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1.
Purpose
Research focusing on the consequences of sensory impairments for the everyday competence of the oldest-old is emerging. The two main goals of this study were to document the prevalence of self-reported vision, hearing, and dual sensory impairment and to explore associations of these impairments with functional disability in near-centenarians and centenarians.Methods
Centenarians and near-centenarians (N = 119; average age = 99) were recruited, with about 80 % living in the community. In-person interviews included self-ratings of vision and hearing impairment and functional disability conceptualized as having difficulties performing personal and instrumental activities of daily livings (PADLs and IADLs).Results
Based on self-report ratings, 17 % of participants were classified as having a visual impairment only, 18 % as having a hearing impairment only, and 38 % with both a visual and hearing impairment (dual sensory impairment). Regression analyses demonstrated that having a vision impairment only and being dual sensory impaired were the strongest predictors of functional disability. They were associated with higher levels of functional disability over and above higher levels of depressive symptomatology, interference of health with desired activities, and living in a nursing home.Conclusions
Sensory impairments—especially dual sensory impairment—are prevalent in the oldest-old. Having dual sensory impairment or a single visual impairment among other factors are strongly associated with less-optimal everyday functioning in the oldest-old. 相似文献2.
Arnau A Espaulella J Serrarols M Canudas J Formiga F Ferrer M 《Gaceta sanitaria / S.E.S.P.A.S》2012,26(5):405-413
Objectives
To identify the factors associated with functional status in a population aged ≥ 75 years without severe dependence.Methods
A cross-sectional study of a random sample (n = 315) of elderly persons in a primary care setting (El Remei Primary Care Center, Vic, Barcelona, Spain) was carried out. Functional status was evaluated by three physical performance tests: the Guralnik chair stand test of lower limb function, Lawton-Brody's index of instrumental activities of daily living (IADL), and the Barthel index of basic activities of daily living (BADL). A backward multiple linear regression model was used to analyze the association of sociodemographic and clinical variables with functional status.Results
The mean age was 81.9 years and 60.6% were female. Around 50% of elderly patients without total dependence showed disability for IADL and a third showed lower limb functional limitation. The variables associated with lower limb functional status were marital status, body mass index, number of drugs, and vision and hearing impairment (R2 = 0.208). The variables associated with IADL were age, cognitive impairment, vision and hearing impairment, and lower limb functional limitation (R2 = 0.434). The variables associated with the Barthel index were age, sex, poor self-perceived health, and lower limb functional limitation (R2 = 0.389).Conclusions
The risk factors associated with functional status in our population ≥ 75 years of age without severe dependence were the number of drugs and sensory impairment. 相似文献3.
Ya-Chuan Tseng Sara Hsin-Yi Liu Meei-Fang Lou Guey-Shiun Huang 《Quality of life research》2018,27(8):1957-1971
Purpose
Sensory impairments are common in older adults. Hearing and visual impairments affect their physical and mental health and quality of life adversely. However, systematic reviews of the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life are scarce. The purpose of this systematic review was to determine the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life.Methods
Searches of EMBASE, PubMed, CINAHL, MEDLINE, Cochrane Library, and Airiti Library were conducted between January 2006 and December 2017 using the keywords “quality of life,” “life satisfaction,” “well-being,” “hearing impairment,” and “visual impairment.” Two authors independently assessed methodologic quality using a modified Downs and Black tool. Data were extracted by the first author and then cross-checked by the second author.Results
Twenty-three studies consisting mostly of community-dwelling older adults were included in our review. Sensory impairment was found to be in significant association with quality of life, with an increase in hearing impairment or visual impairment severity resulting in a lower quality of life. Quality of life for dual sensory impairment was worse than for hearing impairment or visual impairment individually.Conclusions
A significant association was confirmed between hearing impairment, visual impairment, dual sensory impairment, and quality of life. Our review can be used to enhance health care personnel’s understanding of sensory impairment in older adults and enable health care personnel to actively assess older adults’ sensory functions, so that they can help alleviate the negative impact of sensory impairments on QOL in older adults.4.
Debra Parker Oliver Karla Washington Robin L. Kruse David L. Albright Alexandria Lewis George Demiris 《Journal of the American Medical Directors Association》2014,15(10):744-750
Objective
Even though more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had 2 research questions; (1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared with family members of community dwelling hospice patients? (2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting?Methods
This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family members of hospice patients residing in the community.Results
Outcome measures for family members of nursing home residents were compared (n = 176) with family members of community-dwelling hospice patients (n = 267). The family members of nursing home residents reported higher quality of life; however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents, concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting.Conclusion
These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for residents. This study suggests that nursing homes should embrace the opportunity to demonstrate the value of family participation in the care-planning process. 相似文献5.
Objective
To determine the impact of perceived-stress over one's own health, financial condition, job, and conflict with family members, and family members' problems on depressive symptoms in older adults.Methods
We analyzed datasets of the Taiwan Longitudinal Survey on Aging, and used self-reported stress in 2003 and 2007 to represent long-term stress conditions in 4854 ≥ 50-year old persons. The impact of long-term stress on depressive status (evaluated with CES-D10, score range 0–30) was determined with multivariate logistic regression analysis. Persons with proxy interviews, incomplete CES-D data, or cognitive impairment were excluded.Results
Perceived-health stress had stronger impacts on depressive symptoms than most other stress situations. Job-related stress showed no impact. Other stress situations showed modest associations in the middle-aged and young-olds. Ongoing stress had stronger impacts than past stress. Excluding health and job stresses, the impact generally decreased with aging. The association with clinically relevant depression generally followed that with depressive symptoms.Conclusion
All perceived stresses are not equal in their impacts on subsequent depressive symptoms. Perceived-health stress has stronger impacts under most conditions. Better understanding of the associations of various stressors with depressive symptoms could enhance planning of effective strategies to reduce the risk of depression in older persons. 相似文献6.
Fallers in Postacute Rehabilitation Have Worse Functional Recovery and Increased Health Services Use
Stephane Rochat MD Stefanie Monod Laurence Seematter-Bagnoud Constanze Lenoble-HoskovecChristophe J. Büla MD 《Journal of the American Medical Directors Association》2013,14(11):832-836
Objectives
To determine characteristics associated with single and multiple fallers during postacute rehabilitation and to investigate the relationship among falls, rehabilitation outcomes, and health services use.Design
Retrospective cohort study.Setting
Geriatric postacute rehabilitation hospital.Participants
Patients (n = 4026) consecutively admitted over a 5-year period (2003–2007).Measurements
All falls during hospitalization were prospectively recorded. Collected patients' characteristics included health, functional, cognitive, and affective status data. Length of stay and discharge destination were retrieved from the administrative database.Results
During rehabilitation stay, 11.4% (458/4026) of patients fell once and an additional 6.3% (253/4026) fell several times. Compared with nonfallers, fallers were older and more frequently men. They were globally frailer, with lower Barthel score and more comorbidities, cognitive impairment, and depressive symptoms. In multivariate analyses, compared with 1-time fallers, multiple fallers were more likely to have lower Barthel score (adjOR: 2.45, 95% CI: 1.48–4.07; P = .001), cognitive impairment (adjOR: 1.43, 95% CI: 1.04–1.96; P = .026), and to have been admitted from a medicine ward (adjOR: 1.55, 95% CI: 1.03–2.32; P = .035). Odds of poor functional recovery and institutionalization at discharge, as well as length of stay, increased incrementally from nonfallers to 1-time and to multiple fallers.Conclusion
In these patients admitted to postacute rehabilitation, the proportion of fallers and multiple fallers was high. Multiple fallers were particularly at risk of poor functional recovery and increased health services use. Specific fall prevention programs targeting high-risk patients with cognitive impairment and low functional status should be developed in further studies. 相似文献7.
Ping Ni Jing Zhou Zhao Xi Wang Rong Nie Jane Phillips Jing Mao 《Journal of the American Medical Directors Association》2014,15(10):751-756
Objectives
To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD.Design
Population-based cross-sectional survey.Settings
Nursing homes (n = 31) in Wuhan, Mainland Southern China.Participants
Cognitively intact nursing home residents (n = 467) older than 60 years.Measures
Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences.Results
Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio [OR] 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098).Conclusions
Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China. 相似文献8.
Anouke van Rumund Nico Weerkamp Gerrit Tissingh Sytse U. Zuidema Raymond T. Koopmans Marten Munneke Petra J.E. Poels Bastiaan R. Bloem 《Journal of the American Medical Directors Association》2014,15(10):732-737
Introduction
Parkinson's disease (PD) is a complex and disabling disorder. Ultimately, 20% to 40% of patients are admitted to a nursing home, and neurologists often lose track of these patients. Care and treatment of these institutionalized patients have not been addressed comprehensively, but anecdotal reports suggest it is suboptimal. We conducted a qualitative study to analyze the quality of PD care in Dutch nursing homes from the perspective of residents, caregivers, and health care workers.Methods
Experiences and (unmet) needs of 15 nursing home residents with PD and parkinsonism (90% Hoehn and Yahr stage 4 and 5) and 15 informal caregivers were assessed using semistructured interviews. Furthermore, 5 focus group discussions were organized with 13 nurses and 22 other health care professionals to explore the experiences and barriers of PD care.Results
Three core unmet needs were identified: (1) unsatisfactory empathy and emotional support, according to residents and informal caregivers; (2) insufficient staff knowledge on PD-related issues, such as motor fluctuations, leading to poorly timed administration of levodopa; (3) suboptimal organization of care with limited access to neurologists and specialized PD nurses.Conclusions
PD care in Dutch nursing homes is suboptimal according to residents, informal caregivers, and health care workers. Three core areas for improvement were identified, including greater attention for psychosocial problems, improved PD-specific knowledge among nursing home staff, and better collaboration with hospital staff trained in movement disorders. 相似文献9.
N. Martínez-Velilla Pablo Aldaz Herce Álvaro. Casas Herrero Marta Gutiérrez-Valencia Mikel López Sáez de Asteasu Alberto Sola Mateos Ana Conde Zubillaga Berta Ibáñez Beroiz Arkaitz Galbete Jiménez Mikel Izquierdo 《Journal of the American Medical Directors Association》2017,18(10):898.e1-898.e8
Background and objective
The identification of frail individuals has been recognized as a priority for the effective implementation of healthy aging strategies. Only a limited number of studies have examined frailty in nursing homes, and there is a big heterogeneity in the methods used. The primary objective of this study was to determine the prevalence and feasibility of different frailty screening tools in nursing homes as well as its relationship with multimorbidity and disability.Design, setting, and participants
Cross-sectional analysis from a concurrent cohort study, which included 110 participants aged over 65 years and with different degrees of disability at 2 nursing homes.Measurements
The study used 4 different frailty scales: The Fried frailty criteria, the imputed Fried frailty criteria, the Rockwood clinical frailty scale, and the frailty in nursing home scale, and we analyzed their relationship with disability and multimorbidity.Results
The mean age of the study population was 86.3 years (standard deviation 7.3), and 71.8% were female. Most residents had a high percentage of cognitive and functional impairment, multimorbidity, and risk of malnutrition. The following prevalence rates for frailty were determined: 71.8% (62.8, 79.4), 42.7% (33.9, 52.1), and 36.4% (23.8, 51.1) as per according to the Rockwood clinical frailty scale, frailty in nursing home scale, and Fried index (95% confidence interval), respectively. In the case of the Fried index, the prevalence of frailty is based on the percentage of patients meeting the criteria, which is 40% due to the large number of missing values. After the imputation of variables with the multivariate imputation by chained equation software, the prevalence of frailty increased to 66.4% (57.1, 74.5). We observed different statistically significant associations between the frailty scales and the clinical and demographic variables, and also with disability and multimorbidity.Conclusions
Most residents of nursing homes are likely to be frail, but there is no single operational definition of frailty. Although all measures of frailty had similar associations with the clinical variables of the study, there are important conceptual differences that must be considered in addressing the relationships between frailty, disability, and multimorbidity. Further research is required, and homogeneous frailty criteria must be used so that studies and interventions can be compared. 相似文献10.
C. María Pérez-Sánchez D. Nicolás Torres Juan José Hernández Morante 《The journal of nutrition, health & aging》2018,22(7):869-875
Background
although eating disorders are usually linked to young adolescents, these mental disorders can also appear in the elderly, especially in those living in nursing homes, which might be associated or not with the cognitive decline; however, there are few data regarding elderly subjects.Objectives
the objective of the present work was to evaluate the presence of abnormal eating attitudes in nursing home residents and its relation with several cognitive, nutritional and psychological factors that could be influencing their nutritional state.Design and Setting
a observational experimental study was carried out at several nursing homes of Murcia, Spain.Subjects
139 nursing home residents.Methods
EAT-26 test was used to screen classic eating disorders (anorexia and bulimia). Blandford’s scale was employed to determine aversive eating attitudes. Moreover, subjective appetite sensations, body image perception, nutritional (MNA and diet composition) and biochemical data were also evaluated.Results
33% of the subjects had malnutrition. No subject showed symptoms of anorexia or bulimia; however, subjects with cognitive decline frequently showed aversive feeding behaviours (21.6%). Albumin values were significantly lower in subjects with cognitive impairment.Conclusions
our data showed a clear relation between cognitive impairment and altered eating attitudes, which was reflected by both biochemical (albumin) and nutritional parameters, while no classic eating disorder was observed in residents with normal cognitive-status. These data confirm the need to strengthen our efforts towards maintaining the nutritional status of the subjects with cognitive impairment.11.
Alireza Malek Makan Hein van Hout Graziano Onder Harriet Finne-Soveri Henriëtte van der Roest Rob van Marum 《Journal of the American Medical Directors Association》2017,18(12):1037-1042
Introduction
In nursing home (NH) residents with a very short life expectancy, the benefits of preventive cardiovascular medication maintenance are questionable.Objective
To assess the prevalence of 4 classes of preventive cardiovascular medication (PCM) in NH residents, and to explore differences of prevalence across length of stay, mortality risk, cognitive impairment, functional disability, and across countries.Methods
A 12-month prospective cohort study was conducted in 57 NHs in 8 countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands, and Israel). We assessed the prevalence at first measurement of 4 classes of PCM: oral anticoagulants (OAC), platelet aggregation inhibitor (PAI), antihypertensive (AHT), and lipid-modifying agent (LMA), in older (60+ years) residents with valid medication assessments. The PCM prevalence was compared across the length of stay (short <60 days, mid, long >12 months), health instability as defined by Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS) > 3, cognitive impairment by Cognitive Performance Scale (CPS) > 2, and functional disability was measured using the Activities of Daily Living Hierarchy Scale (ADLH) ≥5.Results
Of the 3759 eligible residents, 2175 (57.9%) used at least 1 PCM. The prevalence of the 4 groups of PCM: OAC, PAI, AHT and LMA were 5.6%, 34.9%, 35.7%, and 10.4%, respectively. PCM use was lower in long-stay residents versus mid-stay: 56.0% vs. 62.7%, in cognitively impaired residents (47.1% vs. 67%), in residents with a high mortality risk (47.4% vs. 58.6%), and in residents with a high ADLH score (48.6% vs 64.0%).Conclusion
Although the prevalence of PCM use was lower in long-stay, cognitively impaired residents, persons with a high mortality risk, and residents with more functional disabilities, there seems to be room for deprescribing. 相似文献12.
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13.
14.
Celeste A. Lemay Kathleen M. Mazor Terry S. Field Jennifer Donovan Abir Kanaan Becky A. Briesacher Sarah Foy Leslie R. Harrold Jerry H. Gurwitz Jennifer Tjia 《Journal of the American Medical Directors Association》2013,14(12):895-900
Background/Objectives
Antipsychotic use is common in US nursing homes, despite evidence of increased risk of morbidity and mortality, and limited efficacy in older adults with dementia. Knowledge, attitudes, and beliefs regarding antipsychotic use among nursing home staff are unclear. The study aim was to describe nursing home leadership and direct care staff members’ knowledge of antipsychotic risks, beliefs and attitudes about the effectiveness of antipsychotics and nonpharmacologic management of dementia-related behaviors, and perceived need for evidence-based training about antipsychotic medication safety.Design, Setting, Participants, and Measurements
Survey of leadership and direct care staff of nursing homes in Connecticut was conducted in June 2011. Questionnaire domains included knowledge of antipsychotic risks, attitudes about caring for residents with dementia, satisfaction with current behavior management training, beliefs about antipsychotic effectiveness, and need for staff training about antipsychotics and behavior management.Results
A total of 138 nursing home leaders and 779 direct care staff provided useable questionnaires. Only 24% of nursing home leaders identified at least 1 severe adverse effect of antipsychotics; 13% of LPNs and 12% of RNs listed at least 1 severe adverse effect. Fifty-six percent of direct care staff believed that medications worked well to manage resident behavior. Leaders were satisfied with the training that staff received to manage residents with challenging behaviors (62%). Fifty-five percent of direct care staff felt that they had enough training on how to handle difficult residents; only 37% felt they could do so without using medications.Conclusions
Findings suggest that a comprehensive multifaceted intervention designed for nursing homes should aim to improve knowledge of antipsychotic medication risks, change beliefs about appropriateness and effectiveness of antipsychotics for behavior management, and impart strategies and approaches for nonpharmacologic behavior management. 相似文献15.
Roche Lanquetot MO Ader F Durand MC Carlier R Defferriere H Dinh A Herrmann JL Guillemot D Perronne C Salomon J 《Médecine et maladies infectieuses》2008,38(10):543-548
Objective
Patients with chronic neurological disorders and cognitive impairment after tick bites are difficult to manage despite standard antibiotic therapy for Lyme disease. We wanted to correctly assess the disorders.Methods
Thirty patients were hospitalized for a standardized evaluation of their disorders: clinical examination, biological and serological studies, cerebral MRI, CSF study, neurophysiological exams, and neuropsychological evaluation of cognitive functions.Results
Clinical and biological results were non informative. We observed significant CSF abnormalities (64%), MRI Flair pictures (41%), neurophysiological exams (47%), and cognitive evaluation (100%).Conclusions
A large and standardized evaluation should be made for each patient to improve the management and probably the treatment of these complex chronic symptoms observed after tick bites. 相似文献16.
17.
Kota Tsutsumimoto Takehiko Doi Hyuma Makizako Ryo Hotta Sho Nakakubo Minji Kim Satoshi Kurita Takao Suzuki Hiroyuki Shimada 《Journal of the American Medical Directors Association》2018,19(6):504-510
Objectives
To examine the association between each type of frailty status and the incidence rate of depressive symptoms among community-dwelling older adults.Design
Prospective cohort study.Setting
General communities in Japan.Participants
Participants comprised 3538 older Japanese adults.Measurements
We assessed our participants in terms of frailty status (physical frailty, cognitive impairment, and social frailty), depressive symptoms (geriatric depression scale ≥6), and other covariates, and excluded those who showed evidence of depression. Then, after a 4-year interval, we again assessed the participants for depressive symptoms. Physical frailty was defined by the Fried criteria, showing 1 or more of these were physical frailty. To screen for cognitive impairment, receiving a score below an age-education adjusted reference threshold in 1 or more tests was cognitive impairment. Finally, social frailty was defined using 5 questions, and those who answered positively to 1 or more of these were considered to have social frailty.Results
After multiple imputations, the incidence rate of depressive symptoms after 4 years of follow-up was 7.2%. The incidence rates of depressive symptoms for each frailty status were as follows: 9.6% for physical frailty vs 4.6% without, 9.3% for cognitive impairment vs 6.5% without, and 12.0% for social frailty vs 5.1% without. Finally, through the application of multivariable logistic regression analysis, the incidence of depressive symptoms was found to have a significant association with social frailty (odds ratio 1.55; 95% confidence interval 1.10–2.20) but not with physical frailty or cognitive impairment.Conclusions
This study revealed that social frailty, in comparison with physical frailty and cognitive impairment, is more strongly associated with incidences of depressive symptoms among elderly. 相似文献18.
Albert Lukas Benjamin Mayer Daniela Fialová Eva Topinkova Jacob Gindin Graziano Onder Roberto Bernabei Thorsten Nikolaus Michael D. Denkinger 《Journal of the American Medical Directors Association》2013,14(11):821-831
Objective
To identify pharmacological and nonpharmacological pain management approaches and associated factors in nursing home residents across Europe.Setting, Participants, and Measurements
Cross-sectional study with 4156 residents who were assessed using the interRAI instrument for Long Term Care Facilities (interRAI LTCF), including pharmacological and nonpharmacological pain management modalities. Those reporting pain were included in the analyses (n = 1900). A deeper analysis was performed for the subsample of residents who reported “current pain,” defined as pain at least 1 day within the past 3 days (n = 838), and those who reported “current pain of moderate to severe intensity” (n = 590).Results
Up to 24% of residents who reported pain did not receive any pain medication and up to 11% received it only PRN (as-needed basis), independent of current pain-intensity levels; 61% did not receive any nonpharmacological treatment and 21% received neither pharmacological nor nonpharmacological pain modalities. Considerable differences could be demonstrated across European countries. Factors positively associated with pharmacological pain management were being of female gender, reporting cancer, and having moderate or severe pain. High turnover rates of regular staff and low-to-moderate physicians’ availability were negatively associated. Factors positively associated with nonpharmacological treatment were fractures and need of assistance in activities of daily living. Dementia, large nursing home facilities, above-average and high turnover rates of nursing staff, a low physicians’ availability, and severe pain intensity were negatively associated.Conclusion
Despite some advances in recent years, pain treatment in European nursing home residents remains to be suboptimal and requires further improvement. 相似文献19.
Inken Stange K. Poeschl P. Stehle C. C. Sieber D. Volkert 《The journal of nutrition, health & aging》2013,17(4):357-363
Objectives
To identify nursing home residents with malnutrition or at risk of malnutrition by using different markers, determine if the Mini Nutritional Assessment (MNA®) is able to identify all residents at risk according to single risk markers and explore the relation between risk markers and functional impairment.Design
Cross-sectional study.Setting
Six German nursing homes.Participants
286 residents (86±7y, 89% female).Measurements
Screening for malnutrition or its risk included low BMI (≤22 kg/m2), recent weight loss (WL), low food intake (LI) as single risk markers and MNA (<24 points, p.) as composite marker. Prevalence of single nutritional risk markers in different MNA categories was compared by cross-tables. Mental (cognition, mood) and physical function (mobility) were assessed by interviewing nursing staff and association of impaired status to nutritional risk markers determined by Chi2 test.Results
32.9% of residents had a low BMI, 11.9% WL and 21.3% LI. 60.2% were categorized malnourished (18.2%) or at risk of malnutrition (42.0%) by MNA. 64% presented at least one of these nutritional risk markers. Of those classified malnourished by MNA, 96.2% also showed low BMI, WL or LI. In contrast, eleven residents (9.6%) considered well-nourished by MNA presented single risk markers (9 low BMI, 2 WL). Cognitive impairment, depressive symptoms and immobility was present in 59.0%, 20.8% and 25.5%, respectively. Functional impairment, and in particular severe impairment, was to a higher proportion present in residents at nutritional risk independent of the chosen marker (MNA<24 p., low BMI, WL, LI).Conclusion
The high prevalence of nutritional risk highlights the importance of regular screening of nursing home residents. The MNA identified nearly all residents with low BMI, WL and LI. The close association between nutritional risk and functional impairment requires increased awareness for nutritional problems especially in functionally impaired residents, to early initiate nutritional measures and thus, prevent further nutritional and functional deterioration. 相似文献20.