Elderly Nursing Home Research Articles

Correction: Prevalence and associated factors of skin cancer in aged nursing home residents: A multicenter prevalence study

[This corrects the article DOI: 10.1371/journal.pone.0215379.].

Impact of Salt Substitute and Stepwise Reduction of Salt Supply on Blood Pressure in the Elderly in Nursing Homes (DECIDE-Salt Trial): Protocol and Baseline Characteristics (P13-022-19)

ObjectivesThe aim of this study is to evaluate efficacy, safety, and cost-effectiveness of two sodium reduction strategies, salt substitution and stepwise reduction of salt supply, separately or in combination, on blood pressure (BP) in the elderly in nursing homes in northern China. MethodsThe study is a cluster randomized controlled trial with a two-by-two factorial design conducted in four areas from three northern Chinese provinces. Within each area, nursing homes were randomly assigned (1:1:1:1) to four groups: (1) both replacing normal salt with salt substitute (SS) and training the nursing home manager to reduce 5–10% of salt supply every 3 months (stepwise reduction of salt supply, SRSS), (2) SS only (no SRSS), (3) SRSS only (no SS), or (4) neither SS nor SRSS (control). With a sample size of 1080, 270 in each group, the study would have 80% power to detect a net reduction of 3.0 mmHg in systolic BP, assuming that the standard deviation is 18 mmHg, α = 0.05, intraclass correlation coefficient = 0.02, number of clusters = 36, and participants loss to follow up = 20%. The study began in late 2017 and the interventions will last for two years. The primary outcome will be the changes in mean systolic BP from baseline to 24 months, analyzed by a generalized estimating equations extension of the linear regression model to account for cluster effect. The secondary outcomes will include changes in diastolic BP, incidence of hypertension, 24-hour urinary sodium and potassium excretions, all-cause mortality and incidence of hyperkalemia. Economic evaluations will be conducted as well. ResultsA total of 48 nursing homes were recruited in the study. The baseline examination has been completed. A total of 1598 study participants aged 55 to 102 years old were enrolled. The demographical characteristics of the study population, including baseline systolic and diastolic BP, are shown in Table 1. ConclusionsThe study is well powered to evaluate the effect of the three study interventions in lowering systolic BP in the elderly. It is expected to provide solid evidence for policy development regarding sodium reduction strategies in prevention and control of hypertension and its related diseases in the elderly. Funding SourcesThe study is supported by National Key R&D Program of China. Supporting Tables, Images and/or Graphs▪

Variation of human norovirus GII genotypes detected in Ibaraki, Japan, during 2012\u20132018

BackgroundHuman norovirus (HuNoV) is the major cause of viral acute gastroenteritis for all age groups in various countries. HuNoV GII in particular accounted for the majority of norovirus outbreaks, among which GII.4 caused repeated outbreaks for a long time. Besides GII.4, other norovirus genotypes, GII.2, GII.6, and GII.17, have also been prevalent in various contexts in recent years, but few detailed epidemiological studies of them have been performed and are poorly understood. We thus conducted an epidemiological analysis of HuNoV GII in Ibaraki Prefecture, Japan, by performing surveillance in the six seasons from September 2012 to August 2018.ResultsHuNoV GI occurred almost sporadically for all genotypes; however, each genotype of GII exhibited its typical epidemiological characteristics. Although the number of outbreaks of GII.4 decreased season by season, it reemerged in 2017/2018 season. The timing of the epidemic peak in terms of number of cases for GII.17 differed from that for the other genotypes. The patients age with GII.2 and GII.6 were younger and outbreak of GII.17 occurred frequently as food poisoning. Namely, the primarily infected outbreak group differed for each genotype of HuNoV GII. Moreover, the viral load of patients differed according to the genotype.ConclusionsVarious HuNoV genotypes including GII.2, GII.4, GII.6, and GII.17 were shown to be associated with various types of outbreak sites (at childcare and educational facilities, involving cases of food poisoning, and at elderly nursing homes) in this study. These genotypes emerged in recent years, and their prevalence patterns differed from each other. Moreover, differences in outbreak sites and viral load of patients among the genotypes were identified.

Alzheimer's Disease Microbiome Is Associated with Dysregulation of the Anti-Inflammatory P-Glycoprotein Pathway.

The microbiota-gut-brain axis is a bidirectional communication system that is poorly understood. Alzheimer's disease (AD), the most common cause of dementia, has long been associated with bacterial infections and inflammation-causing immunosenescence. Recent studies examining the intestinal microbiota of AD patients revealed that their microbiome differs from that of subjects without dementia. In this work, we prospectively enrolled 108 nursing home elders and followed each for up to 5 months, collecting longitudinal stool samples from which we performed metagenomic sequencing and in vitro T84 intestinal epithelial cell functional assays for P-glycoprotein (P-gp) expression, a critical mediator of intestinal homeostasis. Our analysis identified clinical parameters as well as numerous microbial taxa and functional genes that act as predictors of AD dementia in comparison to elders without dementia or with other dementia types. We further demonstrate that stool samples from elders with AD can induce lower P-gp expression levels in vitro those samples from elders without dementia or with other dementia types. We also paired functional studies with machine learning approaches to identify bacterial species differentiating the microbiome of AD elders from that of elders without dementia, which in turn are accurate predictors of the loss of dysregulation of the P-gp pathway. We observed that the microbiome of AD elders shows a lower proportion and prevalence of bacteria with the potential to synthesize butyrate, as well as higher abundances of taxa that are known to cause proinflammatory states. Therefore, a potential nexus between the intestinal microbiome and AD is the modulation of intestinal homeostasis by increases in inflammatory, and decreases in anti-inflammatory, microbial metabolism.IMPORTANCE Studies of the intestinal microbiome and AD have demonstrated associations with microbiome composition at the genus level among matched cohorts. We move this body of literature forward by more deeply investigating microbiome composition via metagenomics and by comparing AD patients against those without dementia and with other dementia types. We also exploit machine learning approaches that combine both metagenomic and clinical data. Finally, our functional studies using stool samples from elders demonstrate how the c microbiome of AD elders can affect intestinal health via dysregulation of the P-glycoprotein pathway. P-glycoprotein dysregulation contributes directly to inflammatory disorders of the intestine. Since AD has been long thought to be linked to chronic bacterial infections as a possible etiology, our findings therefore fill a gap in knowledge in the field of AD research by identifying a nexus between the microbiome, loss of intestinal homeostasis, and inflammation that may underlie this neurodegenerative disorder.

Prevalence and associated factors of skin cancer in aged nursing home residents: A multicenter prevalence study.

Non-melanoma-skin cancer is an emerging clinical problem in the elderly, fair skinned population which predominantly affects patients aged older than 70 years. Its steady increase in incidence rates and morbidity is paralleled by related medical costs. Despite the fact that many elderly patients are in need of care and are living in nursing homes, specific data on the prevalence of skin cancer in home care and the institutional long-term care setting is currently lacking. A representative multicenter prevalence study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n = 223 residents were included. Actinic keratoses, the precursor lesions of invasive cutaneous squamous cell carcinoma were the most common epithelial skin lesions (21.1%, 95% CI 16.2 to 26.9). Non-melanoma skin cancer was diagnosed in 16 residents (7.2%, 95% CI 4.5 to 11.3). None of the residents had a malignant melanoma. Only few bivariate associations were detected between non-melanoma skin cancer and demographic, biographic and functional characteristics. Male sex was significantly associated with actinic keratosis whereas female sex was associated with non-melanoma skin cancer. Smoking was associated with an increased occurrence of non-melanoma skin cancer. Regular dermatology check-ups in nursing homes would be needed but already now due to financial limitations, lack of time in daily clinical practice and limited number of practising dermatologists, it is not the current standard. With respect to the worldwide growing aging population new programs and decisions are required. Overall, primary health care professionals should play a more active role in early diagnosis of skin cancer in nursing home residents. Dermoscopy courses, web-based or smartphone-based applications and teledermatology may support health care professionals to provide elderly nursing home residents an early diagnosis of skin cancer.

Prevalence and associated factors of intertrigo in aged nursing home residents: a multi-center cross-sectional prevalence study

BackgroundIn geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics.MethodsA cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated.ResultsThe prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo.ConclusionsEvery sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population.Trial registrationThis study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526. Registration date: 8th November 2014.

Cross-cultural adaptation and validation of the Groningen Frailty Indicator in Chinese nursing home residents.

Frail older people are more likely to develop negative health outcomes. Previous studies have indicated that the Groningen Frailty Indicator is a practical frailty screening instrument with good psychometric properties; however, it has never been implemented in Chinese nursing homes. To cross-culturally adapt and validate the Groningen Frailty Indicator in Chinese nursing home residents. The participants were 192 residents from nursing homes. Reliability was analyzed by internal consistency and test-retest methods. Convergent validity was assessed using Spearman rank correlations between the GFI domains and activities of daily living, the mini nutritional assessment, the Mini-mental state examination, the Social Support Rating Scale, the 20-item Epidemiologic Studies Depression Scale and the Short Form 36 mental component summary. Criterion validity was investigated by performing a receiver operating characteristics curve analysis. The Chinese GFI achieved semantic, idiomatic, and experiential equivalence. It had a high response rate among nursing home elders. It also showed good internal consistency (ICC = 0.712) and excellent test-retest reliability. Regarding construct validity, it presented good known-group divergent validity based on age. The correlations between the GFI domains and their corresponding measures were consistent as hypothesized, demonstrating convergent validity of the GFI. Using the Fried frailty phenotypes as reference criteria, the Chinese GFI showed satisfactory diagnostic accuracy for frailty (AUC = 0.823) and prefrailty (AUC = 0.791). The optimal cutoff point was 4 for frailty and 3 for prefrailty. The GFI was successfully adapted for Chinese nursing home residents and presented acceptable validity and reliability.

Effects of nutrition status on activities of daily living among nursing home residents: the mediating role of physical function

Objective To explore the relationship between nutrition status and activity of daily livingof elders in nursing homes and the mediating effect of physical activity. Methods From Apr to Sep in 2016, 320 elders in nursing homes were selected and were surveyed using the standardized tools. The mediating effects were analyzed with PROCESS. Results The scores of elders′ nutrition status, physical function and activities of daily living were (11.88±2.27), (3.61±3.51), (79.13±26.00) points, respectively. And there were 66.9% elders suffering from activities of living life impaired. The nutrition status were significantly positive correlated with physical function and activities of daily living of elders, and the physical function were significantly positive correlated with activities of daily living of elders. The physical function partly mediated the association between nutrition status and activities of daily living, and the effect was reached to 39.1%. Conclusions The elders′activities of daily life was poor in nursing home in China. The physical function partly mediated the association between nutrition status and activities of daily living. The related departments could combine the long time and short time plans targeting at improving of nutrition status and physical function respectively, to enhance the outcomes of elders in nursing homes. Key words: Nursing home; Elders; Nutrition status; Physical function; Activities of daily living

Prevalence of cancer and management in elderly nursing home residents. A descriptive study in 45 French nursing homes.

This study aimed to determine cancer prevalence occurring after the age of 75 in 45 French nursing homes (NH), as well as residents' characteristics and parameters associated with cancer-specific management. Descriptive retrospective study including 214 residents (mean age, 89.7years) with cancer diagnosed after age 75. The studied parameters were sociodemographic, functional, nutritional and cognitive data; comorbidity assessment; date of tumoral diagnosis; cancer type; tumoral stage; treatment plan; multidisciplinary staff decision and oncologic follow-up. Our results showed that cancer prevalence in NH was 8.4±1.1%, diagnosed before admission in 63% of cases. The most common tumoral sites were skin (26%), digestive tract and breast (18% for both); 12% had metastasis. Cognitive impairment was the most common comorbidity (42%), and 44% of the residents were highly dependent. Multivariate analysis showed that therapeutic decisions were associated with age. Older patients had less staging exploration (odd ratios [ORs], 0.90, 95% confidence interval [CI], 0.85-0.97) and underwent less cancer-specific treatment (ORs, 0.92; 95%CI, 0.86-0.99). Oncologic follow-up was more frequent in younger patients (ORs, 0.90; 95%CI, 0.81-0.99) and those with recent diagnosis (ORs, 0.37; 95%CI, 0.23-0.61). This study identified factors associated with substandard neoplastic management in elderly NH residents. It highlights needs for information, education and training in cancer detection to improve cancer consideration and care in NH.

Factors influencing the quality of life among Indonesian elderly

Purpose In spite of being a significant public health concern, quality of life (QoL) amongst elderly in nursing home (NH) settings is rarely analyzed. The purpose of this paper is to examine the level of QoL and factors influencing QoL amongst elderly NH residents in Indonesia. Design/methodology/approach A survey was conducted amongst 181 elderly at three NHs in three districts in Yogyakarta province, Indonesia. Purposive sampling was used for the study site and sample collection. Face-to-face interviews were performed using the WHO Quality of Life BREF Indonesian version questionnaire to assess elderly QoL. Multivariate linear regression was performed to determine the factors influencing the QoL amongst elderly NH residents. Findings The response rate was 66.3 percent. A total of 64.1 percent of elderly had a fair level of QoL, whereas 16.6 percent still had a poor level of QoL. A total of 86.7 percent of elderly lived in an NH due to compulsion, and more than half (53.6 percent) perceived inadequacy of care. The QoL was significantly low amongst those who live in NHs due to compulsion, no social support resources, not receiving any kind of support, having three chronic diseases and perceived inadequacy of care (p<0.05). Multivariate analysis revealed that perceived adequacy of care reasons for living in NH was associated with QoL (p<0.001). Originality/value Perceived adequacy of care and reason for living in an NH were highlighted as predictors of QoL amongst elderly NH residents. Improving adequate healthcare services and developing treatment strategies to enforce the adaptation process is required in order to maintain the QoL in elderly NH residents.

Unexplained absence resulting in deaths of nursing home residents in Australia-A 13-year retrospective study.

To examine deaths of Australian nursing home (NH) residents following an unexplained absence. Population based cross-sectional study was conducted using coronial data from the National Coronial Information System. Participants are residents of accredited NHs if death followed an unexplained absence and was reported to the Coroner between July 1, 2000 and June 30, 2013. Individual, organisational, environmental, and unexplained absence event factors were extracted from coronial records. Data were analysed using descriptive statistics. Of 21672 NH deaths, 24 (0.1%) followed an unexplained absence. This comprised 17 unintentional external (injury-related) causes and 7 natural cause deaths. Drowning was the most frequent external cause of death (59%, n=10). Deaths occurred more frequently in males (83.3%, n=20), and in the age group 85-94years (37.5%, n=9). The majority of NH residents, for whom data were available (n=15), had a diagnosis of dementia (86.7%, n=13). Most residents were found in waterways (41.7%, n=10). Median distance travelled was 0.5km (IQR: 0.25-2.4km), with almost 70% of residents found within 1.0km of their NH. Most residents left the NH by foot (88.2%, n=15). Half of the residents were found within 6hours of time last seen (median: 6hours, 40minutes; IQR: 6.0-11.45hours). Unexplained absences in elderly NH residents are a relatively common event. This study provides valuable information for aged care providers, governments, and search and rescue teams, and should contribute to debates about balancing issues of safety with independence.

Prevalence and risk factors of depression among Indonesian elderly: A nursing home-based cross-sectional study

BackgroundThe burden of depressive elderly is high globally. However, nursing home-based studies on prevalence and risk factors of depression are scarce due to feasibility and difficulties in data collection. MethodsThis cross sectional study was conducted at three nursing homes (NHs) in three districts in Yogyakarta province, Indonesia. A total of 181 elderly NH residents aged ≥60 were recruited purposively. Information regarding socio-demographics, health-related characteristics and social support among respondents were collected by a modified questionnaire through face-to-face interviews. A short form Geriatric Depression Scale (GDS) Indonesian version was employed to assess levels of depression. Multivariate logistic regression was used to analyze the data. ResultsOverall, the prevalence of geriatric depression was assessed to be at 42.5% (31.5% in women and 11% in men). Risk factors that were found to be significantly associated with depression in the univariate analysis were female, none or lack of social support, had ≥3 chronic diseases, and perceived inadequacy of care. In the multivariate analysis, perceived inadequacy of care remained significant risk factor for depression amongst the elderly NH residents. LimitationsBesides a number of important variables were determined by self-report, the used sampling technique was purposive. In addition, the elderly who had severe cognitive impairment or dementia and were not able to communicate meaningfully were excluded from this study. ConclusionsThe prevalence rates of depression were relatively high among elderly NH residents in our study area. Adequate health services are needed in order to reduce the risk of depression among elderly NH residents.

The effect of religious intervention on depressive symptoms and quality of life among Indonesian elderly in nursing homes: A quasi-experimental study.

PurposeThis study aimed to investigate the effect of religious intervention on depressive symptoms and quality of life (QOL) among Indonesian elderly in nursing homes (NHs).Patients and methodsThis was a quasi-experimental study with repeated measures. Sixty elderly residents at three NHs in three districts in Yogyakarta, Indonesia, with the Geriatric Depression Scale (GDS) score of 5–11 were recruited and purposively assigned to the religious intervention group (combining 36 sessions of listening to Qur’anic recital and 3 sessions of attending a sermon by a preacher, n=30) and the control group (treatment as usual/TAU, n=30). The primary outcome was depression, measured by a short form GDS questionnaire. The QOL as the secondary outcome was assessed by the World Health Organization Quality of Life (WHOQOL)-BREF Indonesian version. Both groups were evaluated at the baseline, 4th, 8th, and 12th week after the interventions were performed.ResultsIn both groups, there were statistically significant reductions in depression scores after the 12-week intervention (P<0.001). There was also a statistically significant improvement in QOL mean scores in both intervention and control groups at the 12-week post-intervention. However, the religious intervention group showed a greater decrease in depressive symptoms and a greater improvement in the QOL mean scores than those in the control group. There was a statistically significant difference in geriatric depression and QOL mean scores between groups at the 4th, 8th, and 12th week post-interventions.ConclusionsIt can be concluded that religious-based intervention has a greater impact on relieving depressive symptoms and increasing the QOL amongst elderly NH residents.

Evaluation of emotional abuse perceived by the elderly living in nursing homes

Introduction: In recent years, a significant increase in elderly population, modernization, industrial improvements, and greater involvement of women in the workforce have led to an increase in elder abuse. Elder abuse and frequent emotional abuse of the elderly have significant negative effects on their health and well-being. This study was conducted to evaluate the level of emotional abuse perceived by the elderly living in nursing homes. Materials and Methods: This cross-sectional and descriptive study was carried out between June 15 and July 15, 2017, at the Nursing Home Elderly Care and Rehabilitation Center in Adana, Turkey. The study sample consisted of a total of 118 elderly individuals who were selected using a simple random sampling method. Research data were collected using a personal information form and the perceived emotional abuse scale for adults (PEASA). The study results were evaluated using the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program. The statistical significance level was set at P 0.05). Conclusion: The study results showed that the mean PEASA score of elderly individuals living in nursing homes was slightly above the scale mean score in general, and these individual perceived moderate emotional abuse.

Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: a multi-center prevalence and correlational study

BackgroundGeriatric patients are affected by a range of skin conditions and dermatological diseases, functional limitations and chronic diseases. Skin problems are highly prevalent in elderly populations. Aim of this study was to investigate possible associations between health, functional and cutaneous variables in aged long-term care residents.MethodsThis observational, cross-sectional, descriptive prevalence study was conducted in a random sample of 10 institutional long-term care facilities in Berlin. In total, n = 223 residents were included. Demographic and functional characteristics, xerosis cutis, incontinence associated dermatitis, pressure ulcers and skin tears were assessed. Stratum corneum hydration, transepidermal water loss, skin surface pH and skin temperature were measured. Data analysis was descriptive and explorative. To explore possible bivariate associations, a correlation matrix was created. The correlation matrix was also used to detect possible collinearity in the subsequent regression analyses.ResultsMean age (n = 223) was 83.6 years, 67.7% were female. Most residents were affected by xerosis cutis (99.1%; 95% CI: 97.7% - 100.0%). The prevalence of pressure ulcers was 9.0% (95% CI: 5.0% - 13.0%), of incontinence associated dermatitis 35.4% (95% CI: 29.9% - 42.2%) and of skin tears 6.3% (95% CI: 3.2% - 9.5%). Biophysical skin parameters were not associated with overall care dependency, but with age and skin dryness. In general, skin dryness and measured skin barrier parameters were associated between arms and legs indicating similar overall skin characteristics of the residents.ConclusionPrevalence of xerosis cutis, pressure ulcers and skin tears were high, indicating the load of these adverse skin conditions in this population. Only few associations of demographic characteristics, skin barrier impairments and the occurrence of dry skin, pressure ulcers, skin tears and incontinence-associated dermatitis have been detected, that might limit the diagnostic value of skin barrier parameters in this population. Overall, the measured skin barrier parameters seem to have limited diagnostic value for the reported skin conditions except xerosis cutis.Trial registrationThis study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526. Registration date: 8th November 2014.

Prevalence and associated factors of skin diseases in aged nursing home residents: a multicentre prevalence study

ObjectivesThe aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics.DesignDescriptive multicentre prevalence...

Effect of wearing fingers rings on the behavioral and psychological symptoms of dementia: An exploratory study.

Objective:This study was conducted to examine the effects of an approach that wears finger rings on elderly females with behavioral and psychological symptoms of dementia.Method:The subjects were seven Japanese dementia patients living in elderly nursing homes. A single-case experimental design was adopted for the study. Each study subject was asked to put rings on her finger (from 9:00 to 19:00) for 7 days. The Neuropsychiatric Inventory, scenes of behavioral and psychological symptoms of dementia, interest in wearing rings, self-awareness, and overall profile were determined to assess the effect on the patients of wearing rings.Results:The majority of nursing care providers stated, based on their assessment, that the “irritability/lability” that was noted during the baseline period disappeared during the ring-wearing intervention period in the three patients who displayed an interest in rings. In the assessment of the self-awareness ability, these three women were aware themselves of their intellect collapsing and were capable of conjecturing their own and others’ minds. It was commonly seen that the nursing staff, even though they had not been asked to do so by the researchers, told the patients, “Mrs. XX, you look so beautiful” when they found a patient wearing rings.Discussion/conclusion:Individuals with low self-esteem are inclined to get angry and display aggression. In subjects with low self-esteem, anger and aggression readily arise when they are slighted by others. Self-esteem is low in those women who are aware of their own status of collapsing intellect. It is concluded that the words of conjuration, “you look so beautiful,” which the wearing of the ring per se by the patient elicited from the caregivers heightened the self-esteem and alleviated “irritability/lability” in the study subjects.

Association of Demographic and Some Age Related With Nutritional Status in Elderly in Nursing Home in Semnan

Nutritional Status and its Related Factors in Older People Residing in Nursing Homes in Semnan Province, Iran, 2017

Gender differences in positive life orientation among the nursing home elders in China: A cross-sectional study

IntroductionLife orientation among the nursing home elders would differ from those of community-dwelling elders due to the different living environment, but may have greater differences in gender. ObjectivesThis study was designed to investigate the positive life orientation and explore the potential risk factors including gender disparities among nursing home elders in China. MethodsThis cross-sectional study was conducted in Northeast China. Two steps cluster sampling procedure were chosen. Basic activities of daily living (BADL) and instrumental activities of daily living (IADL) systems were used to estimate the functional status. Positive life orientation was measured using the six-question life orientation scale (LOS). Results2512 nursing home elders were enrolled in the study. The mean age of the participants was 73.14±6.746years. Of the 1308 men and 1204 women, 14.9% had a positive life orientation in women and 16.1% in men. Higher level of education, independent in BADL and IADL were related to positive life orientation both in men and women. Age and BMI were also found to be significantly associated with positive life orientation in men (OR=0.587, 1.132, respectively). For women, the influence of income and vision on positive life orientation was also significant (OR=1.967, 1.926, respectively). ConclusionThe positive life orientation was higher in men than women. The gender-specific differences contribute to take more effective measures to improve the positive life orientation.

The effectiveness of standardized skin care regimens on skin dryness in nursing home residents: A randomized controlled parallel-group pragmatic trial

BackgroundAged residents of institutional long-term care facilities are at high risk for developing skin and tissue diseases. Besides various common skin problems, dry skin (xerosis cutis) is one of the most frequent skin conditions in this setting. ObjectivesTo investigate the effectiveness of two structured skin care regimens in comparison to routine skin care on xerosis cutis in nursing home residents. DesignA multi-center, pragmatic, randomized, controlled, investigator blinded study with three parallel groups. SettingsThe study was conducted in a random sample of ten out of 291 institutional long-term care facilities of the federal state of Berlin, Germany. ParticipantsLong-term care residents being 65+ years affected by dry skin were included. MethodsThe residents were allocated into one of three study groups. Two interventional groups used standardized skin care regimens, consisting of a body wash and twice daily applications of leave-on products for eight weeks. The third control group performed skin care as usual. All participating residents were examined at baseline and after 4 and 8 weeks. Xerosis cutis was measured with the Overall Dry Skin score. Instrumental skin barrier measurements were performed at baseline and after 8 weeks. Diaries were used to document washing and skin care frequencies. ResultsIn total, 133 residents were included and allocated to one of the three groups. Mean age was 83.8 (SD 8.3) years, 65.4% were female and most residents had care levels I (42.9%) or II (42.9%) according to the German Social Code Book XI. Mean Barthel score was 46.8 (SD 24.2) and mean Braden score was 17.6 (SD 3.7). Leg skin areas were drier compared to arms and trunk areas. At the end of the study the Overall Dry Skin scores in the intervention groups were lower compared to the control group. There were statistically significant improvements of skin dryness in both intervention groups compared to the control group over time. ConclusionsThe results of this pragmatic trial indicate that structured skin care regimens are effective in reducing skin dryness in aged nursing home residents within eight weeks. Trial registrationThe study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.