Nursing Home Research Articles

Compiling a Set of Actionable Quality Indicators for Medical Practitioners in Dutch Nursing Homes: A Delphi Study

Most quality indicators (QIs) currently used in nursing homes reflect the care delivered by the entire multidisciplinary team and are not specific for medical practitioners. International experts have proposed a set of QIs that specifically reflect the quality of medical care in nursing homes. The objective of the Delphi study described here was to compile a set of actionable QIs tailored for medical practitioners working within Dutch nursing homes. This was achieved through the evaluation of 15 existing national QIs and 35 international QIs by a panel of medical practitioners, comprising medical specialists, nurse practitioners, and physician assistants, who are working in Dutch nursing homes. Panelists rated each QI on (1) level of direct control by medical practitioners and (2) its relevance to the quality of medical care. QIs progressing to subsequent rounds required panel agreement on both direct control (≥70% ≥3 points on a 4-point scale) and relevance (≥70% ≥8 on a 10-point scale). In the last round, each panelist selected the 5 most relevant QIs and arranged them in order of importance. These top 5 rankings were converted into points for an overall final ranking. There was consensus on 42 QIs being under the control of medical practitioners, and 21 of these QIs were considered relevant for quality of care. Most of the 21 QIs originated from the international QI set. This finding supports the transferability of the internationally developed QIs to the Dutch nursing home context and provides opportunities to compare the quality of medical care in nursing homes across countries. In the final ranking, the QI related to new medication prescriptions received the highest rating, followed by 3 QIs related to advance care planning. Future research should focus on evaluating the feasibility of measuring the selected QIs and assessing their measurement properties before implementing them in professional learning and quality improvement initiatives for medical practitioners in nursing homes.

Assessing the risks associated with indoor and outdoor air quality in relation to the geographic placement of nursing home

Indoor air quality significantly impacts the well-being and health of elderly residents in nursing homes. This study was conducted to explore the connection between indoor and outdoor PM (Particulate Matter) concentrations in nursing homes and their association with the facilities' location and construction characteristics. The findings revealed that indoor PM2.5 and PM10 concentrations ranged from 0.2 to 124 μg/m3 and 2–188.4 μg/m3, respectively, which were approximately 12.67 and 1.25 times higher than their outdoor counterparts. A strong correlation (P < 0.05) was identified between indoor PM levels and various factors, including proximity to parks, passenger terminals, and gas stations, as well as building attributes such as single-glazed windows, ceramic floor coverings, and the use of radiators. The risk assessment indicated that carcinogenic risk factors were well within acceptable limits for all nursing homes. However, it's important to note that certain PM components, particularly polycyclic aromatic hydrocarbons (PAH), may have long-term adverse effects on the health of nursing home residents. Even though indoor PM levels met the standards established by the U.S. Environmental Protection Agency (USEPA) for particulate matter risk assessments, the study emphasized that even low levels of indoor air pollutants can affect the health and well-being of older adults, particularly considering the increased vulnerability associated with aging. Consequently, the study underscores the importance of nursing home location selection and the regular monitoring of particulate matter concentrations. These measures are essential for enhancing air quality within nursing homes, ultimately contributing to the improved well-being and health of their residents.

Wandering Behavior and SARS-CoV-2 Infection in Veterans Affairs Community Living Center Residents

ObjectiveWandering behavior in nursing home (NH) residents could increase risk of infection. The objective of this study was to assess the association of wandering behavior with SARS-CoV-2 infection in Veterans Affairs (VA) Community Living Center (CLC) residents. DesignRetrospective cohort study. Setting & ParticipantsVeterans residing in 133 VA CLCs. MethodsWe included residents with SARS-CoV-2 test from March 1, 2020 to December 31, 2020 from VA electronic medical records. We identified CLC residents with wandering on Minimum Data Set 3.0 assessments and compared them with residents without wandering. The outcome was SARS-CoV-2 infection, as tested for surveillance testing, in those with and without wandering. Generalized linear model with Poisson link adjusted for relevant covariates was used. ResultsResidents (n = 9995) were included in the analytic cohort mean, (SD) age 73.4 (10.7); 388 (3.9%) women. The mean (SD) activities of daily living score in the overall cohort was 13.6 (8.25). Wandering was noted in 379 (3.8%) (n = 379) of the cohort. The exposure groups differed in prior dementia (92.6% vs 62.1%, standardized mean difference [SMD] = 0.8) and psychoses (41.4% vs 28.1%, SMD = 0.3). Overall, 12.5% (n = 1248) tested positive for SARS-CoV-2 and more residents among the wandering group were SARS-CoV-2 positive as compared with those in the group without wandering (19% [n = 72] vs 12.2% [n = 1176], SMD = 0.19). Adjusting for covariates, residents with wandering had 34% higher relative risk for SARS-CoV-2 infection (adjusted relative risk, 1.34; 95% CI, 1.04–1.69). Conclusions and ImplicationsCLC residents with wandering had a higher risk of SARS-CoV-2 infection. This may inform implementation of infection control and isolation policies as NHs attempt to balance ethical concepts of resident autonomy, proportionality, equity, and utilitarianism.

Clinical Outcomes Following Operative and Nonoperative Management of Odontoid Fractures Among Elderly Individuals with Dementia.

The incidence of odontoid fractures among the elderly population has been increasing in recent years. Elderly individuals with dementia may be at increased risk for inferior outcomes following such fractures. Although surgical intervention has been maintained to optimize survival and recovery, it is unclear if this benefit extends to patients with dementia. We hypothesized that patients with dementia who were treated operatively for odontoid fractures would experience improved survival and lower rates of hospice admission but higher rates of delirium and of intensive interventions. We used Medicare claims data (2017 to 2018) to identify community-dwelling individuals with dementia who sustained type-II odontoid fractures. We considered treatment strategy (operative or nonoperative) as the primary predictor and survival as the primary outcome. The secondary outcomes consisted of post-treatment delirium, hospice admission, post-treatment intensive intervention, and post-discharge admission to a nursing home or a skilled nursing facility. In all models, we controlled for age, biological sex, race, Elixhauser Comorbidity Index, Frailty Index, admission source, treating hospital, and dual eligibility. Adjusted analyses for survival were conducted using Cox proportional hazards regression. Adjusted analyses for secondary outcomes were performed using generalized estimating equations. To address confounding by indication, we performed confirmatory analyses using inverse probability of treatment weighting. In this study, we included 1,030 patients. The median age of the cohort was 86.5 years (interquartile range, 80.9 to 90.8 years), 60.7% of the patients were female, and 90% of the patients were White. A surgical procedure was performed in 19.8% of the cohort. Following an adjusted analysis, patients treated surgically had a 28% lower hazard of mortality (hazard ratio, 0.72 [95% confidence interval (CI), 0.53 to 0.98]), but higher odds of delirium (odds ratio, 1.64 [95% CI, 1.10 to 2.44]). These findings were preserved in the inverse probability weighted analysis. We found that, among individuals with dementia who sustain a type-II odontoid fracture, surgical intervention may confer a survival benefit. A surgical procedure may be an appropriate treatment strategy for individuals with dementia whose life-care goals include life prolongation and maximizing quality of life in the short term following an injury. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Program Pengabdian Masyarakat Untuk Edukasi Dan Deteksi Dini Dislipidemia Dan Obesitas

Dyslipidemia in the elderly is a serious condition characterized by high or low levels of lipids in the blood, including cholesterol and triglycerides, which increases the risk of cardiovascular disease. In this community service activity, education and health checks were carried out on 94 elderly people at the Bina Bhakti Nursing Home. The results showed that 90.3% of elderly people had normal cholesterol levels, while 9.7% had dyslipidemia. As many as 62.4% had optimal HDL levels, but 37.6% had non-optimal HDL levels. Regarding LDL parameters, 62.4% had optimal levels and 37.6% did not have optimal levels. Dyslipidemia was more common in elderly women (10.8%) than men (5.3%). Modifiable risk factors such as diet and physical activity greatly influence blood lipid levels. Education regarding the importance of a healthy diet and regular health checks is very necessary to manage dyslipidemia in the elderly. This activity emphasizes the importance of a comprehensive educational approach and program to reduce the prevalence of dyslipidemia and improve the quality of life of the elderly. Keywords: Education, Hyperlipidemia, Cardiovascular, Elderly, Screening

Oral Health and Swallowing Function of Nursing Home Residents.

Although a good oral environment helps reduce the risk of pneumonia in the elderly, repeated pneumonia can occur even with frequent oral care. The actual risk of pneumonia during oral intake, the choice of whether oral intake is possible, and the choice of food form are often determined using video fluorography (VF), which can provide detailed information on swallowing function. However, few reports have compared the oral environment and swallowing function, leaving the relationship unclear. We examined the relationship between the oral environment and swallowing function and the characteristics of swallowing function in elderly nursing home residents. The subjects were 48 elderly nursing home residents (13 males, 35 females) with a mean age of 89 years who underwent outpatient or inpatient evaluation of their oral environment and swallowing function. There were three groups of residents: those who were evaluated for swallowing as outpatients, those who were hospitalised for pneumonia, and those who were hospitalised for diseases other than pneumonia. The oral environment was assessed by a dentist or dental hygienist using the Oral Health Assessment Tool (OHAT). Swallowing function was assessed by an otorhinolaryngologist using VF. There was no correlation between OHAT and VF scores in the outpatient group or the group hospitalised for pneumonia, but there was a correlation in the group hospitalised for reasons other than pneumonia. In facilities with good oral care, the development of pneumonia may be related to factors other than the oral environment and the OHAT may reflect conditions other than swallowing function. The swallowing function of nursing home residents should be evaluated by VF, which allows observation of all stages of swallowing.

The Perspective of Residents Living With Dementia Toward Their Built Environment: A Walking Interview Study in German Nursing Homes.

In long-term care, the built environment can help residents maintain activities of daily living and thus positively influence their quality of life. The adequacy of the built environment can be systematically assessed using assessment tools. The German Environmental Audit Tool (G-EAT) was translated and psychometrically tested for the German setting. Previous research has shown that the perspective of people living with dementia has not been fully considered in this adaptation. To explore the residents' perspective, the question of how residents living with dementia experience the built environment of nursing homes was investigated. Walking interviews were conducted with residents. Inclusion criteria for participation were the presence of dementia (medically diagnosed or indicated by symptoms) and the ability to express themselves verbally in German. For data analysis, the audio material was transcribed and supplemented by the researchers' field notes and photographs. Data analysis followed an interpretative phenomenological approach. Fourteen residents from 2 nursing homes participated in the walking interviews. A total of 3 themes were identified: (1) being able to maintain the feeling "to refurnish" or having to let it go, (2) experiencing the limits and potentials of being independent because of the built environment, and (3) living in a community of residents. The perspective of the living environment of people living with dementia in nursing homes adds to the knowledge of assessment-based data. Boundaries between physical and social environments are experienced as fluid by residents. They do not see their living space as limited to their living unit but describe the nursing home as a living environment. This broadens the perspective of existing structural definitions in the setting.

Advance Directives Change Frequently in Nursing Home Residents

ObjectivesTo describe the rate, timing, and pattern of changes in advance directives (ADs) of do not resuscitate (DNR) and do not hospitalize (DNH) orders among new admissions to nursing homes (NHs). DesignA retrospective cohort study. Setting and ParticipantsAdmissions to all publicly funded NHs in Ontario, Canada, between January 1, 2013, and December 31, 2017. MethodsResidents were followed until discharged from incident NH stay, death, or were still present at the end of study (December 31, 2019). They were categorized into 3 mutually exclusive baseline composite AD groups: Full Code, DNR Only, and DNR+DNH. We used Poisson regression models to estimate the incidence rate ratios of AD change between different AD groups and different decision makers for personal care, adjusted for baseline clinical and sociodemographic variables. ResultsA total of 102,541 NH residents were eligible for inclusion. Residents with at least 1 AD change accounted for 46% of Full Code, 30% of DNR Only, and 25% of DNR+DNH group. Median time to first AD change ranged between 26 and 55 weeks. For Full Code and DNR Only residents, the most frequent change was to an AD 1 level lower in aggressiveness or intervention, whereas for DNR+DNH residents the most frequent change was to DNR Only. About 16% of residents had 2 or more AD changes during their stay. After controlling for covariates, residents with a DNR-only order or DNR+DNH orders at admission and those with a surrogate decision maker were associated with lower AD change rates. Conclusions and ImplicationsMeasuring AD adherence rates that are documented only at a particular time often underestimates the dynamics of AD changes during a resident's stay and results in an inaccurate measure of the effectiveness of AD on resident care. There should be more frequent reviews of ADs as they are quite dynamic. Mandatory review after an acute change in a resident's health would ensure that ADs are current.

Mental Health Treatment Among Nursing Home Residents With Alzheimer's Disease and Related Dementias

ObjectivesTo examine the prevalence of mental health treatment among nursing home (NH) long-stay residents with Alzheimer's disease and related dementias (ADRD) and explore factors associated with utilization. DesignRetrospective cohort study. Minimum Data Set data (April 2017–September 2018), Medicare Master Beneficiary Summary File, Part B Carrier file and Part D prescription file were used to identify mental illness and ADRD diagnoses, patient characteristics, and mental health treatment. Setting and ParticipantsAll US Medicare- or Medicaid-certified NHs. Fee-for-service Medicare beneficiaries aged 65 and older who had a quarterly or annual Minimum Data Set assessment with ADRD and were enrolled in Medicare Parts B and D. Two cohorts: residents with both ADRD and psychiatric disorders; residents with ADRD only. MethodsPrimary outcomes: receipt of (1) any mental health treatment (medication or psychotherapy); (2) any psychotherapy in a calendar quarter. Secondary outcomes: antipsychotics, antidepressants, hypnotics, antiepileptics, short-session ( ≤ 30 minutes), long-session ( ≥ 45 minutes), and family/group psychotherapy. Covariates included predisposing, enabling characteristics, and needs factors. Generalized Estimating Equation models of quarterly data, nested within patients, were estimated for each outcome among each cohort. ResultsAnalyses included 1,913,945 resident-quarter observations from 503,077 unique NH long-stay residents. Overall, 68.5% of NH long-stay residents with ADRD have psychiatric disorders; of these, 85% received mental health treatment. African American or Hispanic residents were less likely to use antidepressants. African American residents or residents living in rural locations were less likely to receive long-session psychotherapy. Hispanic residents were more likely to receive long-session psychotherapy. Residents in minority groups were more likely to receive group/family psychotherapy. Conclusions and ImplicationsMost of NH long-stay residents with ADRD had psychiatric disorders and most of them received treatment. Antidepressants or long-session psychotherapy were less likely to be provided to African American residents. Factors that determine the efficacy of mental health treatment and reasons for the racial disparities require further exploration.

Discharge to Skilled Nursing Facility Is a Risk Factor for Readmission: A Nationwide Propensity-Matched Study

IntroductionGeneral surgery procedures place stress on geriatric patients, and postdischarge care options should be evaluated. We compared the association of discharge to a skilled nursing facility (SNF) versus home on patient readmission. MethodsWe retrospectively reviewed the Nationwide Readmission Database (2016-2019) and included patients ≥65 y who underwent a general surgery procedure between January and September. Our primary outcome was 30-d readmissions. Our secondary outcome was predictors of readmission after discharge to an SNF. We performed a 1:1 propensity-matched analysis adjusting for patient demographics and hospital course to compare patients discharged to an SNF with patients discharged home. We performed a sensitivity analysis on patients undergoing emergency procedures and a stepwise regression to identify predictors of readmission. ResultsAmong 140,056 included patients, 33,916 (24.2%) were discharged to an SNF. In the matched population of 19,763 pairs, 30-d readmission was higher in patients discharged to an SNF. The most common diagnosis at readmission was sepsis, and a greater proportion of patients discharged to an SNF were readmitted for sepsis. In the sensitivity analysis, emergency surgery patients discharged to an SNF had higher 30-d readmission. Higher illness severity during the index admission and living in a small or fringe county of a large metropolitan area were among the predictors of readmission in patients discharged to an SNF, while high household income was protective. ConclusionsDischarge to an SNF compared to patients discharged home was associated with a higher readmission. Future studies need to identify the patient and facility factors responsible for this disparity.

Kegiatan Penapisan Pemeriksaan Gula Darah Sewaktu terhadap Penyakit Diabetes Mellitus Tipe 2 pada Populasi Lanjut Usia di Panti Werda Hana

Insulin and glucagon, hormones secreted by the pancreas, regulate blood glucose, the main source of energy for cells. Insulin facilitates glucose uptake and glycogen synthesis, whereas glucagon increases blood glucose by stimulating glycogenolysis and gluconeogenesis in the fasting state. An increase in blood glucose above normal over a long period of time can cause diabetes mellitus. The prevalence of type 2 diabetes among the elderly in Indonesia is 6.2%, with a projected increase to 12 million cases by 2030. The causes include genetic factors, aging, unhealthy eating patterns, a lack of movement, and comorbidities such as obesity and hypertension. This activity uses the PDCA (Plan-Do-Check-Action) method, which aims to carry out blood glucose checks as an early detection of type 2 diabetes mellitus. The Hana Nursing Home in South Tangerang hosted this activity, which involved 61 participants. The results of the blood glucose examination showed that 15 people (24.58%) had diabetes and 33 people (54.1%) had pre-diabetes. Early detection and effective management are essential to prevent complications and maintain functional status.

Kegiatan Penapisan Kesehatan Mental Mengenai Depresi Pada Kelompok Lanjut Usia

Depression is a common mental disorder in the elderly, associated with emotional distress, increased health care costs, the risk of suicide, and death from other causes. Depression in the elderly is characterised by persistent sadness, helplessness, anhedonia, changes in appetite, sleep disturbances, psychomotor retardation or agitation, fatigue, impaired concentration, and suicidal ideation. Prevalence varies between 7 and 30%, higher in women. Risk factors include bereavement, social isolation, and somatic diseases, which are more common in old age. Depression increases the risk of dementia, morbidity, and mortality, emphasising the need for early screening. This activity uses the PDCA (Plan-Do-Check-Act) method to screen for depression in 61 elderly participants at the Hana Nursing Home using the Geriatric Depression Scale (GDS) questionnaire. The examination results revealed mild, moderate, and severe depression in 8 people (13.11%), 4 people (6.56%), and 2 people (3.28%), respectively. Early detection using GDS is essential for timely intervention, including counselling and medical advice, to improve quality of life and reduce depression-related morbidity and mortality in the elderly population.

Development and evaluation of a narrative therapy program combined with a solution-focused approach for nursing home residents: A quasi-experimental study

The transition from the family home to a nursing home can be an emotionally stressful experience for older adults. This study aimed to examine the feasibility and effects of a narrative therapy combined with a solution focus (NTCSF) program on the psychological adjustment, depression, and self-efficacy of nursing home residents. A non-random concurrent controlled trial was conducted in Fujian, China that involved 81 participants (intervention = 41, comparison = 40) from four separate nursing homes. The control group received routine institutional care, while the intervention group underwent a three-week NTCSF program in addition to receiving routine care. In the variance analyses, significant differences were found in “psychological adjustment” (T = 4.007, P < 0.001) and “self-efficacy” (T = 3.204, P = 0.002), compared to the control group. There was no significant difference in “depression” (t = -1.550, P = 0.125) between the groups at the baseline, but the experimental group showed a significant decrease in depression (t = -2.204, P = 0.033) after the intervention. The NTCSF program was found to be effective in improving the psychological adjustment of nursing home residents.Trial registration This study was registered on the Chinese Clinical Trial Registry (Registration No: ChiCTR-2100042767).

Providing Ergonomic Exercise Therapy To Reduce Joint Pain In The Elderly In Jember's Nursing Home

Providing Ergonomic Exercise Therapy To Reduce Joint Pain In The Elderly In Jember's Nursing Home

A Study of the Housing Transition of Residents of Private nursing care homes

A Study of the Housing Transition of Residents of Private nursing care homes

Progressive Muscle Relaxation Reduces Blood Pressure in Older Adults with Hypertension

Introduction: The physiological aging process in older adults may lead to various disturbances in the cardiovascular system, including hypertension. One approach to controlling blood pressure is through progressive muscle relaxation therapy. This study aimed to investigate the effect of progressive muscle relaxation on blood pressure in older adults with hypertension at the Social Service Unit for Older Adults in Blitar and Nursing Home in Tulungagung in 2023. Methods: This study employed a quasi-experimental method with a one-group pre-post test design. The population consisted of all older adults with hypertension at the research site in 2023, totaling 80 individuals. Purposive sampling was used to recruit the samples of 39 participants. Observation sheets and a sphygmomanometer were utilized for data collection. Result: The results showed that before receiving progressive muscle relaxation therapy, most participants had stage-1 hypertension, with 23 participants (59%), and stage-2 hypertension, with 16 participants (41%). After the therapy, the majority of participants were included in the stage-1 hypertension category, with 26 participants (67%), and prehypertension, with 5 participants (13%). The Wilcoxon test showed a significant value of ρ = 0.000 &lt; α = (0.05), indicating the effect of progressive muscle relaxation therapy on blood pressure. This means that regular therapy sessions may lead to better blood pressure control in hypertensive patients. Conclusion: Progressive muscle relaxation therapy can increase endorphin hormone production and reduce stress levels, thereby stabilizing blood pressure.

Home Blood Pressure Telemonitoring and Nurse Case Management in Black and Hispanic Patients With Stroke

Black and Hispanic patients have high rates of recurrent stroke and uncontrolled hypertension in the US. The effectiveness of home blood pressure telemonitoring (HBPTM) and telephonic nurse case management (NCM) among low-income Black and Hispanic patients with stroke is unknown. To determine whether NCM plus HBPTM results in greater systolic blood pressure (SBP) reduction at 12 months and lower rate of stroke recurrence at 24 months than HBPTM alone among Black and Hispanic stroke survivors with uncontrolled hypertension. Practice-based, multicenter, randomized clinical trial in 8 stroke centers and ambulatory practices in New York City. Black and Hispanic study participants were enrolled between April 18, 2014, and December 19, 2017, with a final follow-up visit on December 31, 2019. Participants were randomly assigned to receive either HBPTM alone (12 home BP measurements/week for 12 months, with results transmitted to a clinician; n = 226) or NCM plus HBPTM (20 counseling calls over 12 months; n = 224). Primary outcomes were change in SBP at 12 months and rate of recurrent stroke at 24 months. Final statistical analyses were completed March 14, 2024. Among 450 participants who were enrolled and randomized (mean [SD] age, 61.7 [11.0] years; 51% were Black [n = 231]; 44% were women [n = 200]; 31% had ≥3 comorbid conditions [n = 137]; 72% had household income <$25 000/y [n = 234/324]), 358 (80%) completed the trial. Those in the NCM plus HBPTM group had a significantly greater SBP reduction than those in the HBPTM alone group at 12 months (-15.1 mm Hg [95% CI, -17.2 to -13.0] vs -5.8 mm Hg [95% CI, -7.9 to -3.7], respectively; P < .001). The between-group difference in SBP reduction at 12 months, adjusted for primary care physician clustering, was -8.1 mm Hg (95% CI, -11.2 to -5.0; P < .001) at 12 months. The rate of recurrent stroke was similar between both groups at 24 months (4.0% in the NCM plus HBPTM group vs 4.0% in the HBPTM alone group, P > .99). Among predominantly low-income Black and Hispanic stroke survivors with uncontrolled hypertension, addition of NCM to HBPTM led to greater SBP reduction than HBPTM alone. Additional studies are needed to understand the long-term clinical outcomes, cost-effectiveness, and generalizability of NCM-enhanced telehealth programs among low-income Black and Hispanic stroke survivors with significant comorbidity. Clinical Trials.gov Identifier: NCT02011685.

Leadership Matters: Investigating the Association Between Nursing Home Administrator Turnover and Quality.

Existing research has associated nursing home (NH) staff turnover with poor performance, yet the impact of nursing home administrator (NHA) turnover remains relatively understudied. This study aimed to explore the relationship between NHA turnover and NH quality, and to determine if this relationship was mediated by registered nurse (RN) turnover. Utilizing data from multiple secondary sources, including the Care Compare: Skilled Nursing Facility Quality Reporting Program (SNF QRP) and LTCFocus.org, this study employed a longitudinal analysis covering the period 2021-2022 (n = 19,645). The dependent variable was quality star ratings from SNF QRP, whereas the independent variable was NHA turnover, reflecting the number of administrators who left each facility annually. We used Baron and Kenny's mediation testing method, incorporating 2-way fixed effects (state and year level) with appropriate organizational and market level control variables. The results affirmed that NHA turnover negatively affected quality, decreasing the likelihood of a higher star rating by 14% with one departure and 25% with multiple departures (p = .001). Additionally, NHA turnover correlated with an increase in RN turnover by 7% and 11%, respectively, for one and multiple departures (p = .001). RN turnover fully mediated the impact of NHA turnover on quality, nullifying the direct effect of NHA turnover. The results of this study highlight the synergistic relationship between administrators and caregivers in NHs. To enhance NHA retention, NHs should improve compensation and benefits. Nonetheless, broader governmental support and interventions might be necessary to sustain these improvements.

Adherence to Legionella control regulations and guidelines in Norwegian nursing homes: a cross-sectional survey

BackgroundInfection by Legionella bacteria is a risk to elderly individuals in health care facilities and should be managed by preventing bacterial proliferation in internal water systems. Norwegian legislation calls for a mandatory Legionella-specific risk assessment with the subsequent introduction of an adapted water management programme. The present study investigates adherence to legislation and guidelines on Legionella control and prevention in Norwegian nursing homes.MethodsA cross-sectional survey was distributed to Norwegian municipalities to investigate the status of Legionella specific risk assessments of internal water distribution systems and the introduction of water management programmes in nursing homes.ResultsA total of 55.1% (n = 228) of the participating nursing homes had performed Legionella-specific risk assessments, of which 55.3% (n = 126) stated that they had updated the risk assessment within the last year. 96.5% introduced a water management programme following a risk assessment, whereas 59.6% of the ones without a risk assessment did the same. Nursing homes with risk assessments were more likely to monitor Legionella levels than those without (61.2% vs 38.8%), to remove dead legs (44.7% vs 16.5%), and to select biocidal preventive treatment over hot water flushing (35.5% vs 4.6%).ConclusionsThis study presents novel insight into Legionella control in Norway, suggesting that adherence to mandatory risk assessment in nursing homes is moderate-low. Once performed, the risk assessment seems to be advantageous as an introduction to future Legionella prevention in terms of the scope and contents of the water management programme.

Polypharmacy and potentially inappropriate prescribing of benzodiazepines in older nursing home residents

Introduction Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. Methods Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. Results The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2–3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). Conclusions Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.