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1.

Objective

Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents’ needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents.

Design

A longitudinal, retrospective cohort study using an in-person survey.

Setting

Three hundred twenty nursing homes in Kansas enrolled or not enrolled in a pay-for-performance program, Promoting Excellent Alternatives in Kansas (PEAK 2.0), to promote PCC in nursing homes.

Participants

A total of 6214 nursing home residents in 2013-2014 and 5538 residents in 2014-2015, with a Brief Interview for Mental Status score ≥8, participated in face-to-face interviews. Results were aggregated to the nursing home level.

Measurements

My InnerView developed a Resident Satisfaction Survey for Kansas composed of 32 questions divided into QOL, QOC, QOS, and global satisfaction subdomains.

Results

After controlling for facility characteristics, satisfaction with overall QOL and QOC was higher in homes that had fully implemented PCC. Although some individual measures in the QOS domain (eg, food) showed greater satisfaction at earlier levels of implementation, high satisfaction was observed primarily in homes that had fully implemented PCC.

Conclusion

These findings provide evidence for the effectiveness of PCC implementation on nursing home resident satisfaction. The PEAK 2.0 program may provide replicable methods for nursing homes and states to implement PCC systematically.  相似文献   

2.

Objectives

Persons with osteoporotic fracture history are subject to an increased risk for subsequent fractures and mortality. The aim of this retrospective study was to investigate the impact of a previous osteoporotic low-impact (fragility) index fracture (eg, forearm, lower leg) on mortality of a subsequent femoral fracture.

Design

Retrospective cohort study.

Participants/measurements

Claims data of a German health insurance agency including >1.2 million insurants aged 65 years or older and observed between 2004 and 2009.

Methods

A multistate model was developed handling index fractures and care need as time-dependent exposures, while age was chosen as the underlying time scale. Excess risks were expressed as differences in cause-specific hazards. Nelson-Aalen estimates were used for their nonparametric estimation. Time-simultaneous statistical inference was based on confidence bands provided by wild bootstrap resampling.

Results

Excess femoral fracture risk increased with progressive age and was highest in persons with care need. It was observed starting from an age of 79 years in women and 85 years in men onward. A prior index fracture increased mortality after a femoral fracture by increasing femoral fracture risk, while leaving the hazard of death after a subsequent femoral fracture unchanged.

Conclusions

The results indicated that increased mortality of a subsequent femoral fracture is not triggered by an intrinsically increased mortality hazard but an increased femoral fracture incidence.  相似文献   

3.

Objectives

Innovative care environments are developed for people with dementia to encourage person-centered care. This study aims to investigate whether residents of green care farms that provide 24-hour nursing care participate more in (physical) activities and social interaction compared with residents of other nursing homes.

Design

Longitudinal observation study.

Setting

Nursing homes in the Netherlands (green care farms, traditional nursing homes, and regular small-scale living facilities).

Participants

A total of 115 nursing home residents at baseline, 100 at follow-up.

Measurements

Ecological momentary assessments (n = 16,860) were conducted using the Maastricht Electronic Daily Life Observation Tool. Residents living at green care farms were compared with residents living in traditional nursing homes and regular small-scale living facilities. The following aspects were collected for this study: the activity performed by the participant or occurring in his or her vicinity, the engagement in the activity, the level of physical activity during the activity, the physical environment (location where the activity occurred), and the level of social interaction during the activity.

Results

In total, 9660 baseline observations and 7200 follow-up observations were conducted. Analyses showed that residents of green care farms significantly more often participated in domestic activities (P = .004, SE = 1.6) and outdoor/nature-related activities (P = .003, SE = 0.9), and significantly less often engaged in passive/purposeless activities (P < .001, SE = 1.7) compared with residents of traditional nursing homes. Furthermore, residents of green care farms had significantly more active engagement (P = .014, SE = 0.9), more social interaction (P = .006, SE = 1.1), and came outside significantly more (P = .010, SE = 1.1) than residents of traditional nursing homes. Residents of green care farms were significantly more physically active (P = .013, SE = 0.8) than were residents of regular small-scale living facilities. No other significant differences were found.

Conclusion

Green care farms can be a valuable alternative to traditional nursing homes. They provide an attractive, homelike environment and activities that positively influence engagement and social interaction. Research is needed to study how successful elements of green care farms can be implemented in existing nursing homes.  相似文献   

4.

Importance

Dental neglect and high levels of unmet dental needs are becoming increasingly prevalent among elderly residents of long-term care facilities, although frail, elderly, and dependent populations are the most in need of professional dental care. Little is known about the validity of teledentistry for diagnosing dental pathology in nursing home residents.

Objectives

To evaluate the accuracy of teledentistry for diagnosing dental pathology, assessing the rehabilitation status of dental prostheses, and evaluating the chewing ability of older adults living in nursing homes (using direct examination as a gold standard).

Design

Multicenter diagnostic accuracy study performed in France and Germany.

Setting

Eight nursing homes in France and Germany.

Participants

Nursing home residents with oral or dental complaints, self-reported or reported by caregivers, willing to receive oral or dental preventive care. In total, 235 patients were examined. The mean age was 84.4 ± 8.3 years, and 59.1% of the subjects were female.

Intervention

The patients were examined twice. Each patient was his or her own control. First, the dental surgeon established a diagnosis by reviewing a video recorded in the nursing home and accessed remotely. Second, within a maximum of 7 days, patients were examined conventionally (face-to-face) by the same surgeon who established the initial diagnosis.

Measurements

All residents received a comprehensive clinical examination in their home by a trained geriatrician and underwent a dental hygiene evaluation that used the Silness-Loe and Greene-Vermillion dental hygiene assessment indices. The diagnoses established via the video recording and in the face-to-face setting were compared. The main outcome measure was number of dental pathologies.

Results

In total, 128 (55.4%) patients had a dental pathology. The sensitivity of teledentistry for diagnosing dental pathology was 93.8% (95% confidence interval [CI] 90.7–96.9), and the specificity was 94.2% (95% CI 91.2–97.2). Among the 128 cases of dental pathology identified by teledentistry, 6 (4.8%) were false positives. The teledentistry assessments were quicker than the face-to-to-face examinations (12 and 20 minutes, respectively).

Conclusions

Teledentistry showed excellent accuracy for diagnosing dental pathology in older adults living in nursing homes; its use may allow more regular checkups to be carried out by dental professionals.  相似文献   

5.

Objectives

Studies reporting prompted voiding (PV) interventions were of short duration and were delivered by research personnel rather than nursing home staff. This study examined the effectiveness of the use of PV by nursing home staff in managing urinary incontinence among residents over a 6-month period.

Design

A randomized controlled trial.

Setting

Five nursing homes in Hong Kong.

Participants

Data were collected from 52 nursing home residents who had been admitted to the facility for at least 6 months prior to the initiation of the study and whose incontinence had been stable over the 6-month period.

Intervention

The PV intervention was delivered by the staff for 6 months. All nursing home staff were trained to ensure that they would be able to correctly deliver the intervention before initiating the intervention. The control group received the usual care.

Measurements

Outcomes were defined in terms of wet episodes per day, incontinence rate per day, self-initiated toileting per day, and total continent toileting per day. Data were collected at baseline, 3 months postintervention (T1), and 6 months postintervention (T2).

Results

There were significant differences between the two groups in wet episodes per day, incontinence rate per day, and total continent toileting per day at 6 months post-intervention, with positive results found in the intervention group. A decrease of 9.1% was observed in the incontinence rate of the intervention group.

Conclusions

PV was shown to have positive effects, although the effects in this study were not as powerful as those found in overseas studies. The intervention delivered by staff was sustainable for a 6-month period. Nursing home operators should promote better continence care through PV, as it is a sustainable noninvasive behavioral intervention that can be mastered by staff with training.  相似文献   

6.

Objectives

To explore current use and perceptions of glove and gown use in nursing homes.

Design

Qualitative study using focus groups and semi-structured interviews.

Setting

Three community-based nursing homes in Maryland.

Participants

Direct care staff, administrators, and residents.

Methods

We conducted three focus groups among nursing home staff, one focus group among nursing home administrators, and five interviews with residents. Topic guides were created based on our recent study results and a review of the literature. Two investigators separately analyzed the transcribed recordings and identified recurrent themes.

Results

Direct care staff reported using gowns and gloves primarily as self-protection against contact with bodily fluids, not to prevent MRSA transmission. Glove use was described as common and more acceptable to staff and residents than gown use. Administrators were surprised that MRSA transmission to health care worker hands and clothing occurred during activities when direct care staff perceives no contact with bodily fluids. Staff and administrators expressed willingness to use gowns and gloves for high-risk care activities, particularly if use is targeted toward specific types of residents such as those with pressure ulcers. There was a knowledge deficit about MRSA transmission and infection among direct care staff and residents.

Conclusions

Results from this study will inform a strategy to reduce MRSA transmission in long-term care.  相似文献   

7.

Background

Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression.

Objectives

To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness.

Design

Randomized controlled trial with waiting list control group.

Setting

Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients’ homes.

Participants

A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness.

Intervention

Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group.

Measurements

HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician.

Results

The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures.

Conclusions

CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients.

Clinical Trial Registration

www.germanctr.de German Trial Register DRKS 00004728  相似文献   

8.

Background

While obesity can be an antecedent of disability and the prevalence of disabilities in increased in individuals with obesity, it has been highly debated whether obesity itself should be considered a disability. The European Court of justice has set a precedent in 2014, ruling that severe forms of obesity qualify for protection under the disability protection legislation. However, attitudes and opinions of those affected have not been investigated yet.

Objective

To study attitudes of people with obesity regarding the acknowledgment of obesity as a disability.

Methods

Cross-sectional analysis of a population-based study from Germany, conducted in 2015, in n = 1000 individuals with obesity.

Results

We find that 38.2% of all respondents agreed that obesity ought to be considered a disability. In logistic regression analyses, heavier participants expressed a higher support of obesity seen as a disability, regardless of perceived discrimination experiences (ΔOR = 1.54, p = 0.427). Experiences of perceived discrimination were associated with a higher approval of obesity as a disability in individuals with class II obesity (OR = 2.07, p = 0.002) compared to respondents with less severe obesity.

Conclusion

These findings go in line with the European Court of Justice's ruling, where it is stated that only severe forms of obesity qualify for protection under the disability legislation. The results underline the importance of considering adding weight to anti-discrimination legislation.  相似文献   

9.

Objectives

Use of exercise technologies has benefits for community-dwelling older adults in terms of improved gait and balance. But research on the feasibility of use of exercise technologies in various geriatric health care settings is lacking. Hence, the current study examined the feasibility of implementing an exercise technology intended to augment rehabilitation in patients receiving post-acute care (PAC) in a skilled nursing facility (SNF). We focused on 3 indicators of feasibility: extent of usage (including predictors of more intense use), patients' acceptability of the technology, and limited efficacy.

Design

Cross-sectional study with data from patients' electronic medical records (EMR), exercise technology portal, and patient interviews.

Setting

SNF.

Participants

A sample of post-acute patients (n = 237).

Measurements

Sociodemographic and health-related variables, time spent using the technology, and 8 items of the Physical Activity Enjoyment Scale (PACES).

Results

Average time spent using the technology varied greatly (range, 1–460 minutes). A regression analysis showed that patients who had a longer length of stay (β = .01, P < .05) and were younger (β = ?0.01, P < .05) spent significantly more time using the technology. Acceptability of technology was high among patients. Finally, patients who used the technology had lower 30-day rehospitalization rates.

Conclusion

Exercise technology is feasible to use in supporting rehabilitation in patients receiving PAC in a SNF and seems to have beneficial effects.  相似文献   

10.

Objectives

This scoping study is the first step of a multiphase, international project aimed at designing a homecare robot that can provide functional support, track physical and psychological well-being, and deliver therapeutic intervention specifically for individuals with mild cognitive impairment.

Design

Observational requirements gathering study.

Participants and settings

Semistructured interviews were conducted with 3 participant groups: (1) individuals with memory challenges, mild cognitive impairment (MCI), or mild dementia (patients; n = 9); (2) carers of those with MCI or dementia (carers; n = 8); and (3) those with expertise in MCI or dementia research, clinical care, or management (experts; n = 16). Interviews took place at the university, at dementia care facilities or other workplaces, at participant's homes, or via skype (experts only).

Measurements

Semistructured interviews were conducted, transcribed, and reviewed.

Results

Several key themes were identified within the 4 topics of: (1) daily challenges, (2) safety and security, (3) monitoring health and well-being, and (4) therapeutic intervention.

Conclusions

A homecare robot could provide both practical and therapeutic benefit for the mildly cognitively impaired with 2 broad programs providing routine and reassurance; and tracking health and well-being. The next phase of the project aims to program homecare robots with scenarios developed from these results, integrate components from project partners, and then test the feasibility, utility, and acceptability of the homecare robot.  相似文献   

11.

Objective

To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay.

Design

Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program.

Setting/Participants

Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72–85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff).

Intervention

National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients’ (care) needs, care coordination, team cooperation, and quality of care.

Measurements

Data on patients’ characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke.

Results

In the total population, at 1 year postimplementation there was 12% more ADL independence [odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00–2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01–2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09–3.63).

Conclusions

This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries.  相似文献   

12.

Objectives

Identify contextual and implementation factors impacting the effectiveness of an organizational-level intervention to reduce preventable hospital readmissions from affiliated skilled nursing facilities (SNFs).

Design

Observational study of the implementation of Interventions to Reduce Acute Care Transfers tools in 3 different cohorts.

Setting

SNFs.

Participants

SNFs belonging to 1 of 2 corporate entities and a group of independent SNFs that volunteered to participate in a Quality Improvement Organization (QIO) training program.

Intervention

Two groups of SNFs received INTERACT II training and technical assistance from corporate staff, and 1 group of SNFs received training from QIO staff.

Measurements

Thirty-day acute care hospital readmissions from Medicare fee-for-service claims, contextual factors using the Model for Understanding Success in Quality framework.

Results

All 3 cohorts were able to deliver the INTERACT training program to their constituent facilities through regional events as well as onsite technical assistance, but the impact on readmission rates varied. Facilities supported by the QIO and corporation A were able to achieve statistically significant reductions in 30-day readmission rates. A review of contextual factors found that although all cohorts were challenged by staff turnover and workload, corporation B facilities struggled with a less mature quality improvement (QI) culture and infrastructure.

Conclusions

Both corporations demonstrated a strong corporate commitment to implementing INTERACT II, but differences in training strategies, QI culture, capacity, and competing pressures may have impacted the effectiveness of the training. Proactively addressing these factors may help long-term care organizations interested in reducing acute care readmission rates increase the likelihood of QI success.  相似文献   

13.
  相似文献   

14.

Objectives

Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents.

Design

Cross-sectional survey.

Setting

236 nursing facilities from 7 states.

Participants

Nursing facility administrators.

Measurements

Web-based survey to measure whether facilities introduced any policies or procedures designed specifically to reduce potentially avoidable hospitalizations of long-stay nursing facility residents between 2011 and 2015. We surveyed facilities about seven types of interventions and quality improvement activities related to reducing avoidable hospitalizations, including use of Interventions to Reduce Acute Care Transfers (INTERACT) and American Medical Directors Association tools.

Results

Ninety-five percent of responding nursing facilities reported having introduced at least one new policy or procedure to reduce nursing facility resident hospitalizations since January 2011. The most common practice reported was hospitalization rate tracking or review, followed by standardized communication tools, such as Situation, Background, Assessment, Recommendation (SBAR). We found some variation in the extent and types of these reported interventions.

Conclusions

Nearly all facilities surveyed reported having introduced a variety of initiatives to reduce potentially avoidable hospitalizations, likely driven by federal, state, and corporate initiatives to decrease hospital admissions and readmissions.  相似文献   

15.

Background

Many adults are discharged to skilled nursing facilities (SNFs) prior to returning home from the hospital. Patient characteristics and factors that can help to prevent postdischarge adverse outcomes are poorly understood.

Objective

To identify whether early post–SNF discharge care reduces likelihood of 30-day hospital readmissions.

Design

Secondary data analysis using the Electronic Medical Record, Medicare, Medicaid and the Minimum Data Set.

Participants/setting

Older (age > 65 years), community-dwelling adults admitted to a safety net hospital in the Midwest for 3 or more nights and discharged home after an SNF stay (n = 1543).

Measurements

The primary outcome was hospital readmission within 30 days of SNF discharge. The primary independent variables were either a home health visit or an outpatient provider visit within a week of SNF discharge.

Results

Out of 8754 community-dwelling, hospitalized older adults, 3025 (34.6%) were discharged to an SNF, of whom 1543 (51.0%) returned home. Among the SNF to home group, a home health visit within a week of SNF discharge was associated with reduced hazard of 30-day hospital readmission [adjusted hazard ratio (aHR) 0.61, P < .001] but outpatient provider visits were not associated with reduced risk of hospital readmission (aHR = 0.67, P = .821).

Conclusion

For patients discharged from an SNF to home, the finding that a home health visit within a week of discharge is associated with reduced hazard of 30-day hospital readmissions suggests a potential avenue for intervention.  相似文献   

16.

Objectives

To study pain prevalence, pain type, and its pharmacological treatment in Dutch nursing home residents in relation to dementia subtype and dementia severity.

Design

Data were collected as part of the PAINdemiA study, an observational cross-sectional study conducted between May 2014 and December 2015.

Setting

Ten nursing homes in the Netherlands.

Participants

A total of 199 nursing home residents in various stages of dementia.

Measurements

We collected data on pain (by observation: MOBID-2 Pain Scale and by self-report scales), pain type, pain medication, dementia subtype, dementia severity (GDS), and demographic features.

Results

In the whole sample, the prevalence of pain was 43% (95% confidence interval 36%–50%) using the MOBID-2 Pain Scale. Regardless of regularly scheduled analgesics, approximately one-third of the residents with pain suffered from moderate to severe pain. Pain assessment with the MOBID-2 Pain Scale showed no difference in pain between dementia subtypes, but residents with more severe dementia experienced pain more often than those with less severe dementia (27% vs 15%). The prevalence of self-reported pain was significantly higher in residents with vascular dementia (VaD) (54%) compared with those with Alzheimer disease (18%) and other dementia subtypes (14%). Nociceptive pain was the predominant type of pain (72%) followed by mixed pain (25%). Acetaminophen was the most prescribed analgesic (80%).

Conclusion

Most of the participating nursing home residents had no pain; however, pain was observed more often in residents with severe dementia, whereas residents in the early stages of VaD self-reported pain more often that those with other dementia subtypes.As one-third of the residents with clinically relevant pain had moderate to severe pain regardless of using pain medication, more focus should be on how pain management could use more tailored approaches and be regularly adjusted to individual needs.  相似文献   

17.

Objectives

This study aimed to examine the effects of introducing participatory action research (PAR) within the nursing home (NH) on residents’ quality of life (QoL) and NH experience and participation, and to explore their experiences with PAR.

Design

A mixed methods design was chosen, including a clustered randomized controlled trial (RCT) and qualitative interviews.

Setting

For the RCT, 3 NHs were randomly allocated to 3 conditions: an intervention (weekly PAR activity), an active control (weekly reminiscence-activity), or passive control (care as usual). The qualitative study took place in the intervention NH.

Participants

Within the RCT, about 30 residents were recruited for assessments per NH, including 9 PAR participants and 10 reminiscence participants. Qualitative interviews were held with all PAR participants (residents and internal moderator).

Intervention

PAR is a method to structurally involve residents in the NH operation. Weekly PAR sessions were held with 9 residents and 2 moderators. Here, residents critically analyzed and discussed the NH operation, identified possible problems, suggested improvements, which were further implemented by the NH and monitored by the PAR group.

Measurements

Residents’ NH experience (NH Active Aging Survey), QoL (Anamnestic Comparison Self-Assessment), and experienced participation (Impact on Participation and Autonomy) were measured in the RCT at pre-test, post-test (6 months), and follow-up (12 months). The qualitative study took into account interviews with the PAR stakeholders after 6 months.

Results

The RCT showed residents’ QoL improving more between pre-test and follow-up in the intervention and active control NH compared with the passive control NH. No other effects were observed. The qualitative data revealed a positive PAR experience. Participants enjoyed the activity and indicated various positive influences. Still, there was room for improvement, including communication toward other residents and between staff.

Conclusions

Notwithstanding the modest quantitative effects, PAR led to positive experiences and can have a future in the NH when solving some limitations.  相似文献   

18.

Objectives

Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period.

Design

This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study.

Setting

Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included.

Participants

Resident in NH, older than 60 years and had a group iso-resource score ranging from 2 to 5.

Measurements

Pneumonia events were characterized according to the Observatoire du Risque Infectieux en Geriatrie criteria. Direct medical and nonmedical costs were assessed from the French health insurance perspective. Healthcare resources was retrospectively gathered from the French Social Health Insurance database and valued using the tariffs reimbursed by the French health insurance. Sociodemographic variables, clinical factors, vaccinations, cognition, depression, functional status, frailty index, as well as group iso-resource score were also recorded.

Results

Among the 800 patients initially included in the Incidence of Pneumonia and Related Consequences in Nursing Home Resident study, 345 which were listed in the database of the French Social Health Insurance were included in this economic study. Among them, 64 (18%) experienced at least 1 episode of pneumonia during the 1-year follow-up period. Mean annual total additional cost for a patient who experienced at least 1 episode of pneumonia during the 1 year follow-up period is 2813€. On average, total annual costs increased by 60% to 93% when a patient experienced at least 1 episode of pneumonia.

Conclusions

NH-acquired pneumonia has a great impact on total cost of care for NH residents. Our results suggest the potential economic savings that could be achieved if pneumonia could be prevented in NHs.  相似文献   

19.

Objectives

To investigate the prevalence and factors associated with the use of medications of questionable benefit throughout the final year of life of older adults who died with dementia.

Design

Register-based, longitudinal cohort study.

Setting

Entire Sweden.

Participants

All older adults (≥75 years) who died with dementia between 2007 and 2013 (n = 120,067).

Measurements

Exposure to medications of questionable benefit was calculated for each of the last 12 months before death, based on longitudinal data from the Swedish Prescribed Drug Register.

Results

The proportion of older adults with dementia who received at least 1 medication of questionable benefit decreased from 38.6% 12 months before death to 34.7% during the final month before death (P < .001 for trend). Among older adults with dementia who used at least 1 medication of questionable benefit 12 months before death, 74.8% remained exposed until their last month of life. Living in an institution was independently associated with a 15% reduction of the likelihood to receive ≥1 medication of questionable benefit during the last month before death (odds ratio 0.85, 95% confidence interval 0.88–0.83). Antidementia drugs accounted for one-fifth of the total number of medications of questionable benefit. Lipid-lowering agents were used by 8.3% of individuals during their final month of life (10.2% of community-dwellers and 6.6% of institutionalized people, P < .001).

Conclusion

Clinicians caring for older adults with advanced dementia should be provided with reliable tools to help them reduce the burden of medications of questionable benefit near the end of life.  相似文献   

20.

Objectives

A simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function.

Design

Cross-sectional study.

Setting

Single university hospital.

Participants

A total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD.

Measurements

SARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group).

Results

The sarcopenia prevalence rate was 25.5% and increased with age (P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates.

Conclusion

The SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings.  相似文献   

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