Geriatric Nursing Home Research Articles

"Fall Risk Scoring" in Outpatient Gait Analysis: Validation of a New Fall Risk Assessment for Nursing Home Residents.

Falls in senior home residents are common. Individual preventive training can lower the fall risk. To detect the need for training, a systematic assessment of the individual fall risk is needed. The aim of this study was thus to assess whether a fall risk score based on free field insole measurements can distinguish between an at-risk group of senior home residents and a healthy young control group. A published fall risk score was used in senior home residents over the age of 75 and a young (<40 years) control group to determine the individual fall risk. In addition, the fall events over 12 months were assessed. Statistical analysis including ROC analysis was performed to determine the ability of the score to detect participants at heightened fall risk. In total, 18 nursing home residents and 9 young control participants were included. Of the nursing home residents, 15 had at least one fall, with a total of 37 falls recorded over 12 months. In the control group, no falls were recorded. The fall risk score was significantly different between nursing home residents and the control group (9.2+3.2 vs. 5.7±2.2). Furthermore, the score significantly differentiated fallers from non-fallers (10.3±1.8 vs. 5.2±2.5), with a cut-off >7.5 (AUC: 0.95) and a sensitivity of 86.7% (specificity 83.3%). The fall risk score is able to detect the difference between senior nursing home residents and young, healthy controls, as well as between fallers and non-fallers. Its main proof of concept is demonstrated, as based on movement data outside special gait labs, and it can simplify the risk of fall determination in geriatric nursing home residents and can now be used in further, prospective studies.

Dental status and its correlation with polypharmacy and multimorbidity in a Swiss nursing home population: a cross-sectional study

ObjectiveTo assess the correlation between oral health status in terms of present teeth, implants, removable prostheses, and polypharmacy and/or multimorbidity in three Swiss nursing homes with affiliated or integrated dental care.MethodsA cross-sectional study was conducted in three Swiss geriatric nursing homes with integrated dental care. Dental information consisted of the number of teeth, root remnants, implants, and presence of removable dental prostheses. Furthermore, the medical history was assessed in terms of diagnosed medical conditions and prescribed medication. Age, dental status, polypharmacy, and multimorbidity were compared and correlated using t-tests and Pearson correlation coefficients.ResultsOne hundred eighty patients with a mean age of 85.5 ± 7.4 years were included of which a portion of 62% presented with multimorbidity and 92% with polypharmacy. The mean number of remaining teeth and remnant roots were 14.1 ± 9.9 and 1.0 ± 3.1, respectively. Edentulous individuals comprised 14%, and over 75% of the population did not have implants. Over 50% of the included patients wore removable dental prostheses. A negative correlation with statistical significance (p = 0.001) between age and tooth loss (r = − 0.27) was observed. Finally, there was a non-statistically correlation between a higher number of remnant roots and specific medications linked to salivary dysfunction; specifically antihypertensive medication and central nervous system stimulants.ConclusionThe presence of a poor oral health status was associated with polypharmacy and multimorbidity among the study population.Clinical relevanceIdentifying elderly patients in need of oral healthcare in nursing homes is a challenge. In Switzerland, the collaboration of dentists and nursing staff is still improvable, but is urgently needed due to the demographic changes and raising treatment demand of the oldest portion of the population.

Comparison of two skin protection regimes for the Prevention of Incontinence-associated Dermatitis in geriatric care (PID): a study protocol for an exploratory randomised controlled pragmatic trial

IntroductionThe majority of aged long-term care receivers and patients in geriatric acute care are affected by some form of incontinence. These individuals are at risk of developing incontinence-associated dermatitis (IAD),...

Construction and Application of a Three-Level Linkage System for the Prevention and Treatment of Pressure Sores in Geriatric Patients in the Henan Province, China.

To research effective prevention and treatment strategies for pressure sores in geriatric patients and examine the results from application of a three-level linkage system. We developed and constructed a three-level linkage intervention system for pressure sores from Jun 2017 to Dec 2018, centered at the geriatrics department of the Ninth People's Hospital of Zhengzhou, China. The changes included improving the organization structure; formulating a unified evaluation system for quantitation of pressure sore risk management; formulating and standardizing the reporting/feedback mechanism; constructing and improving three-level linkage system staff training; and establishing a quality control system for process monitoring guidance and final evaluation feedback. The incidence of pressure sores significantly decreased, nursing staff's knowledge level regarding pressure sore prevention and treatment increased, and pressure sore cure rate and care satisfaction increased. Implementation of a three-level linkage intervention system for pressure sores in geriatric patients and standardizing pressure injury assessment helps achieve pressure sore prevention and early intervention, effectively reduces the occurrence of pressure sores in geriatric nursing homes, increases the cure rate, and improves care satisfaction among patients.

Management of the COVID-19 pandemic in Catalonian geriatric nursing homes

The covid-19 pandemic has exposed the deficiencies in the provision of social and health services, especially in nursing homes in Catalonia. This fact has triggered the debate on the residential model that Catalonia needs for the 21st century has begun.The objective of this article is to describe the management of the COVID-19 pandemic, during the 5 epidemic waves that affected the nursing homes of Catalonia, from an initial stage of absolute lack of control, to a final stage of pandemic control thanks to the rapid vaccination rate against COVID-19 in this área.

A descriptive Study Evaluating the Impact of COVID-19 on Delivery of Care and Mental Health of Geriatric Nursing Home Staff

IntroductionCOVID-19 has had an unprecedented global impact on public health and socio-economic matters. The magnitude of COVID-19 has undoubtedly affected every aspect of daily life and highlighted the need for increased preparedness, coordination, and monitoring. Amongst all social groups, the elderly is by far the most affected age group in morbidity and mortality [1]. Approximately 1.3 million individuals live in 15,600 nursing home facilities in the United States [2]. In fact, the beginning of COVID-19 may be marked by the 25 deaths in a single King County facility in Washington state. Nursing homes have faced the rapid spread of COVID-19 among residents and staff and have been at the center of the public health emergency during the pandemic. Factors that contribute to this rapid spread include crowding, sharing of bathroom facilities, and gathering in common areas that are not set up for infection control. Nursing homes, in particular, provide ideal environments for devastating infections to spread.Nursing homes, in particular, have essentially been in complete lockdown, not unlike inmates, who both deeply lack social interaction and are currently unable to exist outside the walls of their respective institutions. Those who do not have close family or friends, and rely on the support of voluntary services or social workers, could be at additional risk [6]. To lessen the chance of infection among older people in nursing homes, more local authorities are banning visitors to nursing homes and long-term care facilities. Furthermore, restrictions on group activities such as playing board games, watching TV in a common space, and engaging in art therapy, may harm residents’ mental and physical well-being [8]. Nursing home residents are already susceptible to loneliness, and the lack of social interaction due to decreased visitation from family and friends further compounds the traumatization of COVID-19 on daily living.MethodsMETHODS: This is a descriptive study over a period of 1 month conducted among nursing home staff in Lubbock, TX during the COVID-19 pandemic. Agreeable nursing home staff will have access to a survey (Qualtrics) accessing various aspects relating to the consequences of COVID-19. The survey will be open for a period of 1 month until which the participants will have the opportunity to complete the survey. Data from the surveys will then be collected and analyzed.The survey consists of a self-developed questionnaire along with the validated Perceived Stress Scale (PSS). The scale which was originally developed in 1983 by author Sheldon Cohen is one of the most widely used tools to measure the perception of stress. It has been used in studies assessing the stressfulness of situations and is widely available in the public domain [12].Type of study: Descriptive mixed method triangulation design studySubjects: Healthcare staff with direct patient careInclusion criteria:1. Geriatric Nursing home staff in Lubbock, TX2. Staff agreeable to participate in survey regardless of color, creed, age or sex.3. Staff in direct contact with patients (Nursing and Physicians)Exclusion criteria:1. Ancillary staff not involved in direct patient care2. Staff who refuse to give voluntary consent to participate in surveyDesign: This will be a descriptive, mixed method triangulation design studyutilizing an online, self-administered survey tool created using Qualtrics platform. An information sheet explaining the research project will be given to the nursing home staff. It will include: participation is completely voluntary, that participation will not affect their employment in anyway, and their employer will not have access to the results. It will also explain that by submitting an anonymous survey they are agreeing to take part in the research study. The survey questions will gauge mental health impact on staff and their perspectives on the impact on patients and their own mental health. The survey will contain a mix of 10 close- and open-ended questions.ResultsOutcomes: To determine the impact of COVID-19 on nursing home staff mental health and gather information that may be utilized to create measures to better deliver care in nursing homes.Survey will be sent to 40 members with an expected response rate of about 20 percent and possibly higher.Results will be available by March 2020 for further analysis and distribution.ConclusionsUltimately, COVID-19 has taught painful lessons in the difficulties of isolating the elderly. The need for controlling infection may come at a high cost to the mental health and well-being of patients and staff, which is a critical public health issue. We hope that the results of this study will help us better understand the challenges geriatric nursing facilities have faced during the COVID-19 pandemic and help us develop better strategies for similar threats in the future.FundingNo funding was obtained for the purposes of this study

Risk stratification among metabolically unhealthy obese in independent physically inactive aged women

ObjectivesTo determine whether or not adiponectin levels or basal metabolic rate (BMR) could predict worse risk stratification in patients with insulin resistance (IR) among metabolically healthy and unhealthy obese (MUHO) elderly females with Metabolic syndrome (MetS). MethodsA cross-sectional survey was conducted on 109 elderly females in geriatric nursing home with MetS. The participants were reclassified according to adiponectin levels and IR. ResultsGroup (1) (with IR, n = 41) compared to group (2) (without IR, n = 45) had lower squared adiponectin level and higher fat mass and fat percent (p value = 0.037, 0.030, and 0.035 respectively). Quadratic adiponectin level was an independent predictor for better BMR in group (2) with higher R2 compared to linear adiponectin level (R2 = 0.19, 0.15 consecutively, p value = 0.02, 0.008 consecutively) in group (2) rather than group (1). This revealed U-shaped relation between adiponectin level and BMR in group (2). By ROC curve, fat and lean percentages were statically significant predictors of IR between groups (1) and (2) (AUC = 0.643, 0.636; p value = 0.024, 0.032 Sensitivity = 89.2%, 72.97%; and Specificity = 55.1%, 24.48% respectively). ConclusionCurrent findings supported the possibility of risk stratification among MUHO individuals based on IR, squared adiponectin level, lean and fat percentages.

Prevalence of Multidrug-Resistant Bacterial Colonization and Risk Factors in Geriatric Nursing Home Residents

Prevalence of Multidrug-Resistant Bacterial Colonization and Risk Factors in Geriatric Nursing Home Residents

Identification of Key Odorants in Used Disposable Absorbent Incontinence Products.

PURPOSE:The purpose of this study was to identify key odorants in used disposable absorbent incontinence products.DESIGN:Descriptive in vitro studySUBJECTS AND SETTING:Samples of used incontinence products were collected from 8 residents with urinary incontinence living in geriatric nursing homes in the Gothenburg area of Sweden. Products were chosen from a larger set of products that had previously been characterized by descriptive odor analysis.METHODS:Pieces of the used incontinence products were cut from the wet area, placed in glass bottles, and kept frozen until dynamic headspace sampling of volatile compounds was completed. Gas chromatography–olfactometry was used to identify which compounds contributed most to the odors in the samples. Compounds were identified by gas chromatography–mass spectrometry.RESULTS:Twenty-eight volatiles were found to be key odorants in the used incontinence products. Twenty-six were successfully identified. They belonged to the following classes of chemical compounds: aldehydes (6); amines (1); aromatics (3); isothiocyanates (1); heterocyclics (2); ketones (6); sulfur compounds (6); and terpenes (1).CONCLUSION:Nine of the 28 key odorants were considered to be of particular importance to the odor of the used incontinence products: 3-methylbutanal, trimethylamine, cresol, guaiacol, 4,5-dimethylthiazole-S-oxide, diacetyl, dimethyl trisulfide, 5-methylthio-4-penten-2-ol, and an unidentified compound.

Sensory Characterization of Odors in Used Disposable Absorbent Incontinence Products.

PURPOSE:The objectives of this study were to characterize the odors of used incontinence products by descriptive analysis and to define attributes to be used in the analysis. A further objective was to investigate to what extent the odor profiles of used incontinence products differed from each other and, if possible, to group these profiles into classes.SUBJECTS AND SETTING:Used incontinence products were collected from 14 residents with urinary incontinence living in geriatric nursing homes in the Gothenburg area, Sweden.METHODS:Pieces were cut from the wet area of used incontinence products. They were placed in glass bottles and kept frozen until odor analysis was completed. A trained panel consisting of 8 judges experienced in this area of investigation defined terminology for odor attributes. The intensities of these attributes in the used products were determined by descriptive odor analysis. Data were analyzed both by analysis of variance (ANOVA) followed by the Tukey post hoc test and by principal component analysis and cluster analysis.RESULTS:An odor wheel, with 10 descriptive attributes, was developed. The total odor intensity, and the intensities of the attributes, varied considerably between different, used incontinence products. The typical odors varied from “sweetish” to “urinal,” “ammonia,” and “smoked.” Cluster analysis showed that the used products, based on the quantitative odor data, could be divided into 5 odor classes with different profiles.CONCLUSIONS:The used products varied considerably in odor character and intensity. Findings suggest that odors in used absorptive products are caused by different types of compounds that may vary in concentration.

MRSA Prevalence and Risk Factors among Health Personnel and Residents in Nursing Homes in Hamburg, Germany - A Cross-Sectional Study.

IntroductionThe increase of multidrug-resistant organisms in hospitals causes problems in nursing homes. Staff in geriatric nursing homes are at greater risk of MRSA colonisation. The aim of the study was to describe the occupational exposure to MRSA among health personnel in geriatric nursing.MethodsA point prevalence survey was conducted among health personnel and residents of geriatric nursing homes within the greater Hamburg district. Nasal swabs and, where relevant, wound swabs were collected for the screening survey. Risk factors for MRSA colonisation were identified by means of a questionnaire and using the files held on the residents. Where tests on nursing staff were positive, a control swab was taken; when the results were confirmed positive, decolonisation was performed. The responsible general practitioners were notified of positive MRSA findings among residents. A molecular biological examination of the MRSA samples was performed.ResultsA total of 19 institutions participated in the study. Nasal swabs were taken from 759 nursing staff and 422 residents. Prevalence of MRSA was 1.6% among staff and 5.5% among residents. MRSA colonisation among health personnel indicated a correlation with male gender (OR 4.5, 95% CI 1.4–14.1). Among the residents, chronic skin diseases (OR 3.2, 95% CI 1.0–10.3) and indwelling devices (OR 3.2, 95% CI 1.2–8.1) were identified as risk factors. No link between MRSA in residents and in health personnel could be established.ConclusionThe number of MRSA colonisations among nursing staff and residents of geriatric nursing homes in Hamburg was rather low at 1.6% and 5.5% respectively and equates to the results of other surveys in non-outbreak scenarios.

A qualitative study on caring knowledge training, caring experience and coping style of nursing attendants in elderly homes of Fujian province

Objective To describe the caring knowledge training, caring experiences and coping style of nursing attendants in elderly homes of Fujian province. Methods 15 nursing attendants and 3 managers from 4 different geriatric nursing homes were selected and semi-structured in-depth interviewed and the phenomenological analysis method was used. Results Three themes were found as follows. Theme 1: caring knowledge training: (1)training varied owing to different institutions, nursing skills were focused on; (2)caring knowledge accumulated by work, grope for the rich; (3)most nursing attendants wished to learn, paid attention to practical application; (4) part of the nursing attendants were negative to training, less schooling might be the reason. Theme 2: caring experiences: (1)happiness followed; (2)sense of achievement; (3)unavoidable of troublesome and pressure; (4)dedication existing. Theme 3:copying style: (1)negative compromise; (2)positive coping style; (3)varying with each individual. Conclusions The qualities and coping style of nursing attendants in geriatric nursing homes vary, their work is difficult but they work hard, establishing effective support system is recommended. Key words: Inservice training; Qualitative research; Elderly homes; Caring experiences; Copy style

Reduction of diuretics and analysis of water and muscle volumes to prevent falls and fall‐related fractures in older adults

In an attempt to decrease the incidence of falls and fall-related fractures at a special geriatric nursing home, we endeavored to reduce diuretic doses, and examined the relationship between the effectiveness of this approach with the body compositions and activities of daily living of the study cohort. We enrolled 93 participants living in the community, 60 residents of an intermediate geriatric nursing home and 50 residents of the 100-bed Kandayama Yasuragien special geriatric nursing home. We recorded body composition using a multifrequency bioelectrical impedance analyzer. Daily loop diuretic and other diuretic regimens of those in the special geriatric nursing home were reduced or replaced with "NY-mode" diuretic therapy, namely, spironolactone 12.5 mg orally once on alternate days. The incidence of falls fell from 53 in 2011 to 29 in 2012, and there were no fall-related proximal femoral fractures for 3 years after the introduction of NY-mode diuretic therapy. We also found statistically significant differences in muscle and intracellular water volumes in our elderly participants: those with higher care requirements or lower levels of independence had lower muscle or water volumes. We found that reducing or replacing daily diuretics with NY-mode therapy appeared to reduce the incidence of falls and fall-related proximal femoral fracture, likely by preserving intracellular and extracellular body water volumes. Low-dose spironolactone (12.5 mg on alternate days) appears to be an effective means of treating elderly individuals with chronic heart failure or other edematous states, while preventing falls and fall-related fractures. Geriatr Gerontol Int 2017; 17: 262-269.

Major Oral and Dental Health Problems among Geriatric Residents of Nursing Homes in a defined Population in Iran

ABSTRACTIntroductionIncrease in life expectancy implies the need for more attention to the health of the elderly population, and oral health is not an exception. This study determined the frequency of major oral and dental health problems among institutionalized elderly adults in Qazvin, Iran.Materials and MethodsIn this cross-sectional study, 112 residents of geriatric nursing homes participated. History of systemic diseases and oral symptoms was asked and recorded; then, participants undertook a clinical intra- and extraoral examination. Examination consisted of oral mucosa, periodontal and dental assessment, and temporomandibular joint (TMJ) assessment.ResultsIn total, 93 women and 19 men with an average age of 74.9 (±14.7) and 71.6 (±11.3) years respectively, were examined. A total of 73 patients were completely edentulous. Examination of the oral mucosa showed that 48 patients (42%) had changes in their oral mucosa. Pale mucosa and fissure tongue had the most frequency. However, denture stomatitis was the most prevalent disorder related to the denture. Xerostomia was the most frequent complaining symptom (67.8%) followed by dysphagia (53.7%) and dysgeusia (25.8%). A total of 26 patients (23.2%) had abnormal “clicking” sounds during TMJ assessment.Decayed, missing, and filling teeth (DMF) index in 39 dentate patients revealed 89.7% had decayed teeth, 100% had missing, and 2.6% had filling teeth. Community Periodontal Index of Treatment Needs (CPITN) revealed more than half of the participants had deep or shallow pockets.ConclusionOral and dental health of elderly people in this study was not acceptable. They should be persuaded that there are continual needs for oral health care. Oral examination should be performed as part of development programs for older adults.How to cite this articleMojabi KB, Azimi S, Khansari M. Major Oral and Dental Health Problems among Geriatric Residents of Nursing Homes in a defined Population in Iran. J Contemp Dent 2016;6(2):125-128.

Geriatric nursing home falls: A single institution cross-sectional study

BackgroundFalls are the leading cause of fatal injury in geriatric patients. Nursing home falls occur at twice the rate of community falls, yet few studies have compared these groups. We hypothesized that nursing home residents admitted for fall would be sicker than their community counterparts on presentation and have worse outcomes. MethodsRecords of 1708 patients, age 65 years and older with a documented nursing home status, admitted to our center between 2008 and 2012 were reviewed. Clinical data including injury severity score (ISS), admission Glasgow coma scale (GCS), in-hospital complications, length of stay (LOS), and in-hospital mortality were collected. Continuous data were analyzed using Mann–Whitney tests and categorical data using Fisher exact tests. Variables in the univariate tests were analyzed in a multivariate logistic regression. ResultsNursing home patients were older than community patients, presented with lower GCS, lower hemoglobin, higher international normalized ratio (INR) and a higher percentage of patients with body mass index (BMI)<18.5. LOS for nursing home patients was longer, and they suffered higher rates of in-hospital complications. ISS, rates of traumatic brain injury, operative intervention and mortality were not significantly different. In a multivariate logistic regression, ISS, GCS and age, but not nursing home status, were significant predictors of in-hospital mortality. ConclusionsIn comparison to their community counterparts, nursing home patients presenting after fall are more debilitated and have increased morbidity as evidenced by more in-house complications and increased LOS. However, nursing home residency was not a significant predictor of mortality.

Influenza prevention in nursing homes: Great significance of seasonal variability and spatio-temporal pattern

This work evaluated seasonal variations and spatio-temporal pattern of respiratory tract infections (RTI) in geriatric nursing homes in order to improve effective surveillance, prevention, control and management of RTI. Prospective surveillance of RTI (Low Respiratory Tract infections and Influenza Like Illnesses) was conducted in 11 sites in Alsace over a 10-year period with clinical case definitions and rapid tests (Immunoassay) to identify influenza virus. Influenza national epidemic was a period at high risk of RTI in nursing homes with variable impacts depending on the seasonal period. 2004-2005, 2008-2009, 2011-2012 and 2012-2013 were the periods with the highest impacts. The higher risk was not well understood during these four influenza epidemics and outbreaks occurred in numerous nursing homes despite the alerts and surveillance. Information about seasonal variability and spatio-temporal patterns of the RTI during the national epidemic periods is essential for the nursing homes in order to help the health care workers and the visitors to understand the risk for the residents and then to improve the implementation of the control and prevention measures.

Presentation and Management Outcomes of Corneal and Scleral Perforations in Geriatric Nursing Home Residents.

We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nursing homes, and 37 (26%) were community residents. There were 91 (63%) patients in the non-geriatric group. The mean age of the patients in nursing home geriatric group was 86.5 years (87.5% females). The most common etiology of perforation was trauma. Rupture due to fall was more common in geriatric patients (P < 0.001) whereas laceration due to penetrating eye injury was more common in non-geriatric patients (P < 0.001). There were more cases of infection leading to spontaneous perforation in geriatric nursing home group compared to the other groups (P = 0.001). In the geriatric nursing home group, visual acuity at presentation (P < 0.001) and postoperative visual acuity (P = 0.012) was worse compared to the other groups. Our study showed that corneal and scleral perforations in the geriatric nursing home residents carry a poor visual prognosis. The causes and anatomical outcomes of such events in geriatric age group differ from those in the general population. In our study, geriatric patients residing in nursing homes had worse baseline as well as posttreatment visual acuity, compared to community residents.

Need-based nutritional intervention is effective in improving handgrip strength and Barthel Index scores of older people living in a nursing home: A randomized controlled trial

BackgroundNutritional status is associated with physical functioning in older people. Protein–energy malnutrition can limit functional performance. ObjectivesThis study examined the effectiveness of a “need-based intervention” on improving the physical functioning of older adults living in nursing homes. DesignA 24-week randomized, double-blind, controlled trial. SettingsA privately managed geriatric nursing home in Taiwan. ParticipantsNinety-two persons who were ≥65 years old, ≤25kg/m2, >1 month residence, non-bed-ridden, without acute infection, and able to self-feed or receive oral feeding. MethodsQualified participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each participant in the intervention group would receive a 50g/day soy-protein-based nutritional supplement when he/she was rated as undernourished, defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24kg/m2. The supplement contained 9.5g protein, 250kcal energy, and all essential micronutrients. The supplementation would be suspended if either one of the two “at risk” conditions was not met at the next measurement (every 4 weeks). Handgrip strength and Barthel Index were measured at baseline, mid-point (week 12), and end-point (week 24) of the trial. Results were analyzed with Student's t-test and by the Generalized Estimating Equations controlled for nutritional status. ResultsThe intervention significantly improved (a) handgrip strength of the older adults at weeks 12 and 24, and (b) the overall Barthel Index at week 24 (all p<0.05) according to the Generalized Estimating Equations. Conclusions“Need-based intervention” can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes, without adverse effects. The results probably are the indirect results of the improved nutritional status. The study highlights the importance of routine screening and timely intervention in geriatric care. The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated. We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage.

Multiresistant pathogens in geriatric nursing - infection control in residential facilities for geriatric nursing in Germany.

Background: The increase of multidrug-resistant organisms (MDROs) causes problems in geriatric nursing homes. Older people are at increased a growing risk of infection due to multimorbidity and frequent stays in hospital. A high proportion of the elderly require residential care in geriatric nursing facilities, where hygiene requirements in nursing homes are similar to those in hospitals. For this reason we examined how well nursing homes are prepared for MDROs and how effectively protect their infection control residents and staff.Methods: A cross-sectional study was performed on infection control in residential geriatric nursing facilities in Germany 2012. The questionnaire recorded important parameters of hygiene, resident and staff protection and actions in case of existing MDROs.Results: The response was 54% in Hamburg and 27% in the rest of Germany. Nursing homes were generally well equipped for dealing with infection control: There were standards for MDROs and regular hygiene training for staff. The facilities provided adequate protective clothing, affected residents are usually isolated and hygienic laundry processing conducted. There are deficits in the communication of information on infected residents with hospitals and general practitioners. 54% of nursing homes performed risk assessments for staff infection precaution.Conclusion: There is a growing interest in MDROs and infection control will be a challenge in for residential geriatric nursing facilities in the future. This issue has also drawn increasing attention. Improvements could be achieved by improving communication between different participants in the health service, together with specific measures for staff protection at work.

Cognition and psychopathology in nonagenarians and centenarians living in geriatric nursing homes in Switzerland: a focus on anosognosia

The number of nonagenarians and centenarians is rising dramatically, and many of them live in nursing homes. Very little is known about psychiatric symptoms and cognitive abilities other than memory in this population. This exploratory study focuses on anosognosia and its relationship with common psychiatric and cognitive symptoms. Fifty-eight subjects aged 90 years or older were recruited from geriatric nursing homes and divided into five groups according to Mini-Mental State Examination scores. Assessment included the five-word test, executive clock-drawing task, lexical and categorical fluencies, Anosognosia Questionnaire-Dementia, Neuropsychiatric Inventory, and Charlson Comorbidity Index. Subjects had moderate cognitive impairment, with mean ± SD Mini-Mental State Examination being 15.41 ± 7.04. Anosognosia increased with cognitive impairment and was associated with all cognitive domains, as well as with apathy and agitation. Subjects with mild global cognitive decline seemed less anosognosic than subjects with the least or no impairment. Neither anosognosia nor psychopathological features were related to physical conditions. Anosognosia in oldest-old nursing home residents was mostly mild. It was associated with both cognitive and psychopathological changes, but whether anosognosia is causal to the observed psychopathological features requires further investigation.