Older Home Care Patients Research Articles

Identification of Barriers for Active Disease Management and of Medication-Related Problems through Therapeutic Patient Education in Older Home-Care Patients.

Combining therapeutic patient education (TPE) with a medication review service could foster the adoption of appropriate lifestyles by patients and support care-providers in identifying strategies to improve the quality of prescribed care. This study aimed to identify barriers experienced by patients in managing their diseases and medication-related problems. This was a monocentric, case series, observational study involving home-care patients from the Local Health Authority ASL TO4. Patients were enrolled for a TPE intervention where drug therapies and patient habits were collected through narrative interviews. Medication review was performed to identify potentially inappropriate prescriptions (PIPs). Twenty patients (13 females) with a mean age of 74.7 years were enrolled. Patients had an average of 4.3 diseases and 80.0% of them were treated with ≥5 daily medications. The main PIPs involved ibuprofen, furosemide and pantoprazole. The qualitative analysis of the interviews identified seven macro-themes relating to different aspects of medication management: therapy; diseases; patient; patient journey; professionals; family and caregivers; drug information. The results of this study revealed some critical aspects related to the treatment path and healthcare professionals. These results will be used to plan educational interventions for polypharmacy patients to improve medication adherence and the understanding and management of diseases.

The role of functioning in predicting nursing home placement or death among older home care patients

Objective There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. Design A prospective one-year follow-up study. Settings and subjects Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). Main outcome measures Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). Results Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62–0.86), IADL (0.75, 0.65–0.87) MMSE (0.92, 0.87–0.96), and TUG (1.02, 1.01–1.03). NHP alone was predicted by BADL (0.62, 0.50–0.78), IADL (0.57, 0.45–0.73), and MMSE (0.88, 0.82–0.94) and mortality by TUG (1.02, 1.01–1.03). Conclusion Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.

65 YAŞ VE ÜSTÜ EVDE SAĞLIK HASTALARINDA UYGUNSUZ İLAÇ KULLANIMININ VE GÜNLÜK YAŞAM AKTİVİTELERİNİN DEĞERLENDİRİLMESİ

Introduction: This study aims to evaluate potentially inappropriate medication (PIM) use, the association of PIM use, and activities of daily living in 65 years and older home care patients. Method: The study included 322 patients aged 65 and over who applied to Home Care Unit. Consent was obtained from those who agreed to participate in the study. A questionnaire containing demographic data, drug use information, and Katz Daily Living Activities Index was used which was prepared by the researcher in this study. The drugs used by the patients were evaluated according to the 2015 Beers criteria and inappropriate active substances were detected. The data were defined by statistical analyzes such as mean, percentage, standard deviation, and frequency. Chi-squared test and Student's t-test were used in the analysis. The significance level was accepted as p<0.05. Results: The mean age of the patients was 80.2±8.2 years, and 63.4% (n=204) were female. 70.5% (n=227) of the elderly have three or more chronic diseases. The most common diseases were hypertension (56.2%), diabetes (30.0%), and heart failure (29.8%). 79.2% (n=255) of the group uses four or more drugs. 83.3% (n=260) of the patients get help to use the drugs. 51.6% (n=166) of the patients were fully dependent on activities of daily living and 3.4% (n=11) were fully independent, the level of dependency increases with age (p<0.05). The PIM rate was 61.5% in patients. PIM use was found to be significantly higher in those with more disease, in those who used more drugs, and in females (p<0.05). No relationship was found between inappropriate medication use and addiction level. Conclusion: In this study, it was found that more than half of home care patients aged 65 and over had inappropriate drug use. It was determined that inappropriate medication use increased with polypharmacy, and polymorbidity, and there was no correlation between addiction levels.

Development of a medication literacy assessment instrument (MELIA) for older people receiving home care.

To develop a consensus-based instrument [MELIA] to assess the medication literacy of older home care patients to ultimately optimize medication safety. This study was part of the project 'Study of Medication Safety in Home Care' (doMESTIC), which took place from 2016 to 2020 in Switzerland. The development process for the medication literacy assessment instrument encompassed six steps. First, a scoping literature search was conducted in the Pubmed, CINAHL, EMBASE and Cochrane Library databases as 2) a basis for the development of assessment items. This was followed by 3) a cognitive interview with home care patients and 4) the first round of a Delphi process. Then, 5) a focus group interview with home care experts was conducted before 6) the second Delphi round. The project took place between August 2020 and June 2021. With these different steps, perspectives of both patients and various home care and medication safety experts were included in the development of the assessment instrument. A detailed instrument consisting of 20 items as well as a 7-item short version were developed. The short version is intended for efficient preliminary screening to identify patients at high risk for medication management-related problems. Medication literacy in patients 65 years and older receiving professional home care is a key issue in preventing medication errors. A targeted assessment, starting with an efficient short version of MELIA, allows for prioritization of patients for interventions to optimize medication safety while ensuring their independence as much as possible. Systematic assessment of patients' medication literacy helps to provide them with targeted and individual support in their medication management to avoid medication errors and increase patient safety. The development of MELIA is a first step in providing an assessment instrument specifically for the home care setting. Patient participation was an integral part of the instrument development. The initial 23 items were optimized based on cognitive interviews with four home care patients. The next steps of the instrument development were based on feedback of health care professionals-encompassing advance practice nurses, regular nurses, pharmacists and general practitioners-during a two-step Delphi process as well as a focus group discussion.

Keeping calm on a busy day\u2014an interpersonal skill home care patients desire in health workers: hermeneutical phenomenological method

BackgroundIn Western countries, many health and social care provisions have been transferred to primary care, and most older patients wish to remain in their own homes for as long as possible. For older patients who live alone, health workers could be their only personal contacts. Hence, health workers’ personal skills affect their relationships with these patients. Accordingly, this study aimed to shed light on the interpersonal skills needed by health workers to establish good relationships with older home care patients and highlight the importance of interpersonal skills training in nursing education.MethodsThis study adopted a hermeneutical phenomenological approach. The qualitative method was used to elicit data on patients’ perspectives. Ten home care patients were interviewed individually in their own homes between December 2019 and January 2020.ResultsDespite individual variations, health workers’ interpersonal skills are of significance with regard to the social well-being of patients living at home. The findings revealed that patients want health workers to be mentally present, congruent in their communications, calm and relaxed during the available time spent with them, and capable of facilitating autonomy.ConclusionsIt is important to present patients’ perspectives to ensure that nursing education is geared towards patients’ best interests.Trial registration numberThe Norwegian Centre for Research Data (NSD): 953937.

The needs of older people receiving home care: a scoping review.

Most people in a state of illness or reduced self-sufficiency wish to remain in their home environment. Their physiological needs, and their psychological, social, and environmental needs, must be fully met when providing care in their home environment. The aim of this study is to provide an overview of the self-perceived needs of older people living with illness or reduced self-sufficiency and receiving professional home care. A scoping review of articles published between 2009 and 2018 was conducted by searching six databases and Google Scholar. Inductive thematic analysis was used to analyze data from the articles retrieved. 15 articles were included in the analysis. Inductive thematic analysis identified six themes: coping with illness; autonomy; relationship with professionals; quality, safe and secure care; role in society; environment. Older home care patients living with chronic illness and reduced self-sufficiency are able to express their needs and wishes. Care must, therefore, be planned in line with recipients' needs and wishes, which requires a holistic approach.

Potential Clinical Consequences of Medication Process Problems in Older Home Care Patients

Home care professionals regularly observe drug-related problems during home care provision. Problems related to the process of the medication therapy could involve discrepancies in medication prescriptions between the hospital discharge letter and the medication administration record lists (MARL) or insufficient drug delivery. The objective of this study is to determine the potential clinical consequences of medication process problems observed by home care professionals, since those consequences have not been assessed before.

Prevalence and risk factors of constipation and pollakisuria among older home-care patients.

The prevalence of constipation and prevalence of pollakisuria among older patients receiving home medical care have not been reported, and risk factors for these symptoms are not clear in this setting. The present study sought to determine the prevalence and risk factors of constipation and pollakisuria among older patients receiving home medical care in Japan. This study utilized data from patients in the Observational Study of Nagoya Elderly with Home Medical Care (n = 153). We carried out univariate and multivariate logistic regression analyses with the presence of constipation or pollakisuria as the dependent variable to evaluate the relationships between constipation or pollakisuria and several covariates. The prevalence of constipation and pollakisuria were 56.9% and 15.7%, respectively. Multivariate logistic analysis showed that constipation was associated with Charlson Comorbidity Index score, polypharmacy and pollakisuria, and pollakisuria was associated with constipation and insomnia. Cardiovascular disease was inversely associated with constipation. The prevalence of constipation among home-care patients was as high as that reported for nursing home residents and higher than that among community-dwelling individuals. Clinicians should be aware of increased constipation risk among home-care patients, particularly for those with a high Carlson Comorbidity Index score, polypharmacy and/or pollakisuria. Geriatr Gerontol Int 2019; 19: 277-281.

Translating Evidence-Based Protocols Into the Home Healthcare Setting.

Activity-limiting pain is common among older home care patients and pain management is complicated by the high prevalence of physical frailty and multimorbidity in the home care population. A comparative effectiveness study was undertaken at a large urban home care agency to examine an evidence-based pain self-management program delivered by physical therapists (PTs). This article focuses on PT training, methods implemented to reinforce content after training and to encourage uptake of the program with appropriate patients, and therapists' fidelity to the program. Seventeen physical therapy teams were included in the cluster randomized controlled trial, with 8 teams (155 PTs) assigned to a control and 9 teams (165 PTs) assigned to a treatment arm. Treatment therapists received interactive training over two sessions, with a follow-up session 6 months later. Additional support was provided via emails, e-learning materials including videos, and a therapist manual. Program fidelity was assessed by examining PT pain documentation in the agency's electronic health record. PT feedback on the program was obtained via semistructured surveys. There were no between-group differences in the number of PTs documenting program elements with the exception of instruction in the use of imagery, which was documented by a higher percentage of intervention therapists (p = 0.002). PTs felt comfortable teaching the program elements, but cited time as the biggest barrier to implementing the protocol. Possible explanations for study results suggesting limited adherence to the program protocol by intervention-group PTs include the top-down implementation strategy, competing organizational priorities, program complexity, competing patient priorities, and inadequate patient buy-in. Implications for the implementation of complex new programs in the home healthcare setting are discussed.

Nutritional Issues and Nutrition Support in Older Home Care Patients in the City of Zagreb.

Population aging is a global demographic trend showing continuous growth and among its consequences is a rise in malnutrition that is characteristic for the elderly. The objective of this study was to evaluate nutritional status of elderly home care patients immediately after hospital discharge and to determine factors that affect nutritional status using questionnaires based on validated tools (NRS-2002, DETERMINE checklist) and basic medical history data. The study involved 76 elderly individuals (51.3% of them older than 70) living in the City of Zagreb. The nutritional status assessment using the NRS-2002 tool showed that 57.6% of the subjects were at nutritional risk. The findings of the assessment by use of the DETERMINE tool were also unfavorable, indicating that 82.1% of persons older than 70 were categorized as being at a high nutritional risk, while 17.9% were at moderate risk. The DETERMINE checklist elements (illness; reduced intake of fruits, vegetables or dairy products; alcohol consumption; oral health problems; and weight loss) were linked to a higher NRS score. The mean number of hospital days in subjects at nutritional risk was 14.27 (the mean number in the Republic of Croatia is 8.56 days). Although the study involved a small number of subjects, the results showed a substantial presence of malnutrition among the elderly. A timely -intervention by the healthcare system and training of healthcare personnel can be a step towards achieving a better nutritional status.

Testing of a Statewide Initiative to Enhance Depression Care in Older Home Care Patients

Late-life depression is becoming increasingly prevalent among older adults in the United States and is predictive of a wide range of negative health-related outcomes. Fourteen home care agencies participated in a quasi-experimental, pre-test, post-test design of a depression screening training program nested within a two-cycle, phased introduction of the intervention. The primary aim of this study was to evaluate the effects of the program at three levels of outcomes: the trainers, the trainees, and the agencies. There was a significant increase in the knowledge and self-efficacy of the trainers and trainees and a trend toward decreased hospitalization.

Pilot Study of a Statewide Initiative to Enhance Depression Care Among Older Home Care Patients

Late-life depression is prevalent in home care. This pilot study, part of a statewide initiative to enhance depression care, evaluated the influence of a 2-hour depression screening and intervention workshop on home care professionals’ knowledge, self-efficacy, and attitudes related to depression in older home care patients. A pretest, posttest design was used to evaluate the effects of the workshop with 280 home care professionals from 7 home care agencies. Following the depression workshop, participants’ knowledge levels in evidence-based screening and care for depressed older adults was significantly increased, t(280) = 16.49, p<.001. A significant increase in confidence and attitude ratings were found (p<.001). Findings from this pilot study support broader dissemination throughout Connecticut home care agencies.

Medication Regimens in Older Home Care Patients

Medication regimens in older patients have been strongly associated with adverse events leading to hospitalization in ambulatory care settings. Despite a 29% hospitalization rate, to date, no research regarding medication regimens and readmission to the hospital has been completed in the home care setting. As part of a larger study evaluating predictors of readmission to the hospital from home care, descriptive analyses, chi-square tests, and t tests for independent samples were used in this secondary analysis to evaluate the Outcome and Assessment Information Set and medication records from 911 older patients admitted from the hospital to 15 home care agencies. Patients readmitted back to the hospital were older, sicker, and more cognitively impaired, and had complex medication regimens that included significant polypharmacy and inappropriate medication use. Nurses working with older adults need to be especially vigilant in monitoring medication regimens of patients to reduce opportunities for adverse drug events and subsequent hospitalization.

Older Home-Care Patients’ Preferred Approaches to Depression Care: A Pilot Study

The purpose of this pilot study was to explore the approaches to depression care preferred by older home-care patients and examine characteristics associated with those preferences. Twenty-eight long-term home-care patients, ages 62 to 95, were interviewed. Patients ranked their depression care preferences and provided rationale for their responses. Results indicated prayer was preferred by the highest percentage of patients (50%). Comparing patients with and without depression experience, prayer was preferred by the latter group. The results highlight the importance of addressing patient preferences during care planning to improve participation in geriatric depression care management.

Use of Antipsychotics in Older Home Care Patients in Finland

To investigate the use of antipsychotic medications, and factors associated with such use, in elderly patients in home care in Finland. A retrospective study was designed using cross-sectional data gathered between 1 July and 31 December 2004 in Finland. Data were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set for Home Care (MDS-HC) assessments. Patients aged >or=65 years from five home care units in different parts of Finland (urban and rural) were included, yielding a total of 1106 patient assessments. The prevalence of antipsychotic use was 11% among home care patients. Factors independently associated with use of antipsychotics in the logistic regression model were: any psychiatric diagnosis (odds ratio [OR] 6.62, 95% CI 4.19, 10.45), delusions (OR 4.19, 95% CI 2.22, 7.90), parkinsonism (OR 3.08, 95% CI 1.07, 8.87), not at ease interacting with others (OR 1.88, 95% CI 1.06, 3.36) and moderate-to-severe cognitive impairment (OR 1.47, 95% CI 1.06, 2.04). By contrast, patients aged >or=85 years (OR 0.59, 95% CI 0.43, 0.81) were significantly less likely to be taking antipsychotics. Use of atypical antipsychotic medication was associated in the logistic regression model with delusions (OR 4.05, 95% CI 2.01, 8.17), parkinsonism (OR 3.66, 95% CI 1.10, 12.19), any psychiatric diagnosis (OR 3.06, 95% CI 1.66, 5.63), moderate-to-severe cognitive impairment (OR 2.0, 95% CI 1.32, 3.03) and age >or=85 years (OR 0.66, 95% CI 0.44, 0.99). However, use of conventional antipsychotics was associated only with any psychiatric diagnosis (OR 8.88, 95% CI 5.05, 15.61) and age >or=85 years (OR 0.65, 95% CI 0.44, 0.98). The prevalence of antipsychotic medication use in elderly home care patients was higher than that previously reported among elderly people living in the community in Finland and Sweden (3-9%). Several predictive factors such as psychiatric diagnosis, delusions and cognitive impairment were associated with use of antipsychotics whereas there was a negative association between age >or=85 years and use of antipsychotics.

Depression Recognition and Assessment in Older Homecare Patients

Depression Recognition and Assessment in Older Homecare Patients

In a prospective observational study, influenza vaccination prevented hospitalization among older home care patients

Objective The aim of the study is (1) to describe the prevalence of vaccination against influenza in older home care patients and (2) to investigate the protective effect of influenza vaccination for hospitalization events. Study Design and Setting This is an observational study conducted in four large cohorts of elderly patients in home care during the 1998–1999, 1999–2000, 2000–2001, and 2001–2002 influenza seasons. We analyzed data from the Italian Silver Network Home Care project. A total of 2,201 patients were enrolled in the present study. The main outcome measures were prevalence of vaccination against influenza and the rate of hospitalization according to vaccination status and influenza season. Results The rate of influenza vaccination was around 48% of the studied sample. During the follow-up including the peak of influenza and the total influenza season, 412 subjects (40%) were hospitalized among vaccinated compared to 610 subjects (59%) among not vaccinated ( P < 0.001). After adjusting for age, gender, location of home care program, and all the variables significantly different between vaccinated and not-vaccinated subjects, vaccinated subjects were less likely to be hospitalized compared to not-vaccinated subjects (OR, 0.73; 95% CI 0.60–0.90). Conclusions Vaccination against influenza has an important prognostic implication for frail geriatric patients living in the community.

Symptoms of Depression in Older Home-Care Patients: Patient and Informant Reports.

The purpose of this study was to examine the level of agreement and patterns of disagreement between home-care patient and informant reports of depressive symptoms. The authors interviewed a sample of 355 older home-care patients and their informants using the Structured Diagnostic Interview for DSM-IV (R. L. Spitzer, M. Gibbon, & J. B. Williams, 1995). Informants reported more psychological symptoms than patients, and this type of discrepancy was higher for patients with cognitive impairment and patients who had younger informants. Younger informants also reported more cognitive symptoms, whereas patients were more likely to report suicidal thoughts or ideation if they were not cognitively impaired. The patterns of these discrepancies may reflect age- and cohort-related response bias in the reports of depressive symptoms obtained from older adults.

Organizational and Environmental Factors Affecting the Utilization of Telemedicine in Rural Home Healthcare

ABSTRACT In the last five years, home health agencies have become increasingly interested in telemedicine as a potential means to meet the future healthcare needs of their aged and chronically ill clientele. This case study examines the organizational and environmental conditions that affected the implementation of a telemedicine program in one rural home healthcare organization. Several factors restricted the utilization of telemedicine, including Medicare's Prospective Payment System and corresponding documentation (Outcome Assessment and Information Set), the organization controlling grant funding for the program, and several environmental factors. Findings suggest that in rural communities, older homecare patients may have less opportunity to benefit from telemedicine. The study demonstrates the importance of environmental and organizational factors when implementing a telemedicine program. Recommendations are offered for home healthcare organizations considering development of telemedicine programs.

Late-Life Depression Among Black and White Elderly Homecare Patients

Objective The authors compared the prevalence of major depressive disorder (MDD) and the prescription rates of antidepressant medication, by race, among frail, older homecare patients. Methods A random sample of 56 black and 458 white newly admitted homecare patients age 65 and over was assessed for MDD with structured interviews and medical records, and antidepressant prescription rates were tallied. Results The prevalence of MDD did not differ significantly across racial groups. Only 16.7% of black patients and 32.0% of white patients were prescribed antidepressant medication. Conclusions Prevalence of MDD was similar among black and white elderly homecare patients. In both groups, depression is undertreated and contributes to the burden of this frail, older patient group. The authors compared the prevalence of major depressive disorder (MDD) and the prescription rates of antidepressant medication, by race, among frail, older homecare patients. A random sample of 56 black and 458 white newly admitted homecare patients age 65 and over was assessed for MDD with structured interviews and medical records, and antidepressant prescription rates were tallied. The prevalence of MDD did not differ significantly across racial groups. Only 16.7% of black patients and 32.0% of white patients were prescribed antidepressant medication. Prevalence of MDD was similar among black and white elderly homecare patients. In both groups, depression is undertreated and contributes to the burden of this frail, older patient group.