Nursing Care Facilities Research Articles

Impact of resistance training on sarcopenia in nursing care facilities: A pilot study

The impact of progressive resistance training on sarcopenia among very old institutionalized adults was investigated. Residents of Nursing Care Facilities were included in a controlled trial of twice weekly resistance and balance exercise program for six months (Age: 85.9 ± 7.5 years, Time in care: 707.1 ± 707.5 days, N = 21 per group). Sarcopenia was measured based on the European Working Group on Sarcopenia in Older People criteria. Of the recruited 42 participants, 35.7% had sarcopenia at baseline, with prevalence increasing in the control group post-intervention (42.9%–52.4%). Following training, the exercise group experienced a significant increase in grip strength when compared to controls (p = .02), and a within-group decrease in body mass index and increase in grip strength (p ≤ .007). Resistance and balance exercise has positive benefits for older adults residing in a nursing care facilities which may transfer to reduce disability and sarcopenia transition, but more work is needed to ensure improved program uptake among residents.

Cigarette Smoking Prevalence Among Adults Working in the Health Care and Social Assistance Sector, 2008 to 2012.

The primary objective of this study was to estimate current smoking among workers in the health care and social assistance sector. We analyzed the 2008 to 2012 National Health Interview Survey data for adults (age 18 years or more) working in health care and social assistance sector who reported current cigarette smoking. Of the approximately 18.9 million health care and social assistance workers, 16.0% were current cigarette smokers. Smoking prevalence was highest in women (16.9%) and among workers: age 25 to 44 years (17.7%); with a high school education or less (24.4%); with income less than $35,000 (19.5%); with no health insurance (28.5%); in the nursing and residential care facilities (26.9%) industry; and in the material recording, scheduling, dispatching, and distributing (34.7%) occupations. These findings suggest that specific group of workers in the health care and social assistance sector might particularly benefit from cessation programs and incentives to quit smoking.

Managing high-risk patients: the Mass General care management programme.

The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries-primarily older persons-with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a "whole systems" approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing structure, standards of practice, collaborative approach to care transitions and information technology tools that were used in the original demonstration project.

153 Patient Length of Stay in the Context of the “2-Midnight Rule”: Assessing the Accuracy of Attending Providers’ Predictions

Since the enactment of the “2-midnight rule” in October 2013, CMS requires admitting providers to predict whether patients will require hospitalization less than 2 midnights, in which case they are designated as observation status (OS), or 2 midnights or longer, designated as inpatient (IP). Providers’ inaccurate designation of patients as OS or IP has financial consequences for hospitals and patients. For hospital stays originally designated as IP but lasting <2 midnights, hospitals may not be able to capture CMS payment and patients may be held financially responsible for more of the services provided during the stay. For hospital stays originally designated as OS but lasting 2+ midnights, hospitals are more likely to have a negative margin for the stay and patients may not be eligible for insurance coverage of subsequent skilled nursing facility care. We sought to: a) determine providers’ accuracy in predicting which patients require hospitalization greater than two midnights and b) identify patient characteristics that providers may use to improve prediction accuracy. We conducted an analysis of consecutive adult (18+ years) emergency department (ED) visits resulting in admission to the hospital within a 90-day period (May 2014 through August 2014) where an attending emergency physician prospectively designated the admission type (OS versus IP). Inaccurate predictions were defined as those involving patients who were designated as IP but stayed <2 midnights and patients designated as OS but stayed 2+ midnights. Patient characteristics associated with inaccurate predictions were identified. Linear regression models were fit to explore associations and predictors of accurate versus inaccurate predictions. IRB approval was obtained. A total of 4760 adult patients were admitted to the hospital through the ED during our study period; 58% (n=2760) were IP and 42% (n=2000) OS. Overall 53.7% were males and median age was 63 years (IQR 46 to 78). The overall rate of error in predicted length of stay was 38.3%. Inpatient cohort: Of 2760 patients admitted as IP, 27.6% (761) stayed for < 2 midnights. Patient characteristics associated with these shorter-than-predicted stays include immunosuppression, with 63% of immunosuppressed patients staying for < 2 midnights (P < .001), and younger age (median 60 years [IQR 43-75] for those staying <2 midnights versus 67 [IQR 50-80] for 2+ midnights, p<0.001). Observation cohort: Of the 2000 patients admitted as OS, 53.2% (1063) stayed for 2+ midnights. Patient characteristics associated with longer-than-predicted stays included altered mental status, dialysis requirement, psychiatric issues, hospice care, or nursing home residency. In this study, providers inaccurately predicted patients’ length of stay in almost 40% of cases, and sub-populations of patients were at higher risk for over- and under-estimated of length of stay. Under the “2 midnight rule,” this places hospitals at risk of underpayment and patients at risk of increased financial liability for their hospital stays and subsequent skilled nursing facility care. Future research is needed to identify interventions that can improve providers’ prediction accuracy.

Sleep stage classification by body movement index and respiratory interval indices using multiple radar sensors.

Disturbed sleep has become more common in recent years. To increase the quality of sleep, undergoing sleep observation has gained interest as an attempt to resolve possible problems. In this paper, we evaluate a non-restrictive and non-contact method for classifying real-time sleep stages and report on its potential applications. The proposed system measures body movements and respiratory signals of a sleeping person using a multiple 24-GHz microwave radar placed beneath the mattress. We determined a body-movement index to identify wake and sleep periods, and fluctuation indices of respiratory intervals to identify sleep stages. For identifying wake and sleep periods, the rate agreement between the body-movement index and the reference result using the R&K method was 83.5 ± 6.3%. One-minute standard deviations, one of the fluctuation indices of respiratory intervals, had a high degree of contribution and showed a significant difference across the three sleep stages (REM, LIGHT, and DEEP; p <; 0.001). Although the degree that the 5-min fractal dimension contributed-another fluctuation index-was not as high as expected, its difference between REM and DEEP sleep was significant (p <; 0.05). We applied a linear discriminant function to classify wake or sleep periods and to estimate the three sleep stages. The accuracy was 79.3% for classification and 71.9% for estimation. This is a novel system for measuring body movements and body-surface movements that are induced by respiration and for measuring high sensitivity pulse waves using multiple radar signals. This method simplifies measurement of sleep stages and may be employed at nursing care facilities or by the general public to increase sleep quality.

Changes in Mood in New Enrollees at a Program of All-Inclusive Care for the Elderly.

To examine changes in mood after nine months of enrollment in a Program of All-Inclusive Care for the Elderly (PACE). Cohort study. Alexian Brothers PACE, St. Louis, Missouri. Newly enrolled patients 55 years of age and older, living in the PACE service area, eligible for nursing facility care and able to live safely in the community, with continuous care, for at least nine months (N = 182). Geriatric Depression Scale (GDS)-15 score at the pre-admission evaluation (PAE) and the nine-month evaluation (9ME). Of the 182 patients evaluated, 27% (n = 49) met the definition of depression as defined by the GDS-15 score of ≥ 6 at the PAE. At the 9ME, only 11% of patients met the depression criteria (P < 0.001). Of the patients who met the criteria for depression at the PAE, 80% of patients (n = 39) no longer met these criteria at the 9ME (P = 0.029). Similar findings were observed by age, gender, and race. Greater improvement was observed among those who were depressed at the PAE; the depressed cohort improved by 5.0 points (P < 0.001) on the GDS-15 scale from the PAE to the 9ME, whereas the nondepressed cohort improved by 0.6 points (P = 0.003). The use of PACE as an alternative intervention may be a good option to improve mood in older adults.

Managing the Future of Medicaid.

Managing the Future of Medicaid.

Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia.

To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment. Longitudinal cohort study. Health and Retirement Study (HRS). HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N = 16,186). Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition.

Outcome and prognosis of hypoxic brain damage patients undergoing neurological early rehabilitation.

BackgroundThe prevalence of patients suffering from hypoxic brain damage is increasing. Long-term outcome data and prognostic factors for either poor or good outcome are lacking.MethodsThis retrospective study included 93 patients with hypoxic brain damage undergoing neurological early rehabilitation [length of stay: 108.5 (81.9) days]. Clinical data, validated outcome scales (e.g. Barthel Index—BI, Early Rehabilitation Index—ERI, Glasgow Coma Scale—GCS, Coma Remission Scale—CRS), neuroimaging data, electroencephalography (EEG) and evoked potentials were analyzed.Results75.3% had a poor outcome (defined as BI <50). 38 (40.9%) patients were discharged to a nursing care facility, 21 (22.6%) to subsequent rehabilitation, 17 (18.3%) returned home, 9 (9.7%) needed further acute-care hospital treatment and 8 (8.6%) died. Barthel Index on admission as well as coma length were strong predictors of outcome from hypoxic brain damage. In addition, duration of vegetative instability, prolongation of wave III in visual evoked potentials (flash VEP), theta and delta rhythm in EEG, ERI, GCS and CRS on admission were related to poor outcome. All patients with bilateral hypodensities of the basal ganglia belonged to the poor outcome group. Age had no independent influence on functional status at discharge.ConclusionsAs with other studies on neurological rehabilitation, functional status on admission turned out to be a strong predictor of outcome from hypoxic brain damage.

The clinical effectiveness of a nurse practitioner versus a non-nurse practitioner on hospital admissions of older adults residing in skilled or long-term care nursing facilities: a systematic review protocol

The clinical effectiveness of a nurse practitioner versus a non-nurse practitioner on hospital admissions of older adults residing in skilled or long-term care nursing facilities: a systematic review protocol

멸치볶음 저작⋅연하 용이 노인식 개발

Failure of the functions involved in ingestion leads to, not only loss of enjoyment of eating, but also protein-energy malnutrition. Dysmasesis and difficulty of swallowing occurs in various diseases, but aging is a major cause. In the aging society, the proportion of elderly people with dysmasesis and difficulty of swallowing is expected to increase rapidly. Developing foods for the elderly that are easy to chew and swallow is thus required. This study was conducted to develop easily chewable and swallowable foods for the elderly who can crush foods and ingest with their own tongues, but occasionally have difficulty in drinking fluids such as water and tea. Various foods for the elderly with chewing and swallowing difficulties were used for sensory assessment. The sensory panel consisted of 10 dietitians (10 women) in nursing care facilities. The sensory optimal composite recipes were determined by central composite design (CCD). The sensory measurements were significantly different in saltiness (p

Assessment of functional capability and on-going falls-risk in older institutionalized people after total hip arthroplasty for femoral neck fractures

PurposeTo estimate functional capability and attendant falls-risk in older institutionalized people after total hip arthroplasty (THA) for femoral neck fractures. MethodsThe study population comprised 149 consecutive patients (F104, M45; mean age 83.4 years) who were permanent residents of nursing care facilities four weeks after THA for femoral neck fractures. Individual mental and functional capability status was assessed using the Mini Mental State Examination (MMSE), Timed Up and Go test (TUG) and Tinetti's Performance Oriented Mobility Assessment (POMA) which includes sub-scales for balance (B) and gait (G), in conjunction with identifying any concomitant disorders, reviewing individual pharmacotherapy and leisure time activities. ResultsThe subjects’ mean MMSE was 23.1 points, whereas in Tinetti's POMA they scored 19 points on average, which translated into a five-fold greater falls-risk, whereas average TUG scores of 23.9s effectively corroborated this assertion. Multiple regression analysis effectively highlighted that TUG scores were strongly correlated with the actual number of concomitant disorders, number of regularly taken medications, and usual manner of spending leisure time. ConclusionsInstitutionalized older people after THA for femoral neck fracture continue to be exposed to high risk of recurrent, possibly injurious falls, which is closely correlated with significantly diminished individual functional capabilities.

“Add-on” effect of phytosterols-enriched fermented milk on lipids and markers of cholesterol metabolism in statin-treated elderly patients

The effect of plant sterol (PS) enriched matrices on lipid profile has been evaluated in statin-treated individuals, with LDL-C concentrations between 3.35mmol/L and 4.90mmol/L, but studies in the elderly are scarce. In this study the additional effect of a low-fat PS-enriched fermented milk (PS-FM) on cholesterol metabolism markers and serum lipids was evaluated in the elderly on stable statin therapy with baseline LDL-C<3.35mmol/L. Thirty-five individuals (88.6% women; 81±8years old; BMI 29.9±6.0kg/m2), living in elderly nursing care facilities were placed on a daily intake of 2g PS-FM for 6weeks, in addition to their statin monotherapy. A fasting blood sample was collected at baseline (t0), after 2 consecutive periods of 3weeks intake (t1 and t2), and after 6weeks of washout (t3), for the analysis of serum lipid profile and cholesterol synthesis (lathosterol, desmosterol) and absorption (sitosterol, campesterol and cholestanol) markers. PS-FM consumption led to a LDL-C reduction of 0.15mmol/L (t1) and 0.27mmol/L (t2) from baseline (P<0.05). Serum campesterol and sitosterol (P<0.001) increased (t0–t1; t0–t2), reflecting PS intake and contributing to the inhibition of cholesterol intestinal absorption, leading to a decrease in cholestanol-to-cholesterol ratio. There was a reciprocal homeostatic rise of serum cholesterol precursors, desmosterol and lathosterol (P<0.001) from baseline, based on the up-regulation of the opposing pathway. Statin-treated elderly individuals, with baseline LDL-C<3.35mmol/L, may still have therapeutic benefit from strategies that reduce cholesterol absorption, such as 2g/day PS-FM.

가자미 구이 저작․연하 용이 노인식 개발

This study was conducted to develop food for the elderly, which are well-shaped and easy to chew and swallow. The amounts of water and gelatin were adjusted to facilitate breaking down of the food with the tongue. In the aging society, it is necessary to support the development of a variety of products that can ease the intake functions of swallowing and chewing, while complementing with the essential nutrients supplements; such products can be actively commercialized in the elderly industry. Various types of food, for elderly with difficulties in chewing and swallowing, were used for sensory assessment. Sensory panel consisted of 10 dietitians (10 women) in nursing care facilities. The sensory optimal composite recipes were determined by central composite design (CCD). The sensory measurements were significantly different in the appearance (p

Japan as the front-runner of super-aged societies: Perspectives from medicine and medical care in Japan.

Japan as the front-runner of super-aged societies: Perspectives from medicine and medical care in Japan.

Utilization of acute care among patients with ESRD discharged home from skilled nursing facilities.

Older adults with ESRD often receive care in skilled nursing facilities (SNFs) after an acute hospitalization; however, little is known about acute care use after SNF discharge to home. This study used Medicare claims for North and South Carolina to identify patients with ESRD who were discharged home from a SNF between January 1, 2010 and August 31, 2011. Nursing Home Compare data were used to ascertain SNF characteristics. The primary outcome was time from SNF discharge to first acute care use (hospitalization or emergency department visit) within 30 days. Cox proportional hazards models were used to identify patient and facility characteristics associated with the outcome. Among 1223 patients with ESRD discharged home from a SNF after an acute hospitalization, 531 (43%) had at least one rehospitalization or emergency department visit within 30 days. The median time to first acute care use was 37 days. Characteristics associated with a shorter time to acute care use were black race (hazard ratio [HR], 1.25; 95% confidence interval [95% CI], 1.04 to 1.51), dual Medicare-Medicaid coverage (HR, 1.24; 95% CI, 1.03 to 1.50), higher Charlson comorbidity score (HR, 1.07; 95% CI, 1.01 to 1.12), number of hospitalizations during the 90 days before SNF admission (HR, 1.12; 95% CI, 1.03 to 1.22), and index hospital discharge diagnoses of cellulitis, abscess, and/or skin ulcer (HR, 2.59; 95% CI, 1.36 to 4.45). Home health use after SNF discharge was associated with a lower rate of acute care use (HR, 0.72; 95% CI, 0.59 to 0.87). There were no statistically significant associations between SNF characteristics and time to first acute care use. Almost one in every two older adults with ESRD discharged home after a post-acute SNF stay used acute care services within 30 days of discharge. Strategies to reduce acute care utilization in these patients are needed.

ACOs Turn Up the Heat Among Skilled Nursing Facilities

ACOs Turn Up the Heat Among Skilled Nursing Facilities

Abstract 146: Inpatient Rehabilitation Facility Care Reduces the Likelihood of Death and Rehospitalization After Stroke Compared with Skilled Nursing Facility Care

Introduction: Accountable care and bundled payment initiatives have increased attention on inpatient post-acute care effectiveness. Empirical evidence for whether care at inpatient rehabilitation (IRF) or skilled nursing facilities (SNF) is associated with differential outcomes is limited. Methods: Data from the American Heart Association Get With The Guidelines-Stroke registry were linked with Medicare claims. We compared post-discharge mortality and a composite of all-cause rehospitalization or death for beneficiaries who received IRF or SNF care immediately after hospital discharge. Proportional hazards regression with inverse propensity weighting (IPW) was used to adjust for measured differences in demographic, clinical and hospital characteristics. Acknowledging the possibility of unmeasured differences between groups, an instrumental variable approach (IV=hospital-specific proportion of patients discharged to IRFs vs SNFs) was used to adjust for both measured and unmeasured confounding. Results: From 1,142 hospitals there were 34,574 AIS patients discharged to IRFs and 34,430 to SNFs. Patients receiving SNF vs IRF care were older (83 vs 79 years), had more comorbid illness, and higher unadjusted 7, 90, and 365 day mortality and rehospitalizations (Table). After IPW adjustment mortality and rehospitalization/mortality rates remained significantly better for patients with IRF vs SNF care (Table). Differences attenuated with IV analysis but IRF care continued to be associated with better outcomes (Table). Findings were similar in sensitivity analyses among patients with a NIHSS score. Conclusions: Receiving care at an IRF after AIS was associated with lower mortality and all-cause rehospitalization/death compared with SNF care even after rigorous adjustment for both measured and unmeasured differences in treatment selection. Further research is needed to discern the mechanisms for these potential differences between settings.

介護プロセスの計測と記述

Employees at nursing-care facilities co-operate with each other and provide nursing-care service according to care plans designed to meet residents’ physical condition and needs. Traditionally, improvement of service productivity in nursing-care service has been based on experience and inspiration of managers and employees. Engineering methods to achieve improvement is a relatively new and necessary approach. In this paper, the authors collaborated with eight nursing-care facilities, and developed engineering methods to achieve improvement of their service process and service productivity. At first, we classified employees’ behaviors into a three-layer structure consisting of “service type”, “purpose / situation” and “operation”, and developed task classification for nursing-care service which could express 455 employees’ states. We then described nursing-care service process as transition of employees’ state with eight properties; “id”, “start time”, “end time”, “task”, “place”, “target resident”, “cost” and “detailed information”. Finally, we measured behaviors of 20 employees at four nursing-care facilities to evaluate the task classification for nursing-care service proposed in this paper, and confirmed that it covered 96.9 % of their behaviors. The cover rate was enough high for visualization of nursing-care service process. In addition, we visualized the nursing-care service process of 15 employees at a nursing-care facility with “time-line mode” and “statistical mode”. We also confirmed that our proposed methods were effective to visualize the nursing-care service process and to improve service productivity in the service field.

Development of a Remote Height-Monitoring System for Electric Beds in Hospitals and Nursing Care Facilities

Development of a Remote Height-Monitoring System for Electric Beds in Hospitals and Nursing Care Facilities