Homes In Bergen Research Articles

Ethical dilemmas for nursing home doctors during the COVID-19 pandemic.

Nursing home residents were particularly vulnerable to a serious clinical course of COVID-19. It was therefore decided early in the pandemic that nursing homes needed to be protected through measures such as testing and isolation regimens and restrictions on visiting. This entailed new procedures and guidelines for nursing home doctors. Norwegian and international studies show that the pandemic presented new ethical dilemmas for healthcare staff. The aim of this study was to provide a better understanding of the ethical issues faced by nursing home doctors during the pandemic. Nine semi-structured in-depth interviews with doctors at five nursing homes in Bergen were analysed using Attride-Stirling's thematic network analysis. The doctors told of challenges related to deciding the level of treatment, setting limits for palliative care, adapting visiting restrictions, and assessing the use of coercion with regard to testing and isolation. This entailed difficult ethical considerations whereby doctors were faced with conflicts of interest and value judgements, central to which was consideration for the individual resident versus society. The nursing home doctors in our study found it difficult to find a balance between protecting the residents' autonomy and preventing the spread of infection.

The Effect of Bright Light Treatment on Rest-Activity Rhythms in People with Dementia: A 24-Week Cluster Randomized Controlled Trial.

Bright light treatment is an effective way to influence circadian rhythms in healthy adults, but previous research with dementia patients has yielded mixed results. The present study presents a primary outcome of the DEM.LIGHT trial, a 24-week randomized controlled trial conducted at nursing homes in Bergen, Norway, investigating the effects of a bright light intervention. The intervention consisted of ceiling-mounted LED panels providing varying illuminance and correlated color temperature throughout the day, with a peak of 1000 lx, 6000 K between 10 a.m. and 3 p.m. Activity was recorded using actigraphs at baseline and after 8, 16, and 24 weeks. Non-parametric indicators and extended cosine models were used to investigate rest–activity rhythms, and outcomes were analyzed with multi-level regression models. Sixty-one patients with severe dementia (median MMSE = 4) were included. After 16 weeks, the acrophase was advanced from baseline in the intervention group compared to the control group (B = −1.02, 95%; CI = −2.00, −0.05). There was no significant difference between the groups on any other rest–activity measures. When comparing parametric and non-parametric indicators of rest–activity rhythms, 25 out of 35 comparisons were significantly correlated. The present results indicate that ambient bright light treatment did not improve rest–activity rhythms for people with dementia.

A prospective evaluation of the Flacker-Kiely One Year Mortality Score and the added value of NT-proBNP

Objective: Several mortality indices have been constructed to aid clinical decision making in older adults. We aimed to prospectively validate the Flacker-Kiely (FK) mortality index in a Norwegian nursing home cohort, which has not been done before, and explore whether NT-ProBNP could improve its discriminatory power.Methods: We performed a cohort/mortality study. From November 2017 to July 2018, physicians in all public long-term nursing homes in Bergen, Norway, scored residents according to the original Flacker Kiely index. Mortality data were derived from the Norwegian Cause of Death Registry and NT-ProBNP values were obtained from routinely collected blood chemistry. An alternative FK index using the NT-ProBNP-value as a marker for the presence of heart failure was constructed (FK NT-ProBNP index). The ProBNP cut-off value was selected based on a Cox regression model (“dead/alive 1 year”/” NT-ProBNP (Ng/l)”, where the value with the highest Youden index was identified. We judged index performance by using c-statistics.Results: Both the original FK index and the constructed FK NT-ProBNP index discriminated between risk strata. The FK NT-ProBNP index yielded a C-index of 0.66 compared to 0.62 for the original FK index. Optimal discriminatory power was shown with a NT-ProBNP cut-off value of 1,595 Ng/l as heart failure criterion, and FK NT-ProBNP score 6.6.Conclusions: The prospective mortality estimation ability of the FK-index was comparable to previous retrospective studies. The inclusion of NT-ProBNP as a heart failure criterion strengthen the discriminatory power and utility of the index, both in clinic and administration.

The Possibility of Therapeutic Drug Monitoring of the Most Important Interactions in Nursing Homes.

BackgroundTherapeutic drug monitoring is a relevant tool in drug treatment of elderly patients. The aim of this study was to assess the possibility of therapeutic drug monitoring of the most important potential interactions in nursing homes.MethodsA material of prescribed drugs to 446 patients in three nursing homes in Bergen, Norway from a single day in March 2016 was analysed. Clinically relevant drug interactions (pharmacodynamic or pharmacokinetic) were identified and classified with Stockley`s Interaction Alerts. The most important interaction among several in each patient were ranked by recommended action > severity > evidence according to Stockley`s. The possibility of therapeutic drug monitoring of drug combinations involved in the most important interactions was retrieved from a database of all laboratories performing clinical pharmacology in Norway (the Pharmacology Portal).ResultsTwo or more drugs were used by 443 (99.3%) of 446 patients. Three-hundred and eighty-four patients (86.1%) had > 1 interaction. About 95% of the most important interactions were pharmacodynamic. In 280 (72.9%) of these interactions, Stockley`s recommended adjust dose or monitoring. Among the 384 most important interactions, 93% involved one drug and 41% involved two drugs available for therapeutic drug monitoring.ConclusionIn this pilot study, therapeutic drug monitoring was possible in the majority of the most important interactions in Norwegian nursing homes. This option is of importance since adjust dose or monitoring were frequently recommended actions associated with these interactions.

Teaching Information Literacy for Lifelong Professional Use

This paper presents a pilot study carried out in 2015-2016. The main aims of the project was to map information literacy practices among nurses in primary health care and make a summary of previous research focusing on known obstacles. A further aim of the literature review was to identify good solutions and best practice. In spring 2016 a questionnaire was sent out to nurses working in nursing homes in Bergen, Norway. This presentation will outline specificities of IL in the health care context and will then present a few results from the questionnaire connected to this specific context.

Hospital Admissions from Nursing Homes: Rates and Reasons

Hospital admissions from nursing homes have not previously been investigated in Norway. During 12 months all hospital admissions (acute and elective) from 32 nursing homes in Bergen were recorded via the Norwegian ambulance register. The principal diagnosis made during the stay, length of stay, and the ward were sourced from the hospital's data register and data were merged. Altogether 1,311 hospital admissions were recorded during the 12 months. Admissions from nursing homes made up 6.1% of the total number of admissions to medical wards, while for surgical wards they made up 3.8%. Infections, fractures, cardiovascular and gastri-related diagnoses represented the most frequent admission diagnoses. Infections accounted for 25.0% of admissions, including 51.0% pneumonias. Of all the admissions, fractures were the cause in 10.2%. Of all fractures, hip fractures represented 71.7. The admission rate increased as the proportion of short-term beds increased, and at nursing homes with short-term beds, admissions increased with increasing physician coverage. Potential reductions in hospitalizations for infections from nursing homes may play a role to reduce pressure on medical departments as may fracture prevention. Solely increasing physician coverage in nursing homes will probably not reduce the number of hospitalizations.

Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes

Objective. To describe an innovative team intervention to identify and resolve DRPs (drug-related problems) in Norwegian nursing homes. Design. Descriptive intervention study. Setting. Three nursing homes in Bergen, Norway. Subjects. A total of 142 long-term care patients (106 women, mean age 86.9 years). Results. Systematic medication reviews performed by pharmacists in 142 patients revealed altogether 719 DRPs, of which 504 were acknowledged by the patients’ physician and nurses, and 476 interventions were completed. “Unnecessary drug” and “Monitoring required” were the most frequently identified DRPs. Drugs for treating the nervous system and the alimentary tract and metabolism were most commonly questioned. Conclusions. The multidisciplinary team intervention was suitable to identify and resolve drug-related problems in nursing home settings. Systematic medication reviews and involvement of pharmacists in clinical teams should therefore be implemented on a regular basis to achieve and maintain high-quality drug therapy.

The impact of social support and sense of coherence on health-related quality of life among nursing home residents—A questionnaire survey in Bergen, Norway

Background and objectives Few studies have examined the association between social support and health-related quality of life (HRQOL) among nursing home residents and whether the sense of coherence (SOC) modifies the effect of social support on health-related quality of life. The main aims of this study were to determine the relationship between social support and HRQOL and to investigate whether the SOC modifies the effect of social support on HRQOL. Design A cross-sectional, descriptive, correlational design. Settings All 30 nursing homes in Bergen in western Norway. Participants Two hundred and twenty-seven mentally intact long-term nursing home residents 65 years and older. Methods Data were obtained through face-to-face interviews using the SF-36 Health Survey, Social Provisions Scale and Sense of Coherence Scale. Possible relationships between the Social Provisions Scale and the eight SF-36 subdimensions were analysed using multiple linear regression while controlling for age, sex, marital status, education and comorbid illness. Interactions between the Sense of Coherence Scale and Social Provisions Scale were investigated. Results Attachment affected the mental health subdimension ( p = 0.001), opportunity for nurturance affected social functioning ( p = 0.003) and reassurance of worth affected vitality ( p = 0.001) after adjustment for demographic variables and comorbid illness. After the analysis included the sense of coherence, nurturance still significantly affected social functioning and reassurance of worth still significantly affected vitality. No interaction with sense of coherence was found, and sense of coherence significantly affected all SF-36 subdimensions. Conclusions The opportunity to provide nurturance for others appears to be important for social functioning, and sense of competence and sense of self-esteem appear to be important for vitality. Further, the residents’ relationships with significant others comprise an important component of mental health. Finally, independent of the level of sense of coherence, social support is an important resource for better health-related quality of life. Clinical nurses should recognize that social support is associated with health-related quality of life and pay attention to the importance of social support for the residents in daily practice.

Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment?

Mentally impaired and demented nursing home patients are at increased risk of undertreatment for pain. We wanted to examine pain assessment and complaints and pain treatment of nursing home patients according to mental state, and with special regard to treatment of patients with dementia diagnosis and cognitively impaired patients who did not have a dementia diagnosis. Cross sectional study from three nursing homes in Bergen, Norway including 125 persons (median age 84 years), living permanently in a nursing home. Diagnoses and prescribed and administered analgesic drugs were recorded. An experienced nurse interviewed nurses in charge and patients regarding presence of pain during the last week. Patients who were able to answer whether they had experienced pain during the last week were categorised as communicative. Cognitive function was assessed by means of the Abbreviated Mental Test. Seventeen percent of the patients were cognitively intact, 30% cognitively impaired and 54% had a dementia diagnosis. Forty-seven percent of communicative patients complained of pain, nurses reported pain in 67% patients. Twenty-nine percent of the patients had received scheduled analgesics during the last week, cognitively intact patients 38%, cognitively impaired 30%, demented 25% (p = 0.53). Twenty percent were given analgesics PRN: cognitively intact patients 33%, cognitively impaired 27%, demented 12% (p = 0.05). Logistic regression analyses revealed that patients with dementia diagnosis were less likely to receive PRN medication [Adjusted odds ratio (AOR) 0.22 95% confidence interval (CI) 0.06-0.76] compared to mentally impaired patients. Regarding scheduled medication there was no difference between the groups. Nurses' opinion of pain was a significant factor for receiving analgesic drugs, scheduled AOR 3.95 95% CI 1.48-10.5, PRN 3.80-95% CI 1.28-11.3). A label of dementia may bias the interpretation of pain cues of demented patients, while complaints from cognitively impaired patients may be taken for granted. This may contribute to lower use of PRN medication in demented patients compared to cognitively impaired patients.

Missing the diagnosis: senile dementia in patients admitted to nursing homes

Missed dementia diagnosis may contribute to advanced nursing home placement. Every third dementia case among recently admitted nursing home patients was lacking a diagnosis. Most dementia cases could be identified when implementing specific information from nursing staff. Objective - To establish dementia diagnoses in patients recently admitted to a nursing home by a geriatrician, and to compare the agreement with diagnoses recorded in the nursing home's medical records and with short screening instruments. Design - Descriptive study. Geriatric work-up of the individual patient, information obtained from the medical records of nursing homes, structured interviews with nurses and a short cognitive test. Setting - Nursing homes in Bergen, Norway, with 123 long-term care patients. Main outcome measures - Dementia diagnosis according to the International Classification of Diseases (ICD-10), Clinical Dementia Rating and the Short Portable Mental Status Questionnaire. Results - Fifty-nine percent of the patients were diagnosed as demented according to the ICD-10. One-third of cases were not formerly diagnosed according to nursing home medical records. Clinical Dementia Rating and the Short Portable Mental Status Questionnaire detected "dementia/non-dementia" cases correctly in 93% and 94%, respectively. Conclusion - Geriatric work-up indicates under-diagnosing of dementia among recently admitted nursing home patients. This may have serious consequences for the treatment. Dementia diagnostics in primary health care must be improved. The knowledge of the attending nurses should be better incorporated in the medical work-up of nursing home patients.

Psychotropic drug use in nursing homes--diagnostic indications and variations between institutions.

Psychotropic drug use among nursing home residents with regard to diagnostic indications and patient- and institution characteristics was analysed. A cross-sectional study of medication data from 1552 residents at 23 nursing homes in Bergen, Norway, was performed. Psychotropic drug use (neuroleptics, anxiolytics, hypnotics, antidepressants, and two sedative antihistamines) was analysed with regard to prevalence, diagnostic indications, duration of use, and general patient- and institution characteristics. Psychotropic drugs were taken on a daily schedule by 59% of all residents, most commonly as long-term treatment. Antidepressants (in 70% selective serotonin re-uptake inhibitors) were used by 31%, neuroleptics by 23%, and benzodiazepines by 22% of all the residents. Neuroleptics were given for non-psychotic behavioural and psychological symptoms in 66% of the cases. Sleeping disorders were most commonly treated with long-acting benzodiazepine hypnotics. Psychotropic drug use decreased with increasing patient age. Drug use patterns varied greatly between the different nursing homes: the prevalence of neuroleptic use varied from 0 to 61% of the residents, and antidepressant use varied from 10 to 63%. In nursing homes providing relatively more physician staff time, the residents were more likely to use antidepressants. Psychotropic drugs are used by a majority of nursing home residents as long-term symptomatic treatment. The great variations between the institutions can only to a small extent be explained by quantitative differences between the institutions.

Drug treatment of heart failure - Do nursing-home residents deserve better?

Objective - To describe and assess drug treatment of heart failure (HF) in nursing-home residents. Design - Descriptive cross-sectional study. Individual patient information was obtained from the medical records and drug-dispensing cards. Setting - Nursing homes in Bergen, Norway. Main outcome measures - Demographic data, diagnostic data (main diagnoses, diagnostic indications for the drugs used), medications (drugs, dosage and duration of use). Results - Data were gathered from 23 of 27 obtainable institutions representing 1552 residents (86% of the Bergen nursing-home population); 469 (30%) of the residents used drugs for HF, the majority of whom (293 patients) were treated with furosemide only. Supplementary angiotensin-converting enzyme (ACE) in-hibitors (predominantly in sub-target doses) were provided to 17% of the HF patients. About one out of four used drug combinations which we considered to be potentially harmful for HF patients. Conclusions ? ACE inhibitors are probably under-utilised for HF in nursing-home residents. Potentially harmful drug combinations commonly occur. Both diagnosis and drug treatment for HF should be challenged in the nursing-home setting.

Consumption of psychotropic drugs in nursing home residents: A prospective study in patients permanently admitted to a nursing home

AbstractIn a prospective study, the routine handling of psychotropic drugs in five nursing homes in Bergen, Norway, was examined in patients who were admitted to a permanent stay. A follow‐up was performed after 3 months. Of the 83 patients who were admitted 64% consumed psychotropic drugs, at follow‐up 68%. Both at admittance and after 3 months one‐third of the residents were treated with antipsychotics. For antipsychotics alone evident changes were observed during the observation time. The consumers were more liable to be demented, restless and wandering. The study confirms the high number of residents using psychotropic drugs. It is concluded that 'overprescription' seems to be a general way of treating disruptive behaviour and not confined to nursing homes.