Older Nursing Home Residents Research Articles

Development and validation of a prognostic index for 2‐year mortality in Chinese older residents living in nursing homes

There is no mortality prediction index for Chinese nursing home older residents. The objective of this study was to derive and validate a 2-year mortality prognostic index for them. We carried out a prospective cohort study on 1120 older residents from 12 nursing homes of Hong Kong. We obtained potential predictors of mortality and carried out updated functional assessment. Each risk factor associated independently with 2-year mortality in a derivation cohort was assigned a score based on the odds ratio, and risk scores were calculated for each participant by adding the points of risk factors present. Similar analysis was carried out on the validation cohort. Independent predictors of mortality included: aged 86-90 years (3 points); aged ≥ 91 years (4 points); Charlson comorbidity index ≥ 4 (6 points); Barthel Index 5-60 (5 points); Barthel Index 0 (10 points); number of hospitalizations in the preceding year (Adbefore) 1 (4 points); Adbefore 2 (5 points) and Adbefore ≥ 3 (6 points). In the derivation cohort, 2-year mortality was 10.8% in the low-risk group (≤ 4 points) and 59.9% in the high-risk group (≥ 14 points). In the validation cohort, 2-year mortality was 11.8% in the low-risk group and 60.4% in the high-risk group. The receiver-operator characteristic curve area was 0.761 for the derivation cohort and 0.742 for the validation cohort. Our prognostic index had satisfactory discrimination and calibration in an independent sample of Chinese nursing home older residents. It can be used to identify older residents with a high risk for poor outcomes, who need a different level of care.

Orthostatic Hypotension in Older Nursing Home Residents Who Fall

Orthostatic hypotension (OH) and dizziness have been linked to older adult falls. As a treatable condition, the detection of OH is of clinical importance to falls prevention. Gaps in the literature about symptoms associated with OH among older adult fallers, such as dizziness led to this secondary analysis of blood pressure data and reported symptoms. Of the 194 Registered Nurse (RN) documented falls, most (n = 91; 46.9%) failed to meet the prevailing diagnostic criteria for OH; 18 (9.2%) met criteria; and 8 (4%) nearly met the OH criteria. OH determinations were incomplete or absent in 41% (n = 77). Of the 18 residents with OH, none reported dizziness, instead half reported loss of balance. We conclude, older residents did not report symptoms of dizziness prior to OH drops in blood pressure and falls. Further study is warranted to identify other predictive symptoms of OH and to evaluate nursing staff's understanding of OH.

Changes in Depressive Symptoms, Social Support, and Loneliness Over 1 Year After a Minimum 3-Month Videoconference Program for Older Nursing Home Residents

BackgroundA 3-month videoconference interaction program with family members has been shown to decrease depression and loneliness in nursing home residents. However, little is known about the long-term effects on residents’ depressive symptoms, social support, and loneliness.ObjectiveThe purpose of this longitudinal quasi-experimental study was to evaluate the long-term effectiveness of a videoconference intervention in improving nursing home residents’ social support, loneliness, and depressive status over 1 year.MethodsWe purposively sampled 16 nursing homes in various areas of Taiwan. Elderly residents (N = 90) of these nursing homes meeting our inclusion criteria were divided into an experimental (n = 40) and a comparison (n = 50) group. The experimental group received at least 5 minutes/week for 3 months of videoconference interaction with their family members in addition to usual family visits, and the comparison group received regular family visits only. Data were collected in face-to face interviews on social support, loneliness, and depressive status using the Social Support Behaviors Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at four times (baseline, 3 months, 6 months, and 12 months after baseline). Data were analyzed using the generalized estimating equation approach.ResultsAfter the videoconferencing program, participants in the experimental group had significantly lower mean change in instrumental social support scores at 6 months (–0.42, P = .03) and 12 months (–0.41, P = .03), and higher mean change in emotional social support at 3 (0.74, P < .001) and 12 months (0.61, P = .02), and in appraisal support at 3 months (0.74, P = .001) after adjusting for confounding variables. Participants in the experimental group also had significantly lower mean loneliness and depressive status scores at 3 months (–5.40, P < .001; –2.64, P < .001, respectively), 6 months (–6.47, P < .001; –4.33, P < .001), and 12 months (–6.27, P = .001; –4.40, P < .001) compared with baseline than those in the comparison group.ConclusionOur videoconference program had a long-term effect in alleviating depressive symptoms and loneliness for elderly residents in nursing homes. This intervention also improved long-term emotional social support and short-term appraisal support, and decreased residents’ instrumental social support. However, this intervention had no effect on informational social support.

Evaluation of a Contact Sensor Skirt for an Anti-Collision Power Wheelchair for Older Adult Nursing Home Residents With Dementia: Safety and Mobility

We studied an anti-collision power wheelchair's ability to enable safe, independent mobility in nursing home residents with dementia. The device had a contact sensor skirt that compensated for drivers' absent or delayed responses to obstacles. Safety observations were tracked during device use. In six single-subject studies, distances traveled by residents in manual and anti-collision wheelchairs were compared. Two residents could use the device: One resident's mobility and well-being improved; the other thought it was unhelpful. Another resident with potential for use did not like its usability, speed, and appearance. For two other residents, the device did not compensate for decreased initiation, motor planning, and awareness of obstacles above the sensors. Another resident was withdrawn because of verbal aggression. Interviews and focus groups revealed the device's usefulness. Perceptions of safety were mixed. Further work should improve environmental coverage, sensor skirt reliability, and safety; match technology to the needs of a wider range of residents; and enhance usability, functionality, and acceptance.

Sarcopenia and Mortality among Older Nursing Home Residents

Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, no data are available on sarcopenia in the nursing home population. The aim of the current study was to explore the relationship between sarcopenia and all-cause mortality in a population of elderly persons aged 70 years and older living in a nursing home in Italy. This study was conducted among all subjects (n= 122) aged 70 years and older who lived in the teaching nursing home of Catholic University of Rome between August 1, 2010, and September 30, 2010. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass plus either low muscle strength or low physical performance. The primary outcome measure was survival after 6 months. Forty residents (32.8%) were indentified as affected by sarcopenia. This condition was more common in men (68%) than in women (21%). During the follow-up period, 26 (21.3%) patients died. After adjusting for age, gender, cerebrovascular diseases, osteoarthritis, chronic obstructive pulmonary disease, activity of daily living impairment, and body mass index, residents with sarcopenia were more likely to die compared with those without sarcopenia (adjusted hazard ratio 2.34; 95% confidence interval 1.04-5.24). The present study suggests that among subjects living in a nursing home, sarcopenia is highly prevalent and is associated with a significantly increased risk of all-cause death. The current findings support the possibility that sarcopenia has an independent effect on survival among nursing home residents.

Family members’ perceived meaning of visiting nursing home residents in Taiwan

The purpose of this article is to report the findings of a study to explore perceived family meaning of visiting older nursing home residents in Taiwan. Family involvement in the care of institutionalized elders benefits residents, family and staff. Families have traditionally been involved through in-person visits. One factor influencing family visits is motivation, which is a vague concept, creating a need to better understand the meaning families ascribe to visiting nursing home residents. Understanding this meaning is necessary to develop intervention programmes that facilitate the quality of families' nursing-home visits. However, little is known about the meaning of family visits to nursing home residents in Asian countries. Data were collected April 2009-2010 in audiotaped, individual, in-depth interviews with 15 family members of residents at four nursing homes in Taiwan. These family members included five women and 10 men, predominantly residents' children and spouses. The meaning of family visits to nursing home residents was captured by five major themes: hoping for recovery, honouring filial/karmic responsibility, insuring care quality, maintaining family relationships and making up for guilt. The findings of this study can be considered by nurses and policy makers when designing interventions and allocating resources to improve the quality of family visits with nursing home residents. These interventions can be tailored to family members' perceived meanings for visiting, e.g. those hoping for residents' recovery may benefit from health-promotion programmes, and those honouring filial/karmic responsibility might be helped by education on different ways to show filial respect.

Between Scylla and Charybdis: antipsychotic and other psychotropic medications in older nursing home residents

See related research article by Huybrechts and colleagues at [www.cmaj.ca/cgi/doi/10.1503/cmaj.101406][1]. Restlessness, disruptive vocalizations and physical aggression are among the most distressing manifestations of dementia and may occur in up to 90% of patients with dementia at some time

Prevalence and Risk Factors of Sarcopenia Among Nursing Home Older Residents

Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, there are no data on sarcopenia in nursing home population. We evaluated the prevalence of sarcopenia and its association with functional and clinical status in a population of elderly persons aged 70 years and older living in nursing homes. This study was conducted selecting all the participants (n = 122) living in the teaching nursing homes of Catholic University of Rome who were aged 70 years and older from August 1, 2010, to September 30, 2010. The European Working Group on Sarcopenia in Older People (EWGSOP) criteria were adopted. Accordingly, diagnosis of sarcopenia required the documentation of low muscle mass plus the documentation of either low muscle strength or low physical performance. Forty residents (32.8%) were identified as affected by sarcopenia. The multivariate logistic regression analysis showed a high increase in risk of sarcopenia for male residents (odds ratio [OR] 13.39; 95% confidence interval [CI] 3.51-50.63) and for residents affected by cerebrovascular disease (OR 5.16; 95% CI 1.03-25.87) or osteoarthritis (OR 7.24; 95% CI 2.02-25.95). Residents who had a body mass index higher than 21 kg/m(2) had a lower risk to be sarcopenic (OR 0.76; 95% CI 0.64-0.90) relative to those with body mass index less than 21 kg/m(2). Similarly, sarcopenia was less likely to be present among participants involved in leisure physical activity for 1 hour or more per day (OR 0.40; 95% CI 0.12-0.98). The present study suggests that among participants living in nursing homes, sarcopenia is highly prevalent and it is more represented among male residents (68%) than among female residents (21%). Our findings support the hypothesis that muscle mass is strongly associated with nutritional status and physical activity in nursing homes, too.

Factors Associated With Potentially Preventable Hospitalization Among Nursing Home Residents in New York State With Chronic Kidney Disease

Identify clinical and organizational factors associated with potentially preventable ambulatory care sensitive (ACS) hospitalization among nursing home residents with chronic kidney disease. New York State Nursing home residents (n = 5449) age 60+ with chronic kidney disease and were hospitalized in 2007. Data included residents' sociodemographic and clinical characteristics, nursing home organizational factors, and ACS hospitalizations. Multivariate logistic regression quantified the association between potential determinants and ACS hospitalizations (yes versus no). Prevalence of chronic kidney disease among nursing home residents is 24%. Potentially avoidable ACS hospitalization among older nursing home residents with chronic kidney disease is 27%. Three potentially modifiable factors associated with significantly higher odds of ACS hospitalization include the following: presence of congestive heart failure (OR = 1.4; 95% CI 1.24-1.65), excessive medication use (OR = 1.3; 95% CI 1.11-1.48), and the lack of training provided to nursing staff on how to communicate effectively with physician about the resident's condition. (OR = 1.3; 95% CI 0.59-0.96). To reduce potentially preventable ACS hospitalization among chronic kidney disease patients, congestive heart failure and excessive medication use can be kept stable using relatively simple interventions by periodic multidisciplinary review of medications and assessing appropriate response to therapy; and communication training be provided to nursing staff on how to articulate to the responsible physician important changes in the patients' condition.

Reduction of Inappropriate Medications among Older Nursing-Home Residents

Medication-related problems are common in the growing population of older adults and inappropriate prescribing is a preventable risk factor. Explicit criteria such as the Beers criteria provide a valid instrument for describing the rate of inappropriate medication (IM) prescriptions among older adults. To reduce IM prescriptions based on explicit Beers criteria using a nurse-led intervention in a nursing-home (NH) setting. The pre/post-design included IM assessment at study start (pre-intervention), a 4-month intervention period, IM assessment after the intervention period (post-intervention) and a further IM assessment at 1-year follow-up. 204-bed inpatient NH in Bern, Switzerland. NH residents aged ≥60 years. The intervention included four key intervention elements: (i) adaptation of Beers criteria to the Swiss setting; (ii) IM identification; (iii) IM discontinuation; and (iv) staff training. IM prescription at study start, after the 4-month intervention period and at 1-year follow-up. The mean ± SD resident age was 80.3 ± 8.8 years. Residents were prescribed a mean ± SD 7.8 ± 4.0 medications. The prescription rate of IMs decreased from 14.5% pre-intervention to 2.8% post-intervention (relative risk [RR] = 0.2; 95% CI 0.06, 0.5). The risk of IM prescription increased nonstatistically significantly in the 1-year follow-up period compared with post-intervention (RR = 1.6; 95% CI 0.5, 6.1). This intervention to reduce IM prescriptions based on explicit Beers criteria was feasible, easy to implement in an NH setting, and resulted in a substantial decrease in IMs. These results underscore the importance of involving nursing staff in the medication prescription process in a long-term care setting.

Factors associated with treatment restriction orders and hospice in older nursing home residents

The purpose of the study is to examine factors associated with do-not-resuscitate orders, do-not-hospitalise orders and hospice care in older nursing home residents at admission. Although hospice care is viewed as the 'gold standard,' geographic availability and financial reimbursement limits its use. Treatment restriction orders may represent alternative approaches to defining wishes for end-of-life care. A descriptive correlational study design was employed to examine the use of four care directives and hospice in newly admitted older people NH residents using Maryland Minimum Data Set 2.0 and the On-Line Survey Certification and Reporting in 2000. Analyses reflected 10,023 unduplicated admission records from 77 NHs. The prevalence of do-not-resuscitate and do-not-hospitalise orders at admission was 28 and 3.4%, respectively. A very small percentage of residents received hospice care on admission (1.7%). Appropriately, health-related characteristics had a strong influence on use of do-not-resuscitate orders, do-not-hospitalise orders and hospice care. However, identified predictors were varied among do-not-resuscitate orders, do-not-hospitalise orders and hospice care. Moreover, multivariate logistical modelling found that non-Medicare insurance significantly influenced the likelihood of do-not-resuscitate orders, do-not-hospitalise orders and hospice uses; White race increased the likelihood of having a do-not-resuscitate and do-not-hospitalise order. Treatment restriction orders were associated with an increased of likelihood of hospice use. As policy and reimbursement barriers to hospice use are likely to persist, treatment restriction orders should be used to focus communication with residents, families and providers, with the ultimate goal of more widespread implementation of hospice care principles. White race was consistently associated with increasing the likelihood of having do-not-resuscitate and do-not-hospitalise orders, supporting the importance of cultural sensitivity in advanced care planning. With the association between do-not-hospitalise orders and hospice use, treatment restriction orders should be used as potential triggers to prompting end-of-life care.

Orthostatic Hypotension and Cardiovascular Risk

Orthostatic hypotension (OH) results from a failure of neural and circulatory mechanisms to compensate for the reduction in venous return that normally occurs on assuming the upright posture. OH is defined as a fall in systolic blood pressure of ≥20 mm Hg or diastolic blood pressure of ≥10 mm Hg measured within 3 minutes of standing.1 OH can result from side effects of medications, intravascular volume loss, systemic diseases that involve autonomic nerves (eg, diabetes mellitus or amyloidosis), and, in rare cases, it can be the initial sign of a primary autonomic failure syndrome (multiple system atrophy, pure autonomic failure, and Parkinson’s disease). Severe OH can be a dramatic medical condition, with affected patients unable to stand but for few seconds before disabling symptoms of cerebral hypoperfusion and syncope ensue. Asymptomatic OH is a far more common condition, but one that is often unrecognized. It is a frequent finding in the elderly, with prevalence reported between 6% and 35% or more, depending on the age group and associated comorbidities.2,3 During the past 2 decades, evidence from cross-sectional and longitudinal epidemiological studies has identified OH as an independent risk factor for cardiovascular morbidity and all-cause mortality.4 In prospective studies, the presence of OH at baseline increased the risk of subsequent adverse outcomes, including stroke,5 coronary heart disease,6 and all-cause mortality.2,4,7,8 In this …

Efficacy of Oral Extended-Release Oxybutynin in Cognitively Impaired Older Nursing Home Residents With Urge Urinary Incontinence: A Randomized Placebo-Controlled Trial

To determine the efficacy of oral extended-release oxybutynin for urge urinary incontinence in older female nursing home residents with mild to severe cognitive impairment. Randomized, double-blind, placebo-controlled trial. Twelve skilled nursing homes. Fifty women aged 65 and older with urge incontinence and cognitive impairment. Four-week treatment with daily oral extended-release oxybutynin 5 mg or placebo. Urinary incontinence episodes, urinary frequency, and total dryness assessed hourly over two 8-hour days (8 AM TO 4 PM), and evening and night nursing staff ratings of urinary symptoms. Of the participants, 96% (n = 25) on oxybutynin and 92% (n = 22) on placebo completed the trial. Compared with baseline, both groups achieved asignificant median decrease in mean urinary incontinence episodes and urinary frequency at 4 weeks (P= .01-.05). There were no significant between-group differences in any urological outcome. In the exploratory analysis, there were no significant differences from baseline or placebo in any urological outcome with oxybutynin in participants with mild to moderate cognitive impairment and/or adequate mobility compared with participants with more severe cognitive and physical impairment. Staff ratings found that more participants had improvement in urinary symptoms from baseline with oxybutynin than placebo but significant only for delaying evening voiding (P = .02). Extended-release oxybutynin 5 mg per day for 4 weeks in older cognitively impaired female nursing home residents did not significantly reduce urinary incontinence and urinary frequency or achieve dryness. Participants with mild to moderate cognitive and/or physical impairment were no more likely to benefit from oxybutynin than more severely impaired individuals in an exploratory analysis but further research in a larger population and perhaps using a larger dose is needed.

Anemia Evaluation and Management in Nursing Home Residents

Anemia is often an unrecognized and/or undertreated diagnosis in older adults. Failure to diagnose anemia leads to delayed treatment and thus delayed relief of symptoms. Given the potentially significant impact of anemia on cardiovascular disease and physical performance among older nursing home (NH) residents, it is important to evaluate current clinical practice related to anemia.The purpose of this secondary data analysis was to evaluate the frequency of laboratory evaluation and medication treatment for anemia among older NH residents. Results indicated that more than half of NH residents were anemic at baseline, and of those, less than 20% had additional testing done to further evaluate for an underlying cause of their anemia and only 45.3% received any pharmacologic treatment. Future research is needed to clarify the potential benefits of timely diagnosis and appropriate treatment for anemic older adults in long-term-care settings and establish evidence-based guidelines to direct care in this area.

Antidepressant Prescribing in US Nursing Homes Between 1996 and 2006 and Its Relationship to Staffing Patterns and Use of Other Psychotropic Medications

Few studies have examined factors associated with antidepressant prescribing in older nursing home residents. The primary objective was to describe the change in antidepressant prescribing for nursing home residents between 1996 and 2006. An additional objective was to examine the association between any change in antidepressant prescribing and staffing patterns or coprescribing of other psychotropic medications in the same cohort. Longitudinal. Settings were 12,556 US nursing homes in 1996 and 2006. Online Survey Certification and Reporting (OSCAR) data and the Area Resource File (ARF). Increasing prescribing of antidepressants analyzed using multivariable multinomial generalized estimating equations (GEE). Antidepressant prescribing significantly increased (P < .05) from 21.9% in 1996 to 47.5% in 2006. After controlling for resident, organizational, and market factors, increased antidepressant prescribing was associated with more time spent by physician extenders (adjusted odds ratio [AOR] 2.21; 95% confidence interval [CI] 1.96-2.51), registered nurses (AOR 1.06, 95% CI 1.02-1.10), or nurse aides (AOR 1.08; 95%CI 1.04-1.12) in a facility, as well as the coprescribing of sedative/hypnotics (AOR 1.12; 95% CI 1.08-1.16). Factors found to be protective of increasing antidepressant prescribing (ie, decrease antidepressant prescribing) included having medical directors and physicians spend more time in the facility (AOR 0.60; 95% CI 0.53-0.69 and AOR 0.62; 95% CI 0.54-0.71, respectively), or coprescribing of antianxiety or antipsychotic agents (AOR 0.70; 95% CI 0.68-0.72 and AOR 0.74; 95% CI 0.72-0.77, respectively). Prescribing of antidepressants has increased dramatically in the past decade in older nursing home residents and seems to be associated with certain staffing characteristics and the coprescribing of psychotropic medications. Further research is needed to determine if antidepressants are appropriately prescribed, and if overuse is determined, develop interventions to improve the quality of prescribing of these medications in older nursing home residents.

Older nursing home residents’ experiences with videoconferencing to communicate with family members

This study explored the experiences of older Taiwanese nursing home residents in using videoconferencing to communicate with family members. Enhancing communication between long-term care residents and their family is important. Interactions between residents and their family members can be increased through high-tech videoconferencing programmes. A qualitative, observational research design was used to gain a deeper understanding of the videoconference experiences of older nursing home residents in Taiwan. In-depth interviews were used to gather information from 34 older residents at 10 nursing homes in northern Taiwan. Participants were asked to describe their three-month experience using videoconference communication with their family in the nursing home. Participants (18 women, 16 men) had an average age of 75.38 (SD 10.19, range 60-95). Verbatim transcripts of audiotaped interviews were analysed by content analysis and Atlas.ti software. Participants experiences using videoconference communication with family members were captured by four themes: enriched life, second-best option for visiting, life adjustments and true picture of family life. Our findings may enhance policy makers' and healthcare providers' understanding of older nursing home residents' experience with videoconferencing to communicate with distant family members, thus guiding development and evaluation of nursing home videoconference services to improve older people's lives in nursing homes.

Enhancing three bliss concepts among nursing home elders in Taiwan

The purpose was to examine the effectiveness of the self-care self-efficacy enhancement programme (SCSEEP) to improve the three bliss concepts, life satisfaction, self-esteem and motivation in health behaviours, among Taiwanese nursing home elders. Promoting self-care is the most effective means for Chinese elders to achieve happiness and bliss. No studies have examined how to enhance bliss by improving self-care ability in older nursing home residents in Taiwan. This study used an experimental, longitudinal research design. The 101 subjects were recruited and randomly assigned to an experimental group (n = 55) and a comparison group (n = 46). Subjects in the experimental group received the SCSEEP. Programme from nursing home staff. Subjects in the comparison group received care as usual. The programme was implemented immediately after staff received a SCSEEP. The training programme was based partly on the SCSEEP developed by the principal investigator. Activities used in the SCSEEP included performance accomplishment, vicarious experiences and verbal persuasion. Results found that there was a significant positive correlation between life satisfaction and ADL performance (p = 0.019), self-esteem and ADL performance (p < 0.001) as well as levels of ADL performance and motivation in health behaviour (p = 0.003). Additionally, the repeated measures design revealed a significant difference between scores on four tests of life satisfaction (LS) (p < 0.001), self-esteem (p < 0.001) and motivation in health behaviours (p < 0.001) in two groups of subjects. The SCSEEP is valuable to prevent decline in life satisfaction, self-esteem and motivation in health behaviours among Taiwanese nursing home elders. The SCSEEP provides nursing home staff a series of interventions to improve self-care ability of Chinese nursing home which in turn enhances the three bliss concept.

Evaluation of dental hygiene education for nursing home staff

This paper is a report of a study evaluating the long-term effects on the oral hygiene status of older nursing home residents one and a half years after dental hygiene education was given to the staff. A strong relationship exists between oral infections and general health complications (especially aspiration pneumonia) among nursing home residents and hospitalized older people. It is therefore important to educate nursing home staff in oral hygiene measures and to follow up the effects of the education over time. Dental plaque measurements were conducted at a Swedish nursing home in 2006-2008. Forty-one residents (12 men, 31 women, aged 69-99 years) fulfilled the inclusion criteria and participated in a dental hygiene evaluation 1.5 years after dental hygiene education was given to the staff at the nursing home. Plaque index scores (year 2008) were compared to those soon after the education (year 2006). After the dental hygiene education in 2006, 60 nursing home residents (14 men, 46 women) were available for plaque index measurements, whereas 41 residents (12 men, 29 women) were available 1.5 years later. The median plaque index scores were 17.0 (n = 60) in 2006, and 18.0 (n = 41) in 2008 (Mann-Whitney U-test, P > 0.05). Dental hygiene education for nursing home staff is important to maintain an adequate level of oral hygiene among older nursing home residents over time. Follow-up of dental hygiene education for nursing home staff is recommended to maintain a sufficient level of oral hygiene among the residents.

A Hope Intervention Compared to Friendly Visitors as a Technique to Reduce Depression among Older Nursing Home Residents

Depression is common among older persons. An experimental study was undertaken to test the impact of a four-week hope program on depressed nursing home residents. Residents aged 65 or older, who met the criteria for this pilot study and agreed to participate, were randomly assigned to (a) an intervention group, and provided with weekday hope interventions mainly involving positive messages and pictures or (b) a modified control group, and provided with a friendly weekday greeting. The structured hope intervention was not proven effective for reducing depression or raising hope. Instead, a significant reduction in depression among the control subjects was found, as well as a nonsignificant increase in their level of hope. Although these findings suggest friendly visitors may be a more efficacious nonpharmacological approach for reducing depression, further investigations are needed to confirm this and to explore the impact of other hope interventions.

Anemia and its impact on function in nursing home residents: What do we know?

To provide the advanced practice nurse (APN) information on the prevalence and causes of anemia in elderly nursing home (NH) residents, in order to affect diagnostic and management strategies that may help improve physical function and mobility outcomes. Literature review of current peer-reviewed research articles. In the United States, the prevalence of anemia increases with advancing age, and are reported to be much higher among older NH residents than among community-dwelling older adults. Causes of anemia among the elderly are often multifactorial. Older individuals with anemia, including mild anemia and even low normal level, have demonstrated lower muscle strength, physical function, mobility, and increased morbidity and mortality outcomes. Given the potentially significant relationship between anemia and physical performance outcomes among NH residents, gaining a better understanding will help guide future evidence-based care by allowing the APN an opportunity to tailor both medical and restorative care interventions. Because anemia is a potentially modifiable condition, intervention may preserve, limit, or reverse functional impairment and/or disablement, and allow for maximal functional independence.