Long-term Facilities Research Articles

Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis

BackgroundIn adults aged 50 + years, vaccine-preventable diseases (VPDs) pose a significant health burden and can lead to additional ‘downstream effects’ of infection beyond the acute phase e.g., increasing the risk for non-communicable disease and exacerbating chronic conditions. The aim was to understand and quantify the burden of VPD downstream effects in hospitalised adults in the United States.MethodsThis retrospective observational study analysed hospitalisation claims data (2016–2019) with 1-year follow-up, in adults with a VPD diagnosis versus matched controls (using Optum’s de-identified Clinformatics Data Mart Database). Outcomes included mortality; increase in Charlson Comorbidity Index (CCI) score; new diagnosis of comorbidities; and loss of independence (defined by need for home health/home care and/or move to long-term facility).ResultsMortality was significantly increased in VPD cases versus controls at 30-day (risk ratio [RR] of 4.08 [95% CI 3.98–4.18]) and 1-year follow-up (RR 2.76 [2.73–2.80]). Over a 1-year follow-up period, morbidity increased following VPD hospitalisation: 65–86% of VPD cases had new comorbidities diagnosed (versus 13–41% of controls); with a significantly higher mean increase in CCI score versus baseline (3.23 in VPD cases versus 0.89 in controls, p < 0.001). Adults were observed to experience a worsening of their health status and were less likely to return to their original health state. In addition, 41% of VPD cases had a loss of independence following hospitalisation versus 12% of controls; as seen by an increased need for home assistance (in 25% versus 9% of controls) and/or a move to a long-term care facility (in 29% versus 6% of controls).ConclusionsThis analysis suggests that VPD hospitalised cases suffer significantly worse clinical outcomes than controls, with downstream effects that include increased mortality and morbidity, and greater loss of independence. Evidence on potential downstream effects of infection is relatively new, and this additional burden is generally not considered in vaccine decision-making. More research is needed to disentangle the effect of VPDs on new comorbidities versus the natural course of the condition. Increasing awareness among adults, healthcare providers and decision makers could help to increase adult vaccination coverage, and reduce the clinical burden of VPDs.

The prevention and response to infectious diseases in long-term care facilities in Korea: a nationwide survey.

Long-term care facilities (LTCFs) are communal environments for patients with chronic diseases or older adults, making them particularly susceptible to significant harm during infectious disease outbreaks. Nonetheless, LTCFs have historically been subject to less stringent infection prevention and control (IPC) mandates. This study aimed to assess the current state of LTCFs and to develop an IPC system tailored for these facilities following the coronavirus disease 2019 (COVID-19) pandemic. We conducted an online survey of 11,366 LTCFs in Korea from December 30, 2022 to January 20, 2023, to evaluate the components of IPC in LTCFs. The infectious diseases targeted for IPC included COVID-19, influenza, and scabies. Additionally, we compared institution-based and home-based long-term care insurance facilities. Overall, 3,537 (31.1%) LTCFs responded to the survey, comprising 1,819 (51.4%) institution-based and 1,718 (48.6%) home-based facilities. A majority (87.4%, 2,376/2,720) of these facilities experienced COVID-19 outbreaks. However, only 42% of home-based facilities, in contrast to 90.6% of institution-based facilities, were equipped to manage concurrent COVID-19 cases. Similarly, while 92.1% of institution-based facilities were capable of managing influenza, only 50.5% of home-based facilities could do the same. The incidence of scabies was significantly higher in institution-based facilities than in home-based ones (26.1% vs. 4.3%). Additionally, 88.7% of institution-based facilities managed scabies cases effectively, compared to only 42.1% of home-based facilities. Approximately half of the LTCFs had a basic capacity to respond to infectious diseases. However, there were differences in response capabilities between institution-based facilities and home-based facilities.

6634 Dual-Mediated PTH And Osteolytic Hypercalcemia In Metastatic Endometrial Carcinoma

Abstract Disclosure: C.K. Persaud: None. D.J. Beckman: None. Background: Hypercalcemia of malignancy occurs in 20-30% of advanced stage cancer patients. Etiologies include parathyroid hormone-related peptides (PTHrP)-mediated, osteolytic metastases-mediated, overproduction of 1,25-dihydroxycholecalciferol, and rarely parathyroid hormone (PTH)-mediated. PTH-mediated hypercalcemia of malignancy is rare and occurs through ectopic PTH production or primary hyperparathyroidism. We report a rare case of both PTH-mediated and osteolytic-mediated hypercalcemia in the setting of malignancy. Clinical Case: A 57-year-old female with history of endometrial cancer and multiple solid organ metastasis, presented with two weeks of progressive poor oral intake, nausea, emesis, and right flank pain. On hospital admission, she had a serum calcium of &amp;gt;20.1 mg/dL (8.6-10.2), PTH of 203 pg/mL (15.0-65.0), and creatinine of 1.7 mg/dL (0.7-1.2, baseline 1.3). Non-contrasted CT chest/abdomen/pelvis noted increased size of known right adrenal metastasis, new left adrenal metastasis, periaortic lymphadenopathy, and scattered nodules in the subcutaneous tissues of the abdomen and chest, however bone metastasis were not noted. Patient’s hypercalcemia was treated with zoledronic acid, calcitonin, cinacalcet, and eventually denosumab due to difficulty controlling hypercalcemia. Additional labs obtained during evaluation included ionized calcium &amp;gt;2.5 nmol/L (1.12-1.32), PTHrP &amp;lt;2.0 pmol/L (&amp;lt;2.0), 1,25-dihydroxycholecalciferol &amp;lt;10 pg/mL (21-65). Patient’s right adrenal metastasis biopsy one month prior to admission was subsequently stained for PTH and was negative. Technetium-99m sestamibi scan was obtained for localization of parathyroid adenoma or carcinoma. The scan did not localize, however did show numerous new lytic lesions in the skull, spine, sternum, rib cage, and right humerus. Patient’s hospital course was complicated by progressively worsening renal function, anemia, and thrombocytopenia. Patient was discharged to a long-term acute rehab facility off hypercalcemia treatment with a corrected calcium of 10.0 mg/dL. Conclusion: PTH-mediated hypercalcemia is a rare cause of hypercalcemia of malignancy. PTH levels are typically low or low-normal in osteolytic mediated hypercalcemia. Generally, if PTH is elevated in hypercalcemia, an alternate etiology is not evaluated. This case highlights a rare dual-mediated hypercalcemia of malignancy. The patient’s PTH level elevation was discordant with her high degree of hypercalcemia and prolonged treatment course. She was subsequently found to have widespread bone metastases contributing to hypercalcemia. While multiple etiologies of hypercalcemia can be rare, it is important to evaluate for all contributing causes, especially with additional clinical conditions, such as malignancy. Presentation: 6/3/2024

Opioid use disorder's impact on asthma hospitalizations: A propensity-matched nationwide study

BackgroundPatients with asthma and opioid use disorder (OUD) experience higher rates of acute exacerbation, but the effects of OUD on asthma hospitalizations have been poorly described. ObjectiveTo explore how concurrent OUD may affect the clinical outcomes of adult patients hospitalized for asthma. MethodsUsing the National Inpatient Sample, adult patients admitted for asthma with concomitant OUD were identified and compared with those without OUD. Cohorts were matched in a 1:1 ratio using propensity score matching, with mortality as primary outcome of interest. ResultsA total of 491,990 patients were hospitalized for asthma, and 3.49% had a concomitant diagnosis of OUD. Patients with asthma and OUD were younger, with a mean age of 41 years (SD ± 12.2) vs 51 years (SD ± 17.2) in those without OUD. After matching, both cohorts had 17,125 patients. There was no significant difference regarding in-hospital mortality (odds ratio [OR] 0.92, 95% CI 0.51-1.63, P = .77) between the cohorts. Patients with asthma with OUD had significantly higher rates of mechanical ventilation (OR 1.52, 95% CI 1.23-1.87, P < .001), noninvasive mechanical ventilation (OR 1.37, 95% CI 1.15-1.62, P < .001), and mean length of stay (3.18 vs 2.92 days, P < .001) compared with patients with asthma without OUD. Patients with OUD had no difference in mean total hospitalization costs ($33,514 vs $31,529, P = .054) compared with patients without OUD. Compared with a routine hospital discharge, patients with OUD were more likely to leave against medical advice (relative risk [RR] 2.67, 95% CI 2.28-3.13, P < .001), be discharged to a long-term facility (RR 1.40, 95% CI 1.01-1.95, P = .045), and be discharged with home health care (RR 1.56, 95% CI 1.22-1.99, P < .001) than patients without OUD. ConclusionConcomitant OUD has no impact on mortality in asthma hospitalizations, but patients with asthma with OUD have worse secondary outcomes compared with those without OUD.

Palliative care resources utilized in patients with liver cancer with cirrhosis: Trend in National Inpatient Sample (NIS) study (2016–2020).

59 Background: Liver cancer is the fourth cause of cancer death in the world. Hepatocellular carcinoma represents around 90% of all liver cancer, with an increase in incidence and a worsening survival rate over the years. Liver cirrhosis is the major risk factor for liver cancer development. Early involvement in palliative care/hospice care focusing on quality of life, is associated with improved physical and psychological symptoms and improvement in caregiver stress and bereavement. We examined as primary outcome the utilization and trend of palliative care (PC) among hospitalized patients with liver cancer and cirrhosis using the NIS. Methods: This is a retrospective study using NIS data from 2016 to 2021. We included patients aged 18 years or older who were admitted with a diagnosis of malignancy of the liver and the intrahepatic bile duct and who also had a diagnosis of fibrosis and cirrhosis of the liver. Patients who had a PC encounter during hospitalization were identified. The cohort was divided between patients with PC encounters and those without PC encounters. Cohorts were matched in a 1:1 ratio with no replacement using propensity scores. Total charges during hospitalization, length of stay (LOS), mortality, and disposition were measured as outcomes. Results: A total of 53,475 admissions with a diagnosis of liver malignancy and liver cirrhosis were identified. Of those, 20.8% had an encounter with a PC. The mean age of those with a PC encounter was 65.1 years (SD±7.86), while the mean age for those without was 64.5 years (SD±7.35). Sex and race were similar between both cohorts. Patients with PC encounters had a higher mean Elixhauser index (6.43 vs 5.58, p &lt; 0.001) than those without a PC encounter. Patients with PC encounters had lower total hospital charges ($70,988 vs $94,518, p &lt; 0.001), longer LOS (6.83 vs. 5.82 days, p &lt; 0.001), and higher odds of mortality (aOR 7.20, CI 5.56- 9.32, p &lt; 0.001) compared to those without a PC encounter. Patients with a PC encounter were more frequently discharged to a long-term facility (23.9% vs. 12.6%) or with home health care (36.1% vs. 18.4%) and less often had a routine hospital discharge (13.5% vs. 60.1%), compared to those without a PC encounter. Conclusions: This study highlights the impact of PC on patients hospitalized with liver malignancy and cirrhosis. Despite being underutilized, with only 20.8% of patients receiving PC, those who do experienced lower hospital charges, longer hospital stays, and higher in- hospital mortality. These findings suggest that PC focuses on symptom management and quality of life rather than extending life expectancy. Patients receiving PC are more frequently discharged to long-term care or home health care, indicating a shift towards supportive care. The results advocate for the broader and earlier integration of palliative care in treating liver cancer and cirrhosis to improve patient outcomes and support.

Feeling Lonely, Isolated and Depressed. Older Adults’ Feelings in Long-term Term Facilities: A Scoping Review

Feeling Lonely, Isolated and Depressed. Older Adults’ Feelings in Long-term Term Facilities: A Scoping Review

Employment status of older nursing staff aged 55 years and older in care facilities: A nationwide cross-sectional study in Japan.

An aging nursing workforce requires addressing shortages due to retirement. This nationwide descriptive cross-sectional study in Japan clarified the employment status of older nursing staff aged ≥ 55 years by facility type during January-March 2022. Questionnaires were sent to 8,000 nursing directors, with 1,658 valid responses (response rate: 20.7%). Descriptive statistics and Kruskal-Wallis or χ2 tests analyzed inter-facility differences. A violin plot depicted the proportion of older nursing staff across facilities by age group, and generalized estimating equation (GEE) models examined associated factors at the facility level. Older nursing staff's distribution differed significantly across age groups (p < 0.01), from 0% to 100% within the same facility type. Some facilities had high percentages of staff working beyond retirement age. GEE results showed higher percentages of full-time employees and nurses were negatively associated with the percentage of older nursing staff across most facility types (p < 0.05). For those aged ≥ 65 years, the total population was positively associated with employment in bedded clinics (coef. = 0.07, 95% CI: 0.01 to 0.14, p = 0.03), but negatively associated with the total population (coef. = -0.06, 95% CI: -0.10 to -0.01, p = 0.02) and percentage of the population aged ≥ 65 (coef. = -0.76, 95% CI: -1.43 to -0.08, p = 0.03) in long-term care insurance facilities. Working conditions and environments should be improvement to potentially retain older nursing staff. Job seekers should be matched with managers' needs in facilities with a higher proportion of older nursing staff to ensure a sustainable workforce.

Exposure to doxycycline increases risk of carrying a broad range of enteric antimicrobial resistance determinants in an elderly cohort

High rates of antibiotic prescription in residential aged care are likely to promote enteric carriage of antibiotic-resistant pathogens and increase the risk of antibiotic treatment failure. Despite their importance, relationships between antibiotic exposures and patterns of enteric resistance carriage in this population remain poorly understood. We conducted a cross-sectional metagenomic cohort analysis of stool samples from residents of five long-term aged-care facilities in South Australia. Taxonomic composition was determined, and enteric carriage of antibiotic resistance genes (ARGs) was identified and quantified against the Comprehensive Antibiotic Resistance Database. Both the detection and abundance of stool taxa and ARGs were related to antibiotic exposures up to 12 months prior. Factors associated with the abundance of ARGs of high clinical concern were identified. Stool samples were provided by 164 participants (median age: 88 years, IQR 81-93; 72% female). Sixty-one percent (n=100) of participants were prescribed antibiotics at least once in the prior 12 months (median prescriptions: 4, range: 1-52), most commonly a penicillin (n=55, 33.5%), cephalosporin (n=53, 32.3%), diaminopyrimidine (trimethoprim) (n=36, 22%), or tetracycline (doxycycline) (n=21, 12.8%). More than 1100 unique ARGs, conferring resistance to 38 antibiotic classes, were identified, including 20 ARGs of high clinical concern. Multivariate logistic regression showed doxycycline exposure to be the greatest risk factor for high ARG abundance (adjusted odds ratio [aOR]=14.8, q<0.001) and a significant contributor to inter-class selection, particularly for ARGs relating to penicillins (aOR=3.1, q=0.0004) and cephalosporins (aOR=3.4, q=0.003). High enteric ARG abundance was associated with the number of separate antibiotic exposures (aOR: 6.4, q<0.001), exposures within the prior 30 days (aOR: 4.6, q=0.008) and prior 30-100 days (aOR: 2.6, q=0.008), high duration of antibiotic exposure (aOR: 7.9, q<0.001), and exposure to 3 or more antibiotic classes (aOR: 7.4, q<0.001). Carriage of one or more ARGs of high clinical concern was identified in 99% of participants (n=162, median: 3, IQR: 2-4), involving 11 ARGs conferring resistance to aminoglycosides, four to beta-lactams, one to glycopeptides, three to fluoroquinolones, and one to oxazolidinones. Carriage of ARGs of high clinical concern was positively associated with exposure to doxycycline (aminoglycoside, fluoroquinolone, and oxazolidinone ARGs) and trimethoprim (fluoroquinolone and beta-lactam ARGs). Analysis of doxycycline impact on microbiota composition suggested that observed resistome changes arose principally through direct ARG selection, rather than through the antibiotic depletion of sensitive bacterial populations. The gut microbiome of aged care residents is a major reservoir of antibiotic resistance. As a critical antibiotic in medical practice, a comprehensive understanding of the impact of doxycycline exposure on the gut resistome is paramount for informed antibiotic use, particularly in an evolving landscape of prophylactic applications. Near-universal asymptomatic carriage of clinically critical resistance determinants is highly concerning and reinforces the urgent need for improved management of antibiotic use in long-term aged care.

Can bike sharing achieve self-balancing distribution? Evidence from dockless and station-based cases

In many cities, bike sharing systems, including station-based bike sharing (SBBS) and dockless bike sharing (DBS), are gaining popularity rapidly. Bike rebalancing is one of the most expensive aspects of bike sharing operations, and it takes several hours. In terms of reducing the inefficiencies of frequent short-term bike rebalancing, whether bike distribution achieves long-term self-balance for one day or even longer periods is a critical issue that has received insufficient attention. This paper aims to provide insights into long-term facility planning by investigating the self-balancing phenomenon of shared bikes. It is evaluated using daily stability analyses from the DBS case in Nanjing, China, and the SBBS case in New York, USA. DBS virtual stations were identified throughout the city, and (virtual) stations can be classified into four categories using various clustering methods. The findings demonstrate that 72% of DBS virtual stations and 81% of SBBS stations can achieve bike self-balancing, with only a few (virtual) stations failing to do so. In terms of non-self-balancing stations, bike-increasing stations are primarily located in the city center, whereas bike-fluctuating stations are primarily found near metro lines. This research can assist bike sharing companies with their daily operations and contribute to government management.

Students' core competence performance during fundamental nursing practicum: A cross-sectional survey with importance-performance analysis.

Limited available studies compare the core competence performance of students undertaking their practicum at different level-of-care practicum sites. This study aimed to (1) compare the gaps between the perception of importance for competence and the perceived performance of nursing students at practicum sites involving different level-of-care and (2) identify low competencies that must be prioritized for improvement at different sites during the fundamental nursing practicum. Cross-sectional design. A total of 659 students who had passed their fundamental nursing practicum within 1 month from six nursing colleges in Taiwan were recruited. The students completed the 25-item Core Competence in Fundamental Nursing Practicum Scale, wherein both the importance and performance level of each item are indicated. One-way analysis of variance along with the Scheffe post hoc test and importance-performance analysis were used to explore the gaps between the perception of importance for competence and the perceived performance and to identify weak competencies that must be prioritized for improvement, respectively. Compared with nursing students practicing in district hospitals (predominantly caring for chronically ill patients), nursing students practicing in medical centres (predominantly caring for patients with severe and critical conditions) had larger gaps in total scores and the application of nursing processes. Students in medical centres also had larger gaps in professional attitude than their counterparts in long-term care facilities. Importance-performance analysis identified a common shortfall in communication skills among nursing students for all level-of-care practicum sites. Students at long-term facilities had the highest number of weak competencies that required improvement. The results of this study can guide instructors in designing curricular activities focused on the weaker core competencies of the students at a practicum site for each level of care. No patient or public contributions.

Conservation of plant genetic resources for food and agriculture as an indicator of the sustainable development objectives (SDO) of the 2030 Agenda in the Republic of Moldova

Republic of Moldova adopted the SDOs in 2015 being committed to implement them at national level, along with the elaboration of the 2030 Agenda for Sustainable Development, followed by the National Development Strategy "European Moldova 2030". This strategy, like the Global Agenda 2030, includes food security and sustainable agriculture among its priorities. The present study is about the aspects related to the implementation of objective 2.5.1a. in the Republic of Moldova, regarding the number of plant genetic resources for food and agriculture secured in either medium or long-term conservation facilities. Data on national ex situ conserved plant germplasm collections, which are stored in the ReGen database, have been successfully exported to the WIEWS FAO international database, which provides access to official data on the implementation of the SDO indicator 2.5.1a at the global level.

A world-wide study on delirium assessments and presence of protocols.

Delirium is a common complication of older people in hospitals, rehabilitation and long-term facilities. To assess the worldwide use of validated delirium assessment tools and the presence of delirium management protocols. Secondary analysis of a worldwide one-day point prevalence study on World Delirium Awareness Day, 15 March 2023. Cross-sectional online survey including hospitals, rehabilitation and long-term facilities. Participating clinicians reported data on delirium, the presence of protocols, delirium assessments, delirium-awareness interventions, non-pharmacological and pharmacological interventions, and ward/unit-specific barriers. Data from 44 countries, 1664 wards/units and 36048 patients were analysed. Validated delirium assessments were used in 66.7% (n = 1110) of wards/units, 18.6% (n = 310) used personal judgement or no assessment, and 10% (n = 166) used other assessment methods. A delirium management protocol was reported in 66.8% (n = 1094) of wards/units. The presence of protocols for delirium management varied across continents, ranging from 21.6% (on 21/97 wards/units) in Africa to 90.4% (235/260) in Australia, similar to the use of validated delirium assessments with 29.6% (29/98) in Africa to 93.5% (116/124) in North America. Wards/units with a delirium management protocol [n = 1094/1664, 66.8%] were more likely to use a validated delirium test than those without a protocol [odds ratio 6.97 (95% confidence interval 5.289-9.185)]. The presence of a delirium protocol increased the chances for valid delirium assessment and, likely, evidence-based interventions. Wards/units that reported the presence of delirium management protocols had a higher probability of using validated delirium assessments tools to assess for delirium.

145-OR: Assessing the Current State of Diabetes Care in Long-Term Facilities Using Continuous Glucose Monitoring

Introduction: Recommendations for diabetes care in long term care facilities (LTCF) focuses on avoidance of hypoglycemia and symptomatic hyperglycemia. Using continuous glucose monitoring (CGM), we evaluated the current state of glycemia in LTCF residents with multiple comorbidities. Methods: We conducted a cross-sectional study using CGM in 8 LTC facilities in the United States. A masked Dexcom G6 pro CGM was placed for 10 days on residents with diagnosis of diabetes mellitus (DM) who were on any oral or injectable hypoglycemic medications. Clincial and demographic information were collected from medical records. Results: We evaluated 65 residents (mean age 65 years, 50% female). Fourteen percent of the cohort was on sulfonylurea medications and 68% were on insulin. CGM data showed 26% of the cohort with &amp;gt;1% time spent in hypoglycemia (time &amp;lt;70 mg/dL). A larger burden of hyperglycemia was seen with 54% of the cohort spending &amp;gt;10% time &amp;gt;250mg/dL, 37% spending &amp;gt;25% time &amp;gt;250 mg/dL, and 14% spending &amp;gt;90% time &amp;gt;250 mg/dL. Only 44% of the cohort had &amp;gt;50% Time-in-Range (70-180 mg/dL). The latest A1C was &amp;lt;7% in 45% of the cohort, 7-8% in 27%, 8.1-9% in 12%, and &amp;gt;9% in 16%. Fingerstick reading frequency was 2 or fewer times/day in 74% of the cohort, 3 times/day in 13%, and 4 or more times/day in 13%. On average, this cohort had 13 comorbidities, with 85% having functional disabilities. There was 14% with dementia and 42% with obesity (BMI&amp;gt;30). All 100% of the participants had polypharmacy(≥5 medications/day). Conclusions: In this multi-morbid cohort of residents with diabetes living in LTCF, we identified a high burden of both hypoglycemia and severe hyperglycemia, despite fair control of A1C. More consistent use of CGM could help identify glycemic excursions to improve therapeutic decision-making. Disclosure C. Slyne: None. K. Roberts: None. C.D. Conery: None. H. Brabant: None. N. Krakoff: None. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi. M. Munshi: Consultant; Sanofi. Funding Supported by an investigator initiated grant from Dexcom

Evaluating the Impact of Reminiscence Therapy on Cognitive and Emotional Outcomes in Dementia Patients.

This study examines the impact of reminiscence therapy on cognitive and emotional well-being in institutionalized older patients with dementia. Conducted at the Long-Term Care Health Facility for the Elderly, the research involved 34 participants who underwent therapy sessions that included personalized discussions of past experiences. Using physiological markers such as electroencephalography alpha and beta waves, along with psychological measures such as the Hasegawa Dementia Scale-Revised, the study aimed to quantify the effects of the therapy. Although the results indicated positive correlations between alpha and beta waves, suggesting enhanced relaxation and cognitive engagement, improvements in Hasegawa Dementia Scale-Revised scores were not statistically significant, pointing to variability in therapeutic effectiveness among patients. Despite these mixed outcomes, the findings support the potential of reminiscence therapy as a non-pharmacological intervention to improve the quality of life of dementia patients, though they also underscore the necessity for further research to refine therapy protocols and enhance applicability.

Association Between Malnutrition and Food Texture Levels in Integrated Facilities for Medical and Long-Term Care.

This study aims to investigate the association between malnutrition using the global consensus criteria and food texture levels in residents of Integrated Facilities for Medical and Long-Term Care (IFMLCs), which are new long-term care insurance facilities in Japan. This single-center study had a retrospective cross-sectional design. The study was conducted from November 1 to 30, 2021, and the study participants were residents admitted to an IFMLC during the study period. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Food texture levels consumed by patients at admission were categorized based on the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Multivariate logistic regression models were used to determine the association between the food texture levels consumed and malnutrition. A total of 98 older residents were analyzed in this study. The median age of the participants was 88 years, and 68 (69%) female participants were included. The IDDSI framework levels were 24% in levels 7 and 6 and 26% in levels 5 and 4. A significant difference in the prevalence of low BMI, reduced muscle mass, and reduced food intake or assimilation was noted between IDDSI framework levels 4 and 7. Multivariate logistic regression analysis was performed for malnutrition, adjusting simultaneously for potential confounders. IDDSI level 4 (odds ratio, 5.074; 95% confidence interval, 1.059-28.092; p=0.042) consumption was independently associated with malnutrition. The consumption of lower food texture levels categorized using the IDDSI framework was associated with a higher malnutrition prevalence in IFMLC residents.

Trend and burden of cancer related hospitalizations in the US: Insights from a National Inpatient Sample Database analysis.

1543 Background: Cancer-related hospitalizations constitute one of the primary drivers of cancer-related healthcare expenses. Understanding the burden and characteristics of these hospitalizations is essential to appropriately direct resources, improve outcomes, and avoid unnecessary hospitalizations. Our study sought to evaluate the national trends, reasons, disposition status, length of stay, and associated costs for cancer-related hospitalizations. Methods: We conducted a retrospective analysis of cancer hospitalizations using the 2008-2019 National Inpatient Sample. Cancer-related hospitalizations were identified using validated Clinical Classification Software (CCS) codes 11 to 45. Trends in hospitalization volume, mortality, length of stay, disposition status, and costs were analyzed overall and by cancer type, adjusted according to the US Consumer Price Index. Results: There were 371 million weighted hospitalizations from 2008 to 2019, of which 15.1% (56 million) were cancer related. The most reported cancer types were breast cancer (11.9%), secondary malignancies (11.2%), and prostate cancer (10.3%). The most common reasons for cancer-related hospitalizations were septicemia (4.8%), pneumonia (4.7%), and complications of surgical procedures or medical care (3.1%). Trend analysis showed that the total number of cancer-related hospitalizationsincreased from 12,963 to 16,500 per 100,000 hospitalizations during the study period (relative increase, 27.3%). Mortality rates decreased from 5.1% to 4.0% (relative decrease, 21.6%), while the length of stay decreased from 3.5 to 3.2 days (relative decrease, 8.6%) during the study period. Disposition to home or short-term facilities decreased (relative decrease, 3.1%), while to long-term facilities increased (relative increase, 20.6%) during the same period. Total hospitalization cost increased from $55.5 billion in 2008 to $76.4 billion in 2019 (a relative increase of 37.7%). Conclusions: Our analysis shows that while cancer-related hospitalizations and associated costs increased substantially, mortality rates, and length of stay decreased. These trends reflect rising cancer burden but improvements in hospital cancer care quality and efficiency. Ongoing efforts to optimize cancer treatment, minimize unnecessary hospitalizations, reduce length of stay, and facilitate safe discharges are needed to improve patient outcomes and control costs further. Continued surveillance and health policies should address the rising demand for high-value cancer care.[Table: see text]

Medical Team Intervention Into a Long-Term Care Health Facility in Japan During the First Wave of the COVID-19 Pandemic.

Nursing homes face a high risk of coronavirus disease 2019 (COVID-19) infection; in the early stages of the pandemic, outbreaks in nursing homes resulted in significant deaths among residents. Our medical team intervened in one nursing home struggling to cope with the COVID-19 pandemic. We analyzed the outcomes of 65 residents (52 women and 13 men; mean age, 89 years) during the first wave of infection, as well as changes in resident and staff numbers after the pandemic subsided. The mortality rates in the early and late transfer groups for the first three months of our intervention were 46.7% and 19.2%, respectively. The number of residents and staff fell to 34 and six, respectively, at their lowest point, but recovered to 64 and 33, respectively, by August 2023. Since the successful containment of the outbreak, no clusters of COVID-19-related illnesses have been observed at the facility despite nine infection waves occurring across Japan. Improving staff precautions, designing facilities with effective zoning, and sharing information with government agencies are essential for preventing healthcare-associated infections. Hence, an inter-professional team approach is important to support residents, and ongoing mental health support for staff is essential to maintain optimal healthcare quality in nursing home facilities.

Interventions to Prevent Hospital Admissions in Long-Term Care Facilities: A Rapid Review of Economic Evidence

ObjectivesHospital admissions can be hazardous for older adults, particularly those living in long-term care facilities. Preventing nonessential admissions can be beneficial for this population, as well as reducing demand on health services. This review summarizes the economic evidence surrounding effective interventions to reduce hospital attendances and admissions for people living in long-term care facilities. DesignRapid review of economic evidence. Setting and ParticipantsPeople living in long-term facilities. MethodsWe searched MEDLINE, CINAHL, Cochrane CENTRAL, PubMed, and Web of Science on September 20, 2022, and again on January 10, 2023. Full economic evaluations and cost analyses reporting on advanced care planning, goals of care setting, nurse practitioner input, palliative care, influenza vaccinations, and enhancing access to intravenous therapies were eligible. Data were extracted using a prepiloted data extraction form and critically appraised using either the Drummond-Jefferson checklist or an amended NIH Critical Appraisal Tool appended with questions from a critical appraisal checklist for cost analyses. Data were synthesized narratively. ResultsWe included 7 studies: 3 full economic evaluations and 4 cost analyses. Because of lack of clarity on the underlying study design, we did not include one of the cost analyses in our synthesis. Advanced care planning, a palliative care program, and a high-dose influenza vaccination reported potential cost savings. Economic evidence for a multicomponent intervention and a nurse practitioner model was inconclusive. The overall quality of the evidence varied between studies. Conclusions and ImplicationsA number of potentially cost-effective approaches to reduce demand on hospital services from long-term care facilities were identified. However, further economic evaluations are needed to overcome limitations of the current evidence base and offer more confident conclusions.

Parent SMART: Effects of residential treatment and an adjunctive parenting intervention on behavioral health services utilization

IntroductionScant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART – a technology-assisted intervention for parents of adolescents in residential treatment – was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization. MethodThe study randomized sixty-one parent-adolescent dyads to residential TAU (n = 31) or residential TAU plus Parent SMART (n = 30). Of the 61 dyads, 37 were recruited from a short-term residential facility and 24 were recruited from a long-term facility. Adolescents completed a structured clinical interview and self-reported their behavioral health-related visits to the emergency department, nights in residential/inpatient, and outpatient visits over the past 90 days, at baseline, 12-, and 24-weeks post-discharge. Generalized linear mixed models (GLMMs) examined both linear and non-linear (pre- to post- residential treatment) trends, pooled, and stratified by residential facility to examine behavioral health service utilization. ResultsBoth the linear and pre-post GLMMs revealed that behavioral health-related emergency department visits and residential/inpatient nights decreased across both residential facilities. GLMMs estimating change from the pre- to post period indicated that outpatient visits increased across both facilities. There were no significant effects of the Parent SMART adjunctive intervention in GLMMs, though bivariate tests and the direction of effects signaled that Parent SMART was associated with more nights of residential/inpatient utilization. ConclusionResidential substance use treatment may reduce adolescents' subsequent utilization of costly behavioral healthcare services such as emergency department visits and residential/inpatient nights, while increasing utilization of outpatient services. Parent SMART was not associated with significant changes in behavioral healthcare utilization, but the pattern of results was consistent with prior literature suggesting that stronger parenting skills are associated with greater utilization of non-emergency services.

Barriers and facilitators to caring for individuals with serious persistent mental illness in long-term care

ObjectiveMany older adults in the United States with serious persistent mental illness reside in long-term facilities, and evidence suggests increasing numbers of long-term care residents with serious persistent mental illness. Healthcare professionals in these settings may face challenges in providing care to these residents. The purpose of this study was to describe health care professionals' perceptions of the barriers and facilitators to caring for long-term care residents with serious persistent mental illness. MethodsA qualitative descriptive design was employed. ResultsTen healthcare professionals working in long-term care were interviewed. Themes that emerged from the interviews were: coming to know the individual and their unique needs takes time; offering choices and being flexible facilitates trust; respecting the inherent worth of each individual promotes caring. ConclusionsCaring for individuals with serious persistent mental illness in long-term care requires an individualized, person-centered approach.