Ethical issues in caring for elderly residents of nursing homes

Good decision making is important, especially with patients who are disadvantaged in the ways common to long-term care institutions. Few decisions are as important as where to live and where to receive medical care for chronic illnesses, and these decisions deserve careful consideration by providers. Dying is common in long-term care facilities but is commonly managed poorly. Physicians could help this situation by encouraging advance directives, better educating patients, knowing more adequate symptom control measures, and understanding moral and legal considerations better. Pressures for cost containment are forcing physicians to re-examine and defend their role as patient advocate and to defend reasonable expenditures even on patients who are close to death.     

The prevalence of and the related factors for urinary and fecal incontinence among older residing in nursing homes

Aims and objectives. To determine the prevalence of urinary incontinence and fecal incontinence among older people residing in nursing homes in Istanbul. Background. Urinary incontinence (UI) is a multifactorial condition associated with age‐related changes and disorders of the genitourinary system and systemic problems affecting normal micturition. The impact of UI and fecal incontinence (FI) on older people living in nursing homes is more significant than those living in the community. Design. Cross‐sectional study. Methods. This study was performed with 1110 older people who were 60 years and older residing in five government rest homes on the European side of Istanbul in Turkey. An interview was conducted with the residents that had sufficient cognitive function and agreed to participate. Demographic findings and complaints about incontinence were analyzed using a special questionnaire. Results. The total number of older people who participated was 694; 56·5% females and 43·5% males; 43·4% of females and 20·9% of males. Urge incontinence was common in both groups. FI was more common among females (14%, males 6%) and the mean duration of symptoms was longer. The related factors for UI among older females revealed that history of an episiotomy, frequency, urgency, fecal incontinence and functional incapacity among males; whereas history of stroke and pulmonary disorders were independent variables that increased the incidence of frequency, recurrent urinary tract infections and fecal incontinence. The related factors for fecal incontinence among older females included history of stroke and functional status. Diabetes mellitus requiring medical treatment, frequency, functional incapacity and urinary incontinence were significant related factors for fecal incontinence among males. Conclusions. According to similar studies, the urinary and fecal incontinence rates in nursing home residents were lower compared to the other countries. Incontinence was more common among females according to males. Understanding related factors of incontinence are important for providing care and counseling in nursing homes. Relevance to clinical practice. Nurses can provide appropriate information and support at each step in the protecting, screening, diagnosis and treatment process so that elders’ incontinence is minimized.     

Rapid growth of rehabilitation services in traditional community-based nursing homes

OBJECTIVE: To describe the changes in rehabilitation therapy services in nursing homes based in the community during a period of rapid escalation of Medicare payments to nursing homes. SETTING: All Medicaid-certified nursing homes in Ohio. SUBJECTS: The 52,705 residents newly admitted to nursing homes in 1994 and 1995. DESIGN: Retrospective trend analysis of administrative data. MAIN OUTCOME MEASURES: For newly admitted residents receiving 90 or more minutes of rehabilitation therapy per week, the trends in percentage and in the amount and type of therapy received were determined for eight quarters. RESULTS: Of all newly admitted residents, 50.5% received 90 or more minutes of therapy. When they received such therapy it averaged 412 minutes per week (SD = 259). Those residents who received rehabilitation services increased by 2.2% each quarter (p<.001), and the amount of therapy they received increased by 6.4 minutes each quarter (p<.0001). All three types of rehabilitation therapy-physical, occupational, and speech-increased (p<.015) over the study period. CONCLUSIONS: The traditional nursing home is an important site for the provision of rehabilitation therapy services. Rehabilitation specialists should be aware of these trends as they plan for the future of rehabilitation. The effectiveness of this increased provision of therapy service in terms of measurable outcomes needs to be evaluated.     

Prevalence of dementia syndromes in persons living in homes for the elderly and in nursing homes in southern Sweden

The prevalence of dementia syndromes was studied in individuals aged 70 and over living in institutions integrated into primary care within a limited area in southern Sweden. The populations studied were all persons living in homes for the elderly in the city of Lund (n = 471) and all persons living in nursing homes in the Lund health service district (n = 384). In the former, 30% were moderately demented and 6% severely demented. The corresponding figures for patients in nursing homes were 33% and 36%. Among the various psychiatric symptoms which are common in dementia, confusion was most prevalent. In the homes for the elderly, 32% of the subjects were moderately or severely confused, while the corresponding figure in the nursing homes was 62%. The consumption of sedatives and hypnotics was greater in homes for the elderly than in nursing homes. The presence of moderate or severe dementia was associated with greater use of sedatives and hypnotics in nursing homes. Prevalence studies of this type might be used to study organizational changes in the care of the elderly within a health service district.     

中医特色护理实践教学在养老院中的实施

目的在养老院中实施中医特色护理实践教学,客观评价其效果。方法将"早实践-早临床-多实践-多临床"的理念与中医特色养老护理理论技术相结合的教学模式应用于老年人群,对老年人生存质量和健康状况进行调查,客观评价其效果。结果老年人在中医特色护理干预后,生存质量特异性量表调查显示,除环境领域外各项指标均有明显改善(P<0.05);健康状况调查显示,除社会功能外其余各项均有提高(P<0.01)。结论该实践教学方法明显提升了养老护理品质,值得推广与发展。     

A post-hoc analysis of music therapy services for residents in nursing homes receiving hospice care

This study analyzed the use of music therapy for residents in nursing homes receiving hospice care. An ex-post facto design was utilized to evaluate participants' length of life on the hospice program, time of death in relation to last visit by the social worker and music therapist, the number of sessions and total number of minutes spent in direct care by the social worker and music therapist, and care plan needs treated by the nurse, social worker, and music therapist. A total of 80 participants' medical records were randomly selected for this study. All participants were in nursing homes, 40 of whom had been referred to music therapy. Results showed no significant differences on the time of death in relation to last visit by hospice professional, but there were significant differences in the length of life for those receiving music therapy. Females in this study lived significantly longer than males. Participants received significantly more music therapy sessions than social work sessions, and music therapists spent significantly more time in direct care with participants than did social workers. Care plan needs were analyzed graphically and indicate that music therapists meet important needs of participants.     

Pain prevalence, experiences and management strategies among the elderly in taiwanese nursing homes

The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among elderly residents of nursing homes in Taiwan. Stratified random sampling was used to recruit participants (n = 150). In these elderly nursing home residents, pain prevalence was 65.3% and the average number of pain sites was 3.24 (SD = 2.59). The mean pain intensity was 3.86 (SD = 1.90) and pain interference was 4.30 (SD = 2.28). “Aching” was the word most commonly used (77.6%) to describe pain. Most participants (54.21%) took prescribed medications for dealing with pain; doctors were the main information source for this self-care strategy. Although participants reported severe bouts of pain, they used limited self-care pain management strategies. Since health care providers play an important role in helping the elderly to manage pain, the authors recommend training nursing home staff to perform regular pain assessments and providing current knowledge about pain assessment and management strategies.     

英国老年护理院管理对发展我国老年护理院的启示

2011年6月18日第六次全国爱心护理工程工作会议暨老年基金会工作座谈会重点申明,"十二五"期间,全国将实现拥有600家爱心护理院的目标,为生活不能自理的老人提供更专业、更周到、更加人性化的养老服务.目前,我国老年福利事业发展的状况和保有量,与老龄化社会带来的巨大养老服务需求不相匹配,养老机构服务对象对服务满意度与养老机构管理质量的矛盾十分突出.因此,在政府大力鼓励养老护理院建立的同时,健全护理院的管理凸显其重要性.英国从20世纪30年代初出现老龄化问题,较早开始探寻应对老龄化问题合理的养老体系,并且已形成了较为完善的养老管理制度及监管体制.     

抑郁在养老机构老年人衰弱和生存质量间的中介作用

目的 探讨养老机构老年人衰弱、抑郁和生存质量间的关系以及抑郁在衰弱和生存质量间的中介作用.方法 便利选取杭州市3家养老机构的233例老年人,采用自行编制的一般资料问卷、简版老年抑郁量表、衰弱表型量表、世界卫生组织生存质量评估简表对其进行调查.并采用相关分析及结构方程模型检验抑郁的中介效应.结果 233例养老机构老年人中...     

Preferences for teaching methods in a baccalaureate nursing program: how second-degree and traditional students differ

Accelerated baccalaureate nursing programs are in great demand in the United States. Currently there are 197 such programs, but little research has been conducted on student characteristics and program outcomes. This quantitative study explores preferences of second-degree students and traditional generic students with regard to teaching methods and relationships with faculty. The results indicate that statistically significant differences exist between the two groups of students. Three areas of significance are ability for self-directed learning, expectations of faculty and classroom structure, and obtaining a grade that really matters.