German Long-term Care Facilities Research Articles

We need a radical change to take place now´–The potential of integrated healthcare for rural long-term care facilities

This study explores healthcare professionals' perceptions in rural German long-term care facilities, focusing on integrated health systems. The aim is to understand experiences, challenges, and preferences. Twenty nurses and paramedics participated in in-depth interviews. Thematic analysis was applied to transcripts, revealing key themes: acute healthcare provision, interdisciplinary collaboration, telemedicine use, and preferences for the future healthcare landscape. Themes highlighted factors influencing acute care situations and the crucial role of interdisciplinary collaboration. Integrated care was infrequently encountered despite high demand in rural long-term care facilities. Though uncommon, integrated healthcare remains crucial in addressing long-term care facility residents' complex needs. Healthcare professionals express a strong demand for integrated care in rural areas, citing potential benefits for resident wellbeing, healthcare effectiveness, and job satisfaction. The findings guide healthcare organizations in developing institutional-level strategies for integrated care integration, emphasizing its importance in rural settings.

High prevalence of Pseudomonas aeruginosa carriage in residents of French and German long-term care facilities

ObjectivesTo determine prevalence, incidence, and factors associated with Pseudomonas aeruginosa (PA) intestinal carriage in residents of long-term care facilities (LTCFs) and to understand the population structure of this pathogen in LTCFs from two European countries. MethodsWe assessed the prevalence of PA intestinal carriage and the incidence of acquisition by collecting fecal samples from 403 residents of 20 LTCFs. We collected 289 environmental samples from sinks and drinking water. Factors associated with carriage and acquisition of intestinal PA were identified. All PA isolates had their antibiotic phenotypic resistance profile determined and their genome sequenced, from which we assessed the population structure of the collection and identified resistance determinants. ResultsWe found a high proportion of residents with PA intestinal carriage (51.6%) over the entire study period. Over the follow-up period, 28.6% of the residents acquired intestinal PA. Older age (OR, 1.29; 95% CI, 1.09–1.52; p = 0.002), urinary incontinence (OR, 2.56; 95% CI, 1.37–4.88; p = 0.003), and male sex (OR, 2.55; 95% CI, 1.05–6.18; p = 0.039) were associated with higher probability of carriage. Wheelchair usage (OR, 4.56; 95% CI, 1.38–15.05; p = 0.013) and a body mass index >25 (OR, 3.71; 95% CI, 1.17–11.82; p = 0.026) were associated with higher risk of PA acquisition. Population structure of our isolates was mainly non-clonal with 112 different STs among the 241 isolates. Most represented STs were high risk clones ST253 (n = 26), ST17 (n = 11), ST244 (n = 11), ST309 (n = 10), and ST395 (n = 10). Most PA isolates (86.3%) were susceptible to antibiotics, with no acquired genes conferring resistance to antipseudomonal agents. DiscussionWe found an unexpected high prevalence of PA intestinal carriage in LTCF residents mainly associated with individual-level factors. Our study revealed a polyclonal PA population structure suggesting that individual acquisition is more frequent than resident-to-resident transmission.

Pharmacist-led medication reviews for geriatric residents in German long-term care facilities

BackgroundThe benefit of medication reviews for long-term care (LTC) residents has been generally recognized throughout health care systems. Whereas many studies showed the impact of comprehensive medication reviews performed by specialized clinical pharmacists, little is known about the impact of medication reviews performed by community pharmacists. Involving them in the provision of medication reviews may help satisfy the increasing demand for ensuring medication safety.MethodsCommunity pharmacists supplying drugs to the LTC facilities performed a medication review for German LTC residents aged at least 65 years and taking five or more drugs per day based on the patients’ medication only. Documented potential drug-related problems (DRPs) and the implementation rate of pharmaceutical interventions were evaluated descriptively. To assess the quality of the medication reviews, we developed a corresponding reference system based on the analysis of two experienced clinical pharmacists.ResultsTwelve pharmacies performed medication reviews for 94 LTC residents. Overall, the pharmacists documented 154 potential DRPs (mean 1.6 per patient, SD 1.5) of which the most common were drug-drug interactions (40%) followed by potentially inappropriate medication (PIM) (16%) and inappropriate dosages (14%). 33% of the pharmacists’ interventions to solve DRPs were successfully implemented, mostly dosage adjustments. The identification of potentially severe drug-drug interactions and PIM showed the highest agreement (88 and 73%) with the reference system.ConclusionsThe medication review program of community pharmacists for LTC residents led to the identification of relevant DRPs. The reference system assessing the quality of the service can contribute to its transparency and reveals the potential for its improvement. The community pharmacists’ knowledge of the LTC residents and their relation to the prescribers is crucial for providing successful medication reviews.

Arzneimitteltherapiesicherheit bei Heimbewohnern

Due to demographic change, the number of elderly patients in need of long-term care is continuously increasing. Residents in nursing homes often suffer from various chronic diseases leading to the prescription of aplethora of drugs and ahigh risk for adverse drug reactions (ADR). Particularly, CNS-active drugs are critical in this context. Moreover, the medication process in nursing homes is complex with numerous interfaces and error sources. Therefore, medication safety for long-term care residents is regarded as amultiprofessional challenge.In Germany, several model projects have been conducted and initiated that aim at enhancing medication safety in nursing homes. The AMTS-AMPEL project is the largest intervention study so far dealing with medication safety in German long-term care facilities. After implementation of acomplex multiprofessional intervention consisting of educative and structural measures, prevalence and incidence of preventable ADR could be significantly reduced. This and other projects suggest that medication safety in long-term care residents can be improved by targeted multiprofessional interventions.Although there is already evidence that interventions enhancing medication safety can improve medication appropriateness and solve drug-related problems, they still lack evidence of affecting clinical endpoints like hospitalization rate and mortality. Nevertheless, the model projects already enhance patient safety by increasing the awareness for risks in the medication process in long-term care facilities.

Improving Quality of Work life for Care Providers by Fostering the Emotional well-being of Persons with Dementia: A Cluster-randomized Trial of a Nursing Intervention in German long-term Care Settings.

We tested the feasibility of a nursing intervention (DEMIAN) in routine care and its effects on care providers' job satisfaction, motivation, and work strain. This cluster-randomized trial was conducted in 20 German long-term care facilities. We randomly assigned 20 facilities to an intervention group (84 care providers, 42 residents with dementia) or a control group (96 care providers, 42 residents with dementia). Intervention group providers received two training days on the intervention; 68 providers attended both training days. Sixty two providers completed both baseline and follow-up questionnaires. Trained providers created individualized mini-intervention plans for participating residents. Control group residents received 'usual care'. Intervention group providers stated that the intervention was feasible and helped them improve emotional well-being of residents with dementia. We found significantly decreased time pressure and decreased job dissatisfaction for intervention group providers. DEMIAN is an effective and pragmatic contribution to implementing person-centred care in long-term care, with positive effects on providers' working conditions.

Assessment of Topical Skin Care Practices in Long-Term Institutional Nursing Care from a Health Service Perspective.

Skin aging is associated with increased skin vulnerability and susceptibility to ulcerations and dermatoses, making intensive skin care required, especially for older adults. As part of a nationwide prevalence study, data of 3,385 residents 60 and older were collected to analyze skin care practices in German long-term care facilities. The objective of the current study was to gain detailed insights into frequencies of leave-on skin care product applications by nursing care professionals for older adults. The 10 most frequently treated body parts accounted for >94% of all skin applications. Variations related to gender, age, and skin areas indicate differences in perceived skin care needs, although the evidence base supporting basic skin care interventions in this setting is weak. Gender, age, and clinical status seem to influence skin care practices. These factors must be taken into account to improve topical skin care and health in long-term care. [Journal of Gerontological Nursing, 42(6), 18-24.].

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013.

Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge.

Mobility is the key! Trends and associations of common care problems in German long-term care facilities from 2008 to 2012

BackgroundAlthough enormous efforts have been made in auditing the quality of care, there are only few epidemiological studies available about the actual occurrence of immobility, malnutrition, urinary incontinence, cognitive impairment, falls and pressure ulcers in long-term care facilities. ObjectiveThe objective of this study was to provide prevalence estimates of common nursing care problems in long-term care facilities and to investigate any associations between them. DesignSecondary data analysis of five consecutive annual cross-sectional multicenter studies from 2008 to 2012. Setting262 different long-term care facilities throughout Germany. Participants14,798 residents older than 18 years who gave informed consent. MethodsHealth conditions were rated based on direct resident examinations according to the current international definitions. Demographic characteristics were compared with available national population statistics. Apart from descriptive statistics, Chi2 tests were carried out for bivariate and log-regression models were performed for multivariate associations. ResultsPrevalence rates were stable over the years with the highest prevalence of 73.5% (95% CI 72.8–74.2) being found for urinary incontinence, for cognitive impairment it was 54.1% (95% CI 53.3–54.9) and for immobility it was 36.5% (95% CI 35.7–37.3). The lowest prevalence rates were established for the risk of malnutrition with 13.0 (95% CI 12.4–13.5), for pressure ulcers with 4.8% (95% CI 4.5–5.1) and for falls (4.4% 95% CI 4.1–4.8). In the multivariate model, immobility was most strongly associated with all of the other conditions. No statistically significant associations were found between pressure ulcers and falls, pressure ulcers and urinary incontinence, pressure ulcers and cognitive impairment and between malnutrition and urinary incontinence. ConclusionDecision-makers and clinical practitioners may primarily focus on the maintenance and enhancement of mobility, because this seems to be the key predictor for many other health conditions in the context of care dependency in the nursing home setting.

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

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

Pressure ulcer prevalence rates from 2002 to 2008 in German long-term care facilities

Pressure ulcers continue to be an important issue in long-term care facilities. Besides quality initiatives (implementation of guidelines) and increased public awareness of the problem, little is known about the actual extent of the problem in Germany. The aim of this study is to provide information on the magnitude of this problem and to show whether there have been any changes through the years 2002 to 2008. In addition we wanted to know if the results were representative. 18,706 residents in 218 long-term care facilities (response rate 77.5%). Skin examination of each resident by qualified trained nurses after informed consent was given by resident or proxy. Application of Chi-square tests, chi-square trend tests and one-way ANOVA to assess differences and trends across the years. Comparisons of study samples with data characterizing the potential population. Regarding gender, age, and pressure ulcer risk, the yearly samples were comparable. Pressure ulcer prevalence rates decreased from 12.5% (year 2002) to 5.0% (year 2008) (p<0.001). Prevalence rates, excluding non-blanchable erythema, decreased from 6.6% (year 2002) to 3.5% (year 2008) (p<0.001). Pressure ulcer prevalence in German long-term care facilities decreased from 2002 to 2008. It is highly probable that this decrease was due to more effective strategies and better prevention.

Quantification and classification of errors associated with hand-repackaging of medications in long-term care facilities in Germany

Objective: The aim of this study was to quantify and classify errors associated with the repackaging of residents' medications in long-term care facilities in Germany. Methods: This was a prospective 8-week study conducted in 3 long-term care facilities. Pill organizers, each of which contained all repackaged solid oral dosage forms of long-term medications for a particular resident for an entire day, were inspected and checked against residents' medication sheets by the investigator-pharmacist. On agreement between the pharmacist and the registered nurse responsible for residents' medications, all errors were rectified before medications were administered. The primary study measure was the overall rate of incorrectly repackaged medications relative to all repackaged medications. Secondary measures were the proportion of all pill organizers with medication errors and the proportion of residents who would have been affected by these errors. Errors were categorized by type as follows: wrong time of administration, wrong dose, wrong medication, omission of a medication, extra dose, incorrect halving of tablets, and damaged medication. Results: One hundred ninety-six residents were included in the study, representing 8798 daily pill organizers and 48,512 inspected medications. Residents received a mean of 5.4 solid oral dosage forms of long-term medications per day. Six hundred forty-five errors were detected, for an error rate of 1.3%; the errors involved 7.3% of daily pill organizers and 53.0% of residents. The largest proportion of errors involved incorrect halving of tablets (49.1%), followed by omission of a medication (22.0%), extra dose (9.8%), wrong time of administration (8.4%), damaged medication (6.4%), wrong dose (4.2%), and wrong medication (0.2%). These results may underestimate true rates of repackaging errors across long-term care facilities in Germany, as the conditions in the 3 facilities in this study were near-optimal in terms of the environment, process, and quality of repackaging. Conclusions: Among 48,512 medications inspected over 8 weeks in 3 German long-term care facilities, the rate of repackaging errors was 1.3%, involving 7.3% of daily pill organizers and the medications of 53.00% of residents. The largest proportion of errors involved incorrect halving of tablets.