Life Of Nursing Home Residents Research Articles

Preferences and Quality of Life in Nursing Home Residents: A Mixed Methods Study.

Delivery of person-centered care (PCC) is the standard in nursing homes (NHs) and demonstrates a positive impact on resident quality of life (QOL). PCC inherently recognizes and prioritizes resident preferences; however, preferences, and their degree of importance among residents, demonstrate a variable relationship with QOL that remains underexplored. Therefore, the current study examined the association between preferences and QOL among NH residents. A mixed methods study incorporating surveys was conducted among 144 residents, with semi-structured follow-up interviews with 11 residents. Findings confirm a variable relationship between resident preferences and QOL. Higher order preferences not captured within the preference assessment may influence QOL. High numbers of unimportant and can't do/no choice preferences were linked to resident acclimatization to the NH. QOL was at risk if care was not consistent with preferences. In-depth assessments and robust measures of preferences and QOL should be integrated into care delivery and future research. [Journal of Gerontological Nursing, 50(5), 7-13.].

Factors Associated With the Quality of Life of Nursing Home Residents During the COVID-19 Pandemic: A Cross-Sectional Study.

Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL. Cross-sectional study (July to December 2021). We purposefully selected 9 NHs in Alberta, Canada, based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). We included data for 689 residents from 18 care units. We used the DEMQOL-CH to assess resident QoL through video-based care aide interviews. Independent variables included a COVID-19 outbreak in the NH in the past 2weeks (health authority records), care unit-levels of care aide burnout (9-item short-form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit (validated surveys), and resident covariates (Resident Assessment Instrument-Minimum Data Set 2.0). Recent COVID-19 outbreaks (β= 0.189; 95% CI: 0.058-0.320), higher proportions of emotionally exhausted care aides on a care unit (β= 0.681; 95% CI: 0.246-1.115), and lack of access to geriatric professionals (β= 0.216; 95% CI: 0.003-0.428) were significantly associated with poorer resident QoL. Policies aimed at reducing infection outbreaks, better supporting staff, and increasing access to specialist providers may help to mitigate how COVID-19 has negatively affected NH resident QoL.

How Important Are Choice, Autonomy, and Relationships in Predicting the Quality of Life of Nursing Home Residents?

Older people face major challenges when they move into nursing homes, particularly in relation to independence and their ability to influence their activities of daily living (ADLs). This study evaluated the contribution of resident choice, as well as the staff-resident relationship, to promoting resident quality of life (QoL). A total of 604 residents from 33 nursing homes in Australia completed measures of QoL, perceived levels of choice in various ADLs, and the staff-resident relationship. A hierarchical regression demonstrated that the predictor variables accounted for 25% of the variance in QoL. Two of the four predictor variables (resident choice over socializing and the staff-resident relationship) significantly contributed to resident QoL. These findings reinforce the important contribution of autonomy and social relationships to resident QoL. Nursing home staff have a key role to play in supporting resident autonomy as a means of building residents' chosen social connections, and thereby promoting QoL.

Potentially Inappropriate Treatments at the End of Life in Nursing Home Residents: Findings From the PACE Cross-Sectional Study in Six European Countries

ContextCertain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. ObjectivesTo estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. MethodsA cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. ResultsWe included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). ConclusionAlthough the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff.

A Feasibility Study of a Multifaceted Walking Intervention to Maintain the Functional Mobility, Activities of Daily Living, and Quality of Life of Nursing Home Residents With Dementia.

A Feasibility Study of a Multifaceted Walking Intervention to Maintain the Functional Mobility, Activities of Daily Living, and Quality of Life of Nursing Home Residents With Dementia.

Occupational Balance and Quality of Life in Nursing Home Residents

Introduction: Nursing home residents may have difficulty maintaining occupational balance. The study aimed to explore occupational balance in nursing home residents, and examine the association between occupational balance and quality of life in this group.Methods: Forty-six nursing home residents (age range 69-101 years) in Norway were recruited to participate. The data were analyzed descriptively and with independent t-tests and Spearman’s correlation coefficient rho (rs).Results: The participants’ occupational balance (M = 20.7) was in the higher end of the scale. In the total sample, occupational balance and quality of life were not significantly associated (rs = 0.18, p = 0.23). However, splitting the sample by gender revealed a positive association for men (rs = 0.61, p = 0.01), while it was absent for women (rs = −0.00, p = 0.99).Conclusion: When assessing occupational balance and its correlates in elderly nursing home residents, gender appears important to consider.

노인요양시설의 문화변화와 거주노인의 삶의 질 관계 연구

노인요양시설의 문화변화와 거주노인의 삶의 질 관계 연구

Hospitalization at the end of life among nursing home residents with dementia: a systematic review

BackgroundHalf of nursing home residents (NHR) suffer from dementia. End-of-life hospitalizations are often burdensome in residents with dementia. A systematic review was conducted to study the occurrence of hospitalizations at the end of life in NHR with dementia and to compare these figures to NHR without dementia.MethodsA systematic literature search in MEDLINE, CINAHL and Scopus was conducted in May 2018. Studies were included if they reported proportions of in-hospital deaths or hospitalizations of NHR with dementia in the last month of life. Two authors independently selected studies, extracted data, and assessed quality of studies.ResultsNine hundred forty-five citations were retrieved; 13 studies were included. Overall, 7 studies reported data on in-hospital death with proportions ranging between 0% in Canada and 53.3% in the UK. Studies reporting on the last 30 days of life (n = 8) varied between 8.0% in the Netherlands and 51.3% in Germany. Two studies each assessed the influence of age and sex. There seem to be fewer end-of-life hospitalizations in older age groups. The influence of sex is inconclusive. All but one study found that at the end of life residents with dementia were hospitalized less often than those without (n = 6).ConclusionsWe found large variations in end-of-life hospitalizations of NHR with dementia, probably being explained by differences between countries. The influence of sex and age might differ when compared to residents without dementia. More studies should compare NHR with dementia to those without and assess the influence of sex and age.Trial registrationPROSPERO registration number CRD42018104263.

A Structural Equation Model of Quality of Life in Nursing Home Residents

A Structural Equation Model of Quality of Life in Nursing Home Residents

A Feasibility Study of a Multifaceted Walking Intervention to Maintain the Functional Mobility, Activities of Daily Living, and Quality of Life of Nursing Home Residents With Dementia.

The aim of the study was to evaluate the feasibility, acceptability, and efficacy of a multifaceted walking intervention (MWI) aimed to maintain the functional mobility, activities of daily living function, and quality of life of long-term care home residents with dementia. A quasiexperimental time-series design was used. The 4-month intervention provided one-on-one walking 2-4 days a week, guided by an individualized communication care plan and interviews with collaterals and staff. The MWI was feasible based on high recruitment and adherence rates (86% and 94%, respectively) and highly acceptable to stakeholders. Residents (n = 25) showed significant improvements after the intervention: Timed Up-and-Go (-8.85 seconds, p = .00), Two-Minute Walk Test (27.47 m, p = .00), Functional Independence Measure (0.72, p = .00), and Alzheimer's Disease-Related Quality of Life (2.44, p = .05). The MWI was feasible and improved functional mobility compared to usual care. Physical activity delivered with a person-centered care was feasible and may be beneficial to mitigate decline in long-term care home residents with dementia.

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

Background: Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. Objectives: We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents with the objective of examining whether terminal change is normative or whether one or multiple subgroup(s) with relative stability exist. Methods: We performed a longitudinal analysis based on routine assessments with the Resident Assessment Instrument – Minimal Data Set in 341 nursing homes between 1998 and 2014. In sum, we used 143,052 observations from 30,054 residents (69% women, average age at death 87 years) in the last 3 years of life. We analyzed trajectories of the Cognitive Performance Scale (CPS) score with latent class growth curve models and examined sociodemographic factors (age at death, sex, marital status, prior living situation) as well as functional and mental health (Activities of Daily Living Index and Depression Rating Scale) and dementia diagnosis as correlates of group membership. Results: We identified three distinct classes based on longitudinal trajectories of the CPS score. In the first group (transition from no to mild impairment, 27%), cognitive impairment increased with time to death (linear and quadratic), but remained at relatively mild levels at all times. The trajectories of the second group (transition from moderate to severe impairment, 43%) were characterized by linear and quadratic changes across time to death. The trajectories of the third group (severe impairment, 30%) were characterized by the lowest amount of linear increase across all groups and no quadratic increase indicating no accelerated change. Better functional health and absence of a dementia diagnosis predicted less impairment. Fewer depressive symptoms were associated with low as opposed to moderate or severe, but also severe versus moderate impairment. Conclusion: Our findings suggest that the majority of residents experience terminal change, with the exception of those at already high levels of impairment. Furthermore, late-life cognitive change is related to functional and mental health.

Pain, Neuropsychiatric Symptoms, and Quality of Life of Nursing Home Residents With Advanced Dementia in The Netherlands: A Cross-sectional Study.

Many studies have investigated factors associated with quality of life (QoL) in nursing home residents with dementia. Both pain and neuropsychiatric symptoms (NPS) are clinically relevant and individually associated with a lower QoL; however, there are no studies that investigated pain and NPS together in relation to QoL. In this study, we explored the relationship of pain and NPS with QoL in nursing home residents with dementia by investigating the association between pain concurrently with NPS, and QoL. Secondary data analyses of cross-sectional data from 199 residents were collected by observations at dementia special care units of 10 nursing homes. QoL was measured with Qualidem, pain with the Mobilization Observation Behavior Intensity Dementia (MOBID-2) Pain Scale and NPS with the Neuropsychiatric Symptoms Inventory. The relation of pain and NPS to QoL was studied using multiple linear regression analyses. Analyses were adjusted for age, sex, activities of daily living, comorbidity, medication use, and dementia severity. Regression models with pain and NPS, showed no independent relationship between pain and QoL subdomains, but NPS, in particular agitation and depressive symptoms, were significantly associated with lower QoL subdomain scores. Agitation was related to lower scores on the subdomains "relationship" [95% confidence interval (CI), -0.083 to -0.059], "positive affect" (95% CI, -0.037 to -0.013), "restless tense behavior" (95% CI, -0.003 to -0.004), and "social relations" (95% CI, -0.033 to -0.009), whereas depression was related to lower scores on the subdomains "positive affect" (95% CI, -0.054 to -0.014), "negative affect" (95% CI, -0.114 to -0.074), "restless tense behavior" (95% CI, -0.075 to -0.025), and "social relations" (95% CI, -0.046 to -0.002). Only NPS were significantly associated with QoL in nursing home residents with dementia. Further longitudinal research is needed to estimate the nature of the relationship between pain, NPS, and QoL.

The Determinants of Quality of Life of Nursing Home Residents with Young-Onset Dementia and the Differences between Dementia Subtypes

Aims: The aims of this study are to (1) explore the determinants of quality of life (QoL) in nursing home residents with young-onset dementia (YOD), (2) investigate whether there are differences between dementia subtypes (Alzheimer dementia, vascular/mixed dementia, frontotemporal dementia, other) regarding these determinants, and (3) compare QoL profiles of YOD nursing home residents across dementia subtypes. Methods: This cross-sectional study included 207 nursing home residents. Multilevel modeling was used to determine the relationships between QoL and neuropsychiatric symptoms (NPS), dementia severity, psychotropic drug use (PDU), dementia subtype, age, and gender. Additional multilevel models were used to compare aspects of QoL between dementia subtypes. Results: Residents' QoL was negatively associated with advanced dementia, PDU, and NPS. In general, the relationships between the determinants and QoL were similar across the dementia subtypes. Aspects of QoL differed by dementia subtype. Residents with frontotemporal dementia showed less negative emotions, accepted more help and experienced better quality of relationships with professional caregivers, had a more positive self-image, felt more comfortable in the nursing home environment, and experienced lower quality of social relationships. Conclusions: Considering the high rates of NPS and PDU in YOD residents and their negative associations with QoL, we recommend emphasizing services to manage and reduce NPS and PDU in nursing home residents with YOD. Furthermore, our findings suggest accounting for differences in aspects of QoL by dementia subtype to address specific needs and thereby improve QoL.

The Influence of Thermal Comfort on the Quality of Life of Nursing Home Residents

ABSTRACTThermal comfort (TC) parameters were measured in 130 rooms from nursing homes (NH), following ISO 7730:2005 in order to evaluate the influence of winter season TC indices on quality of life (QoL) in older individuals. Mean radiant temperature (mrT), predicted mean vote (PMV) and predicted percent of dissatisfied people (PPD) indices, and the respective measurement uncertainties were calculated using Monte Carlo Method. The WHOQOL-BREF questionnaire was conducted from September 2012 to April 2013, during the winter season TC sampling campaign. Winter PMV and PPD indices showed significant differences between seasons in median values for comfort. There were also significant differences between seasons for air temperature, air velocity, mrT, and relative humidity. The winter PMV index displayed a “slightly cool” [≤−1] to “cool” [≤−2] in thermal sensation scale [−3 to 3]. PPD index reflected this discomfort as evidenced by a high rate of predicted dissatisfied occupants (64%). The influence of winter season TC on older individual QoL results demonstrated that values of PMV above −0.7 had higher mean score of QoL (coefficient estimate: 11.13 units) compared with values of PMV below −0.7. These findings are of relevance to public health and may be useful for understanding NH indoor environment variables thus implementing preventive policies in terms of standards and guidelines for these susceptible populations.

Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia.

To determine the prevalence of and resident characteristics associated with the prescription of medications of questionable benefit (MQBs) near the end of life in older adults with advanced dementia in nursing homes. Population-based, cross-sectional study using Resident Assessment Instrument Minimum Data Set 2.0 linked to health administrative data. Ontario, Canada. All 9,298 nursing home residents with advanced dementia who died between June 1, 2010, and March 31, 2013; were aged 66 and older at time of death; and received at least one MQB in their last year of life. Prevalence of eight classes of MQBs (e.g., lipid-lowering agents, antidementia drugs) used in the last 120 days and last week of life. Of older nursing home residents with advanced dementia who received at least one MQB in the last year of life, 8,027 (86.3%) received them in the last 120 days and 4,180 (45.0%) in the last week of life. The most commonly prescribed MQB were antidementia (63.6%) and lipid-lowering agents (47.8%). Severe cognitive impairment (adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.07-1.33, P = .002) and fewer signs and symptoms of health instability (aOR = 1.58, 95% CI = 1.44-1.74, P < .001) were associated with MQB use into the last week of life. Seeing a neurologist or psychiatrist was associated with less likelihood of MQB use in the last week of life. Many nursing home residents with advanced dementia are dispensed MQBs in the last week of life. Given that MQBs may cause more harm than benefit in this vulnerable population, it is important for physicians to actively reassess the role of all medications toward the end of life.

FEASIBILITY OF AN INDIVIDUALIZED MULTIFACETED WAKING INTERVENTION AND ITS EFFECTS ON FUNCTIONAL MOBILITY, ADL FUNCTION AND QUALITY OF LIFE IN NURSING HOME RESIDENTS WITH DEMENTIA

FEASIBILITY OF AN INDIVIDUALIZED MULTIFACETED WAKING INTERVENTION AND ITS EFFECTS ON FUNCTIONAL MOBILITY, ADL FUNCTION AND QUALITY OF LIFE IN NURSING HOME RESIDENTS WITH DEMENTIA

Frailty Index and Quality of Life in Nursing Home Residents: Results From INCUR Study.

Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes. The aim of this study was to examine the relationship between frailty and health-related Quality of Life (QoL) in older nursing home patients. The study sample consisted of 590 patients aged 65 years or older. QoL was measured with the Visual Analogue Scale. Frailty was assessed using the Frailty Index as proposed by Rockwood and colleagues. Mean age of the participants was 85.9 (standard deviation [SD] 7.6) years, with 73.6% being female. The mean Frailty Index was 0.40 (SD 0.07) and the mean value of QoL was 67.4 out of 100 (SD 25.9). Before and after adjusting for age, and stratification for sociodemographic, and health-related variables, no significant associations between frailty and QoL were reported. In our study, the Frailty Index was not associated with QoL in nursing home residents.

Vision Care Access and Interdisciplinary Impact on Quality of Life in Nursing Home Residents

Vision Care Access and Interdisciplinary Impact on Quality of Life in Nursing Home Residents

Quality of life, its influencing factors and countermeasures among nursing home residents in Wuhan

Objective To investigate the quality of life and its related factors and countermeasures for nursing home residents in Wuhan, to provide constructive advice for promoting quality of life of residents in nursing home. Methods A convenient sample of 292 nursing home residents from 22 nursing homes was enrolled in Wuhan from September 2012 to August 2013. Several questionnaires were used in this survey including demographic data such as modified version of the quality-of-life concerns in the end of life questionnaire (QOLC-E) and short portable mental status questionnaire (SPMSQ). Results A total of 257 (88%) elderly acquired chronic disease, and the main disorder resulted from heart and lung system (51.0%), sensory system (43.2%), musculoskeletal and skin system (37.0%), and nervous system (32.9%). The total score of life quality was (3.02±0.61), of which discomfort level of body, diet, care and support, negative mood, stress and sense of worth were (3.49±0.47), (2.87±0.82), (3.13±0.53), (3.13±1.11), (3.16±1.14) and (2.33±1.36) respectively. The main influencing factors contained chronic disease, social support (self-feeling of financial burden, feeling of passing into silence, social contact), and widowed. Elderly without chronic disease history, with high social support and non-widowed obtained a high score of life quality. Conclusions It is necessary for us to improve the quality of life for nursing home residents in Wuhan. Several factors affect the elderly quality of life, so the faculty of nursing homes, family members as well as the community workers should have responsibility to take appropriate and corresponding measures in many ways to help elderly improve their life quality. Key words: Elderly; Questionnaire survey; Nursing home; Quality of life; Related factors

Quality of Life of Nursing Home Residents with Dementia: Validation of the German Version of the ICECAP-O

ObjectivesTo validate the ICECAP-O capability wellbeing measure’s German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses.MethodCross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents. We investigated the convergent validity of the ICECAP-O with other Quality of Life (Qol) measures, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer’s Disease Related Quality of Life (ADRQL) measures, and the Barthel-index measure of Activities of Daily Living (ADL). Discriminant validity was investigated using bivariate and multivariate stepwise regression analysis, comparing ICECAP-O scores between subgroups varying in dementia severity, care dependency, ADL status and demographic characteristics.ResultsConvergent validity between the ICECAP-O, EQ-5D+C, ADRQL and Barthel-Index scores was moderate to good (with correlations of 0.72, 0.69 and 0.53 respectively), but differed considerably between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.58 below 65 points on the Barthel-index and 0.80 above 65 points) and other characteristics. The ICECAP-O scores based on available tariffs were related to proxy characteristics gender (0.52 males versus 0.65 females) and work experience (0.61 below 2 years of experience versus 0.68 above 2 years).DiscussionThe results of this study suggest that the ICECAP-O is a promising generic measure for general Qol and capability of people with dementia living in a nursing home. Validity tests generally yielded favorable results. Work experience and gender appeared to influence proxy response, which raises questions regarding appropriate proxies, especially since the ICECAP-O may be completed by proxies relatively often. Further research is necessary to validate the German version of the ICECAP-O, with specific attention to proxy completion for people with dementia.