Cluster Randomized Clinical Trial of Universal Decolonization with Chlorhexidine and Nasal Povidone Iodine Versus Standard of Care for Prevention of Infections and Hospital Readmissions among Nursing Home Residents." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S4—S5. http://dx.doi.org/10.1093/ofid/ofab466.005.
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Abstract Background Nursing home (NH) residents are at high infection and hospital readmission risk. Colonization with multidrug-resistant organisms (MDROs) is common. In ICU and post-hospital discharge settings, decolonization has reduced infection rates. However, the effectiveness of this strategy in NHs is unclear. Methods We performed a cluster randomized trial of 1:1 universal decolonization (decol) vs standard of care bathing (control) in 28 California NHs. After an 18 month baseline evaluation of hospitalization rates due to infection and MDRO prevalence, NHs were randomized to decol or control. Decol consisted of 1) chlorhexidine bathing; 2) nasal povidone iodine bid on admission x 5d and then M-F biweekly x 18 mo. Primary outcome was the probability that a transfer to a hospital was due to infection. Secondary outcome was the probability that a NH discharge was to a hospital. Results Four of 28 NHs dropped from the trial (3 decol, 1 control). Mean facility baseline of hospital transfers due to infection was 58% and 57% in the control and decol groups. In the intervention period, proportions were 57% and 48% in the control and decol groups. When accounting for clustering within NHs, hospital transfers due to infection had an OR of 0.91 (95% CI: 0.82-1.02) in the control group and an OR of 0.73 (95% CI: 0.56-0.95) in the decol group when comparing intervention to baseline period. For the primary outcome, decol had a 18% greater impact v. control (P=0.005, Fig. A). Baseline proportion of NH discharges due to hospitalization was 37% and 39% in the control and decol groups. In the intervention period, proportions were 36% and 33%. When accounting for clustering within NHs, the proportion of discharges due to hospitalization had an OR of 1.14 (95% CI: 1.06-1.22) in the control group and 0.91 (CI: 0.77-1.07) in the decol group when comparing the intervention period to the baseline period. For the secondary outcome, decol had a 23% greater impact v. control (P< 0.0001, Fig. B). In this figure, each nursing home is represented by a circle. The size of the circle represents the amount of contributed patient days to the trial. The groups represent “as randomized” categories. Panel A) compares the probability that a transfer to a hospital was due to infection; panel B) compares the probability that a nursing home discharge was to a hospital. The y-axis represents the odds ratio of these probabilities comparing the baseline to the intervention period. The p values represent the significance of the difference between groups (the trial effect). Conclusion Universal NH decolonization with chlorhexidine and nasal iodophor significantly reduced the proportion of transfers to hospitals due to infection and discharges due to hospitalization. Our findings suggest that NH decolonization reduces serious infections and can decrease morbidity in this vulnerable population. Disclosures Loren G. Miller, MD, MPH, Medline (Grant/Research Support, Other Financial or Material Support, Contributed product) Stryker (Other Financial or Material Support, Contributed product) Xttrium (Other Financial or Material Support, Contributed product) James A. McKinnell, MD, Medline (Grant/Research Support) Raveena Singh, MA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Gabrielle Gussin, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Ken Kleinman, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Raheeb Saavedra, AS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Lauren Heim, MPH, Medline (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Stryker (Sage) (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Xttrium (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)
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Majeed, Sughra, Razia Sultana, Amtul Shakeel, Nadia Ashraf, Farhat Perveen, and Sadia Rafique. "Individualized Approaches to Diabetes Care in Nursing Homes." Pakistan Journal of Medical and Health Sciences 16, no. 11 (December 1, 2022): 3–9. http://dx.doi.org/10.53350/pjmhs202216113.
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Although diabetes care has been widely established as a single entity, data in older, frail individuals with numerous comorbidities and have limited polymedication. This group accounts for a sizable number of nursing home residents (NHs). We came together as a group of experts with multidisciplinary (endocrinologists, geriatricians, Nurses staff, general practitioners and diabetologists) with real-world practice in this field, which is becoming more and more important globally, to compile practical, straightforward guidance on the managing of senior, fragile patients of diabetes. An Individual Care Plan (ICP), which is presented in layman's terms, is the cornerstone of a patient's diabetes treatment. This is due to the demands placed on personnel of NH (medical coordinator, manager, nurses, and caregiver working at the front lines, and the other caregiver worker which is under training). The actual purpose of this document, which is released when the patient is admitted, is to made prescriptions ensure that given at and followed after admission. It details the need for proper treatment, regular monitoring, and dates and times for essential examinations and testing. This entails keeping tabs on the patient's HbA1c, as well as their blood and urine glucose levels and any complications that may arise from the condition (hypoglycemia, cardiovascular disease, foot disorders, ocular problems, malnutrition, kidney failure and peripheral neuropathy). Consequentially, staff education on the unique challenges of care for an elderly person with diabetes, emergency procedures, and maintaining an up-to-date ICP for use by medical professionals is essential. Keywords: Diabetes care, nursing home, staff nurses
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Downs, Murna, Alan Blighe, Robin Carpenter, Alexandra Feast, Katherine Froggatt, Sally Gordon, Rachael Hunter, et al. "A complex intervention to reduce avoidable hospital admissions in nursing homes: a research programme including the BHiRCH-NH pilot cluster RCT." Programme Grants for Applied Research 9, no. 2 (February 2021): 1–200. http://dx.doi.org/10.3310/pgfar09020.
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Background An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support. Objectives Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted. Design A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect. Setting Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7). Participants We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting. Intervention This ran from February to July 2018. Data sources Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed. Results The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, background, assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was < 20% and 80% of individual-level data were collected. Necessary rates of data collection, documentation completion and return over the 6-month study period were achieved. However, intervention tools were not fully adopted, suggesting they would not be sustainable outside the trial. Few hospitalisations for the four conditions suggest it an unsuitable primary outcome measure. Key cost components were estimated. Limitations The study homes may already have had effective approaches to early detection, assessment and treatment for acute health changes; consistent with government policy emphasising the need for enhanced health care in homes. Alternatively, the implementation support may not have been sufficiently potent. Conclusion A definitive trial is feasible, but the intervention is unlikely to be effective. Participant recruitment, retention, data collection and engagement with family carers can guide subsequent studies, including service evaluation and quality improvement methodologies. Future work Intervention research should be conducted in homes which need to enhance early detection, assessment and treatment. Interventions to reduce avoidable hospital admissions may be beneficial in residential care homes, as they are not required to employ nurses. Trial registration Current Controlled Trials ISRCTN74109734 and ISRCTN86811077. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.
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Strube-Lahmann, Sandra, Ursula Müller-Werdan, Kristina Norman, Horst Skarabis, and Nils Axel Lahmann. "Underweight in Nursing Homes: Differences between Men and Women." Gerontology 67, no. 2 (2021): 211–19. http://dx.doi.org/10.1159/000512459.
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<b><i>Objective:</i></b> In Germany, there is an ongoing concern about the high prevalence of underweight on admission to health-care institutions. In order to assess possible sex-specific differences, the aim of this study is to provide valid figures about the prevalence and risk factors of underweight of men and women in German nursing homes. <b><i>Material and Methods:</i></b> A secondary data analysis of 8 annual consecutive cross-sectional studies of 19,686 residents from 280 nursing homes was conducted from 2009 to 2016. Underweight was defined as BMI < 18.5 (<20) for individuals <65 years (≥65 years). For statistical modeling, we used classification and regression trees (CRTs) and random forest in “R.” <b><i>Results:</i></b> Average prevalence of underweight in nursing home residents was 13.7% (13.2–14.2). Initial descriptive results showed that the prevalence of underweight among women was 15.6% (15.0–16.2) and the prevalence of underweight among men was 7.5% (6.7–8.2). The CRT-based modeling indicated that “loss of appetite” as the most important indicator for low BMI. If “loss of appetite” was present, prevalence of underweight increased from 13.5 to 39.1%. Other important indicators were “very large institutions” and the “resident/nurse ratio.” The random forest analysis confirmed the importance of the CRT approach. <b><i>Discussion/Conclusion:</i></b> The multivariate approach revealed that the role of sex for being underweight in nursing homes is marginal. To avoid higher morbidity and mortality in this group, nutritional intervention by clinical practitioners to increase appetite should be given high priority, especially in large long-term care institutions.
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Munro, Jordan, and Graham Grove. "Palliative pain: putting the patient back in control of their analgesia." International Journal of Palliative Nursing 28, no. 5 (May 2, 2022): 232–37. http://dx.doi.org/10.12968/ijpn.2022.28.5.232.
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A common reason for admission to palliative care wards is severe cancer-related pain. The delivery of therapy, an essential component in combating pain, is complicated by boundaries imposed by the law and quality use of medicines standards, which patients do not necessarily face in their own homes. These boundaries significantly delay the time until the patient is relieved of pain. Subcutaneous patient-controlled analgesia (PCA), delivered via a continuous ambulatory drug device, offers a potential method of mitigating these boundaries. This case series describes the experiences of the first four patients treated when subcutaneous PCA was introduced to an Australian palliative care ward and offers comments for consideration for future studies and wider implementation of use. It is noted that although PCA was generally effective overall, considerations about the patient's mental state and pain behaviours should be made before deciding to initiate PCA in lieu of nurse-administered breakthroughs.
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Gohil, Shruti K., Edward Septimus, Ken Kleinman, Neha Varma, Lauren Heim, Syma Rashid, Risa Rahm, et al. "42. INSPIRE-ASP UTI Trial: A 59 Hospital Cluster Randomized Evaluation of INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection versus Routine Antibiotic Selection Practices for Patients with Urinary Tract Infection (UTI)." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S142—S143. http://dx.doi.org/10.1093/ofid/ofab466.244.
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Abstract Background Up to 40% of hospitalized patients receive unnecessary or inappropriately broad antibiotics despite a low risk of multidrug-resistant organism (MDRO) infection. Empiric standard spectrum antibiotic use would reduce extended-spectrum (ES) antibiotic exposure and future resistance. We evaluated whether computerized prescriber order entry prompts providing patient-specific MDRO risk estimates could reduce ES antibiotic use compared to routine stewardship practices in patients hospitalized with urinary tract infection (UTI). Methods This 59-hospital cluster randomized trial compared: 1) INSPIRE prompts providing patient-specific MDRO UTI risk estimates at order entry and recommended standard spectrum antibiotics for risk < 10% versus 2) routine stewardship practices. Prompt used an absolute MDRO risk algorithm based on a 140 hospital data set. Trial population included adults treated with antibiotics for UTI in ED or non-ICU wards in first 3 days of admission (empiric days); prompt was triggered if ES antibiotics were ordered. Prescribers received feedback on prompt response. Trial periods: 18-month Baseline (Apr 2017–Sept 2018); 6-month Phase-in (Oct 2018–Mar 2019); 15-month Intervention (Apr 2019 – June 2020). Primary outcome was ES antibiotic days of therapy (ES-DOT) per empiric day; secondary outcomes were a) vancomycin and b) anti-pseudomonal DOT per empiric day. Unadjusted, as-randomized analyses used generalized linear mixed effects models to assess differences in ES-DOT rates between the intervention vs baseline period across arms (difference in differences), while clustering by patient and hospital. Results Results: We randomized 59 hospitals in 12 states, with 87,749 and 66,996 non-ICU UTI admissions in baseline and intervention periods, respectively. Intervention group had a a 21% reduction in ES-DOT compared to routine care. Vancomycin and anti-pseudomonal DOT were similarly reduced in the intervention group by 17% and 23%, respectively (Table). Conclusion Conclusion: INSPIRE order entry prompts providing real-time, patient-specific MDRO risk estimates with recommendation to use standard spectrum antibiotics in low risk patients significantly reduced empiric ES prescribing in adults admitted with UTI. Disclosures Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Edward Septimus, MD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Ken Kleinman, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Lauren Heim, MPH, Medline (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Stryker (Sage) (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product)Xttrium (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Syma Rashid, MD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Stryker (Sage) (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product)Xttrium (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Taliser R. Avery, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Kenneth Sands, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Julia Moody, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Kimberly N. Smith, MBA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Brandon Carver, BA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Caren Spencer-Smith, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Russell Poland, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Jason Hickok, MBA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Arjun Srinivasan, MD, Nothing to disclose John A. Jernigan, MD, MS, Nothing to disclose Jonathan B. Perlin, MD, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Richard Platt, MD, MSc, Medline (Research Grant or Support, Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)
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Weyerer, Siegfried, Martina Schäufele, and Andreas Zimber. "Alcohol Problems Among Residents in Old Age Homes in the City of Mannheim, Germany." Australian & New Zealand Journal of Psychiatry 33, no. 6 (December 1999): 825–30. http://dx.doi.org/10.1046/j.1440-1614.1999.00653.x.
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Objective: This study aims to determine the prevalence of alcohol problems among residents in old age homes, its demographic and clinical features, and its association with the risk of falling. Method: All residents (n = 1922) living in 20 randomly selected residential and nursing homes in the city of Mannheim, Germany, were included. Based on routine documentation, details of their sociodemographic features, medical diagnoses made upon admission, and current medication were compiled. The home staff filled out for each resident a standardised assessment sheet on activities of daily living-impairment (Barthel Index), behaviour problems, alcohol consumption, and frequency of falls. Results: According to the diagnoses of the primary care physicians, 7.4% of the residents had mental and behavioural disorders due to alcohol (ICD-10: F10). Rates were particularly high among men, and younger and single or divorced residents. A high percentage of those with a diagnosis of alcohol abuse/dependence (41.1%) were transferred from mental hospitals. Home staff reported current alcohol abuse/dependence among 3.4% of all residents. The risk of falling was significantly elevated (Odds ratio: 2.65; p < 0.01) among those with current alcohol problems. Conclusion: The results corroborate the findings from other studies wherein residents of old age homes constitute a group at risk of alcohol abuse and dependence. Alcohol problems were more the cause for, rather than the consequence of, home admission.
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Gohil, Shruti K., Edward Septimus, Ken Kleinman, Neha Varma, Lauren Heim, Syma Rashid, Risa Rahm, et al. "13. INSPIRE-ASP Pneumonia Trial: A 59 Hospital Cluster Randomized Evaluation of INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection versus Routine Antibiotic Selection Practices for Patients with Pneumonia." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S9—S10. http://dx.doi.org/10.1093/ofid/ofab466.013.
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Abstract Background Up to 40% of hospitalized patients receive unnecessary or inappropriately broad antibiotics despite a low risk of multidrug-resistant organism (MDRO) infection. Empiric standard spectrum antibiotic use would reduce extended-spectrum (ES) antibiotic exposure and future resistance. We evaluated whether computerized prescriber order entry prompts providing patient-specific MDRO risk estimates could reduce ES antibiotic use compared to routine stewardship practices in patients hospitalized with pneumonia. Methods This 59 hospital cluster-randomized trial compared: 1) INSPIRE prompts providing patient-specific MDRO pneumonia risk estimates at order entry and recommended standard spectrum antibiotics for risk < 10% versus 2) routine stewardship practices. Prompt used an absolute MDRO risk algorithm based on a 140 hospital data set. Trial population included adults treated with antibiotics for pneumonia in ED or non-ICU wards in first 3 days of admission (empiric days); prompt was triggered if ES antibiotics were ordered. Prescribers received feedback on prompt response. Trial periods: 18-month Baseline (Apr 2017–Sept 2018); 6-month Phase-in (Oct 2018–Mar 2019); 15-month Intervention (Apr 2019 – June 2020). Primary outcome was ES antibiotic days of therapy (ES-DOT) per empiric day; secondary outcomes were a) vancomycin and b) anti-pseudomonal DOT per empiric day. Unadjusted, as-randomized analyses used generalized linear mixed effects models to assess differences in ES-DOT rates between the intervention vs baseline period across arms (difference in differences), while clustering by patient and hospital. Results We randomized 59 hospitals in 12 states, with 59,897 and 51,486 non-ICU pneumonia admissions in baseline and intervention periods, respectively. Intervention group had a 33% reduction in ES-DOT compared to routine care. Vancomycin and anti-pseudomonal DOT were similarly reduced in the intervention group by 27% and 33%, respectively (Table). Conclusion INSPIRE order entry prompts providing real-time, patient-specific MDRO risk estimates with recommendation to use standard spectrum antibiotics in low risk patients significantly reduced empiric ES prescribing in adults admitted with pneumonia. Disclosures Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Edward Septimus, MD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Ken Kleinman, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Lauren Heim, MPH, Medline (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Stryker (Sage) (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product)Xttrium (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Syma Rashid, MD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Stryker (Sage) (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product)Xttrium (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Taliser R. Avery, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Kenneth Sands, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Julia Moody, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Micaela H. Coady, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Kimberly N. Smith, MBA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Brandon Carver, BA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Caren Spencer-Smith, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Russell Poland, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Jason Hickok, MBA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Arjun Srinivasan, MD, Nothing to disclose John A. Jernigan, MD, MS, Nothing to disclose Jonathan B. Perlin, MD, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Richard Platt, MD, MSc, Medline (Research Grant or Support, Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)
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Gerridzen, Ineke J., and M. Anne Goossensen. "Patients with Korsakoff syndrome in nursing homes: characteristics, comorbidity, and use of psychotropic drugs." International Psychogeriatrics 26, no. 1 (September 9, 2013): 115–21. http://dx.doi.org/10.1017/s1041610213001543.
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ABSTRACTBackground:Very limited literature exists on the care and course of patients with Korsakoff syndrome (KS) living in long-term care facilities (LTCFs). Even less literature can be found on the pharmacological treatment of behavioral symptoms of KS. The purpose of the present study was to describe baseline characteristics, comorbidity, and the use of psychotropic drugs in institutionalized patients with KS.Methods:In this cross-sectional descriptive study, 556 patients were included living in ten specialized care units in Dutch nursing homes. Data were collected by means of a retrospective chart review.Results:The majority of patients were men (75%) and single (78%) with a mean age on admission of 56.7 years (SD 8.9, range 29.8–85.3). Mean length of stay was 6.0 years (SD 5.4, range 0.2–33.3). Sixty-eight percent of patients suffered from at least one somatic disease and 66% from at least one extra psychiatric disorder. One or more psychotropic drugs were prescribed to 71% of patients with a great variation in prescription patterns between the different nursing homes.Conclusion:Patients with KS depending on long-term care usually have comorbidity in more than one domain (somatic and psychiatric). The indications for prescribing psychotropic drugs are in many cases unclear and it seems probable that they are often given to manage challenging behavior. Longitudinal studies on the evidence for this prescription behavior and possible alternatives are recommended.
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Yuan, Yiyang, Adrita Barooah, Deborah Mack, Kate Lapane, and Christine Ulbricht. "HEALTH PROFILES OF OLDER NURSING HOME RESIDENTS BY SUICIDAL IDEATION: A LATENT CLASS ANALYSIS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 707. http://dx.doi.org/10.1093/geroni/igac059.2586.
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Abstract In US nursing homes, 2% of residents have documentation of suicidal ideation (SI). Whether older residents’ health profiles differ by SI is unknown. Using the 9th Patient Health Questionnaire-9 (PHQ-9) item on Minimum Data Set 3.0, we identified 15,277 older residents with and 562,184 without SI. Latent class analysis using frailty, cognitive impairment, palliative care index, pain, and remaining PHQ-9 items as indicators identified health profiles by at-admission SI and estimated the association between profiles and SI at 90 days. In residents with at-admission SI, four profiles emerged: (1) frail, intact/moderate cognitive impairment, all depressive symptoms (prevalence: 22.8%); (2) frail, moderate/severe pain, depressed mood, sleep problems, fatigue (32.2%); (3) frail, severe cognitive impairment, depressed mood, fatigue, feelings of worthlessness (22.9%); (4) pre-frail, moderate/severe cognitive impairment, depressed mood (22.0%). Compared to the residents in profile 4, those in profile 1 [adjusted OR (aOR): 1.24; 95% Confidence Interval (CI):1.11-1.37] and those in profile 2 [aOR: 1.11; 95% CI: 1.01-1.22] were more likely to continue reporting SI at 90 days. In residents without at-admission SI, three profiles emerged: (1) frail, depressed mood, fatigue (33.9%); (2) frail, severe cognitive impairment (38.1%); (3) prefrail/frail (28.0%). Residents in profile 1 were more [aOR: 2.80; 95% CI: 2.60-3.00] while those in profile 2 were less [aOR: 0.79; 95% CI: 0.71-0.86] likely profile 1 residents to report SI at 90 days. Findings indicate substantial heterogeneity in the health profiles between and within older residents with and without self-reported SI.
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Brüngger, Beat, and Eva Blozik. "Hospital readmission risk prediction based on claims data available at admission: a pilot study in Switzerland." BMJ Open 9, no. 6 (June 2019): e028409. http://dx.doi.org/10.1136/bmjopen-2018-028409.
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ObjectivesEvaluating whether future studies to develop prediction models for early readmissions based on health insurance claims data available at the time of a hospitalisation are worthwhile.DesignRetrospective cohort study of hospital admissions with discharge dates between 1 January 2014 and 31 December 2016.SettingAll-cause acute care hospital admissions in the general population of Switzerland, enrolled in the Helsana Group, a large provider of Swiss mandatory health insurance.ParticipantsThe mean age of 138 222 hospitalised adults included in the study was 60.5 years. Patients were included only with their first index hospitalisation. Patients who deceased during the follow-up period were excluded, as well as patients admitted from and/or discharged to nursing homes or rehabilitation clinics.MeasuresThe primary outcome was 30-day readmission rate. Area under the receiver operating characteristic curve (AUC) was used to measure the discrimination of the developed logistic regression prediction model. Candidate variables were theory based and derived from a systematic literature search.ResultsWe observed a 30-day readmission rate of 7.5%. Fifty-five candidate variables were identified. The final model included pharmacy-based cost group (PCG) cancer, PCG cardiac disease, PCG pain, emergency index admission, number of emergency visits, costs specialists, costs hospital outpatient, costs laboratory, costs therapeutic devices, costs physiotherapy, number of outpatient visits, sex, age group and geographical region as predictors. The prediction model achieved an AUC of 0.60 (95% CI 0.60 to 0.61).ConclusionsBased on the results of our study, it is not promising to invest resources in large-scale studies for the development of prediction tools for hospital readmissions based on health insurance claims data available at admission. The data proved appropriate to investigate the occurrence of hospitalisations and subsequent readmissions, but we did not find evidence for the potential of a clinically helpful prediction tool based on patient-sided variables alone.
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Leff, Julian. "Can We Manage Without the Mental Hospital?" Australian & New Zealand Journal of Psychiatry 35, no. 4 (August 2001): 421–27. http://dx.doi.org/10.1046/j.1440-1614.2001.00887.x.
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Objectives: Many developed countries, having invested massively in psychiatric hospitals in the past 150 years, are in the process of dismantling them. The central question is whether this change in the location of care from the psychiatric hospital to district-based services has benefited the patients. The objectives of this review are to examine the evidence on which an answer to the above question might be based. Method: Much of the relevant research comes from the 13-year programme of the Team for the Assessment of Psychiatric Services conducted in London, but other research will be reviewed as appropriate. Results and conclusions: Long-stay, non-demented patients, including the elderly, enjoy a better quality of life in the community homes compared with the psychiatric hospitals. Public attitudes constitute an obstacle to social integration into the healthy community, but can be ameliorated with local educational programmes. The provision of work has been unsatisfactory, but the development of social firms holds some promise. Patients with dementia receive better care in community nursing homes compared with hospital wards, according to their relatives' opinions, backed up by observational studies. The part of the service which is most unsatisfactory is the admission facilities. This is due to a variety of causes, including a failure to plan for the admission needs of discharged long-stay patients, the virtual absence of rehabilitation units in the community and an inadequate provision of a range of sheltered accommodation. However, these problems could be resolved with adequate investment in innovative facilities.
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Kirkpatrick, F., and P. Crawford. "551 EASING THE STRAIN OF CONSTIPATION IN CARE HOMES." Age and Ageing 50, Supplement_2 (June 2021): ii8—ii13. http://dx.doi.org/10.1093/ageing/afab116.20.
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Abstract Introduction Older individuals are particularly prone to constipation with a reported prevalence of up 50% for those living in community with the prevalence rising to 70% within nursing homes (De Giorgio et al, 2015 1). Objectives To assess impact of staff education & pharmacist intervention on appropriateness of laxative use: Staff education: Examine the baseline knowledge of care home staff on constipation and laxative use: Formulate an education package to deliver to care home staff on key aspects of laxative use: Evaluate the staff knowledge, post the educational intervention.: Impact of pharmacist medication review on laxative use: Evaluate impact of pharmacist review on appropriateness of laxative use in care Homes. Method Three BHSCT Care Homes being case managed by the Medicines Optimisation Pharmacist were included in the study. Staff Education: The baseline knowledge of care home staff was examined by questionnaire, pre- and post-educational intervention on key aspects of laxative use. Staff directly administering medication or directly impacting on patients’ care in were included. An education package on key aspects of laxative use for delivery in nursing homes was designed and implemented. Impact of Pharmacist medication review on laxative use: We retrospectively examined if 30 patients were prescribed multiple laxatives from the same group as an indicator of inappropriate laxative use, pre and post pharmacist intervention. Results Staff education: Thirty-three staff completed the questionnaires. The educational package developed on laxative use had a positive impact on the knowledge of the staff on constipation and laxative use with statistically significant improvements in staff knowledge post education, with p-value <0.05. Healthcare assistants’ mean percentage increase in knowledge following education mirrored that of nursing staff at almost 50%. Impact of Pharmacist medication review on laxative use: There was a statistically significant improvement in appropriateness of laxative prescribing following the pharmacist led medication review of 30 residents. Fewer patients were prescribed laxatives from the same class following medication reviews with a p value of < 0.00001, the result is significant at p < 0.05. Discussion The positive impact of this study supports the conclusion by Chen et al 2 (2014) that patient and carer education should be first line treatment for non-severe constipation. Shen Q et al 3 (2018) suggested that educational intervention for patients can effectively improve constipation symptoms, treatment and result in improved health habits however this study provides further evidence that the education of care home staff plays a significant role in improving the appropriate management of constipation for care home residents. Pharmacist-led review of laxatives has the potential to improve a Care Home resident’s quality of life, as previously suggested by Dennison et al 4 (2005), with the potential to reduce the risk of complications or hospital admissions from ineffective treatment of chronic constipation. Conclusion The development & delivery of a bespoke laxative educational package along with pharmacist medication review of residents’ current laxatives regimes resulted in a statistically improved appropriateness in laxative use. The education package developed will be shared with Medicines Optimisation for Older People (MOOP) Care Home Pharmacists for delivery in NI trusts. References 1. De Giorgio et al. 2015. Chronic constipation in the elderly: a primer for gastroenterologist. BMC Gastroenterology, 14:130. 2. Dennison, C et al. 2005. the health-related quality of life and economic burden of constipation. Pharmaceoconmics 23 (5), 461–476. 3. Chen I. C. et al. (2014). Prevalence and effectiveness of laxative use among elderly residents in a regional hospital affiliated nursing home in Hsinchu County. Nursing and Midwifery Studies, 3(1), e13962. 4. Shen Q et al. (2018) Nurse-Led Self-Management Educational Intervention Improves Symptoms of Patients With Functional Constipation. West J Nurs Res. 2018 Jun;40(6):874–888. 5. Dennison et al. (2005) The Health-Related Quality of Life and Economic Burden of Constipation. Pharmacoeconomics, 23 (5), 461–476.
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Richardson, Kathryn, George M. Savva, Penelope J. Boyd, Clare Aldus, Ian Maidment, Eduwin Pakpahan, Yoon K. Loke, et al. "Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies." Health Technology Assessment 25, no. 1 (January 2021): 1–202. http://dx.doi.org/10.3310/hta25010.
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Background Sleep disturbance affects around 60% of people living with dementia and can negatively affect their quality of life and that of their carers. Hypnotic Z-drugs (zolpidem, zopiclone and zaleplon) are commonly used to treat insomnia, but their safety and efficacy have not been evaluated for people living with dementia. Objectives To estimate the benefits and harms of Z-drugs in people living with dementia with sleep disturbance. Design A series of observational cohort studies using existing data from (1) primary care linked to hospital admission data and (2) clinical cohort studies of people living with dementia. Data sources Primary care study – Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality data. Clinical cohort studies – the Resource Use and Disease Course in Dementia – Nursing Homes (REDIC) study, National Alzheimer’s Coordinating Centre (NACC) clinical data set and the Improving Well-being and Health for People with Dementia (WHELD) in nursing homes randomised controlled trial. Setting Primary care study – 371 primary care practices in England. Clinical cohort studies – 47 nursing homes in Norway, 34 Alzheimer’s disease centres in the USA and 69 care homes in England. Participants Primary care study – NHS England primary care patients diagnosed with dementia and aged > 55 years, with sleep disturbance or prescribed Z-drugs or low-dose tricyclic antidepressants, followed over 2 years. Clinical cohort studies – people living with dementia consenting to participate, followed over 3 years, 12 years and 9 months, for REDIC, NACC and WHELD, respectively. Interventions The primary exposure was prescription or use of Z-drugs. Secondary exposures included prescription or use of benzodiazepines, low-dose tricyclic antidepressants and antipsychotics. Main outcome measures Falls, fractures, infection, stroke, venous thromboembolism, mortality, cognitive function and quality of life. There were insufficient data to investigate sleep disturbance. Results The primary care study and combined clinical cohort studies included 6809 and 18,659 people living with dementia, with 3089 and 914 taking Z-drugs, respectively. New Z-drug use was associated with a greater risk of fractures (hazard ratio 1.40, 95% confidence interval 1.01 to 1.94), with risk increasing with greater cumulative dose (p = 0.002). The hazard ratio for Z-drug use and hip fracture was 1.59 (95% confidence interval 1.00 to 2.53) and for mortality was 1.34 (95% confidence interval 1.10 to 1.64). No excess risks of falls, infections, stroke or venous thromboembolism were detected. Z-drug use also did not have an impact on cognition, neuropsychiatric symptoms, disability or quality of life. Limitations Primary care study – possible residual confounding because of difficulties in identifying patients with sleep disturbance and by dementia severity. Clinical cohort studies – the small numbers of people living with dementia taking Z-drugs and outcomes not necessarily being measured before Z-drug initiation restricted analyses. Conclusions We observed a dose-dependent increase in fracture risk, but no other harms, with Z-drug use in dementia. However, multiple outcomes were examined, increasing the risk of false-positive findings. The mortality association was unlikely to be causal. Further research is needed to confirm the increased fracture risk. Decisions to prescribe Z-drugs may need to consider the risk of fractures, balanced against the impact of improved sleep for people living with dementia and that of their carers. Our findings suggest that when Z-drugs are prescribed, falls prevention strategies may be needed, and that the prescription should be regularly reviewed. Future work More research is needed on safe and effective management strategies for sleep disturbance in people living with dementia. Study registration This study is registered as European Union electronic Register of Post-Authorisation Studies (EU PAS) 18006. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 1. See the NIHR Journals Library website for further project information.
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Bucy, Taylor, Tetyana Shippee, Mark Woodhouse, John Bowblis, Shekinah Fashaw-Walters, and Nathan Shippee. "NOWHERE ELSE TO GO: EFFECTIVENESS OF THE PASRR PROGRAM TO MEET THE NEEDS OF RESIDENTS WITH SMI ADMITTED TO NURSING HOMES." Innovation in Aging 6, Supplement_1 (November 1, 2022): 639. http://dx.doi.org/10.1093/geroni/igac059.2366.
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Abstract The number of adults with serious mental illness (SMI) who receive care in nursing homes (NHs) continues to rise. The Preadmission Screening and Resident Review (PASRR) program requires screening for SMI prior to NH placement, in order to avoid inappropriate admission and unnecessary institutional care. We interviewed staff responsible for the processing of PASRR documentation at four NHs in Minnesota (n=15), and obtained and analyzed all completed PASRR-II assessments in Minnesota from 2019 (N=532). PASRR assessments overwhelmingly recommended 24-hour NH care (94.7%) with 94% of assessments indicating a need for mental health services while at the NH. Most NH staff interviewed noted that PASRR is not used in the care planning process and described PASRR as a regulatory hoop. Staff shared that PASRR assessments could provide insight into an individual’s mental health history, current and future needs, and can be helpful in assessing NH capacity to provide such services. Although mental health services provided while at the NH are supposed to be facilitated in partnership with the county, there is a lack of follow-up and NH staff are largely left to deal with SMI in isolation. PASRR assessments are supposed to be a tool for care coordination, but leave the NH as the sole responsible point of contact for residents with SMI. A more integrated PASRR program that better focuses on incorporating PASRR into care planning and mental health service delivery in NHs and the broader community is necessary to improve the lives of individuals with SMI.
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Ferson, Mark J., Keira Morgan, Peter W. Robertson, Alan W. Hampson, Ian Carter, and William D. Rawlinson. "Concurrent Summer Influenza and Pertussis Outbreaks in a Nursing Home in Sydney, Australia." Infection Control & Hospital Epidemiology 25, no. 11 (November 2004): 962–66. http://dx.doi.org/10.1086/502327.
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AbstractObjective:To report on the investigation of a summer outbreak of acute respiratory illness among residents of a Sydney nursing home.Design:An epidemiologic and microbiological investigation of the resident cohort at the time of the outbreak and medical record review 5 months later.Setting:A nursing home located in Sydney, Australia, during February to July 1999.Patients:The cohort of residents present in the nursing home at the time of the outbreak.Interventions:Public health interventions included recommendations regarding hygiene, cohorting of residents and staff, closure to further admissions, and prompt reporting of illness; and virologic and serologic studies of residents.Results:Of the 69 residents (mean age, 85.1 years), 35 fulfilled the case definition of acute respiratory illness. Influenza A infection was confirmed in 19 residents, and phylogenetic analysis of the resulting isolate, designated H3N2 A/Sydney/203/99, showed that it differed from strains isolated in eastern Australia during the same period. Serologic evidence ofBordetellainfection was also found in 10 residents; however, stratified epidemiologic analysis pointed to influenza A as the cause of illness.Conclusions:The investigation revealed an unusual summer outbreak of influenza A concurrent with subclinical pertussis infection. Surveillance of acute respiratory illness in nursing homes throughout the year, rather than solely during epidemic periods, in combination with appropriate public health laboratory support, would allow initiation of a timely public health response to outbreaks of acute respiratory illness in this setting.
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Wood, Lisa, Nicholas J. R. Wood, Shannen Vallesi, Amanda Stafford, Andrew Davies, and Craig Cumming. "Hospital collaboration with a Housing First program to improve health outcomes for people experiencing homelessness." Housing, Care and Support 22, no. 1 (December 11, 2018): 27–39. http://dx.doi.org/10.1108/hcs-09-2018-0023.
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PurposeHomelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting people to safe and secure housing needs to be part of the health system response. The paper aims to discuss these issues.Design/methodology/approachThis mixed-methods paper presents emerging findings from the collaboration between an inner city hospital, a specialist homeless medicine GP service and Western Australia’s inaugural Housing First collective impact project (50 Lives 50 Homes) in Perth. This paper draws on data from hospitals, homelessness community services and general practice.FindingsThis collaboration has facilitated hospital identification and referral of vulnerable rough sleepers to the Housing First project, and connected those housed to a GP and after hours nursing support. For a cohort (n=44) housed now for at least 12 months, significant reductions in hospital use and associated costs were observed.Research limitations/implicationsWhile the observed reductions in hospital use in the year following housing are based on a small cohort, this data and the case studies presented demonstrate the power of care coordinated across hospital and community in this complex cohort.Practical implicationsThis model of collaboration between a hospital and a Housing First project can not only improve discharge outcomes and re-admission in the shorter term, but can also contribute to ending homelessness which is itself, a social determinant of poor health.Originality/valueCoordinated care between hospitals and programmes to house people who are homeless can significantly reduce hospital use and healthcare costs, and provides hospitals with the opportunity to contribute to more systemic solutions to ending homelessness.
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Poh, Luting, Si-Ying Tan, and Jeremy Lim. "Governance of Assisted Living in Long-Term Care: A Systematic Literature Review." International Journal of Environmental Research and Public Health 18, no. 21 (October 28, 2021): 11352. http://dx.doi.org/10.3390/ijerph182111352.
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Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operational management, staff management and distribution, service provision and care monitoring, and crisis management), and micro-level regulations (clear criteria for resident admission and staff hiring) that are important in the governance of AL. Large-scale adoption of AL without compromising the quality, equity and affordability would require clear provisions of micro-, meso- and macro-level regulations.
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Palm, Rebecca, Anne Fahsold, Martina Roes, and Bernhard Holle. "Context, mechanisms and outcomes of dementia special care units: An initial programme theory based on realist methodology." PLOS ONE 16, no. 11 (November 16, 2021): e0259496. http://dx.doi.org/10.1371/journal.pone.0259496.
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Background Dementia special care units represent a widely implemented care model in nursing homes. Their benefits must be thoroughly evaluated given the risk of exclusion and stigma. The aim of this study is to present an initial programme theory that follows the principles of realist methodology. The theory development was guided by the question of the mechanisms at play in the context of dementia special care units to produce or influence outcomes of interest in people with dementia. Methods The initial programme theory is based on qualitative interviews with dementia special care stakeholders in Germany and a realist review of complex interventions in dementia special care units. The interviews were analysed using content analysis techniques. For the realist review, a systematic literature search was conducted in four scientific databases; studies were appraised for quality and relevance. All data were analysed independently by two researchers. A realist informed logic model was developed, and context-mechanism-outcome (CMO) configurations were described. Results We reviewed 16 empirical studies and interviewed 16 stakeholders. In the interviews, contextual factors at the system, organisation and individual levels that influence the provision of care in dementia special care units were discussed. The interviewees described the following four interventions typical of dementia special care units: adaptation to the environment, family and public involvement, provision of activities and behaviour management. With exception of family and public involvement, these interventions were the focus of the reviewed studies. The outcomes of interest of stakeholders include responsive behaviour and quality of life, which were also investigated in the empirical studies. By combining data from interviews and a realist review, we framed three CMO configurations relevant to environment, activity, and behaviour management. Discussion As important contextual factors of dementia special care units, we discuss the transparency of policies to regulate dementia care, segregation and admission policies, purposeful recruitment and education of staff and a good fit between residents and their environment.
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DEGUCHI, Y., Y. TAKASUGI, and K. NISHIMURA. "Vaccine effectiveness for influenza in the elderly in welfare nursing homes during an influenza A (H3N2) epidemic." Epidemiology and Infection 125, no. 2 (October 2000): 393–97. http://dx.doi.org/10.1017/s0950268899004410.
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Influenza vaccine effect on the occurrence and severity of influenza virus infection in a population residing in nursing homes for the elderly was studied as a cohort study during an influenza A (H3N2) epidemic in Japan. Of 22462 individuals living in 301 welfare nursing homes, 10739 voluntarily received inactivated, sub-unit trivalent influenza vaccine in a programme supported by the Osaka Prefectural Government. There were statistically significantly fewer cases of influenza, hospital admissions due to severe infection, and deaths due to influenza in the vaccinated cohort compared to the unvaccinated controls. No serious adverse reactions to vaccination were recorded. Thus influenza vaccination is effective for preventing influenza disease in persons aged 65 years and over, and should be an integral part of the care of this population residing in nursing homes.
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Harris, John, Steven Handler, Alison Trinkoff, David Wolf, and Nicholas Castle. "Qualitative Assessment of Resident Obesity in Nursing Homes by Medical Providers." Innovation in Aging 4, Supplement_1 (December 1, 2020): 241. http://dx.doi.org/10.1093/geroni/igaa057.778.
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Abstract We present qualitative themes from an ongoing five-year AHRQ-funded project (R01HS026943) examining the various ways nursing homes provide care for residents with obesity to determine the most effective way to prevent adverse safety events for residents with obesity. Obesity is a common diagnosis among short- and long-stay residents, and in the past, nursing home administrators have reported concerns from admissions issues to negative resident outcomes. No studies have examined the medical provider’s perspective on health of residents with obesity. In this abstract, we present three emergent themes from semi-structured interviews of medical providers (n=6) (nursing home medical directors, staff physicians, nurse practitioners) across the U.S. First, residents with obesity often have several complex and challenging medical conditions that require more services and health monitoring than most residents. Significant medical issues include diabetes, hypertension, cardiovascular disease, arthritis, and sleep apnea. Second, medical providers observe that it is difficult to provide daily custodial and nursing care, but the actual medical harm from substandard care is hard to quantify. Third, medical providers would like to help residents with obesity to lose weight and live healthier lives. There is, however, not an easy way to facilitate weight loss, due to limited resident physical activity, concerns about unhealthy weight loss, and difficulty changing established dietary habits of residents. These findings are limited by sample size, though themes have been consistent within the current participants. Comparing and contrasting these themes with other stakeholder groups (residents, nurse aides, administrators) interviews in the future will strengthen these findings.
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Gaspar, Heloisa Amaral, Cláudio Flauzino de Oliveira, Fabiana Camolesi Jacober, Eduardo Roberto de Deus, and Flavia Canuto. "Home Care as a safe alternative during the COVID-19 crisis." Revista da Associação Médica Brasileira 66, no. 11 (November 2020): 1482–86. http://dx.doi.org/10.1590/1806-9282.66.11.1482.
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SUMMARY INTRODUCTION: There are several reports worldwide about the high mortality related to COVID-19 among residents of nursing homes. The worldwide concern about the safety of patients and professionals in these institutions is relevant. In Brasil, a large part of post-acute care and chronic patients is performed at home through Home Care (HC). OBJECTIVE: This study aims to evaluate the incidence of COVID-19 in Home Care patients and the clinical outcomes of these patients; it also aims to assess the impact of the epidemic on the number of patients, new admissions, and hospitalizations. METHODS: A descriptive study of the COVID-19 cases that affected the population in care by Home Doctor (a private company of Home Care), between the months of March 2020 and May 2020 and analysis of the total number of patients, the hospitalization and death rate in the period compared to the pre-epidemic period. RESULTS: There were 31 confirmed cases of COVID-19, 21 of which were male, mean age 73 years. All patients had multiple comorbidities, the most prevalent were: Systemic Arterial Hypertension (54%) and Stroke (35%). The incidence of COVID-19 was 1% in the studied population. There were 10 hospitalizations with 5 hospital deaths and one case of home death (lethality 19%). Safe care was maintained, with a low death rate (0.6%) and hospitalization (6.1%). CONCLUSION: Home Care is able to maintain safe care during the pandemic due to COVID-19, with a low incidence of COVID-19, low hospitalization rate, and low mortality when compared to nursing homes institutions.
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Shippee, Tetyana, Taylor Bucy, Weiwen Ng, Mark Woodhouse, Shekinah Fashaw-Walters, and John Bowblis. "SERIOUS MENTAL ILLNESS IN MINNESOTA NURSING HOMES: THE ROLE OF RESIDENT AND FACILITY CHARACTERISTICS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 639. http://dx.doi.org/10.1093/geroni/igac059.2367.
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Abstract Multiple studies have shown an increasing prevalence of adults with serious mental illness (SMI) in nursing homes. As adults with SMI age, the reality of care needs that span physical, medical, and psychosocial services necessitates further consideration of the role of comprehensive, ancillary mental health services in nursing homes (NH). Yet, little work examines characteristics of those with SMI, their care needs & the role of facility structural factors. Using the 2011-2017 Minimum Dataset (MDS) assessment data for Minnesota, we examined resident-level demographic characteristics of NH residents with and without SMI, and facility-level characteristics including quality of life (QoL), quality of care (QoC), and state recertification survey scores. We defined SMI as a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, or psychotic conditions other than schizophrenia present on the reference assessment. Individuals admitted with SMI were younger, had better physical health, were more likely to be racial/ethnic minorities, and more likely to be admitted to a facility with a higher proportion of racial/ethnic minority residents. SMI-only admissions were concentrated in larger, for-profit facilities with a high-reliance on Medicaid. Lastly, SMI-only admissions were more likely to occur in facilities with lower QoL, QoC, and inspection scores. There is a growing need for behavioral health services in NHs, yet access to services is inadequate and lacks equity based on geography, race/ethnicity and other system-level disparities.
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Thomas, Roger E. "Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions." Geriatrics 6, no. 2 (May 8, 2021): 48. http://dx.doi.org/10.3390/geriatrics6020048.
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The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents’ own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.
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Holder, Jacquetta M., and David Jolley. "Forced relocation between nursing homes: residents' health outcomes and potential moderators." Reviews in Clinical Gerontology 22, no. 4 (October 19, 2012): 301–19. http://dx.doi.org/10.1017/s0959259812000147.
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SummaryThat transfer of older people from one institution to another is detrimental to well-being, health and survival has been reported for 50 years. This has led to fear, anger and legal challenges when closures occur. Previous reviews identified accounts of relocation followed by adverse outcomes and others where problems were avoided or benefits claimed. This paper reviews the last twelve years of literature on health outcomes following involuntary relocation between nursing homes. Reports of post-move mortality, physical or psychological health suggest and confirm that relocation without preparation carries higher risk of poor outcomes than moves that are orderly and include preparation. The literature on the care home closure process, admissions and individual transfers offers insights into practices that might help minimize adverse outcomes. A number of agencies have produced helpful guidelines. How these are implemented needs to be monitored and linked to in-depth studies of sample closures.
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Gussin, Gabrielle M., James A. McKinnell, Raveena D. Singh, Ken Kleinman, Amherst Loren Miller, Raheeb Saavedra, Lauren Heim, et al. "Decreased Hospitalizations and Costs From Infection in Sixteen Nursing Homes in the SHIELD OC Regional Decolonization Initiative." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s7—s8. http://dx.doi.org/10.1017/ice.2020.479.
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Distinguished OralBackground: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P < .001), a reduction of 7% per quarter in hospitalization days due to infection (P < .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.Funding: NoneDisclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.
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Kim, Hea-Lim, and Hye-Jae Lee. "Patterns of the Concurrent Use of Anti-dementia Drugs and Antipsychotics: Analysis using HIRA-APS-2018 Data." Yakhak Hoeji 66, no. 5 (October 31, 2022): 225–35. http://dx.doi.org/10.17480/psk.2022.66.5.225.
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The number of dementia patients and the associated socio-economic burden are rapidly increasing in Korea. Behavioral and psychological symptoms of dementia increase the burden on caregivers, thus primarily instigating admission to a nursing home. In this study, using 2018 Health Insurance Review and Assessment Service-Aged Patient Sample (HIRA-APS) data, the pattern of concurrent use of anti-dementia and antipsychotic drugs by dementia patients was investigated, and related factors were identified. The most frequently used combination were donepezil-quetiapine (52.8%), donepezil-memantine-quetiapine (13.8%), and donepezil-risperidone (8.8%). Logistic regression analysis revealed male patients, those aged ≥75 years, medical aid beneficiaries, and those with Charlson Comorbidity Index (CCI) ≥5 to be more likely to receive concomitant administration. The likelihood increased in patients visiting nursing or general hospitals, while it decreased in patients visiting tertiary hospitals. Honam, Gyeongsang, and Chungcheong regions showed lower likelihood of concurrent use than Seoul-metropolitan area. The results of this study provide basic evidence for further studies on the outcome of concurrent use in dementia patients.
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Quasdorf, Tina, and Sabine Bartholomeyczik. "Influence of leadership on implementing Dementia Care Mapping: A multiple case study." Dementia 18, no. 6 (October 6, 2017): 1976–93. http://dx.doi.org/10.1177/1471301217734477.
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Dementia Care Mapping is an internationally applied method for enhancing person-centred care for people with dementia in nursing homes. Recent studies indicate that leadership is crucial for the successful implementation of Dementia Care Mapping; however, research on this topic is rare. This case study aimed to explore the influence of leadership on Dementia Care Mapping implementation in four nursing homes. Twenty-eight interviews with project coordinators, head nurses and staff nurses were analysed using qualitative content analysis. Nursing homes that failed to implement Dementia Care Mapping were characterised by a lack of leadership. The leaders of successful nursing homes promoted person-centred care and were actively involved in implementation. While overall leadership performance was positive in one of the successful nursing homes, conflicts related to leadership style occurred in the other successful nursing homes. Thus, it is important that leaders promote person-centred care in general and Dementia Care Mapping in particular. Furthermore, different types of leadership can promote successful implementation. Trial registration of the primary study: Current Controlled Trials ISRCTN43916381.
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Huang, Susan S., Edward Septimus, Ken Kleinman, Lauren Heim, Julia Moody, Taliser R. Avery, Laura E. McLean, et al. "4. 137 Hospital Cluster-Randomized Trial of Mupirocin-Chlorhexidine vs Iodophor-Chlorhexidine for Universal Decolonization in Intensive Care Units (ICUs) (Mupirocin Iodophor Swap Out Trial)." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S3—S4. http://dx.doi.org/10.1093/ofid/ofab466.004.
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Abstract Background ICU universal decolonization with daily chlorhexidine (CHG) baths plus mupirocin nasal decolonization reduces all-cause bloodstream infections (BSI) and MRSA clinical cultures. We assessed nasal iodophor, an antiseptic less susceptible to resistance, in place of mupirocin. Methods We conducted a cluster randomized non-inferiority trial in ICUs, comparing universal decolonization with: 1) Mupirocin-CHG: daily CHG baths and 5 days of twice daily nasal mupirocin, to 2) Iodophor-CHG: same regimen, substituting twice daily 10% povidone-iodine for mupirocin. All adult ICUs in a hospital were assigned to the same strategy. We compared each hospital’s outcomes during the 18-month intervention (Nov 2017-Apr 2019) to its own baseline (May 2015-Apr 2017), during which all hospitals used mupirocin-CHG. The primary outcome was ICU-attributable S. aureus clinical isolates. Secondary outcomes included ICU-attributable MRSA clinical isolates and all-cause BSI. As randomized and as treated analyses used unadjusted proportional hazards models assessing differences in outcomes between baseline and intervention periods across the two groups, accounting for clustering by hospital and patient. Results We randomized 137 hospitals with 233 ICUs in 18 states. There were 442,544 admissions in the baseline period and 349,262 in the intervention period. Median ICU length of stay was 4 days. ICU types included mixed medical surgical (56%), medical (9%), surgical (11%), cardiac (15%), and neurologic (9%). CHG adherence was similar in both arms (85%), but adherence was greater for mupirocin (90%) than iodophor (82%). Primary as-randomized results (Table, Figure) exceeded the non-inferiority margin in favor of mupirocin, for S. aureus clinical cultures (21% superiority, P< 0.001) and for MRSA clinical cultures (20% superiority, P< 0.001). The regimens had similar BSI hazards. Analyses of fully adherent patients are in progress. Figure - Primary and Secondary Outcomes of Mupirocin Iodophor Swap Out Trial Conclusion Universal iodophor-CHG was equivalent to mupirocin-CHG for ICU BSI prevention. Mupirocin-CHG was superior to iodophor-CHG for S. aureus and MRSA clinical isolates, potentially due to greater adherence to mupirocin. Disclosures Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Edward Septimus, MD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Ken Kleinman, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Lauren Heim, MPH, Medline (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Stryker (Sage) (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product)Xttrium (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Julia Moody, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Taliser R. Avery, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Syma Rashid, MD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Stryker (Sage) (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product)Xttrium (Other Financial or Material Support, Conducted clinical trials and studies in which participating hospitals and nursing homes received contributed antiseptic product) Katherine Haffenreffer, BS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Lauren Shimelman, BA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Caren Spencer-Smith, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Selsebil Sljivo, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Ed Rosen, BS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Russell Poland, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Micaela H. Coady, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Eunice J. Blanchard, MSN RN, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Kimberly Reddish, DNP, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Brandon Carver, BA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Kimberly N. Smith, MBA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Jason Hickok, MBA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Karen Lolans, BS, Medline (Research Grant or Support) Nadia Khan, BS, Medline (Research Grant or Support) John A. Jernigan, MD, MS, Nothing to disclose Kenneth Sands, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Jonathan B. Perlin, MD, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Richard Platt, MD, MSc, Medline (Research Grant or Support, Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)
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Snowdon, John. "Depression in nursing homes." International Psychogeriatrics 22, no. 7 (August 3, 2010): 1143–48. http://dx.doi.org/10.1017/s1041610210001602.
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ABSTRACTBackground: Although studies have shown the prevalence of depression in nursing homes to be high, under-recognition of depression in these facilities is widespread. Use of screening tests to enhance detection of depressive symptoms has been recommended.Methods: This paper aims to provoke discussion about optimal management of depression in nursing homes. The utility of the Cornell Scale for Depression in Dementia (CSDD) is considered. CSDD data relating to residents assessed in 2008–2009 were collected from three Sydney nursing homes.Results: CSDD scores were available from 162 residents, though raters stated they were unable to score participants on at least one item in 47 cases. Scores of 13 or more were recorded for 23% of residents in these facilities, but in most of these cases little was documented in case files to show that the results had been discussed by staff, or that they led to interventions, or that follow-up testing was arranged.Conclusions: Results of CSDD testing should prompt care staff (including doctors) to consider causation of depression in cases where residents are identified as possibly depressed. In particular, there needs to be discussion of how to help residents to cope with disability, losses, and feelings of powerlessness. Research is needed, examining factors that might predict response to antidepressants, and what else helps. Accreditation of nursing homes could be made to depend partly on evidence that staff regularly search for, and (if found) ensure appropriate responses to, depression.
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Nouvenne, Antonio, Caterina Caminiti, Francesca Diodati, Elisa Iezzi, Beatrice Prati, Stefano Lucertini, Paolo Schianchi, et al. "Implementation of a strategy involving a multidisciplinary mobile unit team to prevent hospital admission in nursing home residents: protocol of a quasi-experimental study (MMU-1 study)." BMJ Open 10, no. 2 (February 2020): e034742. http://dx.doi.org/10.1136/bmjopen-2019-034742.
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IntroductionNursing home residents represent a particularly vulnerable population experiencing high risk of unplanned hospital admissions, but few interventions have proved effective in reducing this risk. The aim of this research will be to verify the effects of a hospital-based multidisciplinary mobile unit (MMU) team intervention delivering urgent care to nursing home residents directly at their bedside.Methods and analysisFour nursing homes based in the Parma province, in Northern Italy, will be involved in this prospective, pragmatic, multicentre, 18-month quasiexperimental study (sequential design with two cohorts). The residents of two nursing homes will receive the MMU team care intervention. In case of urgent care needs, the nursing home physician will contact the hospital physician responsible for the MMU team by phone. The case will be triaged as (a) manageable by phone advice, (b) requiring urgent assessment by the MMU team or (c) requiring immediate emergency department (ED) referral. MMU team is composed of one senior physician and one emergency-medicine resident chosen within the staff of Internal Medicine and Critical Subacute Care Unit of Parma University-Hospital, usually with different specialty background, and equipped with portable ultrasound, set of drugs and devices useful in urgency. The MMU visits patients in nursing homes, with the mission to stabilise clinical conditions and avoid hospital admission. Residents of the other two nursing homes will receive usual care, that is, ED referral in every case of urgency. Study endpoints include unplanned hospital admissions (primary), crude all-cause mortality, hospital mortality, length of stay and healthcare-related costs (secondary).Ethics and disseminationThe study protocol was approved by the Ethics Committee of Area Vasta Emilia Nord (Emilia-Romagna region). Informed consent will be collected from patients or legal representatives. The results will be actively disseminated through peer-reviewed journals and conference presentations, in compliance with the Italian law.Trial registration numberClinicalTrials.gov Registry (NCT 04085679); Pre-results.
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Redondo-Bravo, Lidia, Beatriz Fernandez-Martinez, Diana Gómez-Barroso, Alin Gherasim, Montserrat García-Gómez, Agustín Benito, and Zaida Herrador. "Scabies in Spain? A comprehensive epidemiological picture." PLOS ONE 16, no. 11 (November 1, 2021): e0258780. http://dx.doi.org/10.1371/journal.pone.0258780.
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Introduction Scabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997–2019 as well as to describe the main environments of transmission using different data sources. Methods We carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes. Results The elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored. Discussion An increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.
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Weeks, Lori, Brittany Barber, Eileigh Storey MacDougall, Elaine Moody, Lexi Steeves-Dorey, Grace Warner, Marilyn Macdonald, and Ruth Martin Misener. "Supporting the Transition From Hospital to Home for Older Adults: Case Study Results." Innovation in Aging 4, Supplement_1 (December 1, 2020): 81. http://dx.doi.org/10.1093/geroni/igaa057.266.
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Abstract It is often during transitions between health services that many issues arise for older adults, such as care that is poorly coordinated, additional burden placed on family and friend caregivers, and inappropriate placement in nursing homes. The Home Again program delivered by the provincial health authority in Nova Scotia, Canada, provides transitional care through providing additional support beyond what is normally provided through home care services to help older adults transition home after a hospital admission. The purpose of this research was to identify what factors contribute to older adults being placed unnecessarily in a nursing home when they could receive care through the Home Again program. Through using a retrospective multiple case study design, we analyzed interviews for five cases including older adult patients, their family or friend caregivers, and healthcare professionals in each case. Results indicate all hospitalized patients experienced a major health event or rapidly declining health. All family and friend caregivers experienced burnout and frustration from the lack of sufficient home care supports and quality of services available, such as services provided throughout the night. Healthcare professionals discussed that patients were placed on a waiting list for nursing homes due to lack of home care supports and resources for caregivers. This study contributes to our knowledge about better processes to ensure that hospitalized older adults are not unnecessarily admitted to nursing homes which can result in reduced healthcare costs and improved delivery and quality of care to older adults and their family and friend caregivers.
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Rojo, Á., and E. Fernandez. "Towards an improvement of medical and psychological care in a nursing home." European Psychiatry 26, S2 (March 2011): 850. http://dx.doi.org/10.1016/s0924-9338(11)72555-x.
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IntroductionValle Inclán Nursing Home is a multifunctional centre of Gerontology, that offers social and health services to elderly people, either with physical independence or with physical and psychic disabilities. Mental illness is studied from a multidisciplinary point of view, and these different therapeutic programs are implemented: psychological support for adjustment disorders, cognitive-behavioural therapy for mood disorders and overall medical examination of dementia. The total sample of patients that are studied is 445, chronologically distributed according the next data: N: 234 (2006), N: 264 (2007), N: 258 (2008) y N: 243 (2009).ObjectivesTo know the prevalence of the main psychiatric pathologies and to compare to data found in scientific literature.To find data that can be used in order to improve the quality of medical care and psychosocial attention.MethodThe prevalence of different psychiatric conditions treated by this mental health department, and the variation of these data for the last four years are showed. These data are compared with those in scientific literature.ResultsMental illness prevalence distribution is similar to the prevalence that is found in scientific literature. Dementia is the most prevalent pathology, and mood disorders are in the second place.ConclusionsThe decrease in the prevalence of mood disorders is probably on account of the implementation of specific psychotherapeutic programs. An increase in the prevalence of dementia can be explained by the improvement of screening of this illness and/or the increasing social request for admission to these nursing homes.
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Tracy, Marissa, Christina B. Felsen, Anita Gellert, and Ghinwa Dumyati. "Trends in Staphylococcus aureus Bloodstream Infections in Nursing Homes in Monroe County, New York." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s417—s418. http://dx.doi.org/10.1017/ice.2020.1073.
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Background: Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) are common in hospitals and nursing homes. Infection prevention efforts reduced MRSA BSI in hospitals but the trend in nursing homes is not well described. In addition, the contribution of methicillin sensitive S. aureus (MSSA) to the total burden of invasive S. aureus (iSA) in nursing homes remains unknown. Methods: As part of the CDC Emerging Infections Program, we conduct population-based surveillance for iSA infections in Monroe County, New York. Case patients were county residents with S. aureus isolated from a sterile site. Our analysis was limited to data from 2009–2018 for MRSA and 2015–2018 for MSSA and to cases classified as hospital-onset (HO, positive culture ≥3 calendar days after admission) or nursing home-onset (NHO, positive culture in nursing homes or within 3 days of hospital admission from a nursing home). Risk factors for iSA BSI in nursing homes were compared using the χ2 and Student t tests in SAS version 9.4 software. Results: During 2009–2014, 664 MRSA cases occurred and 427 (64%) were BSIs. Of these, 228 (53%) were NHO and 199 (47%) were HO. The BSI incidence per 100,000 population of NHO cases declined from 7.9 in 2009 to 2.8 in 2014, mirroring the decline in HO incidence from 8.7 in 2009 to 3.1 in 2014 (Fig. 1). During 2015–2018, 203 MRSA cases (163 BSIs, 80%) and 235 MSSA cases (163 BSIs, 69%) occurred. Of the 163 MRSA BSIs, 94 (58%) were NHO and 69 (42%) were HO, whereas of the 235 MSSA BSIs, only 56 (34%) were NHO and 107 (66%) were HO. MRSA BSI incidence per 100,000 population in both settings plateaued during 2015–2018 (Fig. 1) and MSSA NHO BSI incidence was lower than HO (1.9 NHO vs 3.6 HO). The total iSA BSI incidence was similar in both settings (5.9 vs 5.0 per 100,000 population in HO and NHO, respectively). NHO MSSA and MRSA cases have similar risk factors for BSI; 45 (30%) had decubitus ulcers, 34 (23%) were on chronic dialysis, 41 (27%) had a CVC in place within 2 days of BSI onset, and 63% had prior healthcare exposures. Most of these developed within 4 weeks of hospital discharge (Fig. 2). Conclusions: The incidence of MRSA BSI in nursing homes has declined since 2009 but plateaued starting in 2015. Compared to MRSA, MSSA caused fewer BSIs in nursing homes; however, iSA risk factors, including previous healthcare exposure, were similar. Continued study is needed to identify interventions effective against all iSA infections in nursing homes.Funding: NoneDisclosures: None
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Dening, Karen Harrison, and Zena Aldridge. "Enhanced healthcare in care homes for people with dementia: the Admiral nursing offer." Nursing and Residential Care 23, no. 7 (July 2, 2021): 1–10. http://dx.doi.org/10.12968/nrec.2021.23.7.4.
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Background The UK older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia and comorbidity, many of whom will require 24-hour residential care. It is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it while residing in the care home, many of who will have complex needs with high levels of multimorbidity. However, there is a lack of consistency in the provision of primary care and specialist services to this population and a known gap in knowledge and skills of dementia care in care home staff and primary care teams. Methods This article considers the current health policy drivers to enhance integrated health and social care provision to care homes and proposes a model of care that would support the aims of the NHS Long Term Plan for care to be delivered closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes. It is crucial that such a model includes the correct skill mix to meet the needs of the care home population. Conclusions There are currently gaps in service provision to many care homes. Admiral nurse case managers and specialists in dementia care, are well placed to support the delivery of Enhanced Health in Care Homes and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system.
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McGee, Gail W., Myron D. Fottler, Richard M. Shewchuk, and Carole W. Giardina. "Corporate Structure and Administrators' Job Stress: The Case of Nursing Homes." Health Services Management Research 5, no. 1 (March 1992): 54–65. http://dx.doi.org/10.1177/095148489200500106.
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This paper examined the relationship between the job-related stress of nursing home administrators and the structure of their work setting. Multivariate analysis of covariance (MANCOVA) was used to test the hypothesis that nursing home administrators who are employed in multi-unit, corporate-owned facilities experience more job-related stress than do administrators employed in independent, free-standing organizations. The results indicated that, when controlling for other potential stressors, administrators in corporate-owned nursing homes reported more general job stress and greater role ambiguity than their counterparts in single-unit, autonomous organizations. Recommendations for management strategies and for future studies in this area are discussed.
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Aldridge, Zena, and Karen Harrison Dening. "Admiral Nurse Case Management within Enhanced Health in Care Homes." OBM Geriatrics 05, no. 02 (February 15, 2021): 1. http://dx.doi.org/10.21926/obm.geriatr.2102167.
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The United Kingdom’s (UK) older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia, and comorbidity many of whom may require 24-hour care. Currently it is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it whilst residing in the care home. The provision of high-quality care for this population is a challenge with a lack of consistency in the provision of primary care and specialist services and a known gap in knowledge and skills. The NHS Long Term Plan aims to move care closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes (EHCH). However, such services need to be equipped with the correct skill mix to meet the needs of the care home population. Admiral Nurses are specialists in dementia care and are well placed to support the delivery of EHCH and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system. This paper discusses current gaps in service provision and how both the EHCH framework, and the inclusion of Admiral Nurses, might redress these and improve outcomes.
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Barooah, Adrita, and Pamela Nadash. "ADMISSION AND CARE OF INDIVIDUALS WITH MENTAL ILLNESS IN MASSACHUSETTS NURSING HOMES: A PILOT STUDY." Innovation in Aging 3, Supplement_1 (November 2019): S341. http://dx.doi.org/10.1093/geroni/igz038.1237.
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Abstract Due to the rising prevalence of mental illness in nursing homes (NHs), the US Congress passed the 1987 Pre-Admission Screening and Resident Review (PASRR) mandate, which aims both to limit inappropriate institutionalization of people with mental illness and to ensure that they are served appropriately when living in NHs. Although the PASRR is a federal mandate, states have considerable flexibility in implementing it, resulting in considerable variation across states. This study explores the Commonwealth of Massachusetts’ policies on admission and care of individuals with mental illness in NHs, focusing on implementation of PASRR regulations. Semi-structured phone interviews were conducted with key informants identified through purposive snowball sampling (N=8). Key informants included representatives from NHs, the State Mental Health Authority, state Medicaid office, and independent contractors and an academic expert. Data were analyzed using qualitative content analysis. Participants agreed that the PASRR tools efficiently identified and screened people with mental illness -- thus achieving PASRR’s first aim, but that the regulations did not successfully ensure appropriate services. Interviewees also identified a lack of services and options for diversion of people with mental illness into the community. Nursing home informants noticed a disconnect between the various supervising departments and felt instructions were unclear on the administration of the tool. This work builds a case for a national study to understand how PASRR implementation varies across states, resulting in variations in the proportion of people with mental illness admitted and served in NHs.