Care Dependent Research Articles

Relationship between care dependency and behavioral symptoms among elderly in-patients with Alzheimer's disease in Japan and the Netherlands.

Objective:This study investigates the influence of personal characteristics and health-related variables on the care dependency status among elderly in-patients with clinically diagnosed Alzheimer’s disease in two countries.Methods:A descriptive cross-cultural survey was administered to a convenience sample of 137 elderly in-patients. Patients were recruited from a hospital in Japan (N = 77) and from a nursing home in the Netherlands (N = 60).Results:In both countries, almost all participants are assessed on the severity level of care dependency in the range of “completely care dependent” (Japan: 35.1%; the Netherlands: 20.0%), or “to a great extent care dependent” (Japan: 24.7%; the Netherlands: 45.0%), to “partially care dependent” (Japan: 22.1%; the Netherlands: 21.7%).Conclusion:This study demonstrates that there is no interdependence between the severity level of care dependency and personal characteristics of patients with Alzheimer’s disease in both countries. Regarding the interplay of health-related variables on the severity level of care dependency, a difference was found between countries.

Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study.

Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9%). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3%). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2%, fecal: 50.9 vs. 17.7%, double: 49.1 vs. 14.9%). Urinary incontinence is high even in early dementia at 64%, reaching 94% in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12%) and rise to more than 80% (both types) in severe dementia. These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents' independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.

Comparison of care dependency and related nursing care problems between Austrian nursing home residents with and without dementia

ObjectiveDemographic developments have led to increased chronic diseases, such as dementia, which result in care dependency and nursing care problems like incontinence. This study aims to compare the degree of care dependency and the prevalence of nursing care problems between Austrian nursing home residents with and without dementia. MethodsSince 2009 a cross-sectional study has been conducted annually in Austrian nursing homes. Data from the standardized questionnaire sampling 2155 residents with and 1422 residents without dementia between 2009 and 2012 have been analysed. ResultsSeventy-two percent of residents with dementia compared to 45.5% of residents without dementia are completely or to a great extent care dependent, with the highest care dependency being in hygiene, continence, (un)dressing and avoiding danger. Residents with dementia have a significantly higher prevalence of urinary incontinence (87.9% vs. 69.5%), fecal incontinence (68.2% vs. 44.5%), double incontinence (64.8% vs. 36.1%), restraints (33.5% vs. 22.4%), malnutrition (27.9% vs. 18.4%) and falls (9.9% vs. 7.0%). No significant difference was found for pressure ulcers (5.2% vs. 6.5%). ConclusionResidents with dementia have a significantly higher degree of care dependency than residents without dementia and they also have, except for pressure ulcers, a significantly higher prevalence of nursing care problems. These results should increase awareness among health care professionals of areas requiring target-oriented dementia care. Further research should explore care dependency and nursing care problems in different stages of dementia and compare the development of care dependency and nursing care problems among residents with and without dementia.

Multimorbidity and long-term care dependency--a five-year follow-up.

BackgroundNot only single, but also multiple, chronic conditions are becoming the normal situation rather than the exception in the older generation. While many studies show a correlation between multimorbidity and various health outcomes, the long-term effect on care dependency remains unclear. The objective of this study is to follow up a cohort of older adults for 5 years to estimate the impact of multimorbidity on long-term care dependency.MethodsThis study is based on claims data from a German health insurance company. We included 115,203 people (mean age: 71.5 years, 41.4% females). To identify chronic diseases and multimorbidity, we used a defined list of 46 chronic conditions based on ICD-10 codes. Multimorbidity was defined as three or more chronic conditions from this list. The main outcome was “time until long-term care dependency”. The follow-up started on January 1st, 2005 and lasted for 5 years until December 31st, 2009. To evaluate differences between those with multimorbidity and those without, we calculated Kaplan–Meier curves and then modeled four distinct Cox proportional hazard regressions including multimorbidity, age and sex, the single chronic conditions, and disease clusters.ResultsMean follow-up was 4.5 years. People with multimorbidity had a higher risk of becoming care dependent (HR: 1.85, CI 1.78–1.92). The conditions with the highest risks for long-term care dependency are Parkinson’s disease (HR: 6.40 vs. 2.68) and dementia (HR: 5.70 vs. 2.27). Patients with the multimorbidity pattern “Neuropsychiatric disorders” have a 79% higher risk of care dependency.ConclusionsThe results should form the basis for future health policy decisions on the treatment of patients with multiple chronic diseases and also show the need to introduce new ways of providing long-term care to this population. A health policy focus on chronic care management as well as the development of guidelines for multimorbidity is crucial to secure health services delivery for the older population.

Natural course of care dependency in residents of long-term care facilities: prospective follow-up study.

BackgroundInsight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality.MethodsA prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79–88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15–75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months.ResultsAt baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P < 0.001); participants in the low CDS group stayed longer, had more frequent urine incontinence and more dementia. They had also the highest mortality rate (log rank 32.2; df = 2; P for trend <0.001). Per point lower in CDS score, the mortality risk increased with 2% (95% CI 1%-3%). Adjustment for age, gender, cranberry use, LTCF, length of stay, comorbidity and dementia showed similar results. A one point decrease in CDS score between 0 and 6 months was related to an increased mortality risk of 4% (95% CI 3%-6%).At the 6-month follow-up, 10% improved to a higher CDS group, 65% were in the same, and 25% had deteriorated to a lower CDS group; a similar pattern emerged at 12-month follow-up. Gender, age, urine incontinence, dementia, cancer and baseline care dependency status, predicted an increase in care dependency over time.ConclusionThe majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

Care dependency in patients with chronic obstructive pulmonary disease and heart failure – a secondary data analysis of German prevalence studies

The aim of this study was to compare the degree of care dependency between hospitalised patients with chronic heart failure (CHF) and patients with chronic obstructive pulmonary disease (COPD). Secondary data analysis of five German prevalence studies from 2007 to 2011. Care dependency was measured using the Care Dependency Scale. Hospitalised patients with CHF or COPD are to a limited extent care dependent, and their overall care dependency does not differ (p = 0.56). Care dependency items with the lowest mean were mobility, hygiene, getting (un)dressed, continence, avoidance of danger and daily activities. Patients with CHF or COPD did not differ statistically significantly in those items. Only the items 'eating and drinking' almost achieved statistical significance (p = 0.06). Patients with CHF or COPD did not differ in levels of care dependency. Both patient populations are restricted in engaging in activities potentially associated with physical condition and possibly influenced by perceived dyspnoea. Furthermore, comorbidities like incontinence and cognitive impairment seem to play an important role regarding the degree of care dependency.

Malnutrition in demented care home residents

Introduction.– People with dementia have been identified to be at high riskofmalnutrition, especially if they reside in carehomes. The aim of this studywas to investigate the prevalence and characteristics ofmalnutrition in demented care homepatients longitudinally. Methods.– This study is part of the annual Dutch National Prevalence Measurement of Care Problems conducted by Maastricht University (LPZ).Onpatient level amongstother, demographicdata, (co)morbidity, care dependency and the prevalence aswell as other relevant indicators of nutritional care are measured. The diagnosis of malnutrition is determined by low BMI, undesired weight loss and low nutritional intake. Results.– Seventy-five thousand three hundred and ninety-nine residents (mean age 84) from 670 care home organizations participated over a period of 4 years. Sixty percent of the residents was care dependent and 32,6% suffered from dementia. When discriminating between demented (D) and non-demented (ND) residents, demented residents were overall significantly more care dependent (D 43,2, ND 85,2) P<0.001) and more often malnourished than non-demented residents (D26,7, ND18.0) P<0.001). Looking to the overall care home population and taking into account several care improvement programmes the prevalence of malnutrition shows a gradual but progressive decline over the years, while the malnutrition prevalence in the demented care home population remains rather stable. Conclusions.– That malnutrition prevalence in the demented care home population, despite increasing nutritional attention in daily practice, remains the same over the years, raises the question whether the phenomenon of Alzheimer cachexia should receive renewed scientific attention.

Skin care practice in German nursing homes: a German‐wide cross‐sectional study

Due to anatomical and physiological changes in the course of aging and due to increased vulnerability, there are special skin care needs in elderly and care-dependent persons. Little is known about skin care practice in German long-term care facilities. The aim of the study was to gather epidemiological data about skin care practice in German nursing homes. In spring 2012 a German-wide cross sectional study was conducted in 47 nursing homes. Based on standardized data collection sheets. demographics and variables about methods and frequencies of skin cleansing and application of skin care products for 3 552 nursing home residents were collected and analyzed. The variables age, gender and level of care dependency was representative for the group of all German nursing home residents. More than 90% of investigated nursing home residents required skin care assistance. Washing body parts or the whole body were conducted most frequently (89.1%, 95% CI 88.0- 90.1). Skin care leave-on products were used in 91.7% (95% CI 90.7-92.6), whereas there were large variations between individuals. In total, more than 100 brands were used. Skin care practice in multimorbid care dependent persons shows large variations. How skin care products meet the special requirements of aged skin and whether they enhance the skin barrier function and prevent cuteneous skin damage is unknown.

Care Dependency Independently Predicts Two-Year Survival in Outpatients With Advanced Chronic Organ Failure

Previous studies suggest that care dependency may predict survival in hospitalized patients, but the prognostic value of care dependency in clinically stable outpatients with advanced chronic organ failure remains unknown. The objective of this study was to assess whether and to what extent care dependency predicts 2-year survival in patients with advanced chronic organ failure. Longitudinal observational study. Patients were recruited at the outpatient clinic of one academic and six general hospitals in The Netherlands. A total of 265 clinically stable outpatients with advanced chronic obstructive pulmonary disease (n = 105), chronic heart failure (n = 80), and chronic renal failure (n = 80) were included at baseline. Care dependency was assessed using the Care Dependency Scale (CDS), a 15-item self-administered questionnaire. In addition, patients performed a Timed Up and Go test to assess mobility. Finally, demographics, clinical characteristics, and 2-year survival were recorded. At baseline, 116 patients (43.8%) reported a CDS score ≤ 68 points and were considered as care dependent. In total, 66 patients (24.9%) died within 2 years. The Cox regression model showed that a higher CDS score (lower level of care dependency) was associated with a lower probability of dying within 2 years (hazard ratio, 0.95; 95% CI: 0.90-0.97), whereas older age was associated with a greater probability of dying within 2 years (hazard ratio, 1.06; 95% CI, 1.03-1.09). The level of care dependency independently predicts 2-year survival among clinically stable outpatients with advanced chronic organ failure. Therefore, regular assessment of the level of care dependency should be included in clinical care for patients with advanced chronic organ failure.

Use of physical restraints in nursing homes and hospitals and related factors: a cross‐sectional study

The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals. Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints. A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes (n = 5521) and 15 hospitals (n = 2827). For data analysis, a 3-level random intercept logistic model was used. The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model. Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints. Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.

Care problems and nursing interventions related to oral intake in German Nursing homes and hospitals: A descriptive mulitcentre study

BackgroundReduced nutritional intake in care-dependent patients is a risk factor for malnutrition. The prevalence of malnutrition has been extensively reported, but there is little empirical data on the prevalence of the underlying causes of reduced oral intake and the extent of nursing interventions that address malnutrition. ObjectivesTo report the prevalence of problems that potentially led to decreased nutritional intake. To investigate the association between these problems and body mass index (BMI).To investigate the association between increased care dependency and BMI. To document nutrition-related interventions. DesignCross-sectional multicentre study. SettingA total of 15 hospitals (H) and 76 nursing homes (NH) in Germany were included. ParticipantsA total of 2930 hospital patients and 5521 nursing home residents were included in the study. The mean age was 66.6±16.7 years (in H) and 84.9±9.8 years (in NH); 14.7% (in H) and 50.4% (in NH) were almost or completely care dependent. A BMI≤20kg/m2 was found in 8.5% (in H) and 16.7% (in NH). ResultsMost hospital patients were eating and drinking independently (72.2%), whereas 58.4% of the nursing home residents needed assistance. Major problems in hospitals were polypharmacy (18.6%), loss of appetite (14.6%) and pain (7.8%); in nursing home common problems were functional problems of the upper extremities (17%), loss of appetite (15.5%) and polypharmacy (15.5%). Patients with a high level of care dependency had higher rates of BMI≤20kg/m2. In both settings (H and NH), BMI≤20kg/m2 was significantly associated with loss of appetite (odds ratio (OR) 2.6, 95%CI 1.9–3.5 and OR 7.0, 95%CI 5.9–8.3), nausea (OR 2.1, 95%CI 1.3–3.3 and OR 2.8, 95%CI 1.9–4.1), chewing problems (OR 2.1, 95%CI 1.2–3.4 and OR 2.5, 95%CI 2.1–3.1) and swallowing problems (OR 2.3, 95%CI 1.4–3.6 and OR 2.3, 95%CI 1.9–2.8). Nutrition-related nursing interventions were employed more frequently in nursing homes than in hospitals. ConclusionA high care dependency in general and in terms of eating and drinking should be addressed in daily care to ensure sufficient nutritional intake. Additional problems, such as loss of appetite, should also be addressed with suitable interventions to prevent malnutrition. Nutrition-related interventions need to be increased in German health care facilities.

Translating evidence into nursing practice: oral hygiene for care dependent adults

Oral hygiene is necessary to maintain the health and well-being of hospitalised patients. However, studies indicated that nurses lacked the evidence-based knowledge to deliver proper care. A prior survey conducted on nurses working in the intensive care and high dependency units in our institution revealed that oral care practices varied and highlighted the need for an oral care protocol. These triggered us to embark on an evidence-based project on oral care to improve patients' oral health during their hospitalisation. We aimed to translate the best available evidence to improve our oral care practices. We followed the Iowa Model of Evidence-based Practice. Having identified a problem, we formed a team. We searched for best available evidence on oral care management and appraised them using the Scottish Intercollegiate Guidelines Network checklists. We developed an evidence-based oral care protocol and outlined key changes necessary to improve patients' oral care during hospitalisation. We chose the medical intensive care unit and a neurology ward to pilot the changes. The changes included introducing an oral assessment guide to assess patients' oral condition and intervening appropriately according to their risk levels, recommending 0.2% chlorhexidine solution as the main oral cleaning solution, and standardising oral care documentation. We compared the pre- and post-audits to assess improvement in the nurses' knowledge and compliance to the protocol. Auditors also physically inspected the oral health of functionally dependent patients under the charge of the audited nurses. The team involved 25 patients and 25 nurses in each pre- and post-audits. The median pre- and post-scores were 60% and 100%, respectively. The results revealed that the project led to improvements in nurses' oral care knowledge and practices, especially in nurses taking appropriate interventions as recommended, and in correctly using oral care products to clean patients' mouths. Auditors reported improvement in patients' oral care during their physical assessments of patients' oral cavities. This finding was supported by feedback from other healthcare providers. This evidence-based project heightened nurses' awareness and knowledge on oral care, and led to nurses providing practices based on best available evidence. These have translated to improvements in patients' oral health.

Demenz und Depression determinieren Pflegebedürftigkeit bei M. Parkinson

Parkinson's disease (PD) is frequently accompanied by dementia or depression which can aggravate the clinical picture of the disease and increase the risk of care dependency (CD). Little is known about the associations between PD, these neuropsychiatric comorbidities and CD in outpatients.A nationwide sample of outpatients (n=1,449) was examined by office-based neurologists (n=315) comprising the documentation of the general, neurological status and the degree of CD. The dementia status was clinically rated according to the established DSM-IV criteria. Depression was screened with the Montgomery-Asberg Depression Rating Scale (MADRS).Overall, 18.3% of all patients were care dependent. Even after adjustment for PD severity, patients with depression (OR=2.8; 95% CI 1.8-4.3), dementia (OR=2.7; 95% CI 1.8-4.1) or both (OR=3.9; 95% CI 2.5-60,0) were at higher risk for CD than patients without dementia or depression. Patients aged ≥76 years were fourfold more likely to be care dependent than patients aged ≤65 years (OR=3.5; 95% CI 2.3-5.5). Across all age groups, patients with depression featured the highest increments (from 11.9 to 42.0%).The risk for CD is substantially elevated in outpatients with PD when further neuropsychiatric symptoms are present. The data suggest that depression contributes equally to disability as does dementia.

Socio‐demographic factors related to functional limitations and care dependency among older Egyptians

This paper is a report of a study determining the relationship of socio-demographic factors to functional limitations and care dependency among older care recipients and non-care recipients in Egypt. The population is ageing in Egypt and age-related functional limitations are increasing. Age and gender influence this phenomenon, but its relationship to socio-economic status has not yet been demonstrated for Egypt. Functional limitations are an antecedent to care dependency, which also may be associated with these socio-demographic factors. A cross-sectional study with a two-group comparative design was conducted in Greater Cairo. The sample was composed of 267 non-care recipients and 344 care recipients. Path analysis was used to determine the relationship between variables. Age, gender and acceptance of care were covariates in the multiple regressions. Analyses were conducted separately for care recipients and non-care recipients. Among non-care recipients, lower socio-economic status was related to more functional limitations and higher care dependency. This relationship was not found among care recipients. Older persons from low income groups are more likely to become care dependent but are less able to pay for required care. Currently, untrained volunteer groups of religious organizations try to support these older people in the poorer strata of Egyptian society. Training in the basics of care might help to make their work more effective.

PP258 SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECTS OF HIGH PROTEIN ORAL NUTRITIONAL SUPPLEMENTS (ONS) ON NUTRITIONAL STATUS AND INTAKE

many studies comparing outcome (prevalence), process (screening and treatment of malnutrition) and structure indicators of nutritional care in different countries, using the same methodology. Therefore we conducted a study in Germany (G) and the Netherlands (NL). Methods: A cross-sectional international prevalence study was performed in 151 nursing homes (NL n = 5848, G n = 4923). A standardized questionnaire (3 levels) was used: at institutional and ward level structure indicators of nutritional care were assessed, whereas at patient level demographic data, care dependency and nutritional screening and treatment interventions for malnutrition were measured. Malnutrition was measured by assessing BMI, undesired weight loss and nutritional intake. Results: Dutch residents were older, more often male, more care dependent, and have a lower BMI than German residents. Dutch residents were more at risk of malnutrition (NL = 31.7% and G = 29.1%, p = 0.03), but no significant difference was found in the prevalence of malnutrition between both countries. About half of the malnourished residents received a nutritional intervention. Structure indicators at institutional level were more often fulfilled in the NL, only education was given more often in G. Besides having a specialized person in malnutrition, all other indicators on ward level were more often fulfilled in G. Conclusion: Malnutrition is a problem in more than a quarter of nursing home residents in each of the countries. Despite the fact that nutritional screening is rather frequently performed, nutritional interventions are provided only in about 50% of the malnourished patients. Structure indicators at ward level are more fulfilled in G, whereas at institutional level they are more fulfilled in NL.

Care Dependence

The purpose of this study was to describe people's experiences of being dependent on others for care in their final stage of life, as well as what they felt made their experience of being dependent easier or more difficult. The phenomenological-hermeneutical method was chosen, where data collection consisted of open-ended interviews with nine people undergoing palliative care at a hospice unit or at home. The meaning of being care dependent is described via the following themes: changed relationship with oneself and with others, striving to adapt oneself to the situation, obstacles, and opportunities along the way while dependent. The result is described as an effort, a journey from independence to moments where it was possible to rest and recuperate while struggling with care dependency. Nursing staff require knowledge and understanding of experiences with care dependency to make life easier for people during increasing dependency in the final stage of life.

Care dependency of children in Egypt

This study aimed to modify the Care Dependency Scale so that it could be used for children, to apply its Arabic version to Egyptian children to test the reliability and validity of the modified scale and to compare the care dependency of disabled and non-disabled Egyptian children. A higher dependence of children in their daily tasks undoubtedly places a greater burden on their caregivers. To estimate the extent of the problem of care dependency, data from different countries and proper standard instruments are required. The Care Dependency Scale was modified for children by Delphi technique. This study assessed the care dependency of non-disabled children compared with children with physical and mental disabilities using the modified version of the Care Dependency Scale for paediatrics. The total sample included 260 Egyptian school-age children (50.8% of whom were disabled and 49.2% were non-disabled). Reliability was examined in terms of internal consistency using Cronbach's alpha (0.91). Inter-rater reliability revealed moderate to very good Kappa statistics between 0.57-0.89. Content validity and criterion validity were evaluated. Differences regarding care dependency were found between disabled and non-disabled children. The psychometric properties of the Care Dependency Scale for paediatrics support its usefulness in measuring the care dependency of children in Egypt. This study provides an Arabic version of the Care Dependency Scale for paediatrics that is easy to administer and may be useful to measure the care dependency in various Arabic countries. The findings raise concerns regarding the extent to which disabled and also non-disabled school-age children are care dependent leading to an increased burden of care on nurses or on caregivers in general. The Care Dependency Scale for Paediatrics can help nurses conduct an appropriate assessment of children's care dependency so that any nursing care can be planned according to the children's needs.

The Norton, Waterlow, Braden, and Care Dependency ScalesL Comparing Their Validity When Identifying Patients' Pressure Sore Risk

We compared the sensitivity and specificity of the Norton, Waterlow, and Braden Scales in identifying patients at pressure sore risk. An additional goal was to determine whether or not the Care Dependency Scale (CDS) is able to detect patients at risk for pressure sore development. The investigation was part of a prevalence study involving 754 patients in 3 Berlin hospitals. A questionnaire was used containing the subscales of the 3 risk calculators (Norton, Waterlow, and Braden), and the CDS. On the specified day nurses filled in the questionnaire using data obtained from the patients' charts and direct visualization of the patients' skin. Thirty-four out of 754 patients had at least 1 pressure ulcer. Comparing the 3 risk assessment tools, the Waterlow scale demonstrated the highest sensitivity (0.86) and the Norton scale demonstrated the highest specificity (0.75). Individuals with pressure sores were more likely to be care dependent (t-test: P< .01); 27 of them had a CDS score lower than 55. Using the score of 55 as the cut-off point, the CDS demonstrated a sensitivity of 0.74 and a specificity of 0.83. This study demonstrated remarkable differences among the 3 commonly used risk assessment tools, in regards to sensitivity and specificity. Moreover, the CDS seems to have a diagnostic value similar to the 3 commonly used risk assessment calculators.

Using the Care Dependency Scale for fall risk screening

This paper is a report of a study conducted to estimate the sensitivity and specificity of the Care Dependency Scale as a measure of risk of falling for individuals in hospital and nursing home settings. Falls and their consequences are common problems in hospitals and nursing homes and nurses should assess the potential risks of their patients. Items in fall risk scales resemble a general nursing assessment, which leads to redundant assessment procedures. It would be beneficial to have a single generic instrument for general assessment and fall risk screening. Standardized questionnaires were used in a cross-sectional study in 2004 and data were gathered from 9943 German nursing home residents and hospital patients (response rate 77.1%). Sensitivity and specificity of all Care Dependency Scale scores were calculated for fall risk. Relationships between the 15 scale items and falls were described using odds ratios and logistic regression analysis. Patients with falls in hospitals were more care dependent than those without falls. Sensitivity and specificity values showed that with the Care Dependency Scale a differentiation is possible between the falls group and the no-falls group. High odds ratios and logistic regression analysis suggest that the Care Dependency Scale item 'Avoidance of danger' indicated fall risk. Nursing home residents with and without falls had similar care dependency scores. Nursing assessment in hospitals could be simplified by using the Care Dependency Scale for fall risk screening. Its value in fall risk screening in nursing homes requires further testing.

Falls in German in‐patients and residents over 65 years of age

The aim of the present study was to describe the first fall rates in hospitals and nursing homes throughout Germany. Relationships between age, gender, care dependency, medical disciplines, bed confinement and falls were investigated. Little is known about fall rates in German hospitals and nursing homes. Prevalence studies were conducted in the year 2002 and 2004. Forty hospitals and 15 nursing homes took part in 2002 (3923 patients and 1252 residents older than 65 years) and in 2004 there was a total of 39 hospitals and 29 nursing homes (4451 patients and 2374 residents older than 65 years). Staff nurses used a standardized instrument to collect data about falls in the last two weeks in their institutions and also about other patient problems. Descriptive and inferential statistics were used as well as logistic regression. The first fall rate in 2002 (2004) in the hospitals was 4.7 (4.2) and in the nursing homes 4.5 (5.1) per 1000 patient/resident days. Most of the hospital patients fell on geriatric wards. The high care dependent patients fell more often than the low care dependent patients. In 2002, mobile nursing home residents were at a higher risk of falling than residents confined to bed, but those results could not be confirmed in 2004. Conclusions. Falls of patients over 65 years of age are as much of a problem in German hospitals as they are in German nursing homes. Fall preventive methods should be implemented both in nursing homes and hospitals. Care dependency is a stable risk factor for falls in hospital patients.