Long-term Nursing Home Residents Research Articles

Antihypertensive Medication and Fracture Risk in Older Veterans Health Administration Nursing Home Residents

Limited evidence exists on the association between initiation of antihypertensive medication and risk of fractures in older long-term nursing home residents. To assess the association between antihypertensive medication initiation and risk of fracture. This was a retrospective cohort study using target trial emulation for data derived from 29 648 older long-term care nursing home residents in the Veterans Health Administration (VA) from January 1, 2006, to October 31, 2019. Data were analyzed from December 1, 2021, to November 11, 2023. Episodes of antihypertensive medication initiation were identified, and eligible initiation episodes were matched with comparable controls who did not initiate therapy. The primary outcome was nontraumatic fracture of the humerus, hip, pelvis, radius, or ulna within 30 days of antihypertensive medication initiation. Results were computed among subgroups of residents with dementia, across systolic and diastolic blood pressure thresholds of 140 and 80 mm Hg, respectively, and with use of prior antihypertensive therapies. Analyses were adjusted for more than 50 baseline covariates using 1:4 propensity score matching. Data from 29 648 individuals were included in this study (mean [SD] age, 78.0 [8.4] years; 28 952 [97.7%] male). In the propensity score-matched cohort of 64 710 residents (mean [SD] age, 77.9 [8.5] years), the incidence rate of fractures per 100 person-years in residents initiating antihypertensive medication was 5.4 compared with 2.2 in the control arm. This finding corresponded to an adjusted hazard ratio (HR) of 2.42 (95% CI, 1.43-4.08) and an adjusted excess risk per 100 person-years of 3.12 (95% CI, 0.95-6.78). Antihypertensive medication initiation was also associated with higher risk of severe falls requiring hospitalizations or emergency department visits (HR, 1.80 [95% CI, 1.53-2.13]) and syncope (HR, 1.69 [95% CI, 1.30-2.19]). The magnitude of fracture risk was numerically higher among subgroups of residents with dementia (HR, 3.28 [95% CI, 1.76-6.10]), systolic blood pressure of 140 mm Hg or higher (HR, 3.12 [95% CI, 1.71-5.69]), diastolic blood pressure of 80 mm Hg or higher (HR, 4.41 [95% CI, 1.67-11.68]), and no recent antihypertensive medication use (HR, 4.77 [95% CI, 1.49-15.32]). Findings indicated that initiation of antihypertensive medication was associated with elevated risks of fractures and falls. These risks were numerically higher among residents with dementia, higher baseline blood pressures values, and no recent antihypertensive medication use. Caution and additional monitoring are advised when initiating antihypertensive medication in this vulnerable population.

Factors impacting community living outcomes among former long-term nursing home residents using the interdependence-Human Activity Assistive Technology (i-HAAT) model

ABSTRACT Despite an increased application of social theory in assistive technology (AT) outcomes research, there continues to be a gap in integrating AT conceptual models in research design, data analysis, and results interpretation. This paper merged two preexisting AT models, the Human Activity Assistive Technology model (HAAT) and the interdependence frame for AT into a novel framework, the interdependence-HAAT model (i-HAAT). This model was used to examine the outcomes of former long-term nursing home residents using AT. The model was also used as a framework to facilitate quantitative variable identification and categorization, emphasize the interconnectivity between domain variables, and explore the infrastructural supports necessary for the successful community reintegration of deinstitutionalized AT users. Meaningful integration of theory into practice is the essential next step in generating socially responsive research that addresses AT consumer needs and moves the field forward.

Self- and staff-reported pain in relation to contextual isolation in long-term nursing home residents with Alzheimer's disease and related dementias

We evaluated the degree to which contextual isolation in nursing home residents with Alzheimer's disease and related dementias is associated with documented pain using the Minimum Data Set 3.0, a comprehensive resident assessment required of all nursing home residents in the United States. Contextual isolation was defined as having a socially salient characteristic (demographics, habits and interests, and clinical and care dimensions) shared by fewer than 20% of other residents in the same nursing home. Thirteen percent were contextually isolated on multiple characteristics. Among residents self-reporting pain, residents contextually isolated with respect to multiple characteristics were 8% more likely (95% confidence interval: 7% to 9%) to have pain relative to residents who were not contextually isolated on any characteristics. Long-stay nursing home residents with ADRD who live in settings where they were contextually isolated were more likely to have pain relative to those without contextually isolation on any characteristic.

Daily walking kinematic characteristics of the elderly in different residential settings: experimental study on Chinese community-living elderly and long-term nursing home residents.

Long-term nursing home (NH) care helps NH residents with their daily activities and improves their quality of life, but negatively affects their independent physical activities and increases the risk of dangerous events. Dangerous events in the elderly usually occur in the conversion of walking periods when forward striding has already happened, but the body has not yet entered a completely steady walking. Compare the gait characteristics in Chinese long-term NH residents and community-living elderly during the walking Transitional Period (TP) and Stabilization Period (SP). 32 long-term NH residents and 33 age- and sex-matched community-living elderly were recruited. The 30-Second Chair Stand Test (30-s CST), Timed Up and Go Test (TUGT), and Modified Falls Efficacy Scale (MFES) were used to assess their body function. The Xsens MVN BIOMECH system was used to collect and analyze the gait parameters of participants. Compared to community-living elderly, NH residents had fewer numbers of 30-s CST, took more time to complete TUGT, and lower MEFS scores. NH residents showed slower gait speed (P < 0.001), less peak hip flexion (P = 0.022) and extension (P = 0.003), knee internal rotation (P = 0.023), and ankle plantarflexion (P = 0.001) and internal rotation (P = 0.007) angles during walking. When walking progressed from TP to SP, NH residents showed increased ankle dorsiflexion (P < 0.001), decreased hip internal rotation (P < 0.001), and community-living elderly had increased hip extension (P = 0.005) angles. Chinese long-term NH residents had reduced lower extremities strength and postural balance, and higher fear of falling compared to community-living elderly. Their walking performance also showed high fall risk. Besides, long-term NH residents adopted a distal strategy to propel the body forward, which may be a compensatory measure to compensate for inadequate proximal joint control from forward walking to stable walking, and long-term NH residents have reduced postural stability during this process.

Reducing Falls by Upgrading Lighting in Nursing Homes

•Falls are exceedingly common in post-acute and long-term care residents and a leading cause of injuries, deaths, and worry for residents, families, and caregivers. Fall prevention strategies are resource intensive and multimodal interventions done at the resident level. There is little evidence to date to support environmental modifications to reduce falls. •Does an upgraded, dynamic lighting system reduce the rate of falls in long-term nursing home residents? Reference: Grant LK, St Hilaire MA, Heller JP, Heller RA, Lockley SW, Rahman SA. Impact of Upgraded Lighting on Falls in Care Home Residents. J Am Med Dir Assoc 2022;23:1698–1704.e2. This observational study looked at two pairs of long-term care nursing homes. One member of the pair underwent an upgraded, dynamic lighting system and was compared with the other member who continued standard lighting. The rate of falls was reduced by 43% in the lighting upgrade group versus the standard group. Falls are a common but pathologic part of aging and a classic geriatric syndrome. Many different contributing factors combine to result in a fall. However, falls are preventable through the practice of high-quality geriatric care, which looks to optimize modifiable risk factors, encourage adequate nutrition, stop offending medications, and advocate for participation in exercise and restorative care programs. Despite the success of reducing falls on an individual level, successful fall prevention programs in clinics or nursing homes have low success rates. When a study is published reporting that the fall rates in nursing homes can be reduced by almost 50% with a one-size-fits-all approach, it deserves a closer look. The authors of this study wanted to see what effect an “upgraded” lighting system would have on “care home residents.” Compared with the conventional solid-state lighting, where light has a constant wavelength and brightness, the upgraded lighting had changing intensity and increased blue light exposure during the day and reduced blue light exposure at night. The theoretical benefit of an improved lighting system that illuminates the room is obvious: it will make areas more visible for residents and staff. The health benefits of alternating blue light on improving alertness, cognition, and sleep are less known. This study compared two pairs of long-term care nursing homes owned by the same parent company with the same standardized policies and protocols. The company selected one site from each pair for a lighting upgrade while the other kept its solid-state lighting (fluorescent lamps). The researchers collected data one year before and after the lighting upgrade. To determine fall rates, the researchers reviewed the medical record as documented by the facility staff using the standard reporting tool in the site’s medical record system. There were important differences between the control and experimental groups after they underwent lighting upgrades. First, the experimental group had a higher rate of patients with dementia (42% vs 30%). Second, the experimental group also had more residents and more resident-days, suggesting longer stays in those facilities (146 vs. 98 resident-days, respectively; compared with 151 vs. 126 resident-days before the upgrade). This study found that the rate of falls was about 43% lower in the lighting upgrade sites; the experimental group went from 6.94 to 4.82 falls per 1,000 resident-days compared with the control group, which went from 6.62 to 8.44 falls per 1,000 resident-days. Perhaps of greater interest was that the distribution of falls went from a majority at night to a majority during the day after the lighting upgrade. There was no difference in fall frequency based on time of day in the control sites. These results are exciting in that they suggest a simple lighting upgrade may significantly reduce the rate of falls in nursing homes with minimal to no harm to the residents and little to no ongoing effort from staff. In addition, the early indication is that this fall reduction is perhaps due to improved sleep cycles, which may help in deprescribing potentially dangerous sleep aids. However, caution is needed in interpreting the results. The fall reduction rate is due partly to decreased falls in the experimental group and partly to increased falls in the control group. This may indicate uncaptured differences between the two groups, especially given that the owners selected the sites they wanted to upgrade. In addition, the reduced number of resident-days may reflect that the control groups focused on “short stay” residents undergoing skilled rehabilitation, who may be more likely to fall given their dynamic functional levels. This study is intriguing and warrants additional research to examine the effect of upgraded lighting solutions in nursing homes. If these results can be replicated, there may be a safe, cost-effective solution to prevent falls and their negative consequences for residents. Dr. Salaami is a geriatrician and SNFist with Scripps Clinic in San Diego, CA.

Salutogenic nursing home care: Antonovsky's salutogenic health theory as a guide to wellbeing.

The nursing home (NH) population is characterized by a high symptom burden resulting from chronic illnesses and functional impairments that cannot be cured. Most long-term NH residents are in the last phase of life and in need of palliative care. Hence, health and wellbeing are important aims of salutogenic NH care, which includes more than the treatment of residents' diseases and symptoms. Research shows that cognitively intact long-term NH residents with a high score on sense of coherence (SOC) experience better wellbeing. Therefore, NH care should be developed in a salutogenic direction, promoting residents' health and wellbeing by identifying general and specific resistant resources and facilitating residents' perceived SOC. Based on Antonovsky's salutogenic health theory and focusing on SOC comprising comprehensibility, manageability and meaningfulness along with resistance resources, this article discusses how nurses can apply salutogenic knowledge as a guide to promote wellbeing among long-term NH residents.

Nursing Home to Nursing Home Transfers during the Early COVID-19 Pandemic.

To examine the nursing home to nursing home transfer rates before and during the early COVID-19 pandemic and to identify risk factors associated with those transfers in a state with a policy to create COVID-19-care nursing homes. Cross-sectional cohorts of nursing home residents in prepandemic (2019) and COVID-19 (2020) periods. Michigan long-term nursing home residents were identified from the Minimum Data Set. Each year, we identified transfer events as a resident's first nursing home to nursing home transfer between March and December. We included residents' characteristics, health status, and nursing home characteristics to identify risk factors for transfer. Logistic regression models were conducted to determine risk factors for each period and changes in transfer rates between the 2 periods. Compared to the prepandemic period, the COVID-19 period had a higher transfer rate per 100 (7.7 vs 5.3, P < .05). Age≥80 years, female sex, and Medicaid enrollment were associated with a lower likelihood of transfer for both periods. During the COVID-19 period, residents who were Black, with severe cognitive impairment, or had COVID-19 infection were associated with a higher risk of transfer [adjusted odds ratio (AOR) (95% CI): 1.46 (1.01-2.11), 1.88 (1.11-3.16), and 4.70 (3.30-6.68), respectively]. After adjusting for resident characteristics, health status, and nursing home characteristics, residents had 46% higher odds [AOR (95% CI): 1.46 (1.14-1.88)] of being transferred to another nursing home during the COVID-19 period compared to the prepandemic period. In the early COVID-19 pandemic, Michigan designated 38 nursing homes to care for residents with COVID-19. We found a higher transfer rate during the pandemic than during the prepandemic period, especially among Black residents, residents with COVID-19 infection, or residents with severe cognitive impairment. Further investigation is warranted to understand the transfer practice better and if any policies would mitigate the transfer risk for these subgroups.

TRANSFER TRAUMA AND MAJOR EVENTS AMONG NURSING HOME RESIDENTS BEFORE AND DURING THE COVID-19 PANDEMIC

Abstract The negative consequences of transfers are known as transfer trauma. Nursing home (NH)-to-NH transfers place long-term NH residents at risk for developing transfer trauma and this risk may have increased during the COVID-19 pandemic in the setting of a state policy that increased the number of residents who transferred between NHs. The objective of this cross-sectional cohort analysis was to assess the incidence of transfer trauma and major events (hospitalization/death/discharges) among long-term NH residents who transferred from one NH to another before and during the COVID-19 pandemic using a composite measure of transfer trauma based on validated scales from Minimum Data Set (MDS) assessments. A total of 750 residents transferred in the pre-COVID cohort and 795 in the COVID cohort were eligible for assessment of transfer trauma and major events. After adjusting for demographic characteristics, residents in the COVID cohort were almost twice more likely to die and almost three times more likely to discharge within 90 days compared to those in the pre-COVID cohort (AOR=1.94, 95%CI [1.15, 3.26] and AOR= 2.86, 95%CI [2.30, 3.56], respectively). Residents in the COVID cohort were less likely to experience transfer trauma compared to those in the pre-COVID cohort. In the during-COVID cohort, 26% of residents had a COVID-19 diagnosis and they were less likely to experience transfer trauma compared to residents without a COVID-19 diagnosis (AOR=0.34, 95%CI [0.23, 0.50]). It is important to note that some residents may have not stayed in the nursing home long enough to assess them for transfer trauma.

USING MDS TO MEASURE TRANSFER TRAUMA IN NURSING HOME RESIDENTS

Abstract Transferring long-term nursing home residents between facilities has been shown to compromise their quality of life. The negative consequences associated with transfers have been termed transfer trauma and its spectrum spans from functional, cognitive, and emotional decline to hospitalizations, and even death. The objective of this study was to develop a composite measure of transfer trauma after a nursing home-to-nursing home transfer using clinically relevant events and sub-measures covering functional, cognitive, behavioral, and emotional domains based on validated scales available in the Minimum Data Set (MDS) assessments. MDS Data were used to identify long-stay nursing home residents and obtain information on transfers, clinical assessments, and facilities. This study is a cross-sectional cohort analysis of long-stay nursing home residents in the state of Michigan who had a nursing home-to-nursing home transfer during our study period (March 1, 2018-October 31, 2018). We developed a measure of transfer trauma as a composite from 5 previously validated measures: 1) Activity of Daily Living (ADL) Self-Performance Scale; 2) Cognitive Function Scale (CFS); 3) Patient Health Questionnaire-9 (PHQ-9/PHQ-9-OV); 4) Agitated Reactive Behavior Scale (ARBS); 5) falls. The distribution and frequency of each sub-measure were analyzed to assess scaling of the composite measure. Of a total of 817 residents who transferred in our study period, 549 had complete composite measures, and from those 242 (44%) met criteria for transfer trauma. These findings demonstrate the need for further research to identify underlying transfer trauma and develop interventions to ameliorate the negative effects of transfers on this vulnerable population.

Definition and Contextual Factors of Nursing Home Residents' Mobility in a Holistic View: A Delphi Study.

Current definitions of older adults' mobility do not cover the full range of influencing factors and do not consider nursing home residents. The present study reports expert ratings from a Delphi study regarding factors influencing the mobility of long-term nursing home residents. We invited 129 professionals with expertise in a field relevant to research on mobility in older adults such as health care, medicine, or human movement science to participate in a Delphi study comprising 3 rounds of online questionnaires. Up to 40 experts participated in each round. In the first round, we used open-ended questions to solicit possible definitions, contextual factors, and assessment tools. In the second round, the participants used Likert scales (1-10) to rate their suitability. In the final round, we presented a definition based on consensus as well as the top-rated contextual factors and assessment tools from the first 2 rounds for a final rating of agreement. The experts showed broad agreement on the final version of the mobility definition, with 8.9 ± 1.4 (mean ± standard deviation) out of 10 points. The experts also showed broad consensus on the selected contextual factors, with 8.4 ± 1.8 points to 8.9 ± 1.2 points (out of 10 points). This was also the case for the top 3 assessment tools selected from results of previous rounds, which showed an agreement of 7 or more points (out of 10 points) by 81.6% to 100% of all experts in the different categories. Given that an interdisciplinary group of experts considered various hitherto neglected contextual factors as relevant, the Delphi survey and its results imply the need for an updated interdisciplinary and holistic understanding of mobility in nursing home residents and can provide a basis for putting it into practice.

Influence of social contacts on corona concerns in the nursing home population : Quantitative cross-sectional survey

HintergrundWährend der durch die „coronavirus disease 2019“ (COVID-19) ausgelösten Pandemie im Frühling und im Sommer 2020 stiegen die Sorgen und Ängste von Bewohner*innen der stationären Langzeitpflege vor einer Erkrankung und den Auswirkungen des Virus (Corona-Sorgen). Im Umgang mit Sorgen stellt der Kontakt zu nahestehenden Personen eine wichtige Ressource dar; dieser wurde allerdings gerade in Pflegeeinrichtungen streng reglementiert. Deshalb wird von erhöhten psychischen Belastungen ausgegangen, es mangelt jedoch an repräsentativen Daten.Ziele der ArbeitDie Arbeit verfolgt die Fragestellung: Wie beeinflussen die sozialen Beziehungen von Pflegeheimbewohner*innen ihre Corona-Sorgen?Material und MethodenIm Sommer 2020 wurden in ganz Österreich 259 Pflegeheimbewohner*innen eines Trägers in einer repräsentativen, standardisierten Face-to-face-Befragung interviewt.ErgebnisseErstens zeigen die Daten hohe emotionale Belastungen bei den Pflegeheimbewohner*innen, allerdings auch eine gewisse psychische Resilienz. Zweitens besteht ein Zusammenhang zwischen emotionaler Einsamkeit und höheren Corona-Sorgen („odds ratio“ [OR] = 2,30; p < 0,01). Drittens hängt auch ein häufiger telefonischer und/oder persönlicher Kontakt zu Angehörigen mit höheren Corona-Sorgen zusammen (OR = 1,32; p < 0,05).SchlussfolgerungenIn den aktuellen Zeiten, in denen eine Krise die nächste ablöst, braucht es mehr Wissen über die psychischen Resilienzen von Pflegeheimbewohner*innen und wie diese gefördert werden können. Außerdem braucht es mehr Wissen über die Rolle der Angehörigen, und ob diese eher ein Ausgangspunkt von Sorgen sind oder eine Umgangsstrategie mit Sorgen darstellen.

Who Visits Relatives in Nursing Homes? Predictors of at Least Weekly Visiting.

Within the context of a single study, assess the relative importance of the 6 factors identified in a 2019 systematic review as associated with the likelihood that family members will visit nursing home residents. Retrospective statistical analysis of an existing survey data set. A national survey conducted with 4350 relatives of long-term nursing home residents. Probit models of the probability of visiting a family member at least once weekly, stratified by age of the visitor, were estimated. To account for possible endogeneity of respondent involvement in the choice of nursing home and visit rate, visit rates were estimated using 2-stage residual inclusion in which the first stage explained involvement in nursing home choice. Involvement in nursing home choice has a substantively and statistically significant positive effect on visit probability for all age groups of respondents. Travel time has a substantively and statistically significant negative association on visit probability for all age groups. Younger women are more likely to visit than younger men. For all but the oldest respondents, higher income and full-time employment contribute to involvement in nursing home choice as does being Black or Hispanic. As in previous research, travel time is an important determinant of visit rates. The strong association of involvement in nursing home choice with visit probability suggests a strong psychological motivation for visiting. To improve visiting, future research should focus on better understanding of the psychological factors that are associated with it and rely on better data and improved statistical methods. Our findings also suggest that nursing home administrators should consider adopting initiatives to facilitate and empower family members' involvement in nursing home choice, which in turn may lead to increased visitations.

Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study.

Long-term functional and cognitive outcomes in nursing home residents after procedures are poorly understood. Our objective was to evaluate these outcomes after suprapubic tube (SPT) placement. We performed a retrospective, cohort study in the nursing home setting. Participants were long-term nursing home residents who underwent SPT placement from 2014 to 2016 in the United States. SPT placements were identified in Medicare Inpatient, Outpatient, and Carrier files using International Classification of Diseases and Current Procedural Terminology codes. Residents were identified through the Minimum Data Set (MDS) 3.0 for Nursing Home Residents. MDS Activities of Daily Living (MDS-ADL) and Brief Interview for Mental Status (BIMS) scores were used to assess function and cognition, respectively. Outcomes of interest were worsening MDS-ADL and BIMS scores at 1year postoperatively, 30-day postoperative complications, and 1-year mortality. Functional and cognitive trajectories were modeled to 1 year postoperatively using mixed-effect spline models. From 2014 to 2016, 9647 residents with a mean age of 80.9 (SD 8.1) years underwent SPT placement. At 1year postoperatively, 37.6% of residents died, while of survivors, 33.7% had worsening MDS-ADL and 36.2% worsened BIMS. Residents had steeper postoperative rates of functional decline compared to relatively stable preoperative trends that never recovered to baseline status. However, robustly characterizing an association between SPT placement and functional decline would require a propensity score matched cohort without SPT placement. Decline in cognitive status was not clearly associated with SPT placement, suggesting either the natural course of a vulnerable population or limitations of BIMS scores. Outcomes important to older adults, such as functional ability and cognitive status, do not show improvement after SPT placement. These findings emphasize that this "minor" procedure should be considered with caution in this population and primarily for palliation.

Register-based surveillance of COVID-19 in nursing homes.

This study describes results from the surveillance of COVID-19 infections in nursing homes in the first year of the COVID-19 pandemic. All data in the study are from Beredt C19, an emergency preparedness register that collects data from a wide range of sources. We used the data set 'Health and Care' in the Norwegian Registry for Primary Health Care to define a nursing home population and linked this to other sources in the emergency preparedness register to estimate incidence rates, hospitalisations and deaths related to COVID-19 among nursing home residents in 2020. A log-binomial regression model was used to analyse the risk of death related to COVID-19. Of the 83114 persons who were included in the study, 35758 (43%) were older than 80 years. We found that 570 persons (0.69%) tested positive for SARS-CoV-2 in 2020. A total of 19041 residents died during the study period, whereof 248 (1.3%) deaths were related to COVID-19. The relative risk of dying from COVID-19 rose with age and was highest for long-term nursing home residents. Nursing home residents have a high background mortality, so despite the high lethality of SARS-CoV-2 infection and the high proportion of the COVID-19-related deaths that have occurred in nursing homes, COVID-19-related deaths accounted for a relatively minor proportion of all deaths among nursing home residents.

Positive effect of the INTERCARE nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design

BackgroundUnplanned nursing home (NH) transfers are burdensome for residents and costly for health systems. Innovative nurse‐led models of care focusing on improving in‐house geriatric expertise are needed to decrease unplanned transfers. The aim was to test the clinical effectiveness of a comprehensive, contextually adapted geriatric nurse‐led model of care (INTERCARE) in reducing unplanned transfers from NHs to hospitals.MethodsA multicenter nonrandomized stepped‐wedge design within a hybrid type‐2 effectiveness‐implementation study was implemented in 11 NHs in German‐speaking Switzerland. The first NH enrolled in June 2018 and the last in November 2019. The study lasted 18 months, with a baseline period of 3 months for each NH. Inclusion criteria were 60 or more long‐term care beds and 0.8 or more hospitalizations per 1′000 resident care days. Nine hundred and forty two long‐term NH residents were included between June 2018 and January 2020 with informed consent. Short‐term residents were excluded. The primary outcome was unplanned hospitalizations. A fully anonymized dataset of overall transfers of all NH residents served as validation. Analysis was performed with segmented mixed regression modeling.ResultsThree hundred and three unplanned and 64 planned hospitalizations occurred. During the baseline period, unplanned transfers increased over time (β 1 = 0.52), after which the trend significantly changed by a similar but opposite amount (β 2 = −0.52; p = 0.0001), resulting in a flattening of the average transfer rate throughout the postimplementation period (β 1 + β 2 ≈ 0). Controlling for age, gender, and cognitive performance did not affect these trends. The validation set showed a similar flattening trend.ConclusionA complex intervention with six evidence‐based components demonstrated effectiveness in significantly reducing unplanned transfers of NH residents to hospitals. INTERCARE's success was driven by registered nurses in expanded roles and the use of tools for clinical decision‐making.

Transfers among Long-term Nursing Home Residents during the COVID-19 Pandemic

The COVID-19 pandemic has posed unpredictable challenges globally. Urban elders in Global South nations are among the major population groups vulnerable to COVID-19. A qualitative case study design was used to uncover the challenges and sources of support for poor urban elders during COVID-19 lockdown in Ethiopia. Data were collected from 27 elders age 60 and above in Debre Markos Town via in-depth interviews and document review. Narrative data were analyzed using thematic data analysis. Four prominent themes were identified: 1. Food insecurity (“Hunger would kill us instead of COVID-19”), 2. Hopelessness (“Feeling hopeless and begging to die”), 3. Social isolation (“We prefer social support rather than food donations”) and 4. Gratitude (“Feeling thankful”). The physical distancing program introduced to contain the pandemic isolated many elders and diminished their capacity to access support from others needed to perform their daily activities. An institutional welfare system is needed to ensure older adults in the Global South can live a joyful and dignified life, even through a global pandemic. Moreover, a special emergency fund to meet older adults’ basic needs during a pandemic like COVID-19 should be introduced to minimize the effect of crises on vulnerable groups like destitute older adults in Ethiopia.

Assessing the well-being of residents in nursing facilities

PurposeWell-adapted and validated well-being (WB) instruments for the nursing home population are scarce. To our knowledge, the Laurens Well-Being Inventory for Gerontopsychiatry (LWIG) is a practical and reliable well-being assessment tool that has never been validated for German nursing home populations. Therefore, the purpose of our study was to (1) translate and cross-culturally adapt the LWIG to a German context and (2) test the reliability and validity of the German LWIG in a group of older nursing home residents using the Rasch model.MethodsThis study has a cross-sectional, descriptive study design. Cross-cultural adaption of the LWIG-GER from English to German was performed according to a standardized method. The data obtained from 104 long-term nursing home residents (57 women, 47 men) aged 60–99 years (mean 79.5, standard deviation ±9.11) were analyzed for psychometric testing (exploratory and confirmatory factor analysis, item fit, McDonald’s ω, convergent validity, and known-group validity, Rasch).ResultsThe final LWIG-GER consists of 19 items with three subscales, including “psychological WB”, “social WB”, and “physical WB”. The LWIG-GER showed good overall reliability with McDonald’s ω of 0.83; the LWIG-GER dimensions’ scores were significantly correlated with depression, functional performance, activities, fear of falling, and education.ConclusionsOur findings suggest that the German language version of the LWIG is a reliable and valid tool for measuring WB in nursing home residents. Furthermore, we propose that the LWIG-GER questionnaire can broaden and deepen our understanding of residents’ perception of quality of care and their environment.

Evaluation of the instrumented Timed Up and Go test as a\xa0tool to measure exercise intervention effects in nursing home residents: results from a\xa0PROCARE substudy

Background and objectivesTo achieve independence in activities of daily living, a certain level of functional ability is necessary. The instrumented Timed Up and Go (iTUG) test provides guidance for appropriate interventions, for example, when considering the subphases within the TUG. Therefore, we evaluated the iTUG as a tool to measure the effects of a multicomponent exercise intervention on the iTUG subphases in nursing home residents.MethodsFifty long-term nursing home residents (34 women, 82.7 ± 6.46 [65–91] years; 16 men, 78.6 ± 7.0 [62–90] years) performed the iTUG test before and after a 16-week intervention period (2 × 45–60 min/week). According to the attendance rates, participants were divided into three groups.ResultsThe total iTUG duration decreased from baseline to posttest, F(2,46) = 3.50, p = 0.038, η2p = 0.132. We observed significant correlations between the attendance rates and the total iTUG duration (r(50) = 0.328, p = 0.010). However, we did not observe significant group × time interaction effects in the subphases. The Barthel Index moderated the effect between attendance rate and the total duration of the iTUG test, ΔR2 = 8.34%, F(1,44) = 4.69, p = 0.036, 95% CI [0.001, 0.027].ConclusionsWe confirmed the effectiveness of the iTUG as a tool to measure exercise intervention effects in nursing home residents, especially when participants exhibit high attendance rates. That said, mobility needs to be considered in a more differentiated way, taking into account parameters in the subphases to detect changes more sensitively and to derive recommendations in a more individualized way.

Exploring the Dynamics of Week-to-Week Blood Pressure in Nursing Home Residents Before Death.

Aging is accompanied by an overall dysregulation of many dynamic physiologic processes including those related to blood pressure (BP). While year-to-year BP variability is associated with cardiovascular events and mortality, no studies have examined this trend with more frequent BP assessments. Our study objective is to take the next step to examine week-to-week BP dynamics-pattern, variability, and complexity-before death. Using a retrospective study design, we assessed BP dynamics in the 6 months before death in long-term nursing home residents between 1 October 2006 and 30 September 2017. Variability was characterized using SD and mean squared error after adjusting for diurnal variations. Complexity (i.e., amount of novel information in a trend) was examined using Shannon's entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability. We identified 17,953 nursing home residents (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mm Hg). Despite a slight trend of decreasing systolic week-to-week BP over time (delta = 7.2 mm Hg), week-to-week complexity did not change in the 6 months before death (delta = 0.02 bits). Average weekly BP variability was stable until the last 3-4 weeks of life, at which point variability increased by 30% for both systolic and diastolic BP. Factors associated with BP variability include average weekly systolic/diastolic BP, days in the nursing home, days in the hospital, and changes to antihypertensive medications. Week-to-week BP variability increases substantially in the last month of life, but complexity does not change. Changes in care patterns may drive the increase in BP variability as one approaches death.

Associations between nurse–patient interaction and loneliness among cognitively intact nursing home residents – a questionnaire survey

Nursing home (NH) residents risk loneliness because of many losses. Nurse–patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months’ residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked “Do you sometimes feel lonely?” and used the Nurse–Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse–patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse–patient interaction associates with residents’ loneliness and might be important in alleviating loneliness.