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1.
Chong-Han Kua Vivienne S.L. Mak Shaun Wen Huey Lee 《Journal of the American Medical Directors Association》2019,20(3):362-372.e11
Objectives
Deprescribing is effective in addressing concerns relating to polypharmacy in residents of nursing homes. However, the clinical outcomes of deprescribing interventions among residents in nursing homes are not well understood. We evaluated the impact of deprescribing interventions by health care professionals on clinical outcomes among the older residents in nursing homes.Design
Systematic review and meta-analysis of randomized controlled trials. CINAHL, International Pharmaceutical Abstracts, MEDLINE, EMBASE, and Cochrane Library were searched from inception until September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials. (PROSPERO CRD42016050028).Setting and Participants
Randomized controlled trials in a nursing home setting that included participants of at least 60 years of age.Measures
Falls, all-cause mortality, hospitalization, and potentially inappropriate medication were assessed in the meta-analysis.Results
A total of 41 randomized clinical studies (18,408 residents) that examined deprescribing (defined as either medication discontinuation, substitution, or reduction) in nursing were identified. Deprescribing interventions significantly reduced the number of residents with potentially inappropriate medications by 59% (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.19–0.89). In subgroup analysis, medication review–directed deprescribing interventions reduced all-cause mortality by 26% (OR 0.74, 95% CI 0.65–0.84), as well as the number of fallers by 24% (OR 0.76, 95% CI 0.62–0.93).Conclusions
Compared to other deprescribing interventions, medication review–directed deprescribing had significant benefits on older residents in nursing homes. Further research is required to elicit other clinical benefits of medication review–directed deprescribing practice. 相似文献2.
Paolo Dionigi Rossi Sarah Damanti Carolina Nani Mauro Pluderi Giulio Bertani Daniela Mari Matteo Cesari Dario Consonni Diego Spagnoli 《Journal of the American Medical Directors Association》2019,20(3):373-376.e3
Objectives
To evaluate the effects of repeated cerebrospinal fluid (CSF) tap procedures in idiopathic normal pressure hydrocephalus (iNPH) patients ineligible for surgical treatment.Design
Prospective, monocentric, pilot study.Setting
University hospital.Participants
Thirty-nine patients aged 75 years and older, ineligible for shunting surgical intervention.Intervention
Repeated CSF taps.Measurements
All patients underwent a comprehensive geriatric assessment before and after each CSF tap. Adverse events were recorded.Results
No major side effect was reported. Eleven patients showed no response to the first CSF tap test and were excluded. In the remaining 28 patients, all physical and cognitive functions improved after the drainage procedures, except for continence (which seemed poorly influenced). According to clinical judgment, the mean time frame of benefit between CSF taps was 7 months. Patients withdrawing from the protocol during the clinical follow-up showed a worsening of functional and cognitive performances after the interruption.Conclusions/Implications
Periodic CSF therapeutic taps are safe, allow a better control of iNPH symptoms, and prevent functional decline in geriatric patients. 相似文献3.
Brittany J. Johnson Jessica A. Grieger Thomas P. Wycherley Rebecca K. Golley 《Journal of the Academy of Nutrition and Dietetics》2019,119(5):782-798.e6
Background
Excessive consumption of discretionary choices (nutrient-poor foods and beverages) negatively impacts on children’s diet quality and increases the risk of obesity and related chronic conditions. Dietary guidelines are complex, and simple messages based on effective dietary strategies are needed to improve population compliance with dietary guidelines.Objective
This study aimed to quantify the theoretical nutritional impact of dietary strategies targeting a reduction in discretionary choice intake in Australian children aged 2 to 18 years.Design
This study was a computer simulation dietary modeling design.Participants/setting
Participants were Australian children aged 2 to 18 years (n=2,812, population weighted N=4,770,094) from the National Nutrition and Physical Activity Survey 2011-2012.Intervention
Simulations were performed on 24-hour recall dietary intake data to model theoretical impact on nutrient profile of moderating (50% reduction), substituting (replacing 50% of discretionary choices for core foods), and reformulating (reducing target nutrients within products) mean population intake of all discretionary choices.Main outcome measures
The main outcome measures were absolute and percentage change in nutrient profile (energy, saturated fat, added sugars, sodium).Statistical analyses performed
Simulations were performed using percent adjustment calculations and “What If” analyses. Sensitivity analyses were performed adjusting parameter uncertainties.Results
Moderation (energy ?4.8% to ?19.3%, saturated fat ?10.2% to ?24.5%, added sugars ?24.3% to ?43.1%, sodium ?6.4% to ?20.3%) and substitution (energy ?9.4% to ?15.4%, saturated fat ?7.6% to ?22.5%, added sugars ?39.2% to ?42.7%, sodium ?10.8% to ?19.0%) scenarios saw the greatest reductions across energy and target nutrients, with substitution scenarios modeling a smaller impact on protein, fiber, and micronutrients compared with the moderation strategy. The reformulation scenarios showed less theoretical reductions in energy intake (?1.1% to ?12.8%), despite the differences in saturated fat (?27.5%), added sugars (?25.5%), and sodium (?9.1%), between the primary scenarios compared with base case.Conclusions
Dietary strategies to reduce discretionary choices (moderation) or replace them with core (healthy) food group choices (substitution) show good theoretical improvements in energy intake and nutritional profile. Multinutrient reformulation approaches achieve reductions in saturated fat, added sugar, and sodium. To reduce population discretionary choices intake, the dietary strategies can inform policy and food industry and consumer education action. 相似文献4.
Sascha R. Bolt Laura Verbeek Judith M.M. Meijers Jenny T. van der Steen 《Journal of the American Medical Directors Association》2019,20(3):268-272
Objectives
To examine family caregivers' experiences with end-of-life care for nursing home residents with dementia and associations with the residents dying peacefully.Design
A secondary data analysis of family caregiver data collected in the observational Dutch End of Life in Dementia (DEOLD) study between 2007 and 2010.Setting and participants
Data were collected at 34 Dutch nursing homes (2799 beds) representing the nation. We included 252 reports from bereaved family members of nursing home residents with dementia.Measures
The primary outcome was dying peacefully, assessed by family members using an item from the Quality of Dying in Long-term Care instrument. Unpleasant experiences with end-of-life care were investigated using open-ended questions. Overall satisfaction with end-of-life care was assessed with the End-of-Life Satisfaction With Care (EOLD-SWC) scale, and families' appraisal of decision making was measured with the Decision Satisfaction Inventory. Associations were investigated with multilevel linear regression analyses using generalized estimating equations.Results
Families' reports of unpleasant experiences translated into 2 themes: neglect and lack of respect. Neglect involved facing inaccessibility, disinterest, or discontinuity of relations, and negligence in tailored care and information. Lack of respect involved perceptions of being purposefully disregarded, an insensitive approach towards resident and family, noncompliance with agreements, and violations of privacy. Unpleasant experiences with end-of-life care were negatively associated with families' perceptions of the resident dying peacefully. Families' assessment of their relative dying peacefully was positively associated with satisfaction with end-of-life care and decision making.Conclusions/Implications
Families' reports of unpleasant experiences with end-of-life care may inform practice to improve perceived quality of dying of their loved ones. Humane and compassionate care and attention from physicians and other staff for resident and family may facilitate recollections of a peaceful death. 相似文献5.
Thierry Bautrant Michel Grino Corinne Peloso Frédéric Schiettecatte Magali Planelles Charles Oliver Caroline Franqui 《Journal of the American Medical Directors Association》2019,20(3):377-381
Objectives
To determine whether environmental rearrangements of the long-term care nursing home can affect disruptive behavioral and psychological symptoms of dementia (BPSD) in residents with dementia.Design
Prospective 6-month study.Setting
The study was conducted before (phase 1) and after (phase 2) environmental rearrangements [skylike ceiling tiles in part of the shared premises, progressive decrease of the illuminance at night together with soothing streaming music, reinforcement of the illuminance during the day, walls painted in light beige, oversized clocks in corridors, and night team clothes color (dark blue) different from that of the day team (sky blue)].Participants
All of the patients (n = 19) of the protected unit were included in the study. They were aged 65 years or older and had an estimated life expectancy above 3 months.Measures
Number and duration of disruptive BPSD were systematically collected and analyzed over 24 hours or during late hours (6:00-12:00 pm) during each 3-month period.Results
There was no significant change in the patients' dependency, risk of fall, cognitive or depression indexes, or treatment between phase 1 and 2. Agitation/aggression and screaming were observed mainly outside the late hours as opposed to wandering episodes that were noticed essentially within the late hours. The number of patients showing wandering was significantly lower over 24 hours during phase 2. The number of agitation/physical aggression, wandering, and screaming and the mean duration of wandering episodes were significantly (P = .039, .002, .025, and .026 respectively) decreased over 24 hours following environmental rearrangements. Similarly, a significant reduction in the number and mean duration of wandering was noticed during the late hours (P = .031 and .007, respectively).Conclusions
Our study demonstrates that BPSD prevalence can be reduced following plain environmental rearrangements aimed at improving spatial and temporal orientation. 相似文献6.
Shubing Cai Susan C. Miller Ira B. Wilson 《Journal of the American Medical Directors Association》2019,20(4):497-502
Objective(s)
To examine the change in physical functional status among persons living with HIV (PLWH) in nursing homes (NHs) and how change varies with age and dementia.Design
Retrospective cohort study.Setting
NHs in 14 states in the United States.Participants
PLWH who were admitted to NHs between 2001 and 2010 and had stays of ≥90 days (N = 3550).Measurements
We linked Medicaid Analytic eXtract (MAX) and Minimum Data Set (MDS) data for NH residents in the sampled states and years and used them to determine HIV infection. The main outcome was improvement in physical functional status, defined as a decrease of at least 4 points in the activities of daily living (ADL) score within 90 days of NH admission. Independent variables of interest were age and dementia (Alzheimer's disease or other dementia). Multivariate logistic regression was used, adjusting for individual-level covariates.Results
The average age on NH admission of PLWH was 58. Dementia prevalence ranged from 14.5% in the youngest age group (age <40 years) to 38.9% in the oldest group (age ≥70 years). Overall, 44% of the PLWH experienced ADL improvement in NHs. Controlling for covariates, dementia was related to a significantly lower likelihood of ADL improvement among PLWH in the oldest age group only: the adjusted probability of improvement was 40.6% among those without dementia and 29.3% among those with dementia (P < .01).Conclusions/relevance
PLWH, especially younger persons, may be able to improve their ADL function after being admitted into NHs. However, with older age, PLWH with dementia are more physically dependent and vulnerable to deterioration of physical functioning in NHs. More and/or specialized care may be needed to maintain physical functioning among this population. Findings from this study provide NHs with information on care needs of PLWH and inform future research on developing interventions to improve care for PLWH in NHs. 相似文献7.
Helena Temkin-Greener Tiffany Lee Thomas Caprio Shubing Cai 《Journal of the American Medical Directors Association》2019,20(4):476-480.e1
Objective
Ultrahigh therapy use has increased in SNFs without concomitant increases in residents' characteristics. It has been suggested that this trend may also have influenced the provision of high-intensity rehabilitation therapies to residents who are at the end of life (EOL). Motivated by lack of evidence, we examined therapy use and intensity among long-stay EOL residents.Design
An observational study covering a time period 2012-2016.Setting and participants
New York State nursing homes (N = 647) and their long-stay decedent residents (N = 55,691).Methods
Data sources included Minimum Data Set assessments, vital statistics, Nursing Home Compare website, LTCfocus, and Area Health Resource File.Therapy intensity in the last month of life was the outcome measure. Individual-level covariates were used to adjust for health conditions. Facility-level covariates were the key independent variables of interest. Multinomial logistic regression models with facility random effects were estimated.Results
Overall, 13.6% (n = 7600) of long-stay decedent residents had some therapy in the last month of life, 0% to 45% across facilities. Of those, almost 16% had very high/ultrahigh therapy intensity (>500 minutes) prior to death. Adjusting for individual-level covariates, decedents in the for-profit facilities had 18% higher risk of low/medium therapy [relative risk ratio (RRR) = 1.182, P < .001], and more than double the risk of high/ultrahigh therapy (RRR = 2.126, P < .001), compared to those with no therapy use in the last month of life. In facilities with higher physical therapy staffing, decedents had higher risk (RRR = 16.180, P = .002) of high/ultrahigh therapy, but not of low/medium therapy intensity. The use of high/ultrahigh therapy in this population has increased over time.Conclusions and Relevance
This is a first study to empirically demonstrate that facility characteristics are associated with the provision of therapy intensity to EOL residents. Findings suggest that facilities with a for-profit mission, and with higher staffing of therapists, may be more incentivized to maximize therapy use, even among the sickest of the residents. 相似文献8.
Anupam Chandra Parvez A. Rahman Amelia Sneve Rozalina G. McCoy Bjorg Thorsteinsdottir Rajeev Chaudhry Curtis B. Storlie Dennis H. Murphree Gregory J. Hanson Paul Y. Takahashi 《Journal of the American Medical Directors Association》2019,20(4):444-450.e2
Objectives
Patients discharged to a skilled nursing facility (SNF) for post-acute care have a high risk of hospital readmission. We aimed to develop and validate a risk-prediction model to prospectively quantify the risk of 30-day hospital readmission at the time of discharge to a SNF.Design
Retrospective cohort study.Setting
Ten independent SNFs affiliated with the post-acute care practice of an integrated health care delivery system.Participants
We evaluated 6032 patients who were discharged to SNFs for post-acute care after hospitalization.Measurements
The primary outcome was all-cause 30-day hospital readmission. Patient demographics, medical comorbidity, prior use of health care, and clinical parameters during the index hospitalization were analyzed by using gradient boosting machine multivariable analysis to build a predictive model for 30-day hospital readmission. Area under the receiver operating characteristic curve (AUC) was assessed on out-of-sample observations under 10-fold cross-validation.Results
Among 8616 discharges to SNFs from January 1, 2009, through June 30, 2014, a total of 1568 (18.2%) were readmitted to the hospital within 30 days. The 30-day hospital readmission prediction model had an AUC of 0.69, a 16% improvement over risk assessment using the Charlson Comorbidity Index alone. The final model included length of stay, abnormal laboratory parameters, and need for intensive care during the index hospitalization; comorbid status; and number of emergency department and hospital visits within the preceding 6 months.Conclusions and implications
We developed and validated a risk-prediction model for 30-day hospital readmission in patients discharged to a SNF for post-acute care. This prediction tool can be used to risk stratify the complex population of hospitalized patients who are discharged to SNFs to prioritize interventions and potentially improve the quality, safety, and cost-effectiveness of care. 相似文献9.
Hanna-Maria Roitto Hannu Kautiainen Ulla L. Aalto Hannareeta Öhman Jouko Laurila Kaisu H. Pitkälä 《Journal of the American Medical Directors Association》2019,20(3):305-311
Objectives
The use of psychotropic drugs in long-term care (LTC) is very common, despite their known adverse effects. The prevalence of opioid use is growing among older adults. This study aimed to investigate trends in the prevalence of psychotropics, opioids, and sedative load in a LTC setting over a 14-year period. We also explored the interaction of psychotropic and opioid use according to residents’ dementia status in nursing home (NH) and assisted living facility (ALF) settings.Design
Four cross-sectional studies.Setting
Institutional settings in Helsinki, Finland.Participants
Older residents in NHs in 2003 (n = 1987), 2011 (n = 1576), and 2017 (n = 791) and in ALFs in 2007 (n = 1377), 2011 (n = 1586), and 2017 (n = 1624).Measures
Comparable assessments were conducted among LTC residents at 4 time points over 14 years. The prevalence of regular psychotropics, opioids, and other sedatives and data on demographics and diagnoses were collected from medical records.Results
Disabilities and severity of dementia increased in both settings over time. The prevalence of all psychotropics decreased significantly in NHs (from 81% in 2003 to 61% in 2017), whereas in ALFs there was no similar linear trend (65% in 2007 and 64% in 2017). There was a significant increase in the prevalence of opioids in both settings (30% in NHs and 22% in AFLs in 2017). Residents with dementia used less psychotropics and opioids than those without dementia in both settings and at each time point.Conclusions/Implications
NHs show a favorable trend in psychotropic drug use, but the rates of psychotropic use remain high in both NHs and ALFs. In addition, the rates of opioid use have almost tripled, leading to a high sedative load among LTC residents. Clinicians should carefully consider the risk-to-benefit ratio when prescribing in LTC. 相似文献10.
George A. Heckman John P. Hirdes Paul C. Hébert Anne Morinville Andre C.K.B. Amaral Andrew Costa Robert S. McKelvie 《Journal of the American Medical Directors Association》2019,20(4):438-443
Objectives
To understand how a heart failure diagnosis and admission health instability predict health transitions and outcomes among newly admitted nursing home residents.Design
Retrospective cohort study of linked administrative data, including the Continuing Care Report System MDS 2.0 for nursing homes, the Discharge Abstract Database for hospitalized patients, and National Ambulatory Care Reporting System to track emergency department visits.Setting and participants
Older adults, aged 65 years and above, admitted to nursing homes in Ontario, Alberta, and British Columbia, Canada, from 2010 to 2016.Measures
Mortality and hospitalization were plotted over 1 year. Multistate Markov models were used to estimate adjusted odds ratios (ORs) for transitions to different states of health in stability, hospitalization, and death, stratified by heart failure diagnosis and by interRAI Changes in Health and End-stage disease Signs and Symptoms (CHESS) score, at 90 days following admission to a nursing home.Results
The final sample included 143,067 residents. Adverse events were most common in the first 90 days. A diagnosis of heart failure predicted worsening health instability, hospitalizations, and mortality. The effect of heart failure on hospitalizations and death was strongest for low baseline health instability (CHESS = 0; OR 1.63, 95% confidence interval (CI) 1.58-1.68, and OR 1.71, 95% CI 1.57-1.86, respectively), versus moderate instability (CHESS = 1-2; OR 1.36, 95% CI 1.32-1.39, and OR 1.48, 95% CI 1.41-1.55), versus high instability (CHESS = 3; OR 1.12, 95% CI 1.03-1.23, and OR 1.21, 95% CI 1.11-1.32). The magnitude of the impact of a heart failure diagnosis was greatest for lower baseline health instability. Residents with the highest degree of health instability were also most likely to die in hospital.Conclusions and implications
A diagnosis of heart failure and health instability provide complementary information to predict transfers, deaths, and adverse outcomes. Clearly identifying these at-risk patients may be useful in targeting interventions in nursing homes. 相似文献11.
Daniel Siconolfi Regina A. Shih Esther M. Friedman Virginia I. Kotzias Sangeeta C. Ahluwalia Jessica L. Phillips Debra Saliba 《Journal of the American Medical Directors Association》2019,20(4):503-508.e1
Objectives
Trends over time in the United States show success in rebalancing long-term services and supports (LTSS) toward increased home- and community-based services (HCBS) relative to institutionalized care. However, the diffusion and utilization of HCBS may be inequitable across rural and urban residents. We sought to identify potential disparities in rural HCBS access and utilization, and to elucidate factors associated with these disparities.Design
We used qualitative interviews with key informants to explore and identify potential disparities and their associated supply-side factors.Setting and participants
We interviewed 3 groups of health care stakeholders (Medicaid administrators, service agency managers and staff, and patient advocates) from 14 states (n = 40).Measures
Interviews were conducted using a semistructured interview guide, and data were thematically coded using a standardized codebook.Results
Stakeholders identified supply-side factors inhibiting rural HCBS access, including limited availability of LTSS providers, inadequate transportation services, telecommunications barriers, threats to business viability, and challenges to caregiving workforce recruitment and retention. Stakeholders perceived that rural persons have a greater reliance on informal caregiving supports, either as a cultural preference or as compensation for the dearth of HCBS.Conclusions/implications
LTSS rebalancing efforts that limit the institutional LTSS safety net may have unintended consequences in rural contexts if they do not account for supply-side barriers to HCBS. We identified supply-side factors that (1) inhibit beneficiaries' access to HCBS, (2) affect the adequacy and continuity of HCBS, and (3) potentially impact long-term business viability for HCBS providers. Spatial isolation of beneficiaries may contribute to a perceived lack of demand and reduce chances of funding for new services. Addressing these problems requires stakeholder collaboration and comprehensive policy approaches with attention to rural infrastructure. 相似文献12.
Joseph Carson Stephanie Gottheil Sherri Lawson Tim Rice 《Journal of the American Medical Directors Association》2019,20(4):481-486
Background
Long-term care (LTC) homes expressed concern that patients had experienced medication incidents after hospital discharge as a result of poor coordination of care.Objective
The London Transfer Project aimed to reduce LTC medication incidents by 50% within 48 hours of discharge from general medicine units at the London Health Sciences Centre.Design
This quality improvement study involved 2 hospitals and 5 LTC homes in London, Ontario, Canada. The baseline prevalence of medication incidents was measured and explored for root causes. Two change ideas were tested on general medicine units to improve transfer communication: (1) expediting medication reconciliation and (2) faxing medication plans before discharge.Measures
Evaluation involved time-series measurement and a comparison of baseline and intervention periods. The primary outcome was medication incidents by omission or commission within 48 hours of discharge, which was determined by dual chart reviews in hospital and LTC homes. Process measures included medication reconciliation and fax completion times. Hospital discharge times were included as a balance measure of the new communication process.Results
Four hundred seventy-seven LTC transfers were reviewed between 2016 and 2017; 92 transfers were reviewed for medication incidents in participating homes at baseline (January-April 2016) and implementation (January-April 2017). Medication incidents decreased significantly by 56%, from 44% (22/50) at baseline to 19% (8/42) during implementation (P = .006). Medication reconciliation completion by noon increased from 56% (28/50) to 74% (31/42) but not significantly (P = .076). Faxes sent before discharge increased significantly from 4% (2/50) to 67% (28/42, P = .015). There was no significant change in hospital discharge time.Conclusions/Implications
Medication incidents can be significantly reduced during care transitions by taking a systems perspective to explore quality gaps and redesign communication processes. This solution will be scaled to other inpatient services with a high proportion of LTC residents. 相似文献13.
Silvia Gonella Ines Basso Valerio Dimonte Barbara Martin Paola Berchialla Sara Campagna Paola Di Giulio 《Journal of the American Medical Directors Association》2019,20(3):249-261
Objective
Less aggressive end-of-life (EOL) care has been observed when health care professionals discuss approaching EOL and preferences about life-sustaining treatments with nursing home (NH) residents or their families. We performed a comprehensive systematic review to evaluate the association between health care professionals–residents and health care professionals–family EOL conversations and EOL care outcomes.Design
Systematic review with meta-analysis.Setting and Participants
Seven databases were searched in December 2017 to find studies that focused on health care professionals–residents (without oncologic disease) and health care professionals–family EOL conversations and aimed to explore the impact of EOL conversations on resident's or family's EOL care outcomes.Measures
Random effects meta-analyses with subsequent quality sensitivity analysis and meta-regression were performed to assess the effects of EOL conversations on the decision to limit or withdraw life-sustaining treatments. A funnel plot and Eagger test were used to assess publication bias.Results
16 studies were included in the qualitative and 7 in the quantitative synthesis. Health care professionals–family EOL conversations were positively associated with the family's decision to limit or withdraw life-sustaining treatments (odds ratio = 2.23, 95% confidence interval: 1.58-3.14).The overall effect of health care professionals–family EOL conversations on the family's decision to limit or withdraw life-sustaining treatments remained stable in the quality sensitivity analysis. In the meta-regression, family members with a higher level of education were less influenced by EOL conversations with health care professionals when making decisions about limiting or withdrawing life-sustaining treatments. No publication bias was detected (P = .4483).Conclusions/Implications
This systematic review shows that EOL conversations promote palliative care. Structured conversations aimed at exploring NH resident preferences about EOL treatment should become routine. NH administrators should offer health care professionals regular training on EOL conversations, and resident-centered care that involves residents and their families in a shared decision-making process at EOL needs to be promoted. 相似文献14.
Ning Zhang Susan F. Lu Yanhua Zhou Bo Zhang Sybil Crawford Jerry H. Gurwitz 《Journal of the American Medical Directors Association》2019,20(3):312-316
Objective
To examine the association between body mass index (BMI) and outcomes, including discharge to home, hospitalization, death, or continued residence in the skilled nursing facilities (SNFs), among residents newly admitted to SNFs.Design
Retrospective observational design using the national Minimum Data Set 2.0 from 2006 to 2010.Setting
SNFs in the United States.Participants
Newly admitted SNF residents.Measurements
Four discharge outcomes were assessed at 30 days subsequent to the initial admission to SNF, including discharge to home, hospitalization, death, or continued residence in the SNFs, and examined using a competing hazards model. SNF residents were categorized as underweight (BMI < 18.5), normal to overweight (18.5 ≤ BMI < 30), mildly obese (30 ≤ BMI < 35), and moderately to severely obese (BMI ≥ 35).Results
The study sample was composed of 3,812,333 newly admitted SNF residents. As compared with normal to overweight SNF residents, underweight individuals were less likely [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.82-0.83] to be discharged home and more likely to be hospitalized (HR 1.06, 95% CI 1.05-1.07), or to die (HR 1.59, 95% CI 1.56-1.62), rather than continue to reside in the facility. Residents with mild obesity were more likely (HR 1.12, 95% CI 1.11-1.13) to be discharged home and less likely to be hospitalized (HR 0.96, 95% CI 0.95-0.97) or to die (HR 0.74, 95% CI 0.73-0.76). Moderately to severely obese individuals were also more likely to be discharged home (HR 1.11, 95% CI 1.10-1.11) and less likely to be hospitalized (HR 0.94, 95% CI 0.93-0.95) or die (HR 0.66, 95% CI 0.64-0.68).Conclusions/implications
SNF residents with obesity experience more favorable short-term outcomes compared with underweight or normal to overweight residents. Underweight residents are at the greatest risk for adverse outcomes, emphasizing the need for special surveillance and preventive efforts targeting these individuals. 相似文献15.
Allison M. Lacko Barry M. Popkin Lindsey Smith Taillie 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):400-415
Background
Despite interventions to improve the nutrition of grocery store purchases, also referred to as at-home (AH) foods, by participants in the Supplemental Nutrition Program (SNAP), little is known about what proportion of participants’ intake is from AH foods and how the dietary quality of AH food compares with participants’ away-from-home (AFH) food. Although recent research indicates SNAP participants have dietary quality that is slightly worse than that of income-eligible nonparticipants, it is unknown whether this is attributable to AH or AFH consumption.Objective
The objective of this study is to examine differences in self-reported dietary intake by food source for SNAP participants compared with income-eligible nonparticipants using 2011-2014 data from the National Health and Nutrition Examination Survey (NHANES).Design
This study included data from the NHANES, a cross-sectional, nationally representative survey of the United States population.Study participants
This study included 2,523 adults with low incomes (≤130% of the federal poverty level) in NHANES (2011-2014).Main outcome measures
Self-reported intake of calories, solid fats, added sugars, and servings of nonstarchy vegetables, whole fruits, and whole grains was assessed by food source in SNAP participants and income-eligible nonparticipants.Statistical analysis
Multivariate linear regression was used for each outcome, controlling for relevant sociodemographic characteristics. Data were stratified by food source, including grocery stores, sit-down restaurants, and fast food.Results
SNAP participants had a higher intake of solid fats and added sugar from AH foods than nonparticipants. Added sugar from AH food accounted for 15.3% of total calories consumed by SNAP participants, compared with 11.8% for nonparticipants (P<0.001). SNAP participants consumed fewer calories from sit-down restaurants, but both groups consumed similar amounts of calories from fast food. Consumption of nonstarchy vegetables, whole fruits, and whole grains was low for both groups.Conclusions
SNAP participants had poorer diet quality from consumption of AH food than did nonparticipants. Future research should focus on interventions to improve the healthfulness of grocery store purchases as a mechanism to improve dietary quality of SNAP participants. 相似文献16.
Susan M.H. Gills Garry Auld Ann Hess Susan S. Baker 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):500-506
Background
The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls.Objective
To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN.Design
Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour.Participants and setting
The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states.Main outcome measures
The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups.Statistical analysis performed
Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement.Results
No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first.Conclusion
The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development. 相似文献17.
Michael Dörks Katharina Allers Falk Hoffmann 《Journal of the American Medical Directors Association》2019,20(3):287-293.e7
Objectives
In addition to routinely administered long-term medication, complex drug regimens of nursing home residents often include as needed or pro re nata (PRN) medication. However, there has been no systematic evaluation of the frequency and concomitants of PRN medication in nursing homes. The main objective of this systematic review was to provide a current assessment of PRN drug use in nursing homes.Design
A systematic literature search was performed. Data were identified from 4 electronic bibliographic databases: MEDLINE, Embase, CINAHL, and Scopus. Studies were included if they reported quantitative data on PRN drug use in nursing home residents.Results
Our search strategy resulted in 484 hits, of which 27 articles satisfied the inclusion criteria. The mean number of PRN drugs ranged between 0.4 and 4.9 per resident with a median of 2.5. The proportion of residents prescribed at least 1 PRN drug was between 48.4% and 97.4% (median = 74.9). Administration of prescribed PRN medication was rather low as the proportion of residents with administered PRN drugs ranged from 28% to 55%. Frequently prescribed PRN drugs were analgesics, laxatives, and sedatives. Advanced age, dementia, a higher number of regularly scheduled medications, and length of stay in the nursing home were associated with higher use of PRN drugs.Conclusions/Implications
Although not regularly administered, PRN drug use in nursing home residents should be taken into account as part of complex drug regimens. In that sense, there seems to be an inadequate number of studies reporting on it. When screening tools like the Beers Criteria are adapted, PRN drugs should be included. 相似文献18.
Margaret Slavin Alexandra Polasky Katelyn Vieyra Amy Best Lois Durant Cara Frankenfeld 《Journal of the Academy of Nutrition and Dietetics》2019,119(5):739-749
Background
Assessing nutritional intake in all-you-care-to-eat dining facilities poses unique challenges. New methods that streamline accurate data collection would facilitate better nutrition intervention research in this dining hall environment, which is common on university campuses.Objective
To compare nutrient and food group intake data of university undergraduate students from a single visit to an all-you-care-to-eat campus dining hall, collected by two methods: multiple-pass dietary recall interview and self-administered, electronic survey.Participants/setting
Undergraduate students (n=42) ages 18 and older were recruited as they exited the dining hall during lunch service hours during 1 week.Design
Using a cross-sectional design, participants completed two dietary assessment methods in random order: an electronic tablet-based exit survey listing the available menu items at that service with drop-down menus to report portion size consumed and a multiple-pass structured dietary interview by a single, trained interviewer.Statistical analyses performed
Agreement of nutrients and food groups between the two methods was assessed by Pearson and Spearman correlations and paired t tests. Significance was set at P<0.05.Results
Respondents were primarily underclassmen and women who lived on campus, with 16 of 42 students identifying as white. Students reported an average of 1.1 additional food items via the diet interview method compared with the survey. Average kilocalorie intake by the interview and survey methods was 837±561 and 860±586, respectively. Mean intake of all measured nutrients and all food groups except total and lean protein was not significantly different across the two methods. Spearman correlations between method results ranged across nutrients from r=0.541 to r=0.998 and across food groups from r=0.507 to r=0.948; all were significant at P<0.001. However, mean differences between methods exhibited notable variation.Conclusions
The electronic survey method performs similar to a multiple-pass dietary interview in assessing mean nutrient intake of ethnically diverse university undergraduates in a single eating occasion at an all-you-care-to-eat dining hall, but the survey may not be as efficient at capturing the total number of food items consumed. 相似文献19.
Lauren E. Au Courtney Paolicelli Klara Gurzo Lorrene D. Ritchie Nancy S. Weinfield Kaela R. Plank Shannon E. Whaley 《Journal of the Academy of Nutrition and Dietetics》2019,119(3):435-448
Background
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides supplemental foods to assist participants in meeting their dietary needs. Few studies have described the extent to which WIC-eligible foods contribute to the overall diet of children who were enrolled in WIC prenatally or in early infancy.Objective
Our aims were to examine commonly consumed foods and estimate the proportion of dietary intake contributed by WIC-eligible foods among 13- and 24-month-old children, and to assess differences by WIC participation status at 24-months.Design
This was a national observational study.Participants/setting
Children participating in the WIC Infant and Toddler Feeding Practices Study-2 were included (13 months old [n=2,777] and 24 months old [n=2,450]) from 2013 to 2016.Main outcome measures
Dietary intakes were assessed using 24-hour dietary recalls at 13 and 24 months. The 10 most commonly consumed foods were described using the What We Eat in America food category classification system. WIC-eligible foods were defined as meeting the WIC nutrient criteria set forth in the Federal regulation.Statistical analyses performed
The estimated proportion (mean±standard error) of WIC-eligible foods to total daily intake was calculated for energy, macronutrients, and select micronutrients. Multiple linear regression, adjusted for confounders, was conducted to compare the estimated proportion of nutrient intake from WIC-eligible foods by WIC participation at 24 months.Results
At 13 and 24 months, most (60% and 63%, respectively) of the commonly consumed foods were eligible for purchase as part of the child WIC food package. WIC-eligible foods provided >40% of calories and close to 50% or more of other nutrients, and the contribution of WIC-eligible foods to overall micronutrient intake increased between 13 and 24 months. Children still on WIC at 24 months obtained a larger proportion of calories and most other nutrients from WIC-eligible foods than children no longer on WIC.Conclusions
WIC-eligible foods could contribute to the overall diet of toddlers who were enrolled in WIC prenatally or in early infancy. Further, there may be additional nutritional benefits of staying on the program through 24 months. 相似文献20.
Claudia Schulz Gisela Büchele Martin Rehm Dietrich Rothenbacher Patrick Roigk Kilian Rapp Christian Günster Hans-Helmut König Katrin Reber 《Journal of the American Medical Directors Association》2019,20(4):451-455.e3