Higher Care Dependency Research Articles

Development and validation of a dynamic nomogram for high care dependency during the hospital-family transition periods in older stroke patients

BackgroundThis research aimed to develop and validate a dynamic nomogram for predicting the risk of high care dependency during the hospital-family transition periods in older stroke patients.Methods309 older stroke patients in the hospital-family transition periods who were treated in the Department of Neurology outpatient clinics of three general hospitals in Jinzhou, Liaoning Province from June to December 2023 were selected as the training set. The patients were investigated with the General Patient Information Questionnaire, the Care Dependency Scale (CDS), the Tilburg Frailty Inventory (TFI), the Hamilton Anxiety Rating Scale (HAMA), the Hamilton Depression Rating Scale-17 (HAMD-17), and the Mini Nutrition Assessment Short Form (MNA-SF). Lasso-logistic regression analysis was used to screen the risk factors for high care dependency in older stroke patients during the hospital-family transition period, and a dynamic nomogram model was constructed. The model was uploaded in the form of a web page based on Shiny apps. The Bootstrap method was employed to repeat the process 1000 times for internal validation. The model’s predictive efficacy was assessed using the calibration plot, decision curve analysis curve (DCA), and area under the curve (AUC) of the receiver operator characteristic (ROC) curve. A total of 133 older stroke patients during the hospital-family transition periods who visited the outpatient department of Neurology of three general hospitals in Jinzhou from January to March 2024 were selected as the validation set for external validation of the model.ResultsBased on the history of stroke, chronic disease, falls in the past 6 months, depression, malnutrition, and frailty, build a dynamic nomogram. The AUC under the ROC curves of the training set was 0.830 (95% CI: 0.784–0.875), and that of the validation set was 0.833 (95% CI: 0.766-0.900). The calibration curve was close to the ideal curve, and DCA results confirmed that the nomogram performed well in terms of clinical applicability.ConclusionThe online dynamic nomogram constructed in this study has good specificity, sensitivity, and clinical practicability, which can be applied to senior stroke patients as a prediction and assessment tool for high care dependency. It is of great significance to guide the development of early intervention strategies, optimize resource allocation, and reduce the care burden on families and society.

Predictors of perceived caregiver strain in carers of patients living with heart failure: data from a collectivist society

Abstract Background Informal caregivers are individuals voluntarily caring for someone facing a disease, disability, or any condition requiring particular attention.1 They provide around 90% of in-home care and play a key role in supporting the wellbeing and care of people living with chronic illnesses.2 Such diagnoses alter roles within the family unit and cause feelings of uncertainty, anxiety, depression, resentment, among others. This is true in caregivers of patients living with Heart Failure [HF]. High care dependency and lack of formal support for caregiving have increased the prevalence of caregiver strain. Purpose To describe caregiver strain and identify its determinants among caregivers of patients living with HF. Methods This was a cross-sectional correlational study. Caregivers were assessed for caregiver strain (Modified Caregiver Strain Index [MCSI]), social support (Carers of Older People in Europe Index [COPE]), and quality of life (QOL; Short Form 12). MCSI scores were compared across dyadic variables and then used as the outcome variables to create the regression model. Results 108 patients (age 63.54 ± 10.52 years, 70.4% males, 81.55% married) and caregivers (age 49.37 ± 13.69 years, 14.8% males, 82.2% married) were included. More than 80% of the dyads lived in the same household. Caregivers have been assuming this role for an average of 8.53 years and a mean of 37.73 hours per week. Almost 50% of the caregivers reported providing minimal care for their patient while 35% reported providing full care. An alarming 67.6% of the dyads were considered discordant and did not agree on how and by who the care is performed. Caregiver strain was average in this sample with a mean of 11.32 ± 6.94. Caregivers who provided full care had significantly higher caregiver strain (13.75 ± 6.16 versus 9.82 ± 7.16; F (2,76) = 3.329, p = 0.041). Poor caregiver perceived quality of the dyad was significantly associated with higher caregiver strain (16.07 ± 6 versus 10.71 ± 6.9; p < 0.001). Caregivers of symptomatic patients had lower caregiver strain than caregivers of asymptomatic patients (9.90 ± 7.43 versus 12.69 ± 6.21; p = 0.019). Being stressed in caregiving was significantly associated with higher caregiver strain (r = 0.774; p < 0.001). Having lower physical and/or mental QOL were associated with higher strain (r = -0.291 and -0.536 respectively; p < 0.001). Finally, a higher negative impact from caregiving, a lower mental and physical QOL, and a lower relationship quality explained about 63% of the variance in Caregiver Strain (F = 44.001; p < 0.001). Conclusion Knowledge from this study will help place caregivers’ health at the core of caregiving processes. HF nurses and physicians should start giving special attention to caregivers of HF patients who show signs if high caregiver strain. Interventions to reduce strain should be designed to address caregivers’ appraisal of dyad relationship quality, instrumental social support, and QOL.

Characteristics of Homebound and Patients with Disability Who Use Home-Based Primary Care in Korea: A Retrospective Study for 2018-2022.

(1) Background and Methods: This study evaluated characteristics of South Korean patients necessitating home-based primary care (HBPC) from 2018 to 2022, distinguishing between homebound individuals with chronic conditions and those with registered disabilities. (2) Result: Among 171 HBPC recipients, 56.1% were homebound, predominantly older with a median age of 81 years (interquartile range (IQR 68.5-86.0)), while 43.9% were disabled, generally younger with a median age of 39 years (IQR, 28-64). Activities of daily living were assessed, revealing a median score of 14 (IQR, 10-19), indicative of high care dependency. The most common conditions among homebound patients were dementia (27.1%) and physical mobility difficulties (21.9%), whereas mental disabilities (53.3%) and mobility issues (36.0%) prevailed in disabled patients. The primary HBPC needs for homebound patients included management of acute medical conditions (27.1%) and sores (17.7%). Conversely, regular health check-ups (46.7%) and management of neuropsychiatric symptoms (26.7%) were prevalent among the disabled group. (3) Conclusion: Notably, over 90% of HBPC patients required assistance with daily activities, highlighting significant differences in the needs and characteristics between older, homebound individuals with multiple comorbidities and younger, disabled patients receiving medical aid. These insights emphasize the necessity to develop customized HBPC programs to adequately cater to the diverse patient needs within South Korea.

A randomized controlled trial on the effects and acceptability of individual mindfulness techniques – meditation and yoga – on anxiety and depression in people with Parkinson’s disease: a study protocol

BackgroundBetween 40 and 50% of patients with Parkinson’s disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery. Hence, the aim of this trial is to investigate the effects and underlying mechanism of individual mindfulness techniques among PD patients, as well as exploring participants’ experience in using individual mindfulness techniques as a lifestyle intervention for stress and symptom management.MethodsWe will conduct an assessor-blind three-arm randomized waitlist-controlled trial with a descriptive qualitative evaluation. Up to 168 PD patients will be recruited from community settings and out-patient clinics, and randomized to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses will be measured as mediating variables. All outcome evaluations will be assessed at baseline, 8 weeks, and 24 weeks. Following the intention-to-treat principle, generalized estimating equation models and path analysis will be used to identify the treatment effects and the mediating mechanisms. A subsample of 30 participants from each intervention group will be invited for qualitative interviews.DiscussionThe study would also generate important insights to enhance the patients’ adaptation to debilitating disease. More specifically, symptom management and stress adaptation are highly prioritized healthcare agenda in managing PD. The research evidence will further inform the development of community-based, nurse-led compassionate care models for neurodegenerative conditions, which is complementary to existing health services.Trial registrationWHO Primary Registry – Chinese Clinical Trials Registry number: ChiCTR2100045939; registered on 2021/04/29 (https://www.chictr.org.cn/showproj.html?proj=125878).

The relationship between mental health continuum and care dependency in individuals with chronic obstructive pulmonary disease: A cross-sectional study.

To examine the relationship between mental health continuum and care dependence of hospitalized patients, who were diagnosed with chronic obstructive pulmonary disease (COPD). Descriptive, cross-sectional study. The data were obtained from 448 inpatients diagnosed with COPD, who were treated in clinics, by utilizing questionnaires and face-to-face interviews between November 2021 and February 2022. The Mental Health Continuum Short Form and Care Dependency Scale were used by the researchers with the sociodemographic and clinical characteristics form created in line with the literature. The data were analysed using the SPSS 23.0 software. It was determined that a moderately significant positive relationship between mental health continuum and care dependency. In addition, the patient's perception of own health, disease stage and severity of dyspnoea were also found to be associated with mental health and care dependency. Gender, marital status, employment status and income level were found to be associated with mental health continuum, but not with care dependency. Advanced age, low educational level, alcohol consumption, antidepressant use and comorbidities were found to be associated with both care dependency and mental health continuum. Individuals with COPD who have low mental health, poor health perception, high disease stage and dyspnoea severity have high care dependency. In this study, it was revealed that the level of mental health continuum was significantly associated with care dependency in individuals with COPD; in addition, the individual's perception of poor health, disease stage and dyspnoea severity were other factors associated with care dependency. It is important for nurses working with individuals with COPD to evaluate the mental health of individuals with poor health perception, high disease stage and dyspnoea severity and to plan appropriate interventions to reduce care dependency. No patient or public contribution was required in the design, conduct, analysis or interpretation of this study. Patients/public members only contributed to data collection. Data were obtained from patients hospitalized in the chest diseases clinic of a training and research hospital.

Implementation fidelity of a multifactorial in-hospital fall prevention program and its association with unit systems factors: a single center, cross-sectional study

BackgroundFalls are a common, costly global public health burden. In hospitals, multifactorial fall prevention programs have proved effective in reducing falls’ incidence; however, translating those programs accurately into daily clinical practice remains challenging. This study’s aim was to identify ward-level system factors associated with implementation fidelity to a multifactorial fall prevention program (StuPA) targeting hospitalized adult patients in an acute care setting.MethodsThis retrospective cross-sectional study used administrative data on 11,827 patients admitted between July and December 2019 to 19 acute care wards at the University Hospital Basel, Switzerland, as well as data on the StuPA implementation evaluation survey conducted in April 2019. Data were analysed using descriptive statistics, Pearson’s coefficients and linear regression modelling for variables of interest.ResultsThe patient sample had an average age of 68 years and a median length of stay of 8.4 (IQR: 2.1) days. The mean care dependency score was 35.4 points (ePA-AC scale: from 10 points (totally dependent) to 40 points (totally independent)); the mean number of transfers per patient -(e.g., change of room, admission, discharge) was 2.6 (range: 2.4– 2.8). Overall, 336 patients (2.8%) experienced at least one fall, resulting in a rate of 5.1 falls per 1’000 patient days. The median inter-ward StuPA implementation fidelity was 80.6% (range: 63.9–91.7%). We found the mean number of inpatient transfers during hospitalisation and the mean ward-level patient care dependency to be statistically significant predictors of StuPA implementation fidelity.ConclusionWards with higher care dependency and patient transfer levels showed higher implementation fidelity to the fall prevention program. Therefore, we assume that patients with the highest fall prevention needs received greater exposure to the program. For the StuPA fall prevention program, our results suggest a need for implementation strategies contextually adapted to the specific characteristics of the target wards and patients.

What Facilitates or Hampers Living at Home With Advanced Dementia Until the End of Life? A Qualitative Study Using Retrospective Interviews Among Family Caregivers, General Practitioners, and Case Managers.

This study provides insight into circumstances that facilitate or hamper living at home with advanced dementia until the end of life. Interviews were held with 11 bereaved family caregivers, two general practitioners, and nine case managers, related to a total of 12 persons with advanced dementia who had recently died. Persons with dementia who lived at home until the end of life often had family caregivers that received timely support from professionals and their social network. In the cases where the person with dementia could not live at home until the end of life, safety issues, severely challenging behavior, and high care dependency of the person with dementia played key roles. Case management and a continuous process of advance care planning will improve the chance that the end-of-life setting is in accordance with the key values and needs of both the person with dementia and family caregivers.

Prevalence of SARS-CoV-2 antibodies among Belgian nursing home residents and staff during the primary COVID-19 vaccination campaign

Background Nursing home residents (NHR) and staff have been disproportionally affected by the COVID-19 pandemic and were therefore prioritised in the COVID-19 vaccination strategy. However, frail older adults, like NHR, are known to have decreased antibody responses upon vaccination targeting other viral antigens. Objectives As real-world data on vaccine responsiveness, we assessed the prevalence of SARS-CoV-2 antibodies among Belgian NHR and staff during the primary COVID-19 vaccination campaign. Methods In total, we tested 1629 NHR and 1356 staff across 69 Belgian NHs for the presence of SARS-CoV-2 IgM/IgG antibodies using rapid tests. We collected socio-demographic and COVID-19-related medical data through questionnaires. Sampling occurred between 1 February and 24 March 2021, in a randomly sampled population that received none, one or two BNT162b2 vaccine doses. Results We found that during the primary vaccination campaign with 59% of the study population fully vaccinated, 74% had SARS-CoV-2 antibodies. Among fully vaccinated individuals only, fewer residents tested positive for SARS-CoV-2 antibodies (77%) than staff (98%), suggesting an impaired vaccine-induced antibody response in the elderly, with lowest seroprevalences observed among infection naïve residents. COVID-19 vaccination status and previous SARS-CoV-2 infection were predictors for SARS-CoV-2 seropositivity. Alternatively, age ≥ 80 years old, the presence of comorbidities and high care dependency predicted SARS-CoV-2 seronegativity in NHR. Conclusion These findings highlight the need for further monitoring of SARS-CoV-2 immunity upon vaccination in the elderly population, as their impaired humoral responses could imply insufficient protection against COVID-19. Trial registration This study was retrospectively registered on ClinicalTrials.gov (NCT04738695).

Declining Prevalence of SARS-CoV-2 Antibodies among Vaccinated Nursing Home Residents and Staff Six Months after the Primary BNT162b2 Vaccination Campaign in Belgium: A Prospective Cohort Study.

In the SCOPE study, we monitored SARS-CoV-2 antibodies in a national sample of residents and staff from Belgian nursing homes. Here, we report the seroprevalence among infected and infection-naive residents and staff after the primary COVID-19 vaccination campaign. Among 1554 vaccinated nursing home residents and 1082 vaccinated staff from 69 nursing homes in Belgium, we assessed the proportion having SARS-CoV-2 antibodies approximately two (April 2021), four (June 2021), and six months (August 2021) after a two-dose regimen of the BNT162b2 vaccine. We measured the seroprevalence using SARS-CoV-2 antibody rapid tests and collected socio-demographic and COVID-19 medical data using an online questionnaire. Two months after vaccination (baseline), we found a seroprevalence of 91% (95% CI: 89-93) among vaccinated residents and 99% (95% CI: 98-99) among vaccinated staff. Six months after vaccination, the seroprevalence significantly decreased to 68% (95% CI: 64-72) among residents and to 89% (95% CI; 86-91) among staff (p < 0.001). The seroprevalence was more likely to decrease among infection-naive residents, older residents, or residents with a high care dependency level. These findings emphasize the need for close monitoring of nursing home residents, as a substantial part of this population fails to mount a persistent antibody response after BNT162b2 vaccination.

Abstract 10933: Informal Caregivers’ Burden and Its Predictors in Heart Failure: A Mixed Methods Study

Introduction: Caring for relatives with heart failure is emotionally and physically intensive for informal caregivers leading to caregiver burden. Evidence also suggests that caregiver burden affects the quality of life of both components of the patient-caregiver dyad. Previous research provides a limited understanding of the nature of caregiver burden and its influencing factors from a dyadic perspective. Hypothesis: To develop a comprehensive understanding of caregiver burden, and to identify its predictors with a dyadic perspective Methods: A convergent mixed-method approach was used. In total, 184 patients with heart failure and their informal caregivers completed validated scales to measure burden, care dependency, quality of life, and social support and 50 caregivers participated also to a semi-structured interviews to better understand the caregiver experience. Multiple regression analysis was conducted to identify the predictors and qualitative content analysis was performed on qualitative data. The results were merged using joint displays. Results: Caregiver burden was predicted by patient worse cognitive impairment, lower physical quality of life, and a higher care dependency perceived by the caregivers. Qualitative and mixed analysis demonstrated that caregiver burden has a physical, emotional, and social nature. In particular time constraints, anticipated concerns about personal future, and generalized fatigue and exhaustion were significant predictors of caregiver burden, thereby affecting their caregiving. Conclusions: Caregiver burden can affect the capability of informal caregivers to support and care for their relatives with heart failure. There is a dire need for development and evaluation of individual and community-based strategies to address caregiver burden so as to enhance the quality of life of both caregivers and their relatives with heart failure.

Examining Care Assessment Scores of Community-Dwelling Adults in Flanders, Belgium: The Role of Socio-Psychological and Assessor-Related Factors.

One of the primary objectives of health systems is to provide a fair system by providing a comprehensive and holistic approach to caregiving rather than focusing on a single aspect of a person’s care needs. This approach is often embodied by using standardized care assessments across health and social care settings. These assessments are completed by professional assessors and yield vital information regarding a person’s health or contextual characteristics (e.g., civic engagement, psychosocial wellbeing, environmental characteristics, informal care). However, these scores may be subject to bias that endangers the fairness of the health system. In this study, we investigate to what extent socio-economic and psychological indicators and assessor-related indicators are associated with BelRAI Screener care assessment scores amongst 743 community-dwelling adults nested within 92 assessors in Flanders, Belgium. Findings indicate that there is significant variance in scores at the assessor-level. Socio-psychological characteristics of clients are associated with scores: being fluent in Dutch and providing informal care are associated with low care dependency, while living with children, feelings of depression, and the presence of an informal caregiver during assessment are associated with high care dependency. We discuss the importance of rigorous assessor training and the potential for socio-psychological factors to contribute to the allocation of welfare benefits in light of the Flemish home care system’s potential (lack of) fairness.

Analysis of the care complexity in the surgical area: Persiceto’s score

Introduction: In Italy a new way of thinking about hospitals is emerging. It involves the articulation of care and resources according to the intensity and the complexity of care; patients acquire a central role and are no longer grouped by medical disciplines but by high, medium or low care complexity. Purpose of this study is to test a tool that detects care complexity in the areas of intervention, calculating and analyzing the care complexity of surgical patients in their first day after surgery. Methods: adoption of the Swot method to specify the Persiceto's Score tool, adapted to the Alexandrian context. The Persiceto tool consists of scores obtained from three elements: type of surgery, state of health/concurrent disease condition, autonomy level of the patient in various activities. Results: In an evaluation period of about 60 days the Persiceto tools completed on the first day after surgery were 80. The state of health and concurrent disease condition of the 80 patients was constituted by 43 with moderate systemic disease, 22 with severe systemic disease, 13 in good health and 2 in threatening health conditions. The level of care dependency that emerged from the IDA assessment of the 80 patients was 56 with low care dependency, 23 with average and 1 with high care dependency. Conclusions: This study has shown that a simple, effective and replicable tool can be useful during the reorganization of care intensity during post-surgery to obtain a precise classifications of care complexity.

Regional variation of care dependency after hip fracture in Germany: A retrospective cohort study using health insurance claims data.

ObjectiveTo investigate variation of care dependency after hip fracture across German regions based on the assessment by the German statutory long-term care insurance.Data sources/study settingPatient-level statutory health and long-term care insurance claims data from 2009–2011 and official statistical data from Germany.Study designWe performed a retrospective cohort study. Investigated multinomial outcome categories were increase in care dependency (new onset or a higher care dependency than pre-fracture), no change as reference and death as competing risk in the quarterly period following hip fracture (follow-up 3 months). Regional variation was operationalized with the variance of regional-level random intercepts based on generalized linear mixed models. We adjusted for patient and regional characteristics.Principal findingsThe study included 122,887 hip fracture patients in 95 German postal code regions. Crude outcomes were 30.87% increase in care dependency and 14.35% death. Results indicated modest variation on regional level. Male sex, increasing age, increasing comorbidity, pertrochanteric and subtrochanteric fracture site compared to femoral neck, time from hospital admission to surgery of 3 or more days, as well as increasing inpatient length of stay, non-participation in rehabilitation and regions with lower hospital density were positively associated with an increase in care dependency.ConclusionsSeveral characteristics on patient and regional level associated with the outcome were identified. Variation in the increase in care dependency after hip fracture appeared to be attributable primarily to patient characteristics. Variation on regional level was only modest.

Impaired Mobility and Urinary Incontinence in Nursing Home Residents: A Multicenter Study.

The purpose of this study was to evaluate associations among use of walking aids, mobility status, and occurrence of urinary incontinence (UI) in geriatric patients residing in nursing homes, and to examine associations between UI severity (frequency and amount) and its impact on health-related quality of life (QoL). Multicenter descriptive cross-sectional prevalence study. A total of 2044 patients from nursing homes were included in the study. A majority were female (72.0%), the mean age of participants was 82.1 years (SD 11.2), their mean body mass index was 26.1 (SD 5.4), and their mean Care Dependency Scale score was 46.0 (SD 18.2), indicating a medium to high care dependency. The study setting was 30 nursing homes throughout Germany from 2014 to 2015. Data were collected by trained nurses using a standardized data collection form to collect information about demographic characteristics, health conditions, mobility status measured according to the Elderly Mobility Scale (EMS), UI, and QoL measured using the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF). The prevalence of UI was 69.7% (n = 1804). Analysis of variance showed that, in 1659 nursing home residents with information on UI, 572 reported a medium amount of leakage with a mean impact on health-related QoL of 2.2 (SD 2.2, P < .001) on a scale from 0 (no impact) to 10 (very high impact). The mean of the impact on QoL in 235 residents who reported a large amount of leakage was 2.4 (SD 3.0, P < .001). In 1741 residents with information on the frequency of UI, 637 reported being urinary incontinent more than once a day with a mean impact on QoL of 2.2 (SD 2.1, P < .001) and 359 residents with permanent UI stated a mean impact on QoL of 2.1 (SD 2.8, P < .001). According to the bivariate association of UI with use of walking aids, the highest prevalence of UI (61.2%) was in patients who did not use any walking aids. The Chi-square Automatic Interaction Detector (CHAID) of the relationship between mobility according to the EMS and UI indicated that 71.1% of all patients with UI did not use any walking aids, although their mobility status had been reduced. Findings indicate a significant association between impaired mobility and UI in nursing home residents. Chronic, severe urinary incontinence exerted the greatest impact on health-related QoL. Therefore, we recommend measures to preserve or regain mobility to minimize or prevent UI in geriatric residents and patients and, thus, increase their health-related QoL.

Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study.

Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA). The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis. Of the 3 927 SASOS patients, 255 (6.5%) were admitted to critical care units; of these admissions, 144 (56.5%) were planned, and 111 (43.5%) unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p&lt;0.001). Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p&lt;0.001). The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate 'high care-dependency units' for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867).

A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial

BackgroundHip fracture is a common injury in the geriatric population. Despite surgical repair and subsequent rehabilitation programmes, functional recovery is often limited, particularly in individuals with multi-morbidity. This leads to high care dependency and subsequent use of healthcare services. Fear of falling has a negative influence on recovery after hip fracture, due to avoidance of activity and subsequent restriction in mobility. Although fear of falling is highly prevalent after hip fracture, no structured treatment programme is currently available. This trial will evaluate whether targeted treatment of fear of falling in geriatric rehabilitation after hip fracture using a multi-component cognitive behavioural intervention (FIT-HIP), is feasible and (cost) effective in reducing fear of falling and associated activity restriction and thereby improves physical functioning.Methods/designThis multicentre cluster randomised controlled trial will be conducted among older patients with hip fracture and fear of falling who are admitted to a multidisciplinary inpatient geriatric rehabilitation programme in eleven post-acute geriatric rehabilitation units. Fifteen participants will be recruited from each site. Recruitment sites will be allocated by computer randomisation to either the control group, receiving usual care, or to the intervention group receiving the FIT-HIP intervention in addition to usual care. The FIT-HIP intervention is conducted by physiotherapists and will be embedded in usual care. It consists of various elements of cognitive behavioural therapy, including guided exposure to feared activities (that are avoided by the participants). Participants and outcome assessors are blinded to group allocation. Follow-up measurements will be performed at 3 and 6 months after discharge from geriatric rehabilitation. (Cost)-effectiveness and feasibility of the intervention will be evaluated. Primary outcome measures are fear of falling and mobility.DiscussionTargeted treatment of fear of falling may improve recovery and physical and social functioning after hip fracture, thereby offering benefits for patients and reducing healthcare costs. Results of this study will provide insight into whether fear of falling is modifiable in the (geriatric) rehabilitation after hip fracture and whether the intervention is feasible.Trial registrationNetherlands Trial Register: NTR 5695.

Does the care dependency of nursing home residents influence their health-related quality of life?-A cross-sectional study

BackgroundStudies on health-related quality of life (HRQOL) are missing for nursing home residents independent from their health conditions or interventions after admission. Our aim was to analyse if the care dependency of nursing home residents influence their HRQOL and to describe HRQOL of nursing home residents at the time of admission.MethodEleven German nursing homes were randomly selected for a cross-sectional multicentre study from April 2008 until December 2009. HRQOL was measured with the Nottingham Health Profile (NHP) in the six domains “Physical Mobility”, ”Energy”, “Pain”, “Social Isolation”, “Emotional Reaction” and “Sleep”. Domain scores range from zero (good subjective health status) to 100 (poor subjective health status). Care dependency was evaluated using the Care Dependency Scale, age, sex, cognitive status and diseases were documented by the research assistants. Multivariate regression analysis was performed to quantify the influence of care dependency on HRQOL.Results120 residents were included in total. HRQOL was mostly reduced in the domains “Physical Mobility” and ”Energy“ (mean scores >43.0), while impairment differences in the domains “Pain”, “Social Isolation”, “Emotional Reaction” and “Sleep” were only moderate (≤25.0). HRQOL was not influenced by the age. Women (n = 85) had a significantly poorer HRQOL in the domain “Pain” than men (mean score women: 29.5 ± 31.5; males: 14.9 ± 17.2; p = 0.011). Care dependency had an influence on the domain “Sleep” (ß = −0.195, p = 0.031), while the other domains were not influenced by care dependency. Residents with a low care dependency scored significantly lower (better HRQOL) in the domain “Sleep” than residents with a high care dependency (mean score 15.3; SD ± 19.0 versus mean score 32.8 SD ± 33.2; p < 0.02).ConclusionThe level of care dependency has no influence on the HRQOL from the nursing home residents’ perspective apart from the domain “Sleep”. High care dependency residents have a lower HRQOL in the domain “Sleep” compared to moderate and low care dependency residents. We found a significantly lower HRQOL in women compared to men in the domain “Pain“.

Predicting falls in elderly receiving home care: the role of malnutrition and impaired mobility.

To investigate the role of malnutrition, impaired mobility and care dependency in predicting fallers in older Dutch home care clients. This study is a secondary analysis of data of the annual independent national prevalence measurement of care problems of Maastricht University. The design involves a cross-sectional, multicentre point prevalence measurement (malnutrition, mobility), and a 30 days incidence measurement (falls). Dutch home care organisations. 2971 clients (older than 65 years) from 22 home care organizations participated. A standardized questionnaire was used to register amongst others data of weight, height, number and type of diseases (like for example neurologic diseases, dementia, CVA, COPD, eye/ear disorders, musculoskeletal disorders), nutritional intake, use of psychopharmaca, undesired weight loss, fall history, mobility, and care dependency. The study was able to show that fallers are more often malnourished than non-fallers in the univariate analysis. Most importantly the study indicated by multivariate analysis that fallers could be predicted by the risk factors immobility ((OR 2.516 95% CI 1.144-5.532), high care dependency (OR 1.684 95% CI 1.121-2.532) and malnutrition (OR 1.978 95% CI 1.340-2.920). The findings of this study stress that malnutrition, impaired mobility and care dependency are potential reversible factors related to falls. Therefore early identification and management of nutritional status, impaired mobility and care dependency are important aspects for a possible fall prevention strategy.

Associated factors of different nutrition indicators in German nursing home residents

Malnutrition is one of the most important care problems in the nursing home care sector. The subject of this analysis is the investigation of associative factors for different indicators of malnutrition of residents in nursing homes in Germany. A secondary data analysis was conducted using data from 4,478 nursing home residents. Unintended weight loss or reduced intake and BMI ≤ 20 were analysed as indicators for malnutrition. The influence of age, sex, co-morbidities and care dependency were investigated in logistic regression models. Residents with a high care dependency had a higher risk of suffering weight loss/reduced intake. With regard to BMI ≤ 20, residents aged > 85years, female gender, cancer, musculoskeletal disease as well as high care dependency had a higher risk. In both models, care dependency plays a major role in explaining malnutrition. Associative factors for malnutrition must be interpreted according to the indicators used to define malnutrition.

Use of physical restraints in nursing homes and hospitals and related factors: a cross‐sectional study

The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals. Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints. A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes (n = 5521) and 15 hospitals (n = 2827). For data analysis, a 3-level random intercept logistic model was used. The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model. Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints. Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.