Older Adults In Nursing Homes Research Articles

Assessing Frailty in Chinese Nursing Home Older Adults: A Comparison between the Frail-NH Scale and Frailty Index.

(1) To establish appropriate FRAIL-NH cutoff points in nursing homes in Mainland China; (2) To compare the FRAIL-NH scale and Frailty Index in assessing frailty prevalence and associated factors in nursing homes. A cross-sectional study. Six nursing homes in Changsha, China. A total of 302 residents aged 60 years or older (mean aged 82.71±8.49, 71.2% female). Frailty was assessed using the 34-item Frailty Index and the FRAIL-NH scale. The appropriate FRAIL-NH cutoff points to classify frail status and frailest status were 1.5 (87.6% sensitivity, 63.3% specificity) and 7.5 (94.1% sensitivity, 73.4% specificity), respectively. Based on the FRAIL-NH and Frailty Index, 69.5% (48% for frail and 21.5% for frailest), and 66.5% (60.9% for frail and 5.6% for frailest) of residents were at risk of frailty, respectively. There was no statistically significant difference in the total frailty prevalence assessed by FRAIL-NH and Frailty Index (χ2=0.617, P=0.432). The FRAIL-NH Scale is significantly associated with the Frailty Index (correlation coefficient (r) = 0.74, P < 0.001), but there was a Kappa agreement of 0.39 for frailty classification between the FRAIL-NH and Frailty Index, with the Frailty Index classifying a larger number of individuals as frail. When using FRAIL-NH scale, disease and self-reported health status were associated with frail and frailest status while age was just associated with frailest status. regarding the Frailty Index, age, diseases, medications and self-reported health status were associated with frail and frailest status. The FRAIL-NH is a simple and effective tool to assess the overall frailty rate in nursing homes, and the Frailty Index may be more suitable capturing the multidimensionality of frailty at an individual level. Careful consideration in the selection of a frailty instrument, based on the intended purpose, is necessary.

Resistance Band Exercises Reduce Depression and Behavioral Problems of Wheelchair-Bound Older Adults with Dementia: A Cluster-Randomized Controlled Trial.

To test the effects of a 15-month wheelchair-bound resistance band exercise program on depression and behavioral problems of wheelchair-bound older adults with dementia. Single-blind, cluster-randomized controlled trial with repeated measures. Eight nursing homes in southern Taiwan. Wheelchair-bound nursing home older adults with dementia who participated voluntarily (N = 150) were cluster-randomized to two groups (experimental or control group); 127 completed the study (experimental: four nursing homes, n = 65; control: four nursing homes, n = 62). The resistance band exercises were conducted three times per week in 40-minute sessions in the following two sequences: volunteer-led sessions for the first 6 months (Stage I) followed by DVD-guided sessions for the next 9 months (Stage II). Depression, as measured using the Cornell Scale for Depression in Dementia, and behavioral problems, as measured using the Clifton Assessment Procedures for the Elderly-Behavior Rating Scale, of participants were observed at six time points at 3-month intervals: pretest, two posttests at Stage I, and three posttests at Stage II. By the sixth month of the study, experimental group participants were significantly less depressed and had fewer behavioral problems than control group participants (all P < .05). These small but statistically significant differences persisted throughout the 9 months of the DVD-guided sessions (all P < .05). Volunteer-led sessions followed by DVD-guided sessions of resistance band exercise is effective and practical in institutional settings.

Effects of horticulture therapy on nursing home older adults in southern Taiwan.

This study aimed to test the effects of horticulture therapy on activities of daily living, happiness, meaning of life, and interpersonal intimacy of nursing home older adults in southern Taiwan. A quasi-experimental study was applied. Eighty-five older adults aged 65 or older who lived in nursing homes in southern Taiwan were recruited conveniently. All participants completed the study: experimental group (n=41) and control group (n=44). The experimental group received horticulture therapy for 1h once a week for 8weeks, while the control group continued their routine daily activities. The following questionnaires were administered before and after the intervention period: (1) Barthel Index (BI), (2) Chinese Happiness Inventory short version (CHI), (3) Meaning of Life Scale (MLS), and (4) Interpersonal Intimacy Scale (IIS). The BI, CHI, MLS, and IIS scores significantly improved in the experimental group (p<.05). After 8weeks of horticulture therapy, the BI, CHI, and IIS scores of experimental group participants were significantly better than the scores of control group participants (p<.05); however, the MLS scores of two groups showed no significant differences (p=.738). Horticulture therapy improved activities of daily living, happiness, and interpersonal intimacy of older adults in nursing homes. We recommend that nursing homes recruit and train personnel to lead horticultural therapy and to incorporate the therapy as routine daily activities in the facilities.

Feasible modalities and long-term effects of elastic band exercises in nursing home older adults in wheelchairs: A cluster randomized controlled trial

BackgroundPhysical activity holds promise for mobility-impaired older adults to prevent further disabilities and improve their health. However, staffing constraints have made it challenging to promote physical activity in long-term care facilities. ObjectivesTo test the feasibility and effects of 12 months Wheelchair-bound Senior Elastic Band (WSEB) group-exercises that were led by volunteers for the first six months followed by the DVD-guided for another six months on functional fitness, activities of daily living (ADL), and sleep quality of nursing home older adults in wheelchairs. DesignCluster randomized controlled trial with two groups, pre-test and post-tests. SettingsTen nursing homes, Taiwan. Participants127 participants participated voluntarily; 107 of them completed the study. Inclusion criteria: (1) aged 65 years and over, (2) using wheelchairs for mobility, (3) living in facility for at least three months, (4) cognitively intact, and (5) heavy or moderate dependency in ADL. Majority of participants were middle-old older adults (75–84 years old, 53.2%), female (51.4%), and had chronic illnesses (98.1%). MethodsParticipants were randomly assigned by facility to either the experimental (five nursing homes, n=56) or control group (five nursing homes, n=51). The WSEB program was conducted three times per week and 40min per session in two stages: volunteer-led for the first six months (stage I) followed by the DVD-guided modality for another six months (stage II). The primary outcomes (functional fitness: lung capacity, body flexibility, range of joint motion, and muscle strength and endurance) and the secondary outcomes (ADL measured by the Barthel Index; sleep quality measured by the Pittsburgh Sleep Quality Index) of the participants were measured at three time points: pre-test, at the six-month interval, and at the end of 12 months of the study. No blinding was applied. ResultsAll of the functional fitness indicators of the experimental group participants improved significantly (p<.05), and were all better than the control group at six-month and 12-month of the study (p<.05). No symptoms of discomfort occurred during interventions. ConclusionsNursing home older adults in wheelchairs who received WSEB exercise training had better functional fitness, ADL, and sleep quality than those who did not. It was a feasible way of carrying out this exercise program by using the volunteer-led followed by the DVD-guided modalities. The program can be applied in institutional settings routinely.

Sleep quality and depression of nursing home older adults in wheelchairs after exercises

BackgroundSleep disturbances and depression are costly and potentially disabling conditions that affect a considerable proportion of older adults. The purpose of this study was to test the effectiveness of 6 months of elastic band exercises on sleep quality and depression of wheelchair-bound older adults in nursing homes. MethodsOne hundred twenty-seven older adults from 10 nursing homes participated in this cluster randomized controlled trial, and 114 completed the study. Participants were randomly assigned to two groups: experimental group (five nursing homes, n = 59) and control group (five nursing homes, n = 55). A 40-minute wheelchair-bound senior elastic band exercise program was implemented 3 times per week for 6 months. Sleep quality and depression of the participants were examined at baseline, after 3 months, and at the end of the 6-month study. DiscussionParticipants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study. ConclusionsNursing home directors could recruit volunteers to learn the program and lead the elderly residents in wheelchairs in practicing the wheelchair-bound senior elastic band exercises regularly in the facilities.

Immunogenicity and Safety of Intradermal Trivalent Influenza Vaccination in Nursing Home Older Adults: A Randomized Controlled Trial

ObjectiveTo compare the immunogenicity and safety between full-dose (15 μg) intramuscular (IM) and full-dose (15 μg) intradermal (ID) immunization of the trivalent influenza vaccine in nursing home older adults. DesignA single-center, randomized, controlled, open-label, parallel group trial from October 2013 to April 2014. SettingNine nursing homes in Hong Kong. ParticipantsHundred nursing home older adults (mean age: 82.9 ± 7.4 years). InterventionFifty received ID (Intanza) and 50 received IM (Vaxigrip) vaccination. MeasurementsBaseline measurements included demographics, comorbidity, frailty and nutritional status. Day 21 and day 180 immunogenicity (seroconversion rate, seroprotection rate, geometric mean titer [GMT] fold increase in antibody titer) using hemagglutination-inhibition and adverse events were measured. Noninferiority and superiority of ID compared with IM vaccination in immunogenicity were analyzed. The study was registered on ClinicalTrials.gov; identifier: NCT 01967368. ResultsAt day 21, noninferiority in immunogenicity of the ID vaccination was demonstrated. The seroconversion rate of the H1N1 strain was significantly higher in the ID group. At day 180, immunogenicity of both groups fell but the GMT of all strains in ID group was higher and the difference was significant for H3N2 strain. The seroconversion rate and GMT fold increase of H3N2 strain was significantly higher in the ID group. Local adverse events was significantly more in ID group, but they were mild and resolved in 72 hours. ConclusionsID vaccination is noninferior, and even superior in some parts of immunogenicity assessment, to IM vaccination without compromising safety in nursing home older adults. ID vaccination is a good alternative to IM vaccination in this population.

An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: A cluster randomized trial

BackgroundThe number of older adults using wheelchairs in nursing homes is over 50% of that population, and many of them use wheelchairs due to muscle weakness in the lower extremities. Muscles of older adults are trainable, and progressive resistance exercises using elastic bands can increase muscle strength in older adults. ObjectivesTo test the effectiveness of six-month Wheelchair-bound Senior Elastic Band exercises on the functional fitness of older adults in nursing homes. DesignCluster randomized trial. SettingsTen nursing homes, southern Taiwan. Participants127 participants were recruited, and 114 of them completed the study. Inclusion criteria were: (1) aged 65 and over, (2) using wheelchairs for mobility, (3) living in the facility for at least three months, (4) cognitively intact, and (5) heavily or moderate dependency in their activities of daily living. The mean age of the participants was 79.15 (7.03) years, and 98.20% of them had chronic illnesses. MethodsParticipants were randomly assigned to the experimental (five nursing homes, n=59) or the control (five nursing homes, n=55) group based on the nursing homes where they stayed. A 40-min Wheelchair-bound Senior Elastic Band exercise program was implemented three times per week for six months for the experimental group participants. The functional fitness (activities of daily living, lung capacity, body flexibilities, muscle power and endurance) of the participants was examined at baseline, after three months, and at the end of the six months study. The mixed-design, two-way analysis of variance was used to detect the interaction effects, and one-way repeated measures analysis of variance and analysis of covariance were performed to analyze the within-group and between-group differences. ResultsAt the end of the six-month study, the Wheelchair-bound Senior Elastic Band group had better performances in all of the functional fitness indicators than the control group (all p<0.05). ConclusionsThe Wheelchair-bound Senior Elastic Band exercises significantly improved the functional fitness of the older adults in wheelchairs. It is suggested that the program be incorporated as a part of daily activities for nursing home older adults in wheelchairs.

Factors Associated With Seasonal Influenza Vaccination in Chinese Nursing Home Older Adults

Factors Associated With Seasonal Influenza Vaccination in Chinese Nursing Home Older Adults

Efficacy of Trivalent Seasonal Influenza Vaccination in Reducing Mortality and Hospitalization in Chinese Nursing Home Older Adults

To examine the clinical efficacy of the trivalent seasonal influenza vaccination among Chinese older adults residing in a nursing home. A 12-month prospective cohort study. Participants were divided into 2 groups based on their own choice on vaccination of trivalent seasonal influenza vaccine: vaccinated group and unvaccinated group. Fifty-eight nursing homes in Hong Kong. A total of 1859 older adults residing in a nursing home. All-cause mortality, pneumonia-related mortality, all-cause hospitalization, and pneumonia-related hospitalization. A total of 1859 older adults residing in a nursing home were included: 1214 (65.3%) in the vaccinated group and 645 (34.7%) in the unvaccinated group. At 12 months of study, for all-cause mortality, 14.6% (177 of 1214) of the vaccinated group and 20.2% (130 of 645) of the unvaccinated group had died (P < .001). Multivariate analysis showed the hazard ratio for the vaccinated group was 0.72 (95% confidence interval [CI]: 0.54-0.95; P < .01). For pneumonia-related mortality, 9.4% (114 of 1214) of the vaccinated group and 12.7% (82 of 645) of the unvaccinated group died (P= .033). Multivariate analysis showed the hazard ratio for the vaccinated group was 0.80 (CI: 0.62-0.98; P < .05). The median number of all-cause hospitalizations per 1000 person-months was 55 (0-111) for the vaccinated group and 55 (0-167) for the unvaccinated group (P < .01). The median number of pneumonia-related hospitalizations per 1000 person-months was 0 (0-55) for the vaccinated group and 0 (0-111) for the unvaccinated group (P < .01). Vaccination of trivalent seasonal influenza vaccine in Chinese nursing home older adults significantly reduced all-cause and pneumonia-related mortality and hospitalization.

Association between Functional Status of Chinese Nursing Home Older Adults and Long Term Mortality

To investigate the strength of association between impaired functional status and long-term (3-year) mortality in Chinese nursing home older adults. A 3-year prospective multicenter cohort study. Nine nursing homes in Hong Kong. A total of 672 nursing home older adults (224 men; 448 women), mean age 85.0 ± 7.4. Functional statuses of participants were assessed by Barthel Index (BI) and participants were stratified into different groups according to their BI score: BI score 100, BI score 75-95, BI score 45-70, BI score 15-40, and BI score 0-10. Other covariates included age, sex, comorbidities, score of abbreviated mental test, serum albumin, serum creatinine, serum hemoglobin, and hospitalization in the preceding year. The outcome measures were the 1-year, 2-year, and 3-year all-cause mortality. Older adults with lower BI score had significantly higher all-cause mortality and this trend persisted in 1-year, 2-year, and 3-year mortality (P < .001). After multivariate analysis, there was a dose-response relationship in hazard ratio (HR) between BI score and 3-year all-cause mortality (compared with BI score 100; BI score 75-95: HR 1.38 [CI: 1.00-2.56; P < .05]; BI score 45-70: HR 1.80 [CI: 1.04-3.11; P < .001]; BI score 15-40: HR 2.12 [1.21-3.70; P < .001]; BI score 0-10: HR 3.13 [1.82-5.41; P<.001]; and trend test P < .05). Similar relationships were found in 1-year and 2-year mortality. Impaired functional status is associated with higher short-term and long-term mortality with a dose-response relationship in Chinese nursing home older adults.

Influence of Education and Age on the Abbreviated Mental Test in Chinese Nursing Home Older Adults

Influence of Education and Age on the Abbreviated Mental Test in Chinese Nursing Home Older Adults

The Efficacy of Influenza Vaccination is Reduced in Nursing Home Older Adults With Moderate to Severe Renal Impairment

In patients with end stage renal failure, the immune response toward influenza vaccination and its efficacy to reduce mortality are inferior to patients with normal renal function. 1 Suga T. Niki H. Niikura M. et al. Influenza antibody titers after vaccination of chronic renal failure patients. Tokai J Exp Clin Med. 1990; 15: 245-251 PubMed Google Scholar , 2 Gilbertson D.T. Unruh M. McBean A.M. et al. Influenza vaccine delivery and effectiveness in end stage renal disease. Kidney Int. 2003; 63: 738-743 Crossref PubMed Scopus (99) Google Scholar In 2009, the pandemic H1N1 infection had caused significant mortality in Hong Kong, with 90% virus isolated being H1N1. 3 Wu J.T. Ma E.S.K. Lee C.K. et al. The infection attack rate and severity of 2009 pandemic H1N1 influenza in Hong Kong. Clin Infect Dis. 2010; 51: 1184-1191 Crossref PubMed Scopus (163) Google Scholar , 4 Center of Health Protection. The Government of the Hong Kong. Monthly summary tables of influenza virus isolation 2009. Available at: http://www.chp.gov.hk/. Accessed January 7, 2012. Google Scholar The dual vaccination (seasonal influenza and H1N1) strategy offered additional benefits in reducing mortality in older adults, 5 Chan T.C. Hung I.F. Luk J.K. et al. Efficacy of dual vaccination of pandemic H1N1 2009 influenza and seasonal influenza on institutionalized elderly: A one-year prospective cohort study. Vaccine. 2011; 29: 7773-7778 Crossref PubMed Scopus (16) Google Scholar and this study further examined whether this strategy is still efficacious in older adults with renal dysfunction.

Prevalence of anemia in Chinese nursing home older adults: Implication of age and renal impairment

There is little data regarding the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. The objective of this study was to investigate the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. We carried out a retrospective cross-sectional study in nine nursing homes in Hong Kong. The hemoglobin (Hb) level, mean corpuscular volume (MCV), serum creatinine and comorbidities data of residents were examined. Older adults were regarded as anemic according to the World Health Organization criteria (Hb <13 g/dL for men and <12 g/dL for women). The glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease Study (MDRD [Chinese-adjusted]) equation. Patients with chronic renal impairment were defined as having eGFR <60 mL/min/1.73 m(2) . A total of 812 residents were included (mean age 86.0 ± 7.6 years). The mean hemoglobin was 12.0 ± 1.8 g/dL in men and 11.4 ± 1.6g/dL in women. The mean eGFR was 75.1 ± 31.7 mL/min/1.73 m(2) . A total of 67.0% of residents had anemia (70.5% in men and 65.2% in women). Anemic older adults were older and had a higher prevalence of renal impairment than non-anemic older adults (P<0.001). There was no significant difference between the two groups regarding the prevalence of other comorbidities. When stratified into different age groups, there were significant correlations between anemia and renal impairment in all subgroups (age ≤ 80 years, P<0.05; age 81-90 years, P<0.01; age >90 years, P<0.05). The same correlation was found between normocytic anemia and renal impairment. Conversely, when stratified according to eGFR (≥ 60 mL/min/1.73 m(2) vs <60 mL/min/1.73 m(2) ), we did not observe a significant correlation between anemia and age group. In conclusion, anemia is prevalent in Chinese nursing home residents and is strongly associated with renal impairment. Further studies of early identification and management of anemia with renal impairment are recommended in this population.

Chronic Kidney Disease and Its Association With Mortality and Hospitalization in Chinese Nursing Home Older Residents: A 3-Year Prospective Cohort Study

To investigate chronic kidney disease (CKD) as a predictor of mortality and hospitalization in Chinese nursing homes older residents. A 3-year prospective multicenter cohort study. Nine nursing homes in Hong Kong. Nursing home older adults (812 total; 271 men and 571 women), mean age 86.0 ± 7.6. Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease Study (Chinese-adjusted), and participants were stratified into different severity of renal impairment according to the modified version of Kidney Disease Outcomes Quality Initiative (K/DOQI): stage 1 CKD: GFR > 90 mL/min/1.73 m(2); stage 2 CKD: 60-89 mL/min/1.73 m(2); stage 3A CKD: 45-59 mL/min/1.73 m(2); stage 3B CKD: 30-44 mL/min/1.73 m(2); stage 4/5: <30 mL/min/1.73 m(2). The outcome measures were the all-cause, infection-related, and cardiovascular-related mortality and hospitalizations. Older adults with stage 3B and stage 4/5 CKD had higher all-cause, infection-related, and cardiovascular-related mortality than those with earlier stages of CKD. After multivariate analysis, stage 3B and stage 4/5 CKD were independent predictors of all-cause mortality (stage 3B, hazard ratio [HR]: 1.62, 95% CI: 1.12-2.33, P= .01; stage 4/5, HR: 2.00, 95% CI: 1.34-3.00, P= .001) and infection-related mortality (stage 3B, HR: 1.41, 95% CI: 1.08-2.30, P= .019; stage 4/5, HR: 1.91, 95% CI: 1.13-3.23, P= .016), but not cardiovascular-related mortalities. The all-cause, infection-related, and cardiovascular-related hospitalizations were significantly higher in older nursing home adults with stage 3B and stage 4/5 CKD. In Chinese nursing home older adults, stage 3B and stage 4/5 CKD are independent predictors of all-cause and infection-related mortality. They also predict increased risks of all-cause, infection-related, and cardiovascular-related hospitalizations.

Prevention of Mortality and Pneumonia Among Nursing Home Older Adults by Dual Pneumococcal and Seasonal Influenza Vaccination During a Pandemic Caused by Novel Pandemic Influenza A (H1N1)

To evaluate the efficacy of dual vaccination of seasonal influenza and pneumococcus in nursing home older adults during a novel pandemic of influenza A (H1N1). Nine nursing homes in Hong Kong. A total of 532 nursing home older adults were included in the study. Efficacy of dual vaccination of seasonal influenza and pneumococcus in nursing home older adults during a novel pandemic influenza A (H1N1). A prospective 12-month cohort study was conducted on older residents from December 2009 to November 2010. Participants were divided into 3 groups according to their choice of vaccination: received both seasonal influenza and 23-valent pneumococcal polysaccharide vaccine (PPV-TIV group), received seasonal influenza vaccine alone (TIV group), and those who refused both vaccinations (unvaccinated group). Those who had received vaccination for influenza A (H1N1) were excluded. Outcome measures included mortality from all causes, pneumonia, and vascular causes. There were 246 in the PPV-TIV group, 211 in the TIV group, and 75 in the unvaccinated group. Baseline characteristics were similar among the groups. The 12-month mortality rates of the PPV-TIV, TIV alone group, and unvaccinated group were 17.1%, 27.0%, and 37.3% respectively (P < .001). Multivariate analysis demonstrated that, compared with vaccination of seasonal influenza alone, dual vaccination significantly reduced all-cause mortality (hazard ratio [HR] 0.54; 95% confidence interval [CI]: 0.35-0.84; P < .01), mortality from pneumonia (HR 0.60; 95% CI: 0.35-0.99; P < .05), and mortality from vascular causes (HR 0.24; 95% CI: 0.09-0.64; P < .01). During an influenza pandemic or when the circulating influenza strain was not matched by the trivalent seasonal influenza vaccine, dual vaccination of influenza and pneumococcus provided additional protection to nursing home older adults in reducing mortality.

Prevalence and Associated Comorbidities of Moderate to Severe Chronic Renal Impairment in Chinese Nursing Home Older Adults

To investigate the prevalence and associated comorbidities of Stage 3 (GFR 30-59 mL/min/1.73m(2)) and Stages 4 and 5 (GFR <30 mL/min/1.73m(2)) chronic kidney disease (CKD) among Chinese nursing home older adults. Retrospective cross-sectional study. Glomerular filtration rate (GFR) was estimated by Modification of Diet in Renal Disease Study (Chinese-adjusted) equation and The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Nine nursing homes in Hong Kong Participants included 812 nursing home older adults (271 men and 571 women), mean age 86.0 ± 7.6. Prevalence of Stage 3 (GFR 30-59 mL/min/1.73m(2)) and Stages 4 and 5 (GFR <30 mL/min/1.73m(2)) CKD. The comorbidities associated with renal impairment were also assessed. There were 18.4% of nursing home older adults who had elevated serum creatinine levels above the normal limits. Using Modification of Diet in Renal Disease Study and CKD-EPI equations, 26.4% and 21.2% of them had Stage 3 CKD, whereas 6.8% and 4.4% had Stage 4-5 CKD, respectively. Diabetes mellitus, hypertension, congestive heart failure, and ischemic heart disease correlated significantly with moderate to severe renal impairment in Chinese nursing home older adults. Stages 3 to 5 CKD are prevalent in Chinese nursing home older adults. Early identification of these patients facilitates drug prescription, renal management, and advance care planning.

Advance Directive and End-of-Life Care Preferences Among Chinese Nursing Home Residents in Hong Kong

The objectives of the present study were to describe the knowledge and preferences of Hong Kong Chinese older adults regarding advance directives and end-of-life care decisions, and to investigate the predictors of preferences for advance directive and community end-of-life care in nursing homes. This was a cross-sectional survey conducted in 140 nursing homes in Hong Kong. A total of 1600 cognitively normal Chinese older adults were recruited. Information on demographics, social, medical diseases, preferences of end-of-life care decisions, and advance directives were collected by face-to-face questionnaire interviews. The mean age of the participants was 82.4 years; 94.2% of them would prefer to be informed of the diagnosis if they had terminal diseases and 88.0% preferred to have their advance directives regarding medical treatment in the future. Approximately 35% would prefer to die in their nursing homes. The significant independent predictors for the preference of advance directive included asking for relatives' advice, wishing to be informed of their terminal illness diagnoses, absence of stroke, and having no problems in self-care in European Quality of Life-5 Dimensions. For the preference for community end-of-life care and dying in nursing homes, the independent predictors included older age, not having siblings in Hong Kong, Catholic religion, nonbeliever of traditional Chinese religion, not receiving any old age allowance, lower Geriatric Depression Scale score, and being residents of government-subsidized nursing homes. Most of our cognitively normal Chinese nursing home older adults prefer having an advance directive, and one-third of them would prefer to die in nursing homes.

Secondary effects of cardiovascular drug use on perceptions of functional communication needs of nursing home older adults∗

Approximately one half of all persons 65 years and over in this country have some form of cardiovascular disease for which they are taking a variety of medications. Cardiovascular medications, however, have adverse side effects, like confusion and depression, that can alter the user's behavior and perceptions about the world. This study seeks to examine whether the presence or absence of cardiovascular medications in a sample of nursing home residents over 65 with no history of neurological complications is reflected in how those persons rate the importance of functional communication skills in their everyday lives. Results indicate that, for the subjects in this study, cardiovascular medications do influence how some items on a 50‐item questionnaire are prioritized.