Incontinence in nursing homes. Research and treatment issues from the nursing perspective

While bladder training appears to be a feasible modality for treating urinary incontinence in long-term care patients, many issues exist that prevent effective use of such a program. Multiple factors, including staff, patient, and environmental variables influence the outcome of treatment and research protocols and therefore must be addressed before any protocol can be effectively implemented. This article addresses and examines such issues in long-term care settings.     

Australia's use of the Cornell scale to screen for depression in nursing homes

Aim: To examine the utility of the Cornell scale for depression in dementia (CSDD), following its introduction as a routine measure in nursing homes. Methods: The CSDD is administered in Australian nursing homes as section 10 of the Aged Care Funding Instrument. CSDD, cognitive and behavioural ratings, and medication use, recorded in three Sydney nursing homes in 2008–2009 were reviewed. Staff discussed what actions were taken if CSDD scores indicated depression. Results: Of 223 residents, 23% scored >12 on the CSDD, indicating probable depression. Another 21% were possibly depressed and 29% not depressed. The CSDD had not been completed for 27%, commonly because preliminary screening indicated no depression, but sometimes because severe cognitive impairment made various CSDD items impossible to rate. Second CSDD assessments had usually not been made. Conclusion: Nursing homes need to document policies that will ensure best use is made of CSDD findings.     

BE-ACTIV: a staff-assisted behavioral intervention for depression in nursing homes

PURPOSE: This article (a) describes a 10-week, behavioral, activities-based intervention for depression that can be implemented in nursing homes collaboratively with nursing home activities staff and (b) presents data related to its development, feasibility, and preliminary outcomes. DESIGN AND METHODS: We developed BE-ACTIV, which stands for Behavioral Activities Intervention, in two pilot study phases: a treatment development phase and a feasibility-outcome phase with a small, randomized trial. We first piloted the intervention with five depressed residents in a single nursing home in collaboration with the social services and activities staff. The second phase randomized 20 residents from six nursing homes to receive either the intervention or treatment as usual. RESULTS: The intervention was well received by residents, family, and staff members. Experience with the intervention and input from staff members resulted in modifications to streamline the intervention and improve implementation. Results suggest that BE-ACTIV reduced institutional barriers to participation in pleasant activities, increased resident control over activity participation, increased overall activity participation, and improved depressive symptoms. Despite low power, statistical and graphical comparisons suggest superiority of the intervention over treatment as usual. IMPLICATIONS: Because depression among nursing home residents is prevalent, heterogeneous, and often treatment resistant, there is a need for effective, low-cost interventions that are ecologically acceptable and efficient. BE-ACTIV is a promising intervention; it is brief, addresses institutional barriers, involves facility staff in treatment, and is acceptable to residents. As such, BE-ACTIV merits further evaluation to establish efficacy and effectiveness.     

Teaching nursing homes: their impact on public policy, patient care, and medical education

In summary, teaching nursing homes can be expected to have an impact on public policy development, patient care, and physician training. It is anticipated that research into the important public policy issues regarding relationships between costs and proprietary status and quality of care will be enhanced by developing teaching nursing homes. It will be important to coordinate efforts and evaluations between pilot projects with different funding bases in order to provide research projects with adequate controls. Many results regarding cost-quality comparisons may be of limited applicability to community institutions because of the higher costs inherent to teaching facilities. Nursing home patients living in teaching facilities can expect to be directly benefitted in terms of receiving increased medical attention. They will reside in model facilities providing what is hoped to be the optimal services in all aspects of nursing home care. Possible detrimental aspects for such patients include increased exposure to heroic interventions and possibly poorer care as a result of medical interference with established nursing home team approaches to patient care. As a result of living in a research environment, patients also may be pressured to participate in protocols to which they are not normally exposed. In addition, because many of the geriatric fellowships are based in Veterans Administration facilities (with their predominantly male patient population), it will be important to ensure that current research adequately studies the common problems of elderly women, who represent 70 per cent of those who are in nursing homes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Decision analysis for tuberculosis preventive treatment in nursing homes

There are differing opinions on whether or not to use isoniazid (INH) preventive treatment in older people with significantly reactive ("positive") tuberculin skin tests and fibrotic changes on chest roentgenogram. To assist the clinician facing this decision, a Decision Analysis was completed. Using available data, it is seen that using INH will not have much impact on five-year survivorship, but will reduce the number of tuberculosis disease cases, thus having an overall beneficial impact. Where tuberculosis incidence is higher, the benefit of INH preventive treatment is correspondingly higher.     

Development of a minimum data set-based depression rating scale for use in nursing homes

BACKGROUND: depression is common but under-diagnosed in nursing-home residents. There is a need for a standardized screening instrument which incorporates daily observations of nursing-home staff. AIM: to develop and validate a screening instrument for depression using items from the Minimum Data Set of the Resident Assessment Instrument. METHODS: we conducted semi-structured interviews with 108 residents from two nursing homes to obtain depression ratings using the 17-item Hamilton Depression Rating Scale and the Cornell Scale for Depression in Dementia. Nursing staff completed Minimum Data Set assessments. In a randomly assigned derivation sample (n = 81), we identified Minimum Data Set mood items that were correlated (P < 0.05) with Hamilton and Cornell ratings. These items were factored using an oblique rotation to yield five conceptually distinct factors. Using linear regression, each set of factored items was regressed against Hamilton and Cornell ratings to identify a core set of seven Minimum Data Set mood items which comprise the Minimum Data Set Depression Rating Scale. We then tested the performance of the Minimum Data Set Depression Rating Scale against accepted cut-offs and psychiatric diagnoses. RESULTS: a cutpoint score of 3 on the Minimum Data Set Depression Rating Scale maximized sensitivity (94% for Hamilton, 78% for Cornell) with minimal loss of specificity (72% for Hamilton, 77% for Cornell) when tested against cut-offs for mild to moderate depression in the derivation sample. Results were similar in the validation sample. When tested against diagnoses of major or non-major depression in a subset of 82 subjects, sensitivity was 91% and specificity was 69%. Performance compared favourably with the 15-item Geriatric Depression Scale. CONCLUSION: items from the Minimum Data Set can be organized to screen for depression in nursing-home residents. Further testing of the instrument is now needed.     

Analyses of space available in homes and day centers for the aged, as well as nursing homes for elderly people, in the FRG. Booking and occupation rate in homes and nursing homes for the aged (author's transl)]

Further intention of the survey having been conducted to show the consequences of the "Heimmindestverordnung" (draft dated Nov. 1974) was to obtain a review of the density of occupancy related to housing for the elderly. In homes for the old the rate of one-bed-rooms significantly increased during the last 15 years, whereas the respective quota for rooms with two, three, or more beds showed a decreasing tendency. In nursing homes density also decreased: the rate of one- and two-bed-rooms increased and the respective frequency of rooms equipped with four and more beds decreased from 55% to 13%. Regarding the density of occupancy also the other data collected such as related to variables as association the investigation-unit belongs to, commencement of operation, federal state, size of community led to some striking findings.     

Dynamics of the age structure of residents in homes for the aged and nursing homes

In state-run residential and nursing homes in the GDR the proportion of those residents of at least 80 years of age increased from 41.5 to 56.0 p.c. between 1980 and 1983, diversified on districts they moved between 70.0 and 46.5 p.c. Some selected features were correlated, only a low degree of dependence being found on the age-structure of the district-population (r = +0.26), highest degree on the ratio home-capacity/district-population (r = -0.65).