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1.
Kieran A. Walsh Rebecca Dennehy Carol Sinnott John Browne Stephen Byrne Jennifer McSharry Eoin Coughlan Suzanne Timmons 《Journal of the American Medical Directors Association》2017,18(10):897.e1-897.e12
Background
Antipsychotic prescribing is prevalent in nursing homes for the management of behavioral and psychological symptoms of dementia (BPSD), despite the known risks and limited effectiveness. Many studies have attempted to understand this continuing phenomenon, using qualitative research methods, and have generated varied and sometimes conflicting findings. To date, the totality of this qualitative evidence has not been systematically collated and synthesized.Aims
To synthesize the findings from individual qualitative studies on decision-making and prescribing behaviors for antipsychotics in nursing home residents with dementia, with a view to informing intervention development and quality improvement in this field.Methods
A systematic review and synthesis of qualitative evidence was conducted (PROSPERO protocol registration CRD42015029141). Six electronic databases were searched systematically from inception through July 2016 and supplemented by citation, reference, and gray literature searching. Studies were included if they used qualitative methods for both data collection and analysis, and explored antipsychotic prescribing in nursing homes for the purpose of managing BPSD. The Critical Appraisal Skills Program assessment tool was used for quality appraisal. A meta-ethnography was conducted to synthesize included studies. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence in individual review findings. All stages were conducted by at least 2 independent reviewers.Results
Of 1534 unique records identified, 18 met the inclusion criteria. Five key concepts emerged as influencing decision-making: organizational capacity; individual professional capability; communication and collaboration; attitudes; regulations and guidelines. A “line of argument” was synthesized and a conceptual model constructed, comparing this decision-making process to a dysfunctional negative feedback loop. Our synthesis indicates that when all stakeholders come together to communicate and collaborate as equal and empowered partners, this can result in a successful reduction in inappropriate antipsychotic prescribing.Conclusions
Antipsychotic prescribing in nursing home residents with dementia occurs in a complex environment involving the interplay of various stakeholders, the nursing home organization, and external influences. To improve the quality of antipsychotic prescribing in this cohort, a more holistic approach to BPSD management is required. Although we have found the issue of antipsychotic prescribing has been extensively explored using qualitative methods, there remains a need for research focusing on how best to change the prescribing behaviors identified. 相似文献2.
Janine van Kooten Martin Smalbrugge Johannes C. van der Wouden Max L. Stek Cees M.P.M. Hertogh 《Journal of the American Medical Directors Association》2017,18(6):522-527
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3.
Henry Brodaty Liesbeth Aerts Fleur Harrison Tiffany Jessop Monica Cations Lynn Chenoweth Allan Shell Gordana C. Popovic Megan Heffernan Sarah Hilmer Perminder S. Sachdev Brian Draper 《Journal of the American Medical Directors Association》2018,19(7):592-600.e7
Objectives
Despite limited efficacy and significant safety concerns, antipsychotic medications are frequently used to treat behavioral and psychological symptoms of dementia (BPSD) in long-term residential care. This study evaluates the sustained reduction of antipsychotic use for BPSD through a deprescribing intervention and education of health care professionals.Design
Repeated-measures, longitudinal, single-arm study.Setting
Long-term residential care of older adults.Participants
Nursing staff from 23 nursing homes recruited 139 residents taking regular antipsychotic medication for ≥3 months, without primary psychotic illness, such as schizophrenia or bipolar disorder, or severe BPSD.Intervention
An antipsychotic deprescribing protocol was established. Education of general practitioners, pharmacists, and residential care nurses focused on nonpharmacological prevention and management of BPSD.Measurements
The primary outcome was antipsychotic use over 12-month follow-up; secondary outcomes were BPSD (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and social withdrawal) and adverse outcomes (falls, hospitalizations, and cognitive decline).Results
The number of older adults on regular antipsychotics over 12 months reduced by 81.7% (95% confidence interval: 72.4-89.0). Withdrawal was not accompanied by drug substitution or a significant increase in pro-re-nata antipsychotic or benzodiazepine administration. There was no change in BPSD or in adverse outcomes.Conclusion
In a selected sample of older adults living in long-term residential care, sustained reduction in regular antipsychotic use is feasible without an increase of BPSD. 相似文献4.
Clarissa Shaw Kristine N. Williams Yelena Perkhounkova 《Journal of the American Medical Directors Association》2018,19(12):1129-1132
Objectives
An educational program to enhance communication in nursing home dementia care increased person-centered communication by staff and resulted in reduced resident behavioral symptoms measured as resistiveness to care. The purpose of this analysis was to evaluate effects on resident antipsychotic medication use in participating nursing homes. The National Partnership to Improve Dementia Care set a goal of reducing antipsychotic medications in nursing homes by 15% during the study period.Design
A post hoc analysis of Nursing Home Compare data was used to evaluate change in antipsychotic medication rates in nursing homes receiving the communication education versus the corresponding statewide average change.Setting and Participants
Eleven nursing homes participated in a cluster-randomized controlled trial from 2011 to 2013 in one Midwestern state.Measures
Antipsychotic medication rates were abstracted from Nursing Home Compare data sets. Antipsychotic medication rates were compared for each participating nursing home for the 2 quarters before and the 2 quarters after the communication intervention. To control for other factors supporting reduction in antipsychotic use, changes in the participating nursing homes were compared to the state average change for the corresponding quarters using a 1-sample t test.Results
Antipsychotic medication use decreased on average by 4.88 percentage points (22.9%) in participating nursing homes compared to the state average decrease of 0.68 percentage points (2.7%) during the same period (P = .06).Conclusions
A clinically meaningful reduction in antipsychotic medication usage occurred in the nursing homes that received communication education. Measurable changes in communication and behavioral symptoms were reflected in reductions in antipsychotic medication usage. Improving staff communication has the potential to reduce inappropriate antipsychotic medication use in long-term care. 相似文献5.
Taeko Nakashima Yuchi Young Wan-Hsiang Hsu 《Journal of the American Medical Directors Association》2017,18(5):438-441
Objectives
This study aims to examine whether an advance directive “Do Not Hospitalize” (DNH) would be effective in reducing hospital/emergency department (ED) transfers. Similar effects in residents with dementia were also examined.Design
Cross-sectional study.Setting/subjects
New York State (NYS) nursing home residents (n = 43,024).Measurements and analysis
The Minimum Data Set 2.0 was used to address the study aims. Advance directives with an indication of DNH and Alzheimer disease/dementia other than Alzheimer disease were coded (yes vs no). Logistic regression analyses were performed to quantify the relationship between DNH orders and hospital/ED transfers while adjusting for confounders.Results
Our results show that 61% of nursing home residents had do-not-resuscitate orders, 12% had feeding restrictions, and only 6% had DNH orders. Residents with DNH orders had significantly fewer hospital stays (3.0% vs 6.8%, P <.0001) and ED visits (2.8% vs 3.6%, P = .03) in the last 90 days than those without DNH orders. Dementia residents with DNH orders had significantly fewer hospital stays (2.7% vs 6.3%, P < .0001) but not ED visits (2.8% vs 3.5%, P = .11) than those without DNH orders. After adjusting for covariates in the model, the results show that for residents without DNH orders, the odds of being transferred to a hospital was significantly higher (odds ratio = 2.23, 95% confidence interval = 1.77–2.81) than those with DNH orders.Conclusion
Residents with DNH orders had significantly fewer transfers. This suggests that residents' end-of-life care decisions were respected and honored. Efforts should be made to encourage nursing home residents to complete DNH orders to promote integration of the resident's values and goals in guiding care provision toward the end of life. 相似文献6.
Jeannette C.L. van Duinen-van den IJssel Ans J.M.J. Mulders Martin Smalbrugge Sandra A. Zwijsen Britt Appelhof Sytse U. Zuidema Marjolein E. de Vugt Frans R.J. Verhey Christian Bakker Raymond T.C.M. Koopmans 《Journal of the American Medical Directors Association》2018,19(7):627-632
Objective
The aims of this study were (1) to investigate the relationship between different neuropsychiatric symptoms (NPS) and the level of distress experienced by nurses caring for residents with young-onset dementia (YOD) and (2) to compare these findings with those for nurses caring for residents with late-onset dementia (LOD).Design/Setting
This is a retrospective study conducted in Dutch long-term care facilities. Data were used from the Behavior and Evolution of Young-ONset Dementia studies (BEYOND) Parts I and II and the WAAL Behavior in Dementia-II (Waalbed-II) study.Participants
A total of 382 nursing home residents with YOD and 261 nursing home residents with LOD were included.Measurements
The Neuropsychiatric Inventory, nursing home version, was used to assess nursing staff distress and the frequency (F) and severity (S) of NPS. Multilevel logistic regression analysis was used to investigate the relationships between nursing staff distress related to NPS and YOD and LOD care units, the F × S score per symptom, gender, dementia subtype, and dementia severity.Results
Nurses working in YOD care units rated sleep and nighttime behavior disorders, delusions, and agitation/aggression most often as highly distressing and euphoria most often as not distressing. Multivariate analyses indicated that the frequency and severity of NPS were significantly associated with staff distress in all symptoms, except for apathy. Comparison of the 2 groups of nurses demonstrated that the odds for distress related to sleep and nighttime behavior disorders were higher for nurses in YOD care units than for nurses in LOD units. For both the YOD and LOD nurses, irritability in male residents had higher impact than similar behavior in female residents.Conclusion
This study provides important insight into distress related to individual NPS and the interaction with residents' characteristics. All NPS result in distress. The frequency and severity of the behavior is an important predictor. Sleep and nighttime behavior disorders are more likely to result in distress in YOD nurses than in LOD nurses. The amount of distress related to NPS emphasizes the urgent need for adequate management of NPS and the support of professional caregivers. 相似文献7.
Kevin M. Fain Carlos Castillo-Salgado David D. Dore Jodi B. Segal Andrew R. Zullo G. Caleb Alexander 《Journal of the American Medical Directors Association》2017,18(2):138-144
Objective
We quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naïve prescribing.Design
Cross-sectional study.Setting
Linked Minimum Data Set (MDS) assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare Part D claims.Participants
From a cross-section of all long-stay US nursing home residents in 2008 with an MDS assessment and Medicare Part D enrollment, we identified individuals (≥65 years old) who initiated transdermal fentanyl, excluding those with Alzheimer disease, severe cognitive impairment, cancer, or receipt of hospice care.Measurements
We used Medicare Part D to select beneficiaries initiating transdermal fentanyl in 2008 and determined whether they were “opioid-naïve,” defined as no opioid dispensing during the previous 60 days. We obtained resident and facility characteristics from MDS and OSCAR records and defined persistent pain as moderate-to-severe, daily pain on consecutive MDS assessments at least 90 days apart. We estimated associations of patient and facility attributes and opioid-naïve fentanyl initiation using multilevel mixed effects logistic regression modeling.Results
Among 17,052 residents initiating transdermal fentanyl, 6190 (36.3%) were opioid-naïve and 15,659 (91.8%) did not have persistent pain. In the regression analysis with adjustments, residents who were older (ages ≥95 odds ratio [OR] 1.69, 95% confidence interval [CI] 1.46–1.95) or more cognitively impaired (moderate-to-severe cognitive impairment, OR 1.99, 95% CI 1.73–2.29) were more likely to initiate transdermal fentanyl without prior opioid use.Conclusion
Most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naïve. Changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired. 相似文献8.
Xi Cen Yue Li Michael Hasselberg Thomas Caprio Yeates Conwell Helena Temkin-Greener 《Journal of the American Medical Directors Association》2018,19(12):1104-1109.e4
Objectives
We measured the prevalence and severity of aggressive behaviors (ABs) among nursing home (NH) residents and examined whether individuals with behavioral health disorders were more likely to exhibit aggressive behaviors than others.Setting and participants
The analytical sample included 3,270,713 first Minimum Data Set (MDS) assessments for residents in 15,706 NHs in 2015.Measures
Individuals were identified as having (1) behavioral health disorders only (hierarchically categorized as schizophrenia/psychosis, bipolar disorder, personality disorder, substance abuse, depression/anxiety); (2) dementia only; (3) behavioral health disorders and dementia; or (4) neither. The Aggressive Behavior Scale (ABS) measured the degree of aggressive behaviors exhibited, based on 4 MDS items (verbal, physical, other behavioral symptoms, and rejection of care). The ABS scores ranged from 0 to 12 reflecting symptom severity as none (ABS score = 0), mild (ABS score = 1–2), moderate (ABS score = 3–5), and severe (ABS score = 6–12). Bivariate comparisons and multinomial logistic regressions were performed.Results
Residents with behavioral health disorders and dementia had the highest prevalence of ABs (23.1%), followed by dementia only (15.3%), behavioral health disorders only (9.3%), and neither (5.3%). After controlling for individual risk factors and facility covariates, the relative risk of exhibiting severe ABs was 2.47, 5.50, and 9.42 for residents with behavioral health disorders only, dementia only, and behavioral health disorders and dementia, respectively, with a similar pattern for moderate or mild ABs.Conclusions
Residents with behavioral health disorders were less likely than residents with dementia to exhibit aggressive behaviors in nursing homes. Thus, anecdotally reported concerns that aggressive behaviors are primarily an issue for residents with behavioral health disorders, rather than those with dementia, were not empirically justified. 相似文献9.
Simone J.C. Paulis Irma H.J. Everink Ruud J.G. Halfens Christa Lohrmann Jos M.G.A. Schols 《Journal of the American Medical Directors Association》2018,19(8):646-657
Objectives
To provide an overview of the prevalence rates and risk factors of dehydration among nursing home residents.Design
Systematic literature review.Setting
Nursing homes.Participants
Nursing home residents or institutionalized long-term care residents.Measurements
A systematic literature review was executed on March 15, 2018, using the databases PubMed, CINAHL, and EMBASE to retrieve all articles focused on the prevalence rates and risk factors for acute and chronic dehydration. Studies were included if the target population involved nursing home residents or institutionalized long-term care residents.Results
Nineteen studies were included in this systematic review. Prevalence rates of dehydration varied between 0.8% and 38.5% and were measured using different methods. Furthermore, 49 potential risk factors for dehydration were identified. Of the 12 potential risk factors that were investigated in more than 1 study, cognitive impairment and fever were significantly associated with dehydration among nursing home residents.Conclusions/implications
Dehydration is a relevant and frequently occurring problem among nursing home residents. This systematic review shows that a wide variety of methods are used to assess dehydration and that it is often unclear which type of dehydration (chronic or acute) is measured. This makes it difficult to compare prevalence rates among studies. Moreover, only 2 of 49 potential risk factors (fever and cognitive impairment) were more than once significantly associated with dehydration in the respective studies. Most of the other risk factors were assessed by only 1 study or showed inconsistent results. Therefore, more research into dehydration among nursing home residents is needed. 相似文献10.
Mark Toles Mi-Kyung Song Feng-Chang Lin Laura C. Hanson 《Journal of the American Medical Directors Association》2018,19(10):879-883
Objectives
(1) Compare family decision-makers' perceptions of quality of communication with nursing home (NH) staff (nurses and social workers) and clinicians (physicians and other advanced practitioners) for persons with advanced dementia; (2) determine the extent to which characteristics of NH residents and family decision-makers are associated with those perceptions.Design
Secondary analysis of baseline data from a cluster randomized trial of the Goals of Care intervention.Setting
Twenty-two NHs in North Carolina.Participants
Family decision-makers of NH residents with advanced dementia (n = 302).Measurements
During the baseline interviews, family decision-makers rated the quality of general communication and communication specific to end-of-life care using the Quality of Communication Questionnaire (QoC). QoC item scores ranged from 0 to 10, with higher scores indicating better quality of communication. Linear models were used to compare QoC by NH provider type, and to test for associations of QoC with resident and family characteristics.Results
Family decision-makers rated the QoC with NH staff higher than NH clinicians, including average overall QoC scores (5.5 [1.7] vs 3.7 [3.0], P < .001), general communication subscale scores (8.4 [1.7] vs 5.6 [4.3], P < .001), and end-of-life communication subscale scores (3.0 [2.3] vs 2.0 [2.5], P < .001). Low scores reflected failure to communicate about many aspects of care, particularly end-of-life care. QoC scores were higher with later-stage dementia, but were not associated with the age, gender, race, relationship to the resident, or educational attainment of family decision-makers.Conclusion
Although family decision-makers for persons with advanced dementia rated quality communication with NH staff higher than that with clinicians, they reported poor quality end-of-life communication for both staff and clinicians. Clinicians simply did not perform many communication behaviors that contribute to high-quality end-of-life communication. These omissions suggest opportunities to clarify and improve interdisciplinary roles in end-of-life communication for residents with advanced dementia. 相似文献11.
Vincenzo Solfrizzi Emanuele Scafato Davide Seripa Madia Lozupone Bruno P. Imbimbo Angela D&#x;Amato Rosanna Tortelli Andrea Schilardi Lucia Galluzzo Claudia Gandin Marzia Baldereschi Antonio Di Carlo Domenico Inzitari Antonio Daniele Carlo Sabbà Giancarlo Logroscino Francesco Panza 《Journal of the American Medical Directors Association》2017,18(1):89.e1-89.e8
Objectives
Cognitive frailty, a condition describing the simultaneous presence of physical frailty and mild cognitive impairment, has been recently defined by an international consensus group. We estimated the predictive role of a “reversible” cognitive frailty model on incident dementia, its subtypes, and all-cause mortality in nondemented older individuals. We verified if vascular risk factors or depressive symptoms could modify this predictive role.Design
Longitudinal population-based study with 3.5- and 7-year of median follow-up.Setting
Eight Italian municipalities included in the Italian Longitudinal Study on Aging.Participants
In 2150 older individuals from the Italian Longitudinal Study on Aging, we operationalized reversible cognitive frailty with the presence of physical frailty and pre-mild cognitive impairment subjective cognitive decline, diagnosed with a self-report measure based on item 14 of the Geriatric Depression Scale.Measurements
Incidence of dementia, its subtypes, and all-cause mortality.Results
Over a 3.5-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.02–5.18], particularly vascular dementia (VaD), and all-cause mortality (HR 1.74, 95% CI 1.07–2.83). Over a 7-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia (HR 2.12, 95% CI 1.12–4.03), particularly VaD, and all-cause mortality (HR 1.39, 95% CI 1.03–2.00). Vascular risk factors and depressive symptoms did not have any effect modifier on the relationship between reversible cognitive frailty and incident dementia and all-cause mortality.Conclusions
A model of reversible cognitive frailty was a short- and long-term predictor of all-cause mortality and overall dementia, particularly VaD. The absence of vascular risk factors and depressive symptoms did not modify the predictive role of reversible cognitive frailty on these outcomes. 相似文献12.
Sara Garcia-Ptacek Beatriz Contreras Escamez Eva Zupanic Dorota Religa Lena von Koch Kristina Johnell Mia von Euler Ingemar Kåreholt Maria Eriksdotter 《Journal of the American Medical Directors Association》2018,19(2):154-161
Objectives
To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age.Design
Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry.Participants
A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke.Measurements
Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors).Results
Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P < .001). Mortality at 3 months was higher in patients with dementia (31% vs 23% P < .001) and fewer were living at home without help (21% vs 55%; P < .001). In adjusted analyses, prestroke dementia was associated with higher risk of 3-month mortality (OR 1.34; 95% CI 1.18–1.52), requiring a higher level of residential assistance (OR 4.07; 3.49–.75) and suffering from more dependency in relation to mobility (OR 2.57; 2.20–3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P < .001), but there were no differences in discharge to geriatric rehabilitation (19% for both; P = .976). Patients, who moved independently before stroke, were more often discharged home (60% vs 28%) and had lower mortality. In adjusted analyses, prestroke mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death.Conclusions
Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations. 相似文献13.
Ellen McCreedy Lacey Loomer Jennifer A. Palmer Susan L. Mitchell Angelo Volandes Vincent Mor 《Journal of the American Medical Directors Association》2018,19(5):415-421
Objectives
Federally mandated assessments of nursing home (NH) residents drive individualized care planning. Residents with cognitive impairment may not be able to meaningfully communicate their care needs and preferences during this process—a gap that may be partially addressed by involving surrogates. We describe the prevalence of family participation in the care planning process for long-stay NH residents with varying degrees of cognitive impairment.Design
Retrospective study using administrative data made available as part of an ongoing pragmatic cluster randomized controlled trial.Setting
A total of 292 NHs from 1 large for-profit NH system.Participants
Long-stay NH residents in 2016.Measurements
We identified all care planning assessments conducted in 2016 for long-stay NH residents. Cognitive functioning was defined using the Cognitive Function Scale. The Minimum Data Set was used to determine whether a resident, family member, and/or legal guardian participated in the assessment process. Certification and Survey Provider Enhance Reporting system data was used to identify facility-level correlates of family participation. Bivariate and multivariable hierarchical regression results are presented.Results
The analytic sample included 18,552 long-stay NH residents. Family member/representative participation varied by degree of resident cognitive impairment; 8% of residents with no cognitive impairment had family or representative participation in care planning during 2016, compared with 26% of residents with severe impairment. NHs with more social workers had greater family participation in care planning. Available NH characteristics do not explain most of the variation in family participation between NHs (residual intraclass correlation = .57).Conclusions
Only a minority of family members and surrogates participate in NH care planning, even for residents with severe cognitive impairment. The association between social work staffing and participation suggests family involvement may be a measure of quality improvement capacity. Our findings suggest a lack of voice for a vulnerable population that may have implications on the quality of care received at the end of life. 相似文献14.
Judith L. Poey Linda Hermer Laci Cornelison Migette L. Kaup Patrick Drake Robyn I. Stone Gayle Doll 《Journal of the American Medical Directors Association》2017,18(11):974-979
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15.
Katherine M. Abbott Allison R. Heid Morton Kleban Michael J. Rovine Kimberly Van Haitsma 《Journal of the American Medical Directors Association》2018,19(12):1092-1098
Objectives
Nursing home (NH) residents' preferences for everyday living are the foundation for delivering individualized person-centered care. Yet, work has not examined what the most and least important preferences of nursing home residents are and if those preferences change over time.Design
This study examined the change in nursing home residents' (n = 255) preferences for everyday living over a 3-month period. Participants were recruited from 28 NHs in the suburbs of a major metropolitan East Coast area of the United States.Measures
Residents were interviewed face-to-face using the Preferences for Everyday Living Inventory–Nursing Home version at baseline (T1) and 3 months later (T2). Change was analyzed in 2 ways: (1) percentage exact agreement (eg, respondent stated “very important” at both time points) and (2) percentage of preferences that remained either important or not important between T1 and T2.Results
Sixteen preferences were rated as very or somewhat important by 90% or more of NH residents. With regard to the stability of preference ratings, findings demonstrate an average exact agreement of 59%, and an average important versus not important agreement of 82%. In addition, 68 of the 72 preferences had 70% or higher stability over time. In other words, the preference either remained “important” or “not important” to the NH resident 3 months later. Preferences in the domain of enlisting others in care had the least amount of change.Conclusion/Implications
This study highlights the most important everyday living preferences of NH residents and provides assurance to care providers that the majority of preferences assessed via the PELI are both important to NH residents and stable over time. Preference-based care plans can be designed and used over a 3-month period with confidence by providers. 相似文献16.
17.
Gilles Allali Cyrille P. Launay Helena M. Blumen Michele L. Callisaya Anne-Marie De Cock Reto W. Kressig Velandai Srikanth Jean-Paul Steinmetz Joe Verghese Olivier Beauchet 《Journal of the American Medical Directors Association》2017,18(4):335-340
Objectives
Falls are highly prevalent in individuals with cognitive decline. The complex relationship between falls and cognitive decline (including both subtype and severity of dementia) and the influence of gait disorders have not been studied. This study aimed to examine the association between the subtype (Alzheimer disease [AD] versus non-AD) and the severity (from preclinical to moderate dementia) of cognitive impairment and falls, and to establish an association between falls and gait parameters during the course of dementia.Design
Multicenter cross-sectional study.Setting
“Gait, cOgnitiOn & Decline” (GOOD) initiative.Participants
A total of 2496 older adults (76.6 ± 7.6 years; 55.0% women) were included in this study (1161 cognitively healthy individuals [CHI], 529 patients with mild cognitive impairment [MCI], 456 patients with mild dementia, and 350 with moderate dementia) from 7 countries.Measurements
Falls history was collected retrospectively at baseline in each study. Gait speed and stride time variability were recorded at usual walking pace with the GAITRite system.Results
The prevalence of individuals who fall was 50% in AD and 64% in non-AD; whereas it was 25% in CHIs. Only mild and moderate non-AD dementia were associated with an increased risk for falls in comparison with CHI. Higher stride time variability was associated with falls in older adults without dementia (CHI and each MCI subgroup) and mild non-AD dementia, whereas lower gait speed was associated with falls in all participant groups, except in mild AD dementia. When gait speed was adjusted for, higher stride time variability was associated with falls only in CHIs (odds ratio 1.14; P = .012), but not in MCI or in patients with dementia.Conclusions
These findings suggest that non-AD, but not AD dementia, is associated with increased falls in comparison with CHIs. The association between gait parameters and falls also differs across cognitive status, suggesting different mechanisms leading to falls in older individuals with dementia in comparison with CHIs who fall. 相似文献18.
19.
Jennifer S. Albrecht Lindsay Croft Daniel J. Morgan Mary-Claire Roghmann 《Journal of the American Medical Directors Association》2017,18(2):158-161
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20.
Aline De Vleminck R. Sean Morrison Diane E. Meier Melissa D. Aldridge 《Journal of the American Medical Directors Association》2018,19(7):633-638