Psychometric evaluation of the Hendrich Fall Risk Model

AIMS: The aim of this paper is to report a psychometric evaluation of the Hendrich Fall Risk Model. BACKGROUND: Thoroughly developed and tested instruments for assessment of fall risk are needed to identify patients at risk of falling, to enable the implementation of preventative measures. METHOD: Data from 1977 patients/residents in 45 nursing homes and 7197 patients from 47 hospitals were evaluated in a cross-sectional survey. The internal consistency of the Hendrich Fall Risk Model was examined using the Kuder-Richardson Test. The dimensions of the model were revealed by exploratory factor analysis and the Care Dependency Scale was used to investigate construct validity. Using Spearman Rho the sum of weighted items was correlated with the sum of unweighted items to obtain information about the practicability of a weighted total score. The study was carried out in 2003. RESULTS: The internal consistency of the model was not high (alpha = 0.54). Additionally, factor analysis showed that the model had more than one dimension. The correlation between the fall risk model and Care Dependency Scale was quite high for hospital patients and the total group (Spearman Rho = -0.71 or -0.76 respectively, P < 0.01) and medium for nursing home residents (Spearman Rho = -0.51, P < 0.01). The total scores of the weighted and unweighted items correlated highly (Spearman Rho = 0.96, P < 0.01). CONCLUSIONS: The use of this risk model is not recommended for nursing homes. For hospitals, we advise the use of unweighted items.     

Pressure ulcer risk screening in hospitals and nursing homes with a general nursing assessment tool: evaluation of the care dependency scale

Rationale In view of an increasing necessity for systematic assessments, nursing practice would benefit from a simplification of assessment procedures. These assessments should be scientifically based. Aims To evaluate the possibility of assessing pressure ulcer risk as well as care dependency simultaneously with a standardized instrument for nursing homes and hospitals. Methods Care dependency was measured with the Care Dependency Scale (CDS). The quantitative analyses were accomplished with data from a cross‐sectional study that was performed in 2005 in 39 German nursing homes and 37 hospitals with a total of more than 10 000 participants. The scale's construct validity was calculated with Pearson's r, and predictive validity was evaluated by computing sensitivity and specificity values and the area under the curve (AUC). Item‐level analyses included calculations of odds ratios, relative risks and logistic regression analyses. Results Construct validity of the CDS was r = 0.79 (P < 0.01) in nursing homes and r = 0.89 (P < 0.01) in hospitals. AUC was 0.80 in hospitals and 0.65 in nursing homes. Analyses on item level identified ‘mobility’ as a key item in both settings and additional differing key items for nursing homes and hospitals. Conclusions The CDS is a well‐functioning tool for pressure ulcer risk detection in hospitals. For this purpose, the most appropriate cut‐off point is 69 while special regard is given to the items ‘continence’, ‘mobility’ and ‘hygiene’. In nursing homes the usefulness of the CDS for pressure ulcer risk detection is limited. Here, the most appropriate cut‐off point is 41 and attention is given to the items ‘mobility’, ‘getting (un)dressed’, ‘hygiene’ and ‘avoidance of danger’.     

Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work

BACKGROUND: Occupational and resident characteristics affect levels of staff stress and satisfaction in nursing homes, and levels of staff turnover are high. Working with more cognitively impaired residents, especially on day shift, is associated with high levels of stress in nursing home staff. Workload is highly predictive of the experience of burden and job pressure, while these outcomes vary according to whether staff work full- or part-time. AIMS: To investigate the attitudes of nursing home staff towards residents, strain related to dementia care and satisfaction with work and their associations with demographic, occupational and behavioural disturbance in the home. METHODS: A cross-sectional design was adopted, using a self-completion questionnaire survey of 253 nursing home staff from 12 nursing homes in Sydney's eastern suburbs, and behavioural assessment of all 647 residents from 11 of the 12 homes. Staff attitudes and strain were measured using the Swedish Strain in Nursing Care Assessment Scale and satisfaction using the Swedish Satisfaction with Nursing Care and Work Assessment Scale. RESULTS: Staff members' five most prevalent perceptions of residents with dementia were that they are anxious, have little control over their difficult behaviour, are unpredictable, lonely and frightened/vulnerable. The five attributes staff found most difficult to cope with were being aggressive/hostile, having little control over their difficult behaviour, being stubborn/resistive, deliberately difficult, and unpredictable. Although 91% of staff reported that they were happy in their job, a quarter reported that residents provided no job satisfaction. The five satisfaction statements most agreed with were "The patients/residents at work nearly always receive good care", "It is important to try and enter into the way patients experience what happens to them", "Relatives are given enough information about care and treatment", "I enjoy my current work situation" and "Our work organisation is good". There were significant differences between homes in levels of strain related to dementia care that were not accounted for by the level of behavioural disturbance. CONCLUSIONS: Nursing home staff tended to perceive residents in more negative than positive ways. Staff were generally satisfied with their work. Factors other than resident behavioural disturbance are important influences in nursing staff strain.     

Prospective study of fall risk assessment among institutionalized elderly in Japan

Abstract The purpose of the present study was to identify risk factors for falls among institutionalized elderly, using the standardized risk assessment tool developed by Izumi. We examined 746 patients from three types of facilities: rehabilitation wards in four general hospitals, three long-term care facilities, and three nursing homes, for up to three months. The incidence of falls within all facilities was 12.5%. Patterns of relative risks of falling differed among types of facilities. The highest relative risk of fall in long-term care facilities and nursing homes was nurses' prediction, followed by history of fall and altered mentation. In contrast, that in general hospitals was mobility. In long-term care facilities, history of falls (odds 3.68, 95CI: 1.47–9.23) and interaction (history of falls and assistance with toileting) (odds 3.13, 95CI: 1.48–6.64) showed significance on adjusted-odds ratios for fall. History of falls, altered mentation, and assistance with toileting may be used to screen patients at a high risk for fall at admission.     

Care dependency: testing the German version of the Care Dependency Scale in nursing homes and on geriatric wards

The purpose of this study was the psychometric evaluation of the German version of the dependency scale in nursing homes and on geriatric wards. The 15-item scale was originally developed in the Netherlands for assessing the care dependency of demented and mentally handicapped patients. Data of 81 nursing home residents and of 115 geriatric patients were collected. Residents and patients were assessed several time by professionals and nonprofessionals. Reliability was determined by Cronbach's alpha, showing very good results with values of 0.94 and 0.98. Inter-rater and intrarater reliability show moderate to substantial Kappa values. Criterion validity was examined by comparing the data of the scale with the German nursing personal regulation and the German statutory insurance. The results show that the scores of the Care Dependency Scale correlate to the scores of the two classifications. In general, the German version of the scale can be recommended for use in nursing homes and on geriatric wards.     

Screening the risk of falls: a general or a specific instrument?

Aims and objectives. The aim of this study is to investigate if a general instrument (Care Dependency Scale; CDS) has the same sensitivity and specificity as a specific instrument (Hendrich Fall Risk Model; HFRM) in a screening for fall risks. Background. Falls of older patients are a common problem in hospitals. Apart from falls risk, nurses have to use many assessment tools to detect the patients’ different care problems. To decrease the workload it would be helpful to have a general instrument used as a first screening for possible risks for different healthcare problems, such as falls, instead of specific risk instruments for each individual healthcare problem. Design. A prospective design was used by measuring each patient upon admission and by registering all falls during their hospital stay. Methods. The sample consisted of 560 patients of a geriatric hospital in Germany. All of whom gave their informed consent to participate in the study. Nurses filled in the CDS and the HFRM at the time of hospital admission. Results. The CDS (cut off point ≤54) had a sensitivity of 75% (47/63 fallers) and a specificity of 46% (227/497 non‐fallers). The HFRM (cut off point ≥11) had a sensitivity of 75% (47/63 fallers) and a specificity of 47% (237/497 non‐fallers). Conclusion. The results of the CDS are similar to those of the HFRM in predicting falls. Relevance to clinical practice. The use of the CDS is preferred as it is more general and more reliable than the HFRM. The workload for nursing staff can be decreased when only one instrument is used.     

The Care Dependency Scale for measuring basic human needs: an international comparison

dijkstra a., y?nt g.h., korhan e.a., muszalik m, k?dziora-kornatowska k. & suzuki m. (2012)?The Care Dependency Scale for measuring basic human needs: an international comparison. Journal of Advanced Nursing68(10), 2341-2348. ABSTRACT: Aim. To report a study conducted to compare the utility of the Care Dependency Scale across four countries. Background. The Care Dependency Scale provides a framework for assessing the needs of institutionalized patients for nursing care. Henderson's components of nursing care have been used to specify the variable aspects of the concept of care dependency and to develop the Care Dependency Scale items. Design. The study used a cross-cultural survey design. Method. Patients were recruited from four different countries: Japan, The Netherlands, Poland and Turkey. In each of the participating countries, basic human needs were assessed by nurses using a translated version of the original Dutch Care Dependency Scale. Psychometric properties in terms of reliability and validity of the Care Dependency Scale have been assessed using Cronbach's alpha, Guttman's Lambda-2, inter-item correlation and principal components analysis. Data were collected in 2008 and 2009. Results. High internal consistency values were demonstrated. Principal component analysis confirmed the one-factor model reported in earlier studies. Conclusion. Outcomes confirm Henderson's idea that human needs are fundamental appearing in every patient-nurse relationship, independent of the patient's age, the type of care setting and/or cultural background. The psychometric characteristics of the Care Dependency Scale make this instrument very useful for comparative research across countries.     

End-of-life care for nursing home residents dying from cancer in Nova Scotia,Canada, 2000–2003

INTRODUCTION: With our population aging, an increasing proportion of cancer deaths will occur in nursing homes, yet little is known about their end-of-life care. This paper identifies associations between residing in a nursing home and end-of-life palliative cancer care, controlling for demographic factors. METHODS: For this population-based study, a data file was created by linking individual-level data from the Nova Scotia Cancer Centre Oncology Patient Information System, Vital Statistics, and the Halifax and Cape Breton Palliative Care Programs for all persons 65 years and over dying of cancer from 2000 to 2003. Multivariate logistic regression was used to compare nursing home residents to nonresidents. RESULTS: Among the 7,587 subjects, 1,008 (13.3%) were nursing home residents. Nursing home residents were more likely to be female [adjusted odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.7], older (for > or = 90 vs 65-69 years OR 5.4, CI 4.1-7.0), rural (OR 1.5, CI 1.2-1.8), have only a death certificate cancer diagnosis (OR 4.2, CI 2.8-6.3), and die out of hospital (OR 8.5, CI 7.2-10.0). Nursing home residents were less likely to receive palliative radiation (OR 0.6, CI 0.4-0.7), medical oncology consultation (OR 0.2, CI 0.1-0.4), and palliative care program enrollment (Halifax OR 0.2, CI 0.2-0.3; Cape Breton OR 0.4, CI 0.3-0.7). CONCLUSION: Demographic characteristics and end-of-life services differ between those residing and those not residing in nursing homes. These inequalities may or may not reflect inequities in access to quality end-of-life care.     

Psychometric properties of the extended Care Dependency Scale for older persons in Egypt

Aim. The aim of this study was to determine the validity and reliability of the modified Arabic Care Dependency Scale for self‐assessment of older persons in Egypt and to compare these self‐assessments to proxy assessments by care givers and family members. Background. The Care Dependency Scale is an internationally used instrument to measure care dependency. The Arabic version may improve data collection on this phenomenon in the Middle East where the population is ageing. Design. A cross‐sectional study with a sample of 611 older persons living in Greater Cairo. Participants belonged to three groups: nursing home residents, home care recipients and non‐care recipients; 459 participants were also rated by proxies and 171 repeated their self‐assessment after two weeks. Methods. The correlation between sum scores of the Care Dependency Scale and the Activities of Daily Living scale was calculated to establish criterion validity. Construct validity was determined by comparing care recipients and non‐care recipients with regard to their Care Dependency Scale sum scores and by exploratory factor analysis. Intraclass coefficients were used to assess test‐retest reliability of self‐ratings for each item. Mean differences between self and proxy assessment were calculated. Results. The Care Dependency Scale had a strong correlation to the Activities of Daily Living scale and is able to distinguish between care recipients and non‐care recipients. Factor analysis revealed one factor for basic needs and one factor for psychosocial needs. ICC values were >0·7 for most items related to the factor for basic needs among care recipients. Proxy assessment yielded higher care dependency than self assessment. Conclusion. Care Dependency Scale items for basic needs are suitable to assess care dependency among Egyptian care recipients. Relevance to clinical practice. Assessment of care dependency is useful to obtain data for appropriate resource allocation among care recipients.     

Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes

Researchers have demonstrated that the use of physical restraints in nursing homes can be reduced, particularly where advanced practice nurses (APNs) are utilized. We examined the link between APN practice, siderail reduction, and the costs of siderail alternatives in 273 residents in four Philadelphia nursing homes. The majority of participants were cognitively and physically impaired with multiple co-morbidities. APNs recommended a total of 1,275 siderail-alternative interventions aimed at reducing fall risk. The median cost of siderail alternatives to prevent falls per resident was $135. Residents with a fall history experienced a significantly higher cost of recommendation compared to non-fallers. Findings suggest that an APN consultation model can effectively be implemented through comprehensive, individualized assessment without incurring substantial costs to the nursing home.     

养老机构老年人心理调适水平及影响因素分析

目的 了解入住养老机构老年人心理调适的现状及影响因素,为促进其健康老龄化提供理论依据。方法 采用整群抽样法,于2019年4月—6月,采用一般资料调查表、养老机构老年人心理调适量表、知觉压力量表、社会支持评定量表和一般自我效能量表,对福州市10所养老机构符合纳入标准的248名老年人进行横断面调查。采用多元线性回归分析心理调适水平的影响因素。结果 养老机构老年人心理调适量表总分为（87.83±15.33）分,条目均分为（3.82±0.67）分。多元线性回归分析显示,社会支持、养老机构生活满意度、知觉压力、是否交友是影响其心理调适水平的主要因素（P<0.05）。结论 养老机构老年人的心理调适水平较低,护理人员可通过加强养老机构老年人的社会支持和压力应对、促进交友等措施,提高老年人的心理调适水平。     

社区中危以上跌倒风险老年人护理干预效果的评价

目的探讨护理干预在预防社区中危以上跌倒风险老年人跌倒中的应用方法及效果。方法 2015年1-12月,采用便利抽样法选取上海市南码头街道某居委中危以上跌倒风险的老年人100例为研究对象,实施入户跌倒危险因素分析与个性化护理干预措施,采用老年人跌倒风险评估量表、跌倒预防知-信-行问卷及跌倒居家环境危险因素评估表对干预效果进行调查。结果干预后,社区中危以上跌倒风险老年人的跌倒发生率及跌倒风险评分低于干预前、跌倒预防知-信-行评分高于干预前、跌倒环境危险因素评分低于干预前,差异均有统计学意义(均P0.05)。结论个性化的跌倒危险因素分析与护理干预可以提高社区中危以上跌倒风险老年人的跌倒预防知-信-行,减少环境危险因素,有效预防跌倒的发生。     

Outcome measures correlated with falls in nursing home residents—A pilot study

Most fall risk and normal values are collected from the community-dwelling population, which is not representative of nursing home residents. The purpose of this study was twofold: 1) to determine the relationship of clinical impairment and activity limitation variables to the number of falls in nursing home residents; and 2) to determine the amount of variability that can be explained for the number of falls from these predictor variables. Seventeen active nursing home residents (83.7 ± 11.7 years) consented to participate. Mini-Mental Status Examination (MMSE), lower extremity handheld dynamometry, ankle plantar flexion (PF)/dorsiflexion (DF) active range of motion (AROM), hand grip strength, gait speed (GS), Timed Up and Go (TUG), and 5 Times Sit-to-Stand (5TSTS) were recorded in a single visit. Regression analysis was performed to identify the better clinical outcome tool to determine falls. This was followed by a stepwise multiple regression model to predict the criterion variable—number of falls. Of the clinical impairment measures collected, significant correlations with past falls include the following: right DF AROM (?0.436; p = 0.040) and right DF strength (?0.504; p = 0.023). Of the activity limitation measures collected, significant correlations with past falls include the following: 5TSTS (0.585; p = 0.007); TUG time (0.475; p = 0.027); and GS (0.457; p = 0.032). The stepwise multiple regression model explained 59% of the variance using right DF AROM, right DF strength, 5TSTS, and TUG time. These measures are benchmarks for the community dwelling population. The present study indicates that these measures might also be useful in determining fall risk screening for ambulatory nursing home residents.     

'Knowing what makes them tick': Motivating cognitively impaired older adults to participate in restorative care

Nursing home residents with dementia represent a majority of the most functionally impaired individuals residing in nursing homes. Although many perceive this population as having little restorative potential, maintaining resident functional abilities for as long as possible helps to optimize quality of life and decrease caregiver burden. This study used a qualitative design with a focus group methodology to explore facilitators and barriers to engaging cognitively impaired residents in functional activities and exercise. A purposive sample of seven geriatric nursing assistants who were experts in dementia care participated in the study. Twenty-seven codes were reduced to three themes: (i) knowing what makes them tick and move; (ii) teamwork and utilizing resources; and (iii) barriers to restorative care. The study findings were used to revise the Restorative Care for the Cognitively Impaired Intervention and could direct future implementation of programmes in nursing home settings.     

Working in care homes: a survey

AIM: To explore the impact of policy changes on care homes and the provision of nursing in care homes. METHOD: Eight hundred Royal College of Nursing (RCN) members working in nursing care homes were surveyed by postal questionnaire in 2004. RESULTS: A 37 per cent response rate (n = 296) was achieved. Of these, 274 worked in homes registered to provide care for older people and/or those with dementia. Although the majority of respondents were happy in their posts, they said that they were not always able to meet residents' needs. They voiced concerns about inappropriate admissions, the assessment process and the need to fill beds to maintain income. Although 65 per cent of residents were state-funded, almost 75 per cent of the homes charged these residents a top-up fee. CONCLUSION: Care homes should be given enough resources to ensure that the needs of residents are met. The RCN is developing a programme to lobby government for adequate resources for care home placements.     

养老机构睡眠障碍老人跌倒风险的危险因素研究

目的 了解养老机构睡眠障碍老人跌倒风险的影响因素。方法 采用便利抽样法,应用一般资料调查表、Morse跌倒评估量表、死亡焦虑量表和Kolcaba舒适状况量表对河北省7所养老机构内60岁及以上的睡眠障碍老人进行调查。结果 445例养老机构睡眠障碍老人中,高跌倒风险者为220例（49.4%）。Logistic回归分析结果显示,高舒适状况、不使用助行器和无下肢疾病是养老机构睡眠障碍老人跌倒风险的保护因素（P<0.05）,使用助眠药和高死亡焦虑是养老机构睡眠障碍老人跌倒风险的危险因素（P<0.05）。结论 养老机构睡眠障碍老人跌倒风险较高,护理人员可采用积极沟通、心理疏导、健康知识宣教等方式降低跌倒风险,预防跌倒发生。