Nursing Home Facilities Research Articles

Group Therapy With the Elderly in a Nursing Home Setting: Theory and Strategy for Healing and Meaning in Late Life

Nursing home care includes caring for the emotional and psychological needs of the elderly. There is a growing need for mental health clinicians who are trained to offer care to the elderly in nursing home facilities. Group psychotherapy with the elderly has been shown to be an effective form of treatment. This article provides a theoretical framework for understanding the challenges and psychosocial crises of the elderly. This article also offers a strategy for conducting group psychotherapy in a nursing home setting to promote the use of groups and facilitate effective treatment.

Orthostatic Hypotension Predicts a Poor Prognosis in Elderly People with Dementia.

Objective The purpose of the present study was to assess the prevalence of orthostatic hypotension (OH) and elucidate its associations with the demographic characteristics and the prognosis in elderly subjects with dementia who visited a hospital for elderly daycare. Methods A total of 64 outpatients (44 females) with a mean age of 84±6 years who visited a hospital for daycare were enrolled in the study. The prevalence of OH and demographic characteristics were examined. Then, the subjects were followed up for 1 year. The blood pressure was measured in the supine position and immediately, 1, 3 and 5 minutes after standing. Poor outcome measures included death, hospitalization for any reason, and admission to a nursing home or geriatric facility. Results OH was present in 17 patients (26.6%). The presence of OH was associated with a higher supine systolic blood pressure. The increase in heart rate in the standing position was also reduced in subjects with OH compared with those without. The presence of OH was associated with faster time in the timed up-and-go test compared with those without OH. During the follow-up period, 22 patients (34.4%) had a poor prognosis, of which 8 (36.4%) had OH, which tended to be higher than those with a favorable prognosis. The event-free survival rate appeared to be lower in subjects with OH than in those without. Conclusion OH is relatively common in frail elderly patients with dementia, and it also appears to be associated with a poor prognosis.

Supra-Infected Hepatic and Renal Amebic Abscesses-A Case Report

We describe the case of a 69-year-old man referred from a nursing home facility for acute severe anemia. On presentation, the patient complained of fever, chills, and abdominal pain. Physical exam was significant for a fever of 103.8 F, pale conjunctivae, rales over the right lung base and direct tenderness to palpation overlying the right upper quadrant. Laboratory analysis revealed a normocytic normochromic anemia of 6.7 g/dL, leukocytosis of 17.2 K/μL, elevated creatinine and hepatic function panel with a urinalysis remarkable for turbid cloudy appearing urine, positive for leucocyte esterase and white blood cells. Abdominal Ultrasonography (US) and computed tomography (CT) of the abdomen and pelvis with contrast revealed a 9.2 cm in maximal diameter low-density collection in the posterior aspect of the right lobe of the liver contiguous with a 7.2 cm maximal diameter multi-loculated collection of the superior pole of the right kidney. CT guided drainage of the liver revealed anchovy paste like material and positive cultures for proteus mirabilis species were obtained from both the hepatic and renal foci. Serum entamoeba antibody testing for IgG was positive and intravenous metronidazole with oral iodoquinol was started. Ultimately the patient’s clinical status improved and he was subsequently discharged

They Are Called Nursing Homes for a Reason: RN Staffing in Long-Term Care Facilities.

According to the Centers for Medicare and Medicaid Services (CMS), the Consolidated Medicare and Medicaid regulations have not been systematically reviewed and updated since 1991. Existing regulations require that, with certain exceptions, an RN provide services in a facility for 8 consecutive hours per day, 7 days per week; licensed practical nurses (LPNs) 24 hours per day; and sufficient staff to meet residents' needs. The requirements to determine "sufficient" staff remain undefined by CMS. Several national organizations support RN staffing 24 hours per day each day of the week (24/7). These organizations provided evidence refuting CMS' position that it does not have sufficient information at this time to require a specific number of staff or hours of nursing care per resident. Consideration should be given to the Institute of Medicine recommendation affrming the need for and requiring the presence of at least one RN within every nursing home facility at all times. Currently, there is a bill in the House of Representatives that supports 24/7 RN coverage in nursing homes, which must become both bipartisan and bicameral to be passed.

Cost‐Effectiveness of Nutrition Intervention in Long‐Term Care

To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. Randomized, controlled trial. Five skilled nursing home facilities. Long-stay residents with orders for nutrition supplementation (N = 154). Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain.

Sleep, Cognition and Dementia.

The older patient population is growing rapidly around the world and in the USA. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation all of which may be misinterpreted as dementia. The key sleep disorders impacting patients with dementia include insomnia, hypersomnolence, circadian rhythm misalignment, sleep disordered breathing, motor disturbances of sleep such as periodic leg movement disorder of sleep and restless leg syndrome, and parasomnias, mostly in the form of rapid eye movement (REM) sleep behavior disorder (RBD). RBD is a pre-clinical marker for a class of neurodegenerative diseases, the "synucleinopathies", and requires formal polysomnographic evaluation. Untreated sleep disorders may exacerbate cognitive and behavioral symptoms in patients with dementia and are a source of considerable stress for bed partners and family members. When left untreated, sleep disturbances may also increase the risk of injury at night, compromise health-related quality of life, and precipitate and accelerate social and economic burdens for caregivers.

Phoning in sick--telehealth in the iPhone age: As mobile devices become ubiquitous, can health care finally be delivered effectively over the Internet?

Phoning in sick--telehealth in the iPhone age: As mobile devices become ubiquitous, can health care finally be delivered effectively over the Internet?

A nursing minimum dataset for documenting nutritional care for adults in primary healthcare: a scoping review protocol

A nursing minimum dataset for documenting nutritional care for adults in primary healthcare: a scoping review protocol

A population-level study of place of death and associated factors in Sweden.

The aims of this study were to examine, on a population level, where people die in Sweden, and to investigate associations between place of death and underlying cause of death, socioeconomic and environmental characteristics, with a particular interest in people dying from life-limiting conditions typically in need of palliative care. This population-level study is based on death certificate data for all deceased individuals in Sweden in 2012, with a registered place of death (n=83,712). Multivariable logistic regression was performed to investigate associations between place of death and individual, socioeconomic and environmental characteristics. The results show that, in 2012, 42.1% of all deaths occurred in hospitals, 17.8% occurred at home and 38.1% in nursing home facilities. Individuals dying of conditions indicative of potential palliative care needs were less likely to die in hospital than those dying of other conditions (OR = 0.73; 95% CI = 0.70-0.77). Living at home in urban areas was associated with higher likelihood of dying in hospital or in a nursing home (OR = 1.04 and 1.09 respectively). Educational attainment and marital status were found to be somewhat associated with the place of death. The majority of deaths in Sweden occur in institutional settings, with comparatively larger proportions of nursing home deaths than most countries. Associations between place of death and other variables point to inequalities in availability and/or utilization of health services at the end of life.

Osteoarthritis, Drug use and risk of Cardiac Ischaemic events: a case-control study

e126 Volume 37 Number 8S were more frequently women, especially those treated with antidepressants. In addition, those treated with antipsychotics were older, and were less often visited by a GP but were more often admitted to hospital the month prior to admission. Both, those treated with antipsychotics and those treated with antidepressants more often lived in and were discharged to nursing home facilities. Furthermore, those treated with antipsychotics more often died during admission. Conclusions: The prevalence of psychotropic medicines prescription was high in the elderly, especially the prescription of anxiolytics or hypnotics-sedatives and antidepressants. Women were more frequently prescribed than men, especially for antidepressants, and patients treated with antipsychotics had worse outcomes.

Hospital palliative care support teams in France: A nationwide descriptive study

Summary Background Hospital palliative care support teams have been widely developed in France since 1987. However, very few studies have been conducted to evaluate and measure this development with more details. Methods A retrospective, questionnaire-based survey was conducted among all hospital palliative care support teams in France. The questionnaire aimed to investigate the organization, the composition, the clinical support and the teaching and research activities of the palliative care support teams. Results Among 353 hospital palliative care support teams in 2012, 297 (84.1%) participated in the study. Most hospital palliative care support teams are located in public hospitals (87.9%), including 46 in teaching hospitals. Exactly 55.6% of all palliative care support teams have the possibility to intervene both in hospitals and in nursing home facilities. Hospital palliative care support teams have a median annual budget of 289,000 €, with an average of 1.1 physician, 1.5 nurse, 0.2 nurse manager, 0.7 psychologist and 0.1 social worker. On average, each palliative care team follows 359 patients (SD = 233). About 92.8% of all interventions occur in hospital facilities and 3.1% in nursing homes. Overall, more than 75% of all interventions from palliative care support teams occur at the patients’ bedside, however, less than 25% of these interventions are conducted alongside with the staff member caring for the patients. Finally, hospital palliative care support teams are engaged in both initial education and continuing education initiatives. Conclusion Our study shows that in France, hospital palliative care support teams face many challenges with limited resources. Although these transversal services have a great potential for disseminating the palliative care approach in various settings (including nursing homes), our study raises important questions regarding the effectiveness and the sustainability of small and isolated teams.

Occurrence of Depressive Symptoms Among Older Adults after a Stroke in the Nursing Home Facility.

The aim of the study was to analyze the prevalence of depressive symptoms among older adults after stroke in a nursing home (NH). The study was conducted in a NH and included 50 patients after stroke with a mean age of 74.62 (±8.2). The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Acceptance Illness Scale (AIS) and Barthel Index (BI) were used. Mean GDS was 7.60 (±2.75); 74% of patients had depressive symptoms. The study showed a significant relationship between GDS and marital status (p=.043). A negative correlations between GDS and MMSE (p=.029), GDS and BI (p=.049), and GDS and AIS (p<.0001) were found. The occurrence of depressive symptoms in older adults after stroke depends on their mental and functional status, degree of acceptance of illness, and marital status. Early detection of depressive symptoms in stroke patients allows rehabilitation nurses to optimize the therapeutic effects.

Implementing an evidence-based intervention to improve care for ventilator-dependent residents in a nursing home facility

Introduction: Pneumonia is a potentially preventable cause of readmissions among nursing home residents. It was found to be a frequent cause of readmission among ventilator-dependent residents in a nursing home facility. The objective of this project was to implement and evaluate a comprehensive respiratory care program for residents dependent on ventilators and potentially decrease the readmission rate in a community nursing home. Methods: A quality improvement project was undertaken to improve the care provided to ventilator-dependent resident. Components of the project included implementation of the ventilator associated pneumonia (VAP) protocol, a hand hygiene bundle, and an education program on respiratory care. To assess the program impact, process monitoring of the elements of the VAP protocol, adherence to hand hygiene, and readmission rates were undertaken at baseline and following implementation of the program. Results: The VAP protocol was successfully implemented through education, changes to documentation, and an institutional policy. Process auditing showed improvement over time in adherence to the two elements of the protocol, elevation of head of bed and daily oral care, directly related to VAP prevention. Correct hand washing occurred 12% of the time, increasing to 68% at 6 weeks post-implementation; however, adherence decreased to 35% at the 7 months follow-up. A chart review of the reasons for readmission showed a downward trend in readmissions related to pneumonia from 29% pre-intervention to 9% following the intervention. Conclusions: This project reflects an improvement in the care provided to residents dependent on ventilators. This was accomplished by adapting the VAP protocol to fit within the nursing home context.

The high price of obesity in nursing homes.

This article provides a commentary on the costs of obese nursing home patients. We conducted a comprehensive literature search, which found 46 relevant articles on obesity in older adults and effects on nursing home facilities. This review indicated obesity is increasing globally for all age groups and older adults are facing increased challenges with chronic diseases associated with obesity more than ever before. With medical advances comes greater life expectancy, but obese adults often experience more disabilities, which require nursing home care. In the United States, the prevalence of obesity in adults aged 60 years and older increased from 9.9 million (23.6%) to 22.2 million (37.0%) in 2010. Obese older adults are twice as likely to be admitted to a nursing home. Many obese adults have comorbidities such as Type 2 diabetes; patients with diabetes incurred 1 in every 4 nursing home days. Besides the costs of early entrance into nursing facilities, caring for obese residents is different than caring for nonobese residents. Obese residents have more care needs for additional equipment, supplies, and staff costs. Unlike emergency rooms and hospitals, nursing homes do not have federal requirements that require them to serve all patients. Currently, some nursing homes are not prepared to deal with very obese patients. This is a public health concern because there are more obese people than ever in history before and the future appears to have even a heavier generation moving forward. Policymakers need to become aware of this serious gap in nursing home care.

Variation in the place of death among nursing home residents in France.

recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. a cross-sectional retrospective survey was conducted in 2013. coordinating physicians in 3,705 nursing homes in France. a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P < 0.001). our study demonstrates the existence of major differences across regions in France and highlights the need for targeted interventions regarding end-of-life care in nursing home facilities.

Caregiver and Patient's Comfort Investigation Based on Head Motion Behavior Analysis During Transfer Care

As well known the aging of Japan is thought to be more serious than any other countries, and its accelerated aging population issue has raised increasing attention of government, nursing industry and normal citizen. As reported, nearly 60% of older adults are sheltered in nursing home facilities that provide a wide range of care. For elder patients, it is very important to keep themselves healthy by matching or realizing “Diaper zero” program; Correspondingly, caregivers’ job burden has to be increased owing to increasing number of transfer care from bed or wheel chair to toilet. What's more, it is easy to result in caregivers’ body fatigue and overworked, especially for one caregiver-to-many elder patients nursing facilities. Therefore, it is urgent to establish a comfortable transfer care method/procedure for both caregiver (reduced physical burden) and elder patient (safety and relieved) during transfer care process in nursing care field. In this paper caregiver and patient's comfort investigation based on head motion behavior analysis during transfer care process from wheel chair to toilet by the care of expert and non-expert was compared. Especially elder patient and caregiver's head impact issue were focused and clarified based on MA analysis. As a result, both caregiver and elder patient suffered a more serious head impact effect through non-expert's transfer care process than expert. Additionally, non-expert's head larger acceleration change through MA period resulted in accumulated fatigue issue finally. In conclusion, expert caregiver was able to control the rhythm of whole care process and make elder patient more comfortable than non-expert caregiver.

Perspectives of Spanish psychiatrists on the management of dementias: The PsicoDem survey

IntroductionMental health services are not systematically involved in the care of dementias in Spain. Nevertheless, many patients with dementia attend these services. The perspective of psychiatrist as regards this situation has not been evaluated at the national level to date, and it may be of interest to determine their actual involvement and the strategies to foster it. Material and methodsA survey was conducted on 2000 psychiatrists on a range of mental health care services. Respondents provided socio-demographic data and information about clinical aspects, together with their opinions regarding the management of dementia. Responses were described by their raw frequencies and measures of association for cross-tabulations resulting from selected pairs of questions. Inferences were made by calculating their 95% confidence intervals. ResultsPsychiatrist involvement in the management of dementias was limited, aside from those involved in psycho-geriatric units or nursing homes facilities. However, there were wide, regional differences. Nearly all respondents (81%) were ready to augment their knowledge and skills in the area of dementia. In particular, the insufficient medical education, together with other organisational factors, such as the difficulties in ordering diagnostic tests (i.e. neuroimaging), or prescribing anti-dementia drugs in some regions, were common barriers psychiatrists faced when approaching patients with dementia. ConclusionsIncreasing psychiatrist involvement and boosting coordinated efforts with other specialists in a form of integrated care may advance the care of dementias in Spain to a more valuable level.

PERSONAL AND HEALTH-RELATED FACTORS ASSOCIATED WITH RECREATIONAL ACTIVITY PREFERENCES AMONG NURSING HOME RESIDENTS

Background: Recreational activities have the potential to improve nursing home residents’ quality of life, but little is known about the factors that are associated with the preferences that residents may voice regarding specific types of activities. Objectives: To identify personal, and health-related factors associated with recreational activity preferences in nursing home residents. Design: Cross-sectional study. Setting: An urban nursing home facility in the United States. Participants: Newly admitted, long-stay nursing home residents (N = 123). Measurements: Data obtained from residents’ admission Minimum Data Set (MDS) 3.0, including age, gender, race/ethnicity, marital status, subjective vision and hearing impairment ratings, cognitive functioning, depressive symptoms, and pain presence were examined as predictors of eight activity preferences items (i.e., having books, listening to music, participating in religious services) using multivariate logistic analyses. Results: In general, nursing home residents reported high preferences for most recreational activities. Vision and hearing impairments were significantly associated with vision-specific (reading) and hearing-specific activities (listening to music), respectively. Racial/ethnic minority residents were more likely to prefer group activities, keeping up with news, and religious practices, when compared to non-minority residents. Conclusions: Understanding activity preferences is a necessary first step in establishing and designing recreational programs that meet the needs of diverse populations in nursing homes.

The effect of a “surveillance nurse” telephone support intervention in a home care program

This study is an evaluation of a unique “surveillance nurse” telephone support intervention for community-dwelling elderly individuals in a home care program. A combined propensity-based covariate-matching procedure was used to pair each individual who received the intervention (“treatment” condition, nT = 930) to a similar individual who did not receive the intervention (“control” condition, nC1 = 930) from among a large pool of potential control individuals (nC0 = 4656). The intervention consisted of regularly scheduled telephone calls from a surveillance nurse to proactively assess the individual's well-being, care plan status, use of and need for services (home support, adult day program, physiotherapy, etc.) and home environment (e.g., informal caregiver support). Treatment and control conditions were compared with respect to four service utilization outcomes: (1) rate of survival in the community before institutionalization in an assisted living or nursing home facility or death, (2) rate of emergency room registrations, (3) rate of acute care hospitalizations, and (4) rate of days in hospital, during home care enrollment. Results indicated a beneficial effect of the surveillance nurse intervention on reducing rate of service utilization by increasing the duration of the home care episode.

(13) Diabetes care in the hospital, nursing home, and skilled nursing facility.

(13) Diabetes care in the hospital, nursing home, and skilled nursing facility.