Prevalence of skin disease among nursing home staff in southern Taiwan

To establish the prevalence of skin disease among nursing home workers in southern Taiwan, dermatological examination was performed on 75 nursing home staff from 11 institutions in Tainan county. Fungal infections were the most common skin diseases identified, affecting 21.4% of all employees. Other conditions included xerosis (13.3%), scabies (10.7%) and dermatitis (8.0%). Fungus was found mainly on the feet and hands (68.7% and 31.3% of all fungal cases respectively). Most xerosis sites were identified on the lower leg (90.0% of all xerosis cases), while all workers with scabies had the disease on their forearm. Dermatitis was diagnosed predominately on the forearm (50.0% of all dermatitis cases). The prevalence of fungus and scabies was higher than other studies, while dermatitis occurred less frequently than previous reports. Although not statistically significant, we believe that wet work and occupational contact with nursing home patients may have been important risk factors for these conditions.     

Dietary fiber intakes of nursing home residents and independent-living older adults

Daily dietary fiber intakes were determined for two groups of older adults with significantly different bowel habits: nursing-home (NH) residents who habitually took laxatives and independent-living (IL) adults who took laxatives occasionally. Fiber intakes were calculated from neutral detergent fiber (NDF) and Southgate total dietary fiber values. IL subjects (n = 7) consumed on average 9.0 +/- 1.6 g NDF and 18.8 +/- 4.6 g total fiber daily. The NH menu provided a similar amount of NDF but more total fiber. NH residents (n = 6) consumed approximately 70-85% of the fiber served. When fiber intakes were expressed as energy, NH and IL subjects consumed similar amounts of NDF but IL subjects consumed less total fiber. Grain products were major fiber sources for both groups; IL subjects consumed more fiber from fruits. Comparisons of fiber intakes, bowel function, lifestyles, and medications suggest that dietary fiber is only part of the basis for inadequate large bowel function experienced by some elderly populations.     

Use of antihypertensive drug therapy in older persons in an academic nursing home

OBJECTIVES: To determine the prevalence of hypertension and the appropriate treatment of hypertension in older persons in an academic nursing home. DESIGN: The charts of all persons aged > or = 59 years currently residing in a nursing home affiliated with Westchester Medical Center/New York Medical College were analyzed by two geriatrics fellows according to a protocol designed by one of the authors (W.S.A.). SETTING: An academic nursing home affiliated with Westchester Medical Center/New York Medical College. PARTICIPANTS: The study population included 96 men and 159 women, mean age 77 +/- 9 years (range, 59-100 years). RESULTS: Hypertension was present in 129 of 255 persons (51%). Clinical cardiovascular disease or target organ damage or diabetes mellitus was present in 121 of 129 persons (94%) with hypertension. Hypertension was poorly controlled in 21 of 129 persons (16%). Of 129 persons with hypertension, 70 (54%) were treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers, 61 persons (47%) with beta blockers, 43 persons (33%) with diuretics, 36 persons (28%) with calcium channel blockers, 5 persons (4%) with alpha blockers, and 5 persons (4%) with other antihypertensive drugs. Of 54 persons with hypertension and diabetes mellitus, 37 persons (69%) were treated with ACE inhibitors or angiotensin II type 1 receptor blockers. Of 58 persons with hypertension and coronary artery disease, 33 persons (57%) were treated with ACE inhibitors or angiotensin II type 1 receptor blockers, 31 persons (53%) with beta blockers, 20 persons (34%) with diuretics, 18 persons (31%) with calcium channel blockers, 2 persons (4%) with alpha blockers, and 4 persons (7%) with other antihypertensive drugs. Of 31 persons with hypertension and heart failure, only 5 persons (16%) had measurement of left ventricular ejection fraction. Of 31 persons with hypertension and heart failure, 30 persons (97%) were treated with diuretics, 21 persons (68%) with ACE inhibitors or angiotensin II type 1 receptor blockers, 18 persons (58%) with beta blockers, and 8 persons (26%) with calcium channel blockers. CONCLUSIONS: Of older persons with hypertension in an academic nursing home, 16% had poor control of their hypertension. There was overuse of calcium channel blockers and alpha blockers and underuse of diuretics, beta blockers, and ACE inhibitors in treating hypertension. Physician education needs to be intensified to provide better medical care of older persons with hypertension through the use of optimal doses of drugs found to be effective and safe by evidence-based studies.     

The presence of malnutrition in community‐living older adults receiving home nursing services

Aim: To determine the extent of malnutrition and malnutrition risk among community‐living older people (aged 65 years and over) who are receiving care from a metropolitan home nursing service in Victoria, Australia. Method: Over a 3‐month period (May–July 2009), 235 clients aged 65 years and over from a community nursing service providing home nursing care were assessed for malnutrition using the Mini Nutritional Assessment (MNA®, Nestle, Vevey, Switzerland). Results: Thirty‐four per cent (34.5%) of clients were identified as being at risk of malnutrition, while 8.1% were found to be malnourished. There was no significant relationship between nutrition risk and gender, country of birth or living arrangements. Conclusion: Malnutrition and nutrition risk was found to be an issue among this sample of community‐living older adults who were receiving home nursing care in Victoria, Australia. In this study, just over 40% of the participants were either at risk of malnutrition or malnourished, which highlights the vulnerability of this group of older people and the need for routine nutrition screening and a targeted intervention program to address nutrition issues.     

Transitions of older adults to home care

To discover the process of admission and transition of older adults to home care following hospital discharge, or during periods of illness, ethnographic methodology was used to explore the experience of 65 participants in the "culture" of home care: patients, families, nurses, home care staff, and discharge planners. Two themes resulting from ethnographic analysis are presented: identification of patients and needs, and transfer of information. Support from family and friends was an essential addition to referral by discharge planners, physicians, and casefinding in facilitating transition to home care. Accurate, timely patient information was found to expedite home nursing assessment and insure continuity of care.     

Positive effects of art therapy on depression and self-esteem of older adults in nursing homes

Depression and self‐esteem affects the health and quality of life of older adults who live in nursing homes. This study tested the effectiveness of art therapy activities on reducing the depression and improving the self-esteem of elderly living in long‐term care institutes. This was a quasi‐experimental study. A purposive sampling strategy was used to select 55 subjects who were aged 65 and above with intact mental functions and depression tendencies and currently residing in nursing homes in Kaohsiung, Taiwan. 29 subjects who participated in a selection of 12 artistic activities were assigned to the experimental group and 26 subjects who adhered to their ordinary activities were allocated to the control group. Structured questionnaires of the artistic group were used for data collection. The art therapy programs showed promising effects in improving the depression and self‐esteem of older adults living in nursing homes. Art therapy activities benefit the mental health of older adults. Incorporating artistic activities into social work care may help develop long‐term care into a more diverse, unique, and innovative direction.     

Effects of anorexia on mortality among older adults receiving home care: An observational study

Purpose  

We describe the prevalence of secondary anorexia in a population of older people living in community and receiving home care. In addition, we examined the relationship between secondary anorexia and mortality.     

Absence of influenza vaccination among high-risk older adults in Taiwan

Background  

Older adults, who often have more than one chronic disease, are at greater risk of influenza and its complications. However, because they often see physicians for other more pressing complaints, their physicians, focusing on one condition, may forget to suggest preventive measures for other diseases such as influenza. This study investigates what major factors affect an older adult with more than one chronic condition missing a vaccination opportunity.     

Perceived social position and health in older adults in Taiwan

We examined whether perceived social position predicted mental and physical health outcomes (depressive symptoms, cognitive impairment, mobility restrictions, and self-assessed health) in a prospective study based on a nationally representative sample of older persons in Taiwan. Cross-sectional and longitudinal models were used to demonstrate the relationship between perceived social position and health, as reported by participants in the Social Environment and Biomarkers of Aging Study in Taiwan (SEBAS). Lower perceived social position predicted declining health beyond what was accounted for by objective indicators of socioeconomic position. As predicted, the effect was substantially reduced for all health outcomes in the presence of controls for baseline health. After including these controls, perceived social position was significantly related only to depressive symptoms. The findings suggest that the strength of the association between perceived social position and health may have been overstated in cross-sectional studies.     

Sarcopenia and mortality among older nursing home residents

Background and AimsSarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, no data are available on sarcopenia in the nursing home population. The aim of the current study was to explore the relationship between sarcopenia and all-cause mortality in a population of elderly persons aged 70 years and older living in a nursing home in Italy.MethodsThis study was conducted among all subjects (n = 122) aged 70 years and older who lived in the teaching nursing home of Catholic University of Rome between August 1, 2010, and September 30, 2010. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass plus either low muscle strength or low physical performance. The primary outcome measure was survival after 6 months.ResultsForty residents (32.8%) were indentified as affected by sarcopenia. This condition was more common in men (68%) than in women (21%). During the follow-up period, 26 (21.3%) patients died. After adjusting for age, gender, cerebrovascular diseases, osteoarthritis, chronic obstructive pulmonary disease, activity of daily living impairment, and body mass index, residents with sarcopenia were more likely to die compared with those without sarcopenia (adjusted hazard ratio 2.34; 95% confidence interval 1.04–5.24).ConclusionsThe present study suggests that among subjects living in a nursing home, sarcopenia is highly prevalent and is associated with a significantly increased risk of all-cause death. The current findings support the possibility that sarcopenia has an independent effect on survival among nursing home residents.     

Effects of institutional mechanisms on nursing home quality

This study explores institutional mechanisms explaining the variation in nursing home quality. A two-level panel design with the national data is conducted. Structural equation modeling is employed to examine the main and interaction effects of institutional factors on nursing home quality at both facility and state levels. The findings indicate that the quality of nursing homes is more responsive to regulatory and payment constraints than to normative and mimetic mechanisms. The potential demand for care, Medicaid reimbursement rate, and occupancy rate are positively associated with nursing home quality. An interaction effect between the regulatory mechanism and nurse staffing is statistically significant. The findings lend support to the importance of multi-level analysis of nursing home quality.     

Opportunities for improving post-hospital home medication management among older adults

Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g. Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.     

Effects of resistive training on strength gains in older adults

This study was designed to evaluate the effects of a moderate intensity, 16-week resistive strength training program on the rate and pattern of strength changes in trunk, upper, and lower extremity muscle groups. This study was also designed to determine the importance of muscle mass on strength gains during a training intervention with older adults. A repeated measures experimental design was employed with 43 experimental (ES) and 42 comparison subjects (CS). The active older sample had a relatively high level of strength for their age (72.1 yr) and had no contraindications for strength training. The ES trained five upper, three trunk, and three lower extremity muscle groups. Both ES and CS received pre- and post-testing assessments for muscle strength, muscle morphology, body composition, flexibility, and balance. The ES also received intermittent testing for one repetition maximum (1RM). ANOVA and Scheffé HSD tests were used to evaluate the data. The ES experienced significant strength gains (over 41% for each body segment) following the intervention. The rate of gain in this study was less than but the absolute strength gain was reasonably similar to values reported by studies in the literature [1,2]. There was no change in muscle mass (p>.05) following training. These results suggests that stronger active older adults have a muscle mass sufficient for greater strength and that training enables them to use available muscle mass more effectively. These results further suggest that muscle hypertrophy may be possible following strength training but it is not always necessary for strength improvement in older adults.     

A relational perspective on autonomy for older adults residing in nursing homes

Aim To review critically the traditional concept of autonomy, propose an alternative relational interpretation of autonomy, and discuss how this would operate in identifying and addressing ethical issues that arise in the context of nursing home care for older adults. Background Respect for patient autonomy has been the cornerstone of clinical bioethics for several decades. Important though this principle is, there is debate on how to interpret the core concept of autonomy. We review the appeal of the traditional approach to autonomy in health care and then identify some of the difficulties with this conception. Methods We use philosophical methods to explain and discuss the traditional and relational conceptions of autonomy and we illuminate our discussion with examples of various contextual applications. Conclusion We support the relational conception of autonomy as offering a richer, more contextualized understanding of autonomy which attends to the social, political and economic conditions that serve as background to an agent’s deliberations. To illuminate these ideas, we discuss the situation of frail older adults who frequently find their autonomy limited not only by their medical conditions but also by cultural prejudices against the aged and by the conditions commonly found within the nursing homes in which many reside. We propose ways of improving the relational autonomy of this population.