A comparison of care in private nursing homes,geriatric and psychogeriatric hospitals

There is considerable debate about who should provide long-term institutional care for the elderly. We describe and compare care in three private nursing homes, 12 long-term geriatric and 10 psychogeriatric hospital wards which service a Scottish city using measures of patient dependency, patient morale, regime, environment and staff morale. There was overlap of phsyical dependency between geriatric and psychogeriatric wards but lower dependency in nursing homes. There was a high prevalence of cognitive impairment in all sectors (<80%) limiting the use of patient self-report measures, but nursing home patients were more satisfied with staff than geriatric patients (p < 0.05). Nursing home staff had greater job satisfaction than geriatric (p <0.01) or psychogeriatric (p < 0.05) staff. There were large variations between homes and between wards in measures of regime and environment, with overlap of most measures between the three settings, suggesting that where care is provided is less important than how it is shaped at the level of individual homes and wards.     

Medication use in people with late stage Parkinson's disease and parkinsonism living at home and in institutional care in north-east England: A balance of symptoms and side-effects?

BackgroundPeople with Parkinson's disease (PD) and parkinsonism living in care homes (residential or nursing care) in the UK represent around 10–15% of all people with PD and 3–5% of all care home residents. There are few previous data on medication use in those living in care homes with PD. In this study we aimed to compare medication use in a representative cohort of people with PD living in care homes in north-east England with those living in their own homes.MethodAll people with late stage (Hoehn and Yahr III-V) idiopathic PD, PD dementia, or atypical parkinsonian syndromes under the care of the Northumbria Healthcare NHS Foundation Trust PD service on 1st January 2015 were identified. Demographic, disease characteristics and medication use data were collected from an audit of medical notes of all those identified.ResultsWe identified 377 people who met the inclusion criteria, 91 (24.1%) of whom were living in a care home. Disease stage, age and age at disease onset were all significantly higher and levodopa equivalent dose significantly lower in those living in care homes, although disease duration and levodopa dose were not. Greater age, lower levodopa equivalent dose and higher disease stage were independently associated with being in a care home.ConclusionsAlthough people in care homes had more advanced disease, they were on a significantly lower levodopa equivalent dose. This is likely to be due to the requirement to balance symptom management with drug side-effects.     

A SURVEY OF THE RELATIONSHIP BETWEEN COMMUNITY MENTAL HEALTH TEAMS AND RESIDENTIAL HOMES FOR THE ELDERLY

Members of community mental health teams for the elderly (CMHTE), officers in local authority social services residential homes for the elderly (Part III homes) and GPs in Leicestershire were sent questionnaires regarding contact and the relationship between CMHTE and Part III homes. There was general agreement between the three groups on the role of CMHTE members in the homes and the benefits of regular liaison involvement of a team member in a home. There was a high level of agreement for open access to CMHTE from Part III home officers by all three groups surveyed.     

Physical dependency and dementia in nhs continuing care wards and contracted nhs beds in voluntary nursing homes

All patients in hospital based and voluntary nursing home based National Health Service (NHS) continuing care geriatric beds in one London Health District were screened for psychiatric morbidity and physical dependency. They were followed-up at one year. Patients in hospital based continuing care beds had more severe dementia and physical dependency and higher mortality rates than those in voluntary nursing home based NHS continuing care beds. The implications of these findings are discussed in the light of governmental policy to encourage growth of private and voluntary sector nursing homes.     

Mental illness among new residents to residential care

The prevalence of organic impairment, depressive illness and anxiety was assessed in 32 subjects (group A) within two weeks of admission to one of four local authority homes for the elderly in Fife, Scotland. This group was compared with an age and sex matched control group (group B) who continued to live at home. Both groups were reinterviewed six months later. Levels of organic impairment, depression and anxiety were significantly higher in group A at the time of admission. At follow-up, levels of organic impairment and depression remained unchanged in both groups. The level of anxiety was significantly lower in group A but remained unchanged in group B at follow-up. Forty per cent (13 subjects) of group A were diagnosed at first interview as suffering from major depressive episode, minor depressive disorder, generalized anxiety disorder and/or phobic disorder but no-one was receiving treatment. This study reinforces the case for specialist assessment prior to admission to residential care as advocated by the British Geriatric Society. Improved liaison between social and psychiatric services is essential if psychiatric morbidity in the elderly is to be identified and treated, and residential places are to be used appropriately.     

Psychiatric symptomatology in elderly people admitted to nursing and residential homes

This paper reports the prevalence of psychiatric morbidity in a cohort of elderly new admissions to nursing and residential homes. Three hundred and eight people aged over 65 were assessed within two weeks of admission to 30 nursing or residential homes in north-west England, using screening measures of cognitive impairment, depression and dependency. Population 'casemix' data were collected from homes. Almost two-thirds of the cohort, and 61% of those in residential, as opposed to nursing, homes showed clinically significant cognitive impairment. Just under 45% were identified as depression 'cases'. More respondents in the lower of two social class categories were found in both cognitively impaired and depressed groups. The high level of psychiatric morbidity in this new admission cohort raises questions about the availability of specialist expertise for this population, for both treatment and pre-admission assessment.     

An overview of behaviour difficulties found in long-term elderly care settings.

STUDY OBJECTIVE: To provide an understanding of the nature and prevalence of behaviour difficulties in long-term care facilities, to compare care settings and comment on the appropriateness of the need for specialist care. DESIGN: Nurses or carers implemented two rating scales in randomly selected settings. SETTING: Nursing homes, residential homes and NHS elderly long-stay wards. SUBJECTS: Elderly long-stay patients. MAIN RESULTS: NHS and nursing home long-term care facilities show similar behaviour difficulties, with nursing homes experiencing more behaviour manifestations in most cases. Residential facilities have behaviour difficulties to a lesser extent. CONCLUSIONS: Nursing homes have limited formal psychiatric intervention compared to NHS settings. Behaviour difficulties result in increased work for general practitioners and increased hospital referrals. More prospective research is required into the antecedents, effects and treatments of patients with behaviour difficulties in nursing homes. For example, it may be appropriate that specialist input is provided for nursing homes in order to implement behaviour intentions and contribute to the reduction of GP callouts and pharmacological interventions.     

Patterns of neuroleptic use among the institutionalised elderly

A survey was conducted of neuroleptic use amongst the residents of Local Authority homes for the elderly, and elderly patients in geriatric, psychogeriatric and general hospital wards in one of the London boroughs. Some 13% of the residents and patients surveyed were found to have received neuroleptics in the 24 h preceding the survey. Marked variation between homes and between wards and hospitals was observed, although for the sample overall associations were observed between disturbed behaviour and mood and the likehood of receiving neuroleptics. Issues regarding the use of neuroleptics in the non-psychotic elderly are discussed.     

Spanish validation of the Person-centered Care Assessment Tool (P-CAT)

Objectives: Person-centered Care (PCC) is an innovative approach which seeks to improve the quality of care services given to the care-dependent elderly. At present there are no Spanish language instruments for the evaluation of PCC delivered by elderly care services. The aim of this work is the adaptation and validation of the Person-centered Care Assessment Tool (P-CAT) for a Spanish population.

Method: The P-CAT was translated and adapted into Spanish, then given to a sample of 1339 front-line care professionals from 56 residential elderly care homes. The reliability and validity of the P-CAT were analyzed, within the frameworks of Classical Test Theory and Item Response Theory models.

Results: The Spanish P-CAT demonstrated good reliability, with an alpha coefficient of .88 and a test–retest reliability coefficient of .79. The P-CAT information function indicates that the test measures with good precision for the majority of levels of the measured variables (θ values between ?2 and +1). The factorial structure of the test is essentially one-dimensional and the item discrimination indices are high, with values between .26 and .61. In terms of predictive validity, the correlations which stand out are between the P-CAT and organizational climate (r = .689), and the burnout factors; personal accomplishment (r = .382), and emotional exhaustion (r = ? .510).

Conclusion: The Spanish version of the P-CAT demonstrates good psychometric properties for its use in the evaluation of elderly care homes both professionally and in research.     

Dementia syndromes in nursing home patients.

Patients (n = 191) living in four comparable somatic nursing homes (NH) (nursing homes for physical illness) were studied in order to evaluate dementia syndromes. Dementia and symptoms of depressed mood occurred frequently (72% and 63%, respectively). Dementia was often undiagnosed at admittance. Neither the length of time spent in institutions, nor marital status, age, or sex seemed to be of more than minor importance to the prevalence of dementia syndromes. Concerning functional impairment, convergence of findings across the societies studied indicates that psychiatric symptoms and psychopathology are intrinsic parts of long-term care of the elderly.     

Psychiatric diagnosis and uncooperative behavior in nursing homes.

The prevalence of psychiatric disorders and behavioral disturbances in nursing homes is high, but the relationship between the two is unknown. We studied 454 new admissions who were diagnosed by research psychiatrists using DSM-III-R criteria and compared patients who nursing staff designated as cooperative or uncooperative by psychiatric diagnosis and use of restraints and neuroleptics. Uncooperative patients (n = 79; 17.4%) had a variety of psychiatric disorders (total, 87.3%) but particularly had dementia syndromes complicated by delusions, depression, or delirium (44.3%). Uncooperative patients were more frequently restrained and prescribed neuroleptics. Determining the origins of behavior disorders in patients with psychiatric disorders in nursing homes may reduce behavior disturbances.     

Psychiatric disorders in the nursing home: A selective review of studies related to clinical care

Existing research demonstrates that nursing homes are the modern mental institutions for the elderly in the United States, but that training of staff and physicians, processes of care, and the recognition and treatment of mental disorders lag behind the current state of scientific knowledge. The prevalence of diagnosable psychiatric disorders has been estimated to be 80% or higher. The most common of these disorders are the dementias, primarily Alzheimer's or vascular, that can be uncomplicated or complicated by the presence of hallucinations, delusions, depression or behavioral symptoms. Other common disorders include depression and delirium. Problems currently under investigation include the effectiveness of special care units for patients with dementia, the characterization and treatment of the non-cognitive, psychiatric symptoms of dementia, including consideration of the appropriate use of psychotropic medications, and the recognition, diagnosis, and treatment of depression. Although there is a clear need for more research, the available data already demonstrate the need for augmented psychiatric input into nursing home care.