Elderly Long-term Care Residents Research Articles

Building Medication Profiles in the Elderly: a Qualitative Study Based on Medication Information Literacy in a Long-Term Care Facility.

Long-term care facilities are increasingly challenged with meeting the diverse healthcare needs of the elderly population, particularly concerning medication management. Understanding medication information literacy and behavior among this demographic is imperative. Therefore, this qualitative study aims to explore medication information literacy and develop distinct medication profiles among elderly long-term care residents. In this study, we conducted in-depth semi-structured interviews with 32 participants aged 65 or older residing in a long-term care facility. The interviews were designed to explore participants' understanding of medication information, medication management practices, and experiences with healthcare providers. Thematic analysis was employed to analyze the interview data, allowing for the identification of common patterns and themes related to medication-taking behavior among the elderly residents. The thematic analysis revealed four distinct medication behavior profiles among the elderly long-term care residents: (1) Proactive Health Self-Managers, (2) Medication Information Adherents, (3) Experience-Based Medication Users, and (4) Nonadherent Medication Users. These findings provide valuable insights into the diverse approaches to medication management within long-term care facilities and underscore the importance of tailored interventions to support the specific needs of each profile. This study highlights the necessity for tailored medication education and support to optimize medication management for the elderly. With the aging population expansion, addressing the unique medication challenges within long-term care facilities becomes increasingly critical. This research contributes to ongoing endeavors to enhance healthcare services for the elderly, striving for safer and more effective medication-taking behavior.

Contemporary nutrition-based interventions to reduce risk of infection among elderly long-term care residents: A scoping review.

BackgroundElderly long-term care residents (ELTCRs) face considerable burden of infection, especially evident during the COVID-19 pandemic. The nutritional status of the host can influence susceptibility to infection by altering immune system integrity, therefore, nutrition-based interventions may be a viable complement to existing infection prevention measures.ObjectiveThis scoping review sought to identify nutritional interventions and factors that have the strongest evidence to benefit ELTCRs, and thus best poised for rigorous clinical trial evaluation and subsequent implementation.MethodsA database search of OVID-Medline, OVID-Embase, and Web of Science was performed from 2011 to 2021 to identify nutritional intervention studies which attribute to changes in infection in contemporary ELTCR settings. Articles were screened in duplicate and data extraction completed by a single reviewer, while a second reviewer verified the data which was fitted to identify evidence for nutritional interventions related to reducing rates of infection among ELTCRs.ResultsThe search identified 1018 studies, of which 11 (nine clinical trials and two observational cohort studies) satisfied screening criteria. Interventions that significantly reduced risk of infection included whey protein (any infection), Black Chokeberry (urinary tract infection), and vitamin D (acute respiratory tract infection, skin and soft tissue infection). Both zinc and a dedicated meal-plan significantly improved lymphocyte parameters. Vitamin D deficiency was associated with the development of respiratory tract infections. Probiotic and soy-based protein interventions did not significantly affect risk of infection or lymphocyte parameters, respectively.ConclusionThe current scoping review was effective in identifying the use of nutrition-based interventions for infection prevention among ELTCRs. In this study, some nutrition-based interventions were observed to significantly influence the risk of infection among ELTCRs. Nutritional interventions such as vitamin D (preventing deficiency/insufficiency), Black Chokeberry juice, zinc gluconate, whey protein, and varied and nutrient dense meal plans may be suitable for future rigorous clinical trial evaluation.

Acceptability and tolerability of alcohol-based hand hygiene products for elderly residents in long-term care: a crossover study

BackgroundHand hygiene is a critical component of infection control. Much of the focus on improving hand hygiene in healthcare settings has been directed towards healthcare worker compliance but its importance for patients, including those in long-term care facilities (LTCFs), is increasingly being recognised. Alcohol-based hand rub (ABHR) can lead to improved compliance. We aimed to determine acceptability and tolerability of two ABHRs for hand hygiene of elderly LTCF residents using a modified version of the WHO protocol.MethodsThirty six elderly LTCF residents participated in this crossover study. A modified and translated (Chinese) version of the WHO protocol for evaluation of two or more ABHRs was used to determine product acceptability and tolerability for one gel (bottle with reclosable cap) and one foam (pump). During the 3-day testing period, participants were provided with their own portable bottle of ABHR. A research nurse objectively assessed the skin integrity of the hands at baseline and throughout the study. Skin moisture content was determined using a Scalar Moisture Checker Probe (Science Technology Resources, Ca, USA). Participants rated ABHR tolerability and acceptability using the WHO checklist at the end of each test period.ResultsBoth products passed the WHO criteria for acceptability and tolerability. The foam (86%) scored higher than the gel (51%) for ease of use possibly because some participants found the cap of the gel bottle difficult to open due to finger stiffness. No evidence of damage to skin integrity was observed. Overall, skin moisture content had improved by the end of the study. Residents preferred either of the test products to the liquid formulation currently in use by the LTCF.ConclusionsOverall, the elderly were willing to use ABHR for hand hygiene. Both products were well tolerated and preferred over the usual product provided by the LTCF. However, forgetfulness and difficulty rubbing the product over the hands due to finger stiffness posed a challenge for some residents. This could be overcome by using healthcare worker-assisted hand hygiene at specified times each day and prompts to serve as reminders to perform hand hygiene.

Depressive symptoms and associated factors in elderly long-term care residents.

To determine the prevalence and factors associated with depressive symptoms in institutionalized elderly. This is an epidemiological cross-sectional study with 42 elderly in a Long-Term Care Institution for the Elderly (LTCIE). Data was collected from April to December 2014 through a questionnaire with information on demographic and socioeconomic aspects, the Geriatric Depression Scale short version (GDS-15) and the Mini Mental State Examination (MMSE). Of the elderly studied, 54.8% had depressive symptoms and were predominantly females (64.7%). There was a significant association between depressive symptoms and variables retired (p = 0.043); urinary incontinence (p = 0.028); self-perceived health (p-value = 0.042) and sleep quality (p-value = 0.000). The study found a high prevalence of depressive symptoms in institutionalized elderly, associated with the presence of urinary incontinence, (negative) self-perceived health, (poor) quality of sleep and retirement (yes). Following the study and in the face of the needs of this population, it is necessary to seek measures that act directly on the modifiable variables, preventing and treating them.

Characteristics of Elderly Long-Term Care Residents Who Were Injured and Transferred to Hospital Emergency Departments in Korea: A Retrospective Multicenter Study.

The objective of this retrospective multicenter study was to investigate the mechanism and characteristics of trauma experienced by patients aged ≥65 years who were transferred from a long-term care hospital to one of five university hospital emergency departments. Of 255,543 patients seen in one of the five emergency departments, 79 were transferred from a long-term care hospital because of trauma. The most common trauma mechanism was slipping down, with 33 (58.9%) patients, followed by falling from a bed (17.9%), striking an object such as a wall or corner (10.7%), overextending a joint (8.9%), and unknown mechanisms (3.6%). Many cases of slip (39.4%) occurred in relation to the bathroom. Comparing slip and fall from a bed, we found more hip fractures (95.2%) because of slipping down than falling from a bed (57.1%); traumatic brain injury only occurred in slip cases. These traumas cause significant morbidity in elderly patients; therefore, we sought to identify strategies that prevent slip in long-term care hospitals.

Understanding Administrators’ Perceptions of Recreational Therapy in Long-Term Care

Although research continues to suggest that recreational therapy benefits elderly residents in long-term care (Buettner & Fitzsimmons, 2011; Fitzsimmons, Sardina, & Buettner, 2014; Kolanowski, Fick, Frazer, & Penrod, 2010; Seitz et al., 2012), administrators often remain unfamiliar with the profession and the abilities of the Certified Therapeutic Recreation Specialist (CTRS) (Bedini & White, 2018; Harkins & Bedini, 2013). Through the use of semi-structured interviews, this qualitative study sought New England administrators’ perceptions of recreational therapy in the long-term care (LTC) industry. Thematic analysis of the data indicated three overarching themes: financial support, facility culture, and knowledge of recreational therapy. These three themes are suggested to influence administrators’ decisions to utilize recreational therapy (RT) in their facilities. Recommendations for the profession include administrator education on the benefits of recreational therapy; continuing with evidence-based research to advocate for the Centers for Medicare and Medicaid Services (CMS) coverage; and creating a facility culture through family, resident, and staff education where RT is considered a necessity in LTC. Subscribe to TRJ

Prevalence of Skin Tears in Elderly Patients: A Retrospective Chart Review of Incidence Reports in 6 Long-term Care Facilities

The incidence and prevalence of skin tears in long-term care (LTC) facilities has not been well established. To ascertain the point prevalence of reported skin tears, a retrospective review of incident reports was performed in 6 LTC facilities in western Pennsylvania from November 1, 2016 through December 31, 2016. Report data, including resident age; gender; mobility limitations; skin tear location, number, and cause (if known); occurrence time (7 am to 3 pm, 3 pm to 11 pm, or 11 pm to 7 am nursing shift); and history of previous skin tears, were abstracted. All data were entered into a statistical analysis program and analyzed using descriptive statistics. Period prevalence was used to determine prevalence rate; an independent t test was used to compare the presence of skin tears between genders. Differences between location and cause of skin tears were evaluated using a multinomial test of related proportions. A test of proportions was used to evaluate skin tear occurrence time (nursing shift) differences. The overall point prevalence rate was 9% (N = 1253 residents) ranging from 6 to 28 skin tears per facility. The average age of residents with a skin tear (n = 119) was 83.5 years. The majority (111, 93%) had mobility limitations. Falls accounted for 38 skin tears (31.9%), followed by propelling in a wheelchair (18, 15.1%; X2 =7.14; P = .008). Forearm skin tears (37, 31.1%) occurred significantly more frequently than lower leg skin tears (19, 16%; P = .016). Significantly more skin tears occurred during the 7 am to 3 pm shift (47, 39.5%) and 3 pm to 11 pm shift (49, 41.2%) than during the 11 pm to 7 am shift (23, 19.3%; X2 = 5.78; P <.01). The results of this study confirm skin tears are a significant problem among elderly residents in LTC, especially because the reported rate is likely lower than the actual rate. Research to further elucidate the incidence and prevalence of skin tears and associated risk factors is needed to help develop evidence-based risk assessment, classification systems, treatment guidelines, and preventive measures.

Serum C-Reactive Protein and Congestive Heart Failure as Significant Predictors of Herpes Zoster Vaccine Response in Elderly Nursing Home Residents.

Elderly long-term care residents often exhibit a myriad of risk factors for immune dysfunction, including chronic inflammation and multiple comorbid conditions, which undoubtedly contribute to their enhanced susceptibility to infection. Hence, understanding the factors required for optimal vaccine responsiveness is critical. We examined 187 elderly nursing home residents (aged 80-102 years) and 50 community-dwelling seniors (aged 60-75 years) immunized with the live-attenuated varicella-zoster virus (VZV) vaccine. Specifically, we examined whether vaccine responsiveness was associated with serum C-reactive protein (CRP), tumor necrosis factor, interleukin 1β, 6, and 10, leukocyte telomere length, chronic disease status, and frailty. Elderly participants had significantly higher levels of CRP, tumor necrosis factor, and interleukin 6 and shorter leukocyte telomere length. Vaccine responsiveness was inversely related to the CRP level in elderly participants, but not seniors, and those with congestive heart failure were less likely to achieve a 2-fold response (odds ratio, 0.08). The latter relationship is probably due to immunosenescence, because heart failure was associated with increased senescent CD4+ T cells, and reduced naive and effector and central memory CD8+ T cells. In summary, these data improve our understanding of vaccine responsiveness for those in long-term care, suggesting that certain risk factors are associated with a greater likelihood of vaccine failure.

Care of the older person

In this series, commentaries in evidence-based nursing from the past 2 years from a specific nursing theme are brought together and highlights are discussed. The topic for this edition is...

The gap between indicated and prescribed stroke prevention therapies in a high-risk geriatric population.

The use of oral anticoagulation (OAC) in the elderly population with atrial fibrillation (AF) treated in long-term care (LTC) facilities is inconsistent. We examined the magnitude and sources of the gap between indicated and prescribed OAC in the elderly population with AF. We retrospectively scanned the electronic medical record (EMR) and pharmacy data of 25 LTC facilities in Ontario, Canada. The diagnosis of AF was drawn from EMR. Different attributable risk factors for possible failure to prescribe OAC were examined. In total, 3378 active resident data were examined in the 25 LTC facilities. All the residents were ≥65years old with mean age of 85 ± 8years and 2449 (72%) were female. We identified 433 (13%) residents with AF with mean age 87 ± 7years and mean CHADS2 score of 3 ± 1. Out of all residents with AF, 273 (63%) were on OAC therapy. Residents were mostly treated with warfarin (N = 114 (42%)), rivaroxaban (N = 71 (26%)) or apixaban (N = 62 (23%)) followed by dabigatran (N = 26 (10%)). Antiplatelet drugs as the only stroke prevention therapy were used in 88 (20%) residents, and 28 (6%) residents were on anticoagulation and antiplatelet drugs. Seventy-two (17%) residents were not on any antiplatelet or antithrombotic therapy. None of the potential attributable risks identified consistently correlated with the failure to prescribe indicated therapy. This data set suggests that 37% of eligible elderly LTC residents failed to receive recommended stroke prevention therapies.

Fulfilled preferences, perceived control, life satisfaction, and loneliness in elderly long-term care residents

ABSTRACTObjectives: Person-centered care constructs such as fulfilled preferences, sense of control, and life satisfaction might contribute to loneliness among nursing home residents, but these relationships have not been thoroughly explored. The aim of this study was to examine the relationship between fulfilled preferences and loneliness in nursing home residents with perceived control and life satisfaction as potential mediators.Methods: The study utilized a cross-sectional design, examining the targeted variables with a questionnaire administered by trained research staff. A convenience sample of 65 residents (median age = 71) of eight nursing homes were interviewed. Linear regression analysis was utilized to examine the mediation hypotheses.Results: The relationships between fulfilled preferences and loneliness (β = −.377, p = .002), fulfilled preferences and perceived control (β = −.577, p < .001), and perceived control and loneliness (β = .606, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = −.040, p = .744) became non-significant when perceived control was included in the model. The relationships between fulfilled preferences and life satisfaction (β = .420, p < .001) and life satisfaction and loneliness (β = −.598, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = −.152, p = .174) became non-significant when life satisfaction was included in the model.Conclusion: The findings suggest an important association between person-centered care, particularly fulfilling personal care and recreation preferences, and social-affective needs of long-term care residents. Fulfilling preferences may be an appropriate intervention target for loneliness.

Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004-2013.

Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities. We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (≥65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and sedative antidepressants, anti-epileptics, and benzodiazepines. We used time-series analysis to assess trends over time. The study sample increased by 21% over the 10-year study period, from 49,251 patients to 59,785 patients. The majority of patients (within the range of 75%-79%) were dispensed at least one psychotropic medication. At the beginning of the study period atypical antipsychotics (38%) were the most frequently dispensed psychotropic, followed by benzodiazepines (28%), non-sedative antidepressants (27%), sedative antidepressants (17%), anti-epileptics (7%), and conventional antipsychotics (3%). Dispensing of anti-epileptics (2% increase) and conventional antipsychotics (1% decrease) displayed modest changes over time, but we observed more pronounced changes in dispensing of benzodiazepines (11% decrease) and atypical antipsychotics (4% decrease). Concurrently, we observed a substantial growth in the dispensing of both sedative (15% increase) and non-sedative (9% increase) antidepressants. The proportion of patients dispensed two or more psychotropic drug classes increased from 42% in 2004 to 50% in 2013. Utilization patterns of psychotropic drugs in institutionalized patients with dementia have changed over the past decade. Although their use declined slightly over the study period, atypical antipsychotics continue to be used at a high rate. A decline in the use of benzodiazepines along with an increased use of sedative and non-sedative antidepressants suggests that the latter class of drugs is being substituted for the former in the management of neuropsychiatric symptoms. Psychotropic polypharmacy continues to be highly prevalent in these patient samples.

The burden of overweight and obesity on long-term care and Medicaid financing.

The obesity rate among the elderly long-term care (LTC) residents in the United States is increasing rapidly. However, there is a paucity of research investigating the burden of obesity on LTC and Medicaid financing. The purpose of this study is to fill the knowledge gap by estimating the burden of overweight and obesity on LTC and Medicaid financing. Using nationally representative Cost and Use Files of Medicare Current Beneficiary Survey from 1997 to 2005, we used 2-part model and cohort-based simulation to evaluate the effect of overweight and obesity on LTC days and Medicaid expenditures across the lifespan among the current elderly population. Combining the per capita estimates with 2010 census, we project future aggregate burden of obesity on LTC demand and Medicaid cost among baby boomers. Obesity and related chronic diseases lead to higher probability to enter LTC facility in a younger age, more LTC days before death, and higher lifetime LTC cost reimbursed by Medicaid. However, such effect is only statistically significant among women, not significant among men. At the population level, we project that overweight and obesity will induce 1.3 billion or more LTC patient days and $68 billion or more Medicaid costs (in 2012 value) among baby boomers. Overweight and obesity among the elderly will bring tremendous burden to LTC providers and Medicaid. Policy makers should keep the burden of obesity on LTC in mind when planning LTC and Medicaid policy reform.

Manage catheter-related urinary tract infection in the elderly in long-term care by limiting catheter use and avoiding the inappropriate use of antimicrobials

Elderly residents of long-term care facilities often require chronic indwelling catheterization for the management of urinary voiding. As a result of urethral catheterization, residents are bacteriuric, primarily due to biofilm formation along the catheter, and may develop symptomatic urinary tract infection (UTI). To avoid the development of resistance, UTI should be treated with short courses of appropriate antimicrobials. Strategies, including avoiding the use of catheters whenever possible, should be followed to prevent and manage catheter-related UTI in elderly long-term care residents.

PC-FACS

PC-FACS

The eye of the beholder: tuberculosis screening for elderly long-term care residents [Editorial

The eye of the beholder: tuberculosis screening for elderly long-term care residents [Editorial

Pain Management and Assessment Using MDS 3.0

Pain management of elderly residents in long-term care (LTC) facilities presents clinical challenges. The Minimum Data Set (MDS) details the process. The purpose of this research was to evaluate pain management and assessment in the LTC setting using the MDS.

Narcotic Use in Long-term Care

Introduction/Objective: Pain is a common problem, which has a significant functional and quality of life impact on nursing home residents. The prevalence of substantial pain is thought to be as high as 80% among nursing home residents. Several causes of pain have been identified the most common being arthritis, others include cancer, low back pain, crystal induced arthropathies, and leg cramps. Multiple studies found that pain is both under recognized and under treated in nursing homes. The multiple medical problems as well as cognitive impairment and communication difficulties represent some of the difficulties in assessing and treating pain in these individuals. Pain in elderly long-term care residents has many well-documented consequences. Some of these consequences include depression, anxiety, decreased socialization, sleep disturbance, impaired ambulation, and increased health care utilization. Other conditions that may be worsened by pain are gait disturbances, slow rehabilitation, and adverse effects from multiple drug prescriptions. The most widely used management strategy is administration of analgesic medications. Non-opioid analgesics carry a high incidence of adverse effects in the elderly the most prominent being gastrointestinal bleeding from long-term use of NSAIDs. Opioids have been widely studied for persistent pain with proved efficacy. Older people constitute a heterogeneous population, making optimum dosage and common side effects difficult to predict. Some of the common adverse effects include constipation, nausea and vomiting, sedation, impaired judgment, impaired psychomotor function, and respiratory depression. Lower starting doses, longer dose intervals, and slow titration are used to limit these effects. A careful review of indication, comorbid conditions, degree of benefit and potential side effects is needed at the time of opioid prescription. Once a prescription is in place, a regular review of appropriate dosing, drug substitution and discontinuation is needed. A clear documentation of indication and review are often lacking in clinical practice. If this is truly the case then a policy of careful titration to effect and initially frequent review would seem sensible. The objective of this study is to establish the prevalence of opioid use and the associated documentation of indications and in a long-term facility.

Evidence remains lacking that vaccinating healthcare workers prevents influenza in elderly residents in long-term care

Evidence remains lacking that vaccinating healthcare workers prevents influenza in elderly residents in long-term care

A 5‐year follow‐up of older adults residing in long‐term care facilities: utilisation of a comprehensive dental programme

This study will compare the clinical outcomes of 139 elders residing in long-term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years. Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care. A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition. Eighty-three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70-73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56-72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, chi(2) = 7.9, df = 2). Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.