Elderly Nursing Home Research Articles

Pharmacokinetics and Saturable Absorption of Gabapentin in Nursing Home Elderly Patients.

Pharmacokinetic data of gabapentin (GBP) in community-dwelling elderly patients show a significant effect of advanced age on GBP pharmacokinetics due to altered renal function. However, there are no data in elderly nursing home (NH) patients to evaluate gabapentin absorption and elimination. Our objective was to characterize the pharmacokinetics of GBP in elderly nursing home patients maintained on GBP therapy. This was a prospective pharmacokinetic study in elderly nursing home patients (≥60years) receiving GBP for the management of chronic pain or epilepsy from seven nursing homes. Pharmacokinetic parameters were estimated by nonlinear mixed-effects modeling. A one-compartment model described the data and clearance (CL) was associated with estimated glomerular filtration rate (eGFR) (p < 0.0001). The GBP CL in elderly nursing home patients was 2.93L/h. After adjusting for the effect of GFR, GBP CL was not affected by age, sex, body weight, or comorbidity scores. No significant effects of body size measures, age, and sex were detected on volume of distribution. Dose-dependent bioavailability of GBP was demonstrated, and the saturable absorption profile was described by a nonlinear hyperbolic function. Prediction-corrected visual predictive check (pc-VPC) suggests adequate fixed- and random-effects models that successfully simulated the mean trend and variability in gabapentin concentration-time profiles. In this analysis, the parameters of the hyperbolic nonlinearity appear to be similar between elderly and younger adults.

Prevalence of Frailty in Nursing Home Residents According to Various Diagnostic Tools.

Although the theoretical foundations of frailty are well established in the literature, it remains an evolving concept lacking any unique definition or diagnostic criteria for use in clinical practice and epidemiological research. No consensus exists about the accurate prevalence rates of frailty. The various operational definitions of frailty can at least partly explain such discrepancies. To compare the prevalence of frailty, measured with different diagnostic tools, among elderly nursing home residents. This is an analysis of baseline data collected among the SENIOR (Sample of Nursing home Elderly Individuals: an Observational Research) cohort. Nursing homes. A total of 662 volunteer subjects from 28 nursing homes were included in this analysis. Among them, the mean age was 83.2 ± 8.99 years and 484 (72.5%) of them were women. The percentages of frail and non-frail subjects were calculated according to 10 different definitions. Prevalence of frailty varies from 1.70% (Frailty Index) to 76.3% (Groningen Frailty Indicator) depending on the tool used. The prevalence of frailty is highly dependent on the diagnostic tool used. It would be necessary to reach a consensus on which diagnostic tools to use if one wishes to have comparable data obtained in epidemiological studies.

Epidemiology of Respiratory Pathogens among Elderly Nursing Home Residents with Acute Respiratory Infections in Corsica, France, 2013-2017.

Background The current study aims to describe the demographical and clinical characteristics of elderly nursing home (NH) residents with acute respiratory infections (ARIs) during four winter seasons (2013/2014–2016/2017), as well as the microbiological etiology of these infections. Methods Seventeen NHs with at least one ARI resident in Corsica, France, were included. An ARI resident was defined as a resident developing a sudden onset of any constitutional symptoms in addition to any respiratory signs. Nasopharyngeal swabs from ARI residents were screened for the presence of 21 respiratory agents, including seasonal influenza viruses. Results Of the 107 ARI residents enrolled from NHs, 61 (57%) were positive for at least one of the 21 respiratory pathogens. Forty-one (38.3%) of the 107 ARI residents had influenza: 38 (92%) were positive for influenza A (100% A(H3N2)) and three (8%) for influenza B/Victoria. Axillary fever (≥38°C) was significantly more common among patients infected with influenza A(H3N2). Conclusion The circulation of seasonal respiratory viruses other than influenza A(H3N2) seems to be sporadic among elderly NH residents. Investigating the circulation of respiratory viruses in nonwinter seasons seems to be important in order to understand better the dynamic of their year-round circulation in NHs.

Anticholinergic Medication Burden and 5-Year Risk of Hospitalization and Death in Nursing Home Elderly Residents With Coronary Artery Disease

ObjectivesTo assess the association of the anticholinergic medication burden with hospitalization and mortality in nursing home elderly patients and to investigate the role of coronary artery disease (CAD). DesignLongitudinal (5-year) retrospective observational study. SettingNursing homes in Italy. ParticipantsA total of 3761 nursing home older residents. MeasurementsA comprehensive clinical and functional assessment was carried out through the interRAI long-term care facility instrument. The anticholinergic burden was assessed through the anticholinergic cognitive burden (ACB) scale. Occurrence of hospitalization/all-cause mortality was the primary composite outcome. First hospitalization and all-cause mortality were the secondary outcomes of the study. Hazard ratios (HRs) and subdistribution HRs were obtained through Cox and competing risk (death as competing event for hospitalization) models. ResultsWithin the sample (mean age 83 ± 7 years; 72% females) the incidence rate of the primary outcome was 10/100 person-year. After adjusting for potential confounders and compared with participants with an ACB of 0, those with an ACB of 1 [HR 1.46; 95% confidence interval (CI) 1.12–1.90] and ABC of 2+ (HR 1.41; 95% CI 1.11–1.79) presented an increased risk of developing the primary outcome. After stratification, the risk for the primary outcome increased along with the anticholinergic burden, only for participants affected by CAD (HR 1.53; 95% CI 0.94–2.50 and HR 1.71; 95% CI 1.09–2.68 for the ACB of 1 and ACB of 2+ groups). An ACB score of 2+ was marginally associated with first hospitalization, considering death as a competing risk, only for those with CAD (subdistribution HR 3.47; 95% CI 0.99–12.3). ConclusionsAnticholinergic medication burden is associated to hospitalization and all-cause mortality in institutionalized older adults. CAD increases such risk. The effectiveness and safety profile of complex drug regimens should be reconsidered in this population.

Prevalence of Different Combinations of Antiepileptic Drugs and CNS Drugs in Elderly Home Care Service and Nursing Home Patients in Norway.

Introduction. Antiepileptic drugs (AEDs) are used to treat different conditions in elderly patients and are among the drug classes most susceptible to be involved in drug-drug interactions (DDI). The aim of the study was to describe and compare use of AEDs between home care service and nursing home patients, as these patients are not included in nationwide databases of drug utilization. In the combined population, we investigate DDI of AEDs with other central nervous system- (CNS-) active drugs and DDIs involving AEDs in general. Materials and Methods. Point-prevalence study of Norwegian patients in home care services and nursing homes in 2009. At the patient level, we screened for different DDIs involving AEDs. Results. In total, 882 patients (7.8%) of 11,254 patients used AEDs and number of users did not differ between home care services and nursing homes (8.2% versus 7.7%). In the combined population, we identified 436 potential DDIs in 45% of the patients. Conclusions. In a large population of elderly, home care service and nursing home patients do not differ with respect to exposure of AEDs but use more AEDs as compared to the general population of similar age. The risk of DDIs with AEDs and other CNS-active drugs should be taken into consideration and individual clinical evaluations are assessed in this population.

Vitamin D Deficiency in Nursing Home Elderly in Korea

Copyright©2016 Korean Geriatric Society This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/). ▸Received: March 30, 2016, ▸Revised: May 24, 2016 ▸Accepted: June 14, 2016 Address for correspondence: Mu Young Kim, MD Department of Family Medicine, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul 02053, Korea Tel: +82-2-2276-7941, Fax: +82-2-2276-8509 E-mail: moowija@hanmail.net 노인요양시설 거주 노인의 비타민 D 결핍

Professional Domiciliary Oral Care for Elderly in Nursing Homes—A Randomized Controlled Pilot Trial

Domiciliary dental care (DDC) makes regular dental visits possible for people with different functional limitations who otherwise would not be able to access a dental clinic. DDC also facilitates cooperation with nursing staff. To our knowledge, the effect of DDC on oral health among elderly people in nursing homes has not been studied. As part of a project to establish recommendations for DDC, the aim of this randomized, controlled, single-blind, pilot trial with three parallel arms was to study the effect of professionally conducted oral care intervention, in domiciliary setting, on gingival bleeding on probing, dental plaque and oral mucosa. For three months, the participants were given either A) monthly professional DDC with oral care intervention, B) monthly individual oral care instructions, or C) oral care as usual. A total of 102 (n = 107) individuals completed the study. After three months, gingival bleeding on probing was significantly reduced among more participants in groups A and B compared with group C (p < 0.0004). Dental plaque scores changed significantly over three months for group B compared with group C (p < 0.04). Mucosal-plaque scores were significantly reduced in group A compared with both group B and C (p < 0.0001). All other intergroup differences were statistically non-significant. Compared with care as usual, professional DDC has the most favourable effect on gingival bleeding, whereas individual oral care instructions result in the highest reduction of dental plaque. Both professional oral care interventions and individual oral-hygiene instructions should be included in a domiciliary oralcare programme.

Psychotropic Drug Prescription in Patients with Dementia: Nursing Home Residents Versus Patients Living at Home.

Psychotropic drugs are frequently prescribed in nursing homes (NH). Nonetheless, we hoped that institutionalization decreases the number of psychotropic drug classes prescribed, because NH residents may have more psychosocial interventions than patients living at home. The aim was to compare the type and number of psychotropic drugs prescribed in elderly NH residents with dementia with those in community-living patients. This cross-sectional study included elderly patients (at least 75 years old) with dementia recorded in the National Alzheimer's data Bank ("Banque Nationale Alzheimer") during the year 2012 and who were taking at least one psychotropic drug. Psychotropic drugs were classified as follows: antidepressant, anxiolytic, hypnotic, and antipsychotic drugs. Patients were classified into three categories of dementia severity according to the MMSE score. Among the 50,932 patients with dementia recorded in the BNA, 40.1% had at least one psychotropic drug prescribed. Most of the patients who were treated by at least one psychotropic drug class had antidepressant therapy (69.0%), whatever their residence type, and 16.1% were treated with antipsychotics. Among the study population, 51.9% of the NH residents and 67.4% of the patients living at home had only one psychotropic drug class prescribed. Living in a NH was significantly associated with the more frequent prescription of anxiolytic, hypnotic, and antipsychotic drugs, and with a greater number of psychotropic drug classes prescribed, whatever the severity of the dementia. We underlined the more frequent prescription of psychotropic drugs in NH residents regardless of MMSE scores.

Nursing assistants: "he seems to be ill" - a reason for nurses to take action: validation of the Early Detection Scale of Infection (EDIS).

BackgroundSigns and symptoms of infection in frail elderly are atypical, causing delay in diagnosis and treatment. To improve communication between healthcare staff of signs and symptoms of infection we developed an instrument, using qualitative data from observations by nursing assistants when they suspected infection. The aim of this study was to assess the validity of nursing assistants observations by developing and testing the instrument for early detection of infection in elderly nursing home residents.MethodsThe early detection of infection (EDIS) instrument was based on data from focus interviews with nursing assistants. Over one year the nursing assistants used EDIS to document episodes of suspected early signs and symptoms of infection in 204 nursing home residents. Two physicians classified documented episodes as “no infection”, “possible infection”, and “infection”. The content validity of the 13 items of the EDIS was established to explore the relationships between the items. The construct validity was used to explore the relationship between the items and the presence or absence of infection. The predictive value of the developed model was evaluated by the percentage of correct classifications of the observed cases. Generalized linear model (ordinal multinomial distribution and logit link) was used.ResultsOf the 388 events of suspected infection, 20 % were assessed as no infection, 31 % as possible infection and 49 % as infection. Content validity analysis showed that 12/13 of the items correlated significantly with at least one other statement. The range in number of significant inter-correlations was from 0 (“pain”) to 8 (“general signs and symptoms of illness”). The construct validity showed that the items “temperature” , “respiratory symptoms” and “general signs and symptoms of illness” were significantly related to “infection”, and these were also selected in the model-building. These items predicted correct alternative responses in 61 % of the cases.ConclusionThe validation of EDIS suggests that the observation of “general signs and symptoms of illness”, made by nursing assistants should be taken seriously in detecting early infection in frail elderly. Also, the statement “He/She is not as usual” should lead to follow-up.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0114-0) contains supplementary material, which is available to authorized users.

A multi-center prevalence study and randomized controlled parallel-group pragmatic trial to compare the effectiveness of standardized skin care regimens on skin health in nursing home residents: A study protocol

BackgroundAged long-term residents suffer from a wide range of skin problems. Dry skin associated with severe pruritus, scratching and inflammation is the most prevalent, but exact figures are lacking. Maintaining skin and tissue health as well as enhancing the quality of life are major goals in institutional long-term care. Using mild and moisturizing skin care products is considered to improve the skin barrier and to reduce adverse events. However, the available evidence supporting particular skin care approaches is limited. ObjectiveThis study aims at answering two general questions: (1) What is the prevalence of skin conditions and skin diseases in aged nursing home residents and how are they associated with general person and health related characteristics? (2) Does a structured skin care regimen improve the skin health of aged nursing home residents? Design and methodsUsing a random sample of all nursing homes of the state of Berlin, residents of seven institutions will undergo nursing, medical, and dermatological assessments. Biophysical skin parameters like transepidermal water loss or skin surface pH will be measured. Residents with dry skin will be included in a three arm randomized pragmatic trial investigating the effectiveness of two standardized skin care regimens compared to usual care. The primary outcome will be the Overall Dry Skin score. The follow-up period will be two months. SettingsInstitutional long-term care facilities in Berlin, Germany. ParticipantsLong-term care residents being 65+ years who gave their informed consent. Sample size and statistical methodsDue to the explorative nature of this study a formal sample size analysis is not possible. The expected sample size in the first part of the study is considered sufficiently large (n=280) to obtain precise point estimates. It is planned to allocate n=50 eligible nursing home residents in a 1:1:1 ratio per group in the intervention part. The detectable mean difference using these group sizes would be 0.32 between groups. Depending on the level of measurement variables will be described using absolute and relative frequencies, means, medians, and associated spread estimates. Possible bi- and multivariable associations will be analyzed. The primary outcome of dry skin will be described by mean differences and one-way ANOVA analysis with post-hoc pairwise two-sample t-tests. ResultsThe study started in September 2014. The results are expected in July 2015. Trial registrationThe study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Nurse Assistant Communication Strategies About Pressure Ulcers in Nursing Homes.

There is growing recognition of benefits of sophisticated information technology (IT) in nursing homes (NHs). In this research, we explore strategies nursing assistants (NAs) use to communicate pressure ulcer prevention practices in NHs with variable IT sophistication measures. Primary qualitative data were collected during focus groups with NAs in 16 NHs located across Missouri. NAs (n = 213) participated in 31 focus groups. Three major themes referencing communication strategies for pressure ulcer prevention were identified, including Passing on Information, Keeping Track of Needs and Information Access. NAs use a variety of strategies to prioritize care, and strategies are different based on IT sophistication level. NA work is an important part of patient care. However, little information about their work is included in communication, leaving patient records incomplete. NAs' communication is becoming increasingly important in the care of the millions of chronically ill elders in NHs.

Investigation of food stockpile for disaster in elderly nursing homes

Investigation of food stockpile for disaster in elderly nursing homes

Comparison of Somatosensory Gaming (SG)- based rehabilitation exercise programs at elderly nursing homes

Comparison of Somatosensory Gaming (SG)- based rehabilitation exercise programs at elderly nursing homes

Cost-utility analysis of a pharmacotherapy follow-up for elderly nursing home residents in Spain.

To compare the cost-effectiveness of a pharmacotherapy follow-up for elderly nursing home (NH) residents with that of usual care. Prospective observational study with a concurrent control group conducted over 12 months. Fifteen NHs in Andalusia assigned to control (n = 6) or intervention (n = 9). Residents aged 65 and older. Pharmacotherapy follow-up. Negative outcomes associated with medication, health-related quality of life, cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER). ICERs were estimated for three scenarios: unadjusted cost per QALY (first scenario), costs adjusted for baseline prescribed medication and QALYs adjusted for baseline utility score (second scenario), and costs and QALYs adjusted for a fuller set of baseline characteristics (third scenario). Three hundred thirty-two elderly residents were enrolled: 122 in the control group and 210 in the intervention group. The general practitioner accepted 88.7% (274/309) of pharmacist recommendations. Pharmacist interventions reduced the average number of prescribed medication by 0.47 drugs (P < .001), whereas the average prescribed medication increased by 0.94 drugs in the control group (P < .001). Both groups reported a lower average EuroQol-5D utility score after 12 months (intervention, -0.0576, P = .002; control, -0.0999, P = .003). For the first scenario, usual care dominated pharmacotherapy follow-up (was less effective and more expensive). Adjusted ICERs were € 3,899/QALY ($5,002/QALY) for the second scenario and € 6,574/QALY ($8,433/QALY) for the third scenario. For a willingness to pay of € 30,000/QALY ($38,487/QALY), the probabilities of the pharmacotherapy follow-up being cost-effective were 35% for the first scenario, 78% for the second, and 76% for the third. Pharmacotherapy follow-up is considered cost-effective for elderly NH residents in Spain.

The Effect of Cognitive Stimulation on Nursing Home Elders: A Randomized Controlled Trial

This paper describes the effectiveness of cognitive stimulation therapy (CST) on cognition and depressive symptoms in older adults in nursing homes (NHs). A randomized controlled trial, carried out from 2012 to 2013, included 56 residents from four NHs, 36 women and 20 men (randomized into experimental and control groups). Eight participants dropped out. Participants of the experimental group underwent 14 CST sessions (7 weeks) in groups of six to eight older adults, and participants of the control group received usual care. The Montreal Cognitive Assessment, the Geriatric Depression Scale-15, and the Barthel Index of activities of daily living (ADLs) were administered at baseline and postintervention. Repeated measures revealed that CST increased cognition (F = 8.581; p = .005; partial η squared = 0.157; power = 0.82). There were no statistically significant differences in depressive symptoms (F = 1.090; p = .302). Baseline level of ADLs did not affect the outcomes. CST had significantly improved cognition, explaining the 15.7% variability, but there was no statistical evidence of its effectiveness on depressive symptoms. This improvement was not affected by the baseline level of dependence-independence in ADLs. CST offers a range of activities, providing general stimulation for thinking, concentration, and memory, usually in a social setting. These results will support implementation of CST in NHs. In addition to the impact on elderly independence and autonomy, CST may also have an economic impact by reducing the direct costs of the impact of elders' cognitive frailty.

경기도 일부 노인요양시설의 영양사 유무에 따른 영양관리 현황

The purpose of the study was to examine the current status of nutritional management at elderly nursing homes. A survey was performed of 83 nursing homes from January 5, 2011 to January 21, 2011 via mail. A total of 34 nursing homes responded to the survey and 149 elderly subjects were analyzed according to the presence of a dietitian. Among the 34 nursing homes, 70.6% had a dietitian on duty. All of the facilities with a dietitian had the dietitian making the meal plan, whereas 70% of the facilities without dietitian served meals planned by a non-professional person. Overall, however, a low proportion of nursing homes implemented dietetic treatments for residents with diseases. For the nutritional assessment of these residents, a mini nutritional assessment (MNA) was performed. MNA scores were significantly associated with body mass index (BMI), mid-arm circumference (MAC), calf circumference (CC), ingestion problems, and weight loss during the last 3 months (P

Hypodermoclysis (subcutaneous infusions) – a simple and easy-to-teach tool to avoid hospital admissions due to dehydration in frail nursing home (NH) residents

Introduction.– Dehydration is an important cause for acute physical and cognitive decline in frail elderly. Hypodermoclysis (HDC) used to bewidely unknown in our country until a decade ago. Thus, dehydrated NH residents were usually transferred to hospital for intravenous rehydration. Methods.– We offered lectures and training sessions to the nursing staff of 10 homes with a total of 1000 beds in our catchment area between 2005 and 2011. The chief nursing officers were interviewed before 2005 and after 2011, and questioned about their use of and experience with HDC and, if appropriate, reasons for their non-use of this technique. Results.–Before 2005, only 10%ofNHspractisedHDC,whereas after 2011, 90–100% of homes did so. Hospital admissions fell markedly although it was difficult to assess the true incidence. Unfamiliarity with the technique of HDC, doubts about it’s efficiacy and fear of off-label-use of i.v. infusions were the main reasons not to practise HDC. Conclusions.– By the means of information and training of nursing home staff, HDC could be established in most homes as a treatment of acutely unwell, dehydrated elderly NH residents without the need for hospital admission.

Zoledronic Acid Prevents Bone Mineral Density Loss at the Hip, but not at the Knee, in Persons with Acute Spinal Cord Injury

Percentage with renal insufficiency < 30 egfr (mL/min/m2) 5% (3) Dysphagia 63% (40) CONCLUSION: The low rate of therapy for osteoporosis was most unexpected. The Rheumatology faculty gives annual educational lectures related to management and screening for Osteoporosis and fracture prevention targeted to health providers in the long term care unit. We have initiated a survey of health care providers at our VA to determine feedback of perceived limitations in osteoporosis screening and management to further determine future optimal interventions. 1. Paniagua MA, Malphurs JE, Samos LF. BMI and low bone mass in an elderly male nursing home population. Clinical interventions in aging 2006:1 (3) 283-287. 2. Parikh S, Mogun H, Avorn J, Solomon DH. Osteoporosis Medication Use in Nursing Home Patients with Fractures in 1 US State. Arch Intern Med. 2008; 168 (10):1111-1115.

Nutrition, Balance and Fear of Falling as Predictors of Risk for Falls Among Filipino Elderly in Nursing Homes: A Structural Equation Model (SEM)

While a number of empirical studies have been conducted regarding risk for falls among the elderly, there is still a paucity of similar studies in a developing country like the Philippines. This study purports to test through Structural Equation Modeling (SEM) a model that shows the interaction between and among nutrition, balance, fear of falling, and risk for falls in Filipino elderly in institutionalized settings. Two hundred sixty-nine elderly from various nursing homes in the Philippines participated in this study. A robotfoto was used to obtain the demographic data of the respondents, the Mini Nutritional Assessment (MNA) was used to measure nutritional status, the Timed Up and Go Test (TUGT) was performed to determine balance, the Falls Efficacy Scale (FES) was used to measure fear of falling, and the Morse Fall Scale (MFS) was administered to ascertain the risk for falls. The structural equation model revealed that: (a) nutritional status has no influence on balance, (b) a better nutritional status leads to decreased use of ambulatory aids (β = −3.00), (c) a low degree of fear of falling leads to poorer balance (β = .73), (d) a high degree of fear of falling results to lower risk for falls (β = −.89), and (e) a better balance leads to a decreased risk for falls (β = −.16). Findings yielded in this study provide valuable inputs in the development of a comprehensive fall prevention program in nursing homes and other healthcare institutions in the country.

Health Promotion Behaviors among Elderly in Nursing Home at Baghdad City

Objective: The aim of this study is to evaluate the elderly health promotion behavior through use five domains of physical activities, nutrition patterns, drugs use, psychological well being, seeking of health care. And also to determine the relationship between health promotion behaviors and demographic characteristics (age, gender, and level of education. Methodology: non- experimental (descriptive study) conducted in nursing home at Baghdad city among elderly's' on A non-probability (purposive sample) of (N=80) person were matched with them of general population. The data were collected through the use of semi-structured interview by questionnaire, which consists of two parts (1) divide, section A. cover letter and B. Sociodemographic data which consists of 3-items, (2) health promotion behaviors questionnaire consists of 60-items distributed to four dimensions include, domains, physical activities, nutrition patterns, drugs use, psychological well being, and seeking of health care. Results: The findings of the present study indicate that most the elderly's' unable on practicing physical activity in nursing home residents The drug use domain is perfect for health promotion behaviors domains among elderly's' in nursing home residents, and demographic data no impact upon heath promotion behaviors. Recommendations: The study recommends that Implementation of health education programs by the Ministry of Labor and Social Affairs to improve the elderly's' health promotion behaviors. The elderly of nursing home residents can be considered the target for programs to applying and reinforcing health promotion issues.