Patients In Long-term Care Hospitals Research Articles

요양병원 노인환자의 구강건강상태와 구강건강관리 요구도

Objectives: The purpose of this study is to identify oral health status and oral health care needs of elderly patients in long-term care hospital. Methods: Oral health examination was carried out by a dentist and questionnaire was completed by direct individual interview by a dental hygienist for 245 elderly patients in seven long-term care hospitals in Daegu from March 12 to April 16, 2011. Results: Those who need dental care were 188(76.7%) and was done by oral health examination by a dentist. 93 patients(38.0%) wanted dental care and 63 patients(25.3%) need dental care. The most important dental service in the elderly patients was denture and prosthetic service. As demand for denture and prosthetic service exceeds the supply, but only 35.9 percent of the elderly received the dental care service by the estimation of the caregivers. Conclusions: It will be necessary to establish the customized dental care service for the elderly patients in long term care hospitals. The oral health education for the caregivers is very important and the continuing education program must be implemented in the future.

Medicare Payment Policy Creates Incentives For Long-Term Care Hospitals To Time Discharges For Maximum Reimbursement.

Long-term care hospitals are postacute care facilities for patients requiring extended hospital-level care. These facilities are reimbursed by Medicare under a prospective payment system with a short-stay outlier policy, which results in substantially lower payments for patients discharged before a diagnosis-related group-specific short-stay threshold. Using Medicare data, we examined the impact of the short-stay policy on lengths-of-stay and Medicare reimbursement among patients in long-term care hospitals who require prolonged mechanical ventilation. After accounting for case-mix and facility-level differences, we found that discharges for reasons other than death in the period 2005-10 were most likely to occur on the day of or immediately after the short-stay threshold; this held true regardless of facility ownership. In contrast, live discharges in 2002—the year before the prospective payment system started phasing out cost-based payment—were evenly distributed around the day that later became the short-stay threshold. Our findings confirm that the short-stay outlier payment policy created a strong financial incentive for long-term care hospitals to time patient discharges to maximize Medicare reimbursement. The results suggest that the new very-short-stay policy implemented in December 2012 could have a similar effect.

Nutrition Status of Elderly Female Patients in Long-term Care Hospital according to Meal Types and Eating Ability

Objectives: This study was carried out to determine nutritional status of elderly patients in a long-term care hospital according to meal type and eating ability. Methods: Subjects were 47 female patients aged over 65 (79.3 ± 7.1 years) who resided in a long-term care hospital in Seoul. Thirty seven patients who ate diet orally were grouped according to meal type (27 general diet and 10 soft diet) and eating ability (26 eating by oneself and 11 eaten with help) and 10 were on tube feeding. Nutritional status was determined by food consumption and mid-arm circumference. Results: The mean adequacy ratios (MARs) of 12 nutrients (protein, calcium, phosphorus, zinc, vitamin A, vitamin B , vitamin B , vitamin B , niacin, folic acid, vitamin C) were 0.687 for general diet, 0.565 for soft diet, 0.680 for eating by oneself and 0.677 for eaten with help, which were significantly lower than 0.982 for tube feeding (p < 0.05 or p < 0.01). The patients on tube feeding had significantly lower % arm circumference compared to those who ate general diet (84.0% vs. 95.4%, respectively, p < 0.05). Nutrients intakes, nutrient adequacy ratio (NAR) and index of nutritional quality (INQ) were not different between meal types as well as eating ability. The most insufficiently consumed nutrients by the patients on diet were folic acid, vitamin B , and calcium (NAR 0.334~0.453, 0.515~ 0.539, and 0.516~0.533, respectively). Conclusions: The results suggested that regardless of meal type or eating ability, the subjects who were on diets in this study might have inadequate intake of folic acid as well as vitamin B , and calcium, which need to be reflected on menu planning. The measurement of mid-arm circumference presented more risk of malnutrition of patients on tube feeding than those on diets, despite apparently better nutrient consumption.

A Study on the Factors Related to the Food Service Satisfaction of Elderly Patients Hospitalized in Long-term Care Hospitals

This study was conducted to help increase the level of satisfaction with and use of long-term care hospitals and enhance the positive effects on hospital management by ensuring that studies on factors related to elderly patients hospitalized in long-term care hospitals are conducted more actively not only in areas related to nutrition, but also in hospital management and public health administration, and that nutritional department, which takes care of hospital food service, and the hospital management will cooperate with each other more closely, and thus quality medical service will be provided to patients. The elderly patients hospitalized in a long-term care hospital in Jeollabuk-do were surveyed from May 1, 2012 till May 31, 2012, and a total of 229 questionnaires were included in this study. According to the results of this study, the elderly patients in long-term care hospitals were relatively highly satisfied with the overall hospital food service and individual food service satisfaction factors. They were least satisfied with responses to food service complaints and provision of nutritional information. Accordingly, it is deemed necessary to establish countermeasures. As the overall hospital food service subfactors, i.e. food factor, service factor and cleanliness factor, had a statistically significant positive effect, in order to raise the satisfaction with hospital food service, all items related to food service satisfaction factors must be managed perfectly and thoroughly, and then satisfaction with hospital food service can be enhanced and good results can be produced in hospital management.

Physical symptoms, Hope and Family Support of Cancer Patients in the General Hospitals and Long-term Care Hospitals

Purpose: The purpose of this study was to compare reported physical symptoms, hope and family support of cancer patients between general hospitals and long-term care hospitals. Methods: Subjects were 175 patients diagnosed with cancers from two general hospitals and six long-term care hospitals located in G city. Subjects completed a questionnaire with questions about general characteristics and questions about the disease, physical symptoms, hope and family support. Data was collected from February to April and the data were analyzed using an independent t-test and one-way ANOVA. Results: The subjects in long-term care hospitals showed higher percentage in pain, nausea, fatigue, sleep disorder, and change in appearance. There was a significant difference in family support between two groups. A significant positive correlation was found between hope and family support in subjects in general and long-term care hospitals. Conclusion: Significant differences were found in some physical symptoms and family support between cancer patients in general hospitals and long-term care hospitals. Thus, nurses in long-term care hospitals need provide care suitable for the characteristics of cancer patients in long-term care hospitals.

The effect of a nutritional education program on the nutritional status of elderly patients in a long-term care hospital in Jeollanamdo province: health behavior, dietary behavior, nutrition risk level and nutrient intake

This study was conducted to assess improvements in nutritional status following the application of nutrition education to elderly patients in a long-term care hospital. The study was carried out from January to May 2009, during which a preliminary survey, a pretest, the application of nutrition education, and a post-test were applied in stages. The number of subjects at pretest was 81, and the number of participants included in the final analysis was 61 (18 men, 43 women), all of whom participated in both the nutrition education program and the post-test. The survey consisted of general demographic items, health behaviors, dietary behaviors, the Nutrition Screening Initiative checklist, and nutrient intake assessment (24 hour recall method). The nutrition education program lasted for four weeks. It included a basic education program, provided once a week, and mini-education program, which was offered daily during lunch times. The survey was conducted before and after the education program using the same assessment method, although some items were included only at pretest. When analyzing the changes in elderly patients after the nutritional education program, we found that, among subjective dietary behaviors, self-rated perceptions of health (P < 0.001) and of depression (P < 0.001) improved significantly and that dietary behavior scores also improved significantly (P < 0.001), while nutritional risk levels decreased. In terms of nutrient intake, subjects' intake of energy, protein, fat, carbohydrate, calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, and vitamin C all increased significantly (P < 0.001). These results indicated that nutritional education is effective in improving the nutritional status of elderly patients. We hope that the results of this study can be used as preliminary data for establishing guidelines for nutrition management tailored to elderly patients in long-term care hospitals.

How well do nurses recognize malnutrition in elderly patients?

Malnutrition is a common and underrecognized clinical problem among aged institutionalized patients. The aim of this study was to investigate how well nurses recognize malnutrition in elderly patients in long-term care hospitals in Helsinki. In this descriptive, cross-sectional study, the nutritional status of 1043 elderly patients was assessed with the Mini Nutritional Assessment (MNA), their body mass indices (BMIs) (kg m(-2)) were counted, and factors related to their nutritional care were queried using a structured questionnaire. In addition, we asked the opinions of 53 nurses on whether they considered their patients to suffer from malnutrition. All the long-term care hospitals in Helsinki, Finland participated in this study. The mean age of the patients was 81 years. The nurses considered only 15.2% of the patients to be malnourished, although the MNA showed that 56.7% were malnourished (MNA<17 points). Those recognized as malnourished were truly anorectic, with a mean BMI of 17.2. Of those patients having a BMI<20 and MNA<17, the nurses considered only one-third to be malnourished. Of those having a BMI>24 but MNA<17, only 2% were recognized as having malnutrition. Even those patients considered to be malnourished received snacks and nutritional supplements less than the patients that the nurses considered to have normal nutritional status. However, only one in six of the malnourished patients received oral nutritional supplements. The nurses recognized malnutrition in their aged patients poorly. Nutrition education for nurses is urgently needed, as malnutrition and weight loss have been considered significant problems, and the benefits of nutritional care are well established.

Nursing Education in Gerontological Clinical Settings: What Do Elderly Patients Think of Student-Rendered Care?

Gerontological units are commonly used as clinical placements for first year nursing students, but the ethics of sending novice nursing students to gerontological units for their first clinical placement is often challenged. Although this environment allows student learning at a slower pace, some believe that students are practicing on a captive population and that this undervalues the specialist knowledge and skills required to care for older patients. This qualitative study explores the perspectives of 12 older patients in long-term care hospitals who had first-year nursing students involved in their care. Data were gathered using face-to-face, semi-structured interviews. A thematic analysis of data then identified themes and patterns used by older adults to describe their perspectives of student-rendered care. Findings revealed that with the exception of one patient, this group of older patients found first-year student-nurse-rendered care to be a positive experience. The emergent themes indicated that patients enjoyed the extra care, attention, and the increased social opportunities the students provided. The patients also demonstrated an interest in participating in student learning. The findings are discussed in relation to social exchange theory and the concept of reciprocity.

Impact of HAART on causes of death of persons with late-stage AIDS.

The increasing use of highly active antiretroviral therapies (HAARTs) has changed the course of AIDS-related illnesses and enhanced the quality of life of patients infected with human immunodeficiency virus (HIV) and may have changed the causes of deaths in patients with acquired immunodeficiency syndrome (AIDS). The aim of the present study was to investigate causes of deaths in long-term care hospital patients with late-stage AIDS who expired at the Coler-Goldwater Memorial Hospital in New York City in 1995, and in 1998 and 1999, that is, immediately before and the two most recent years after the advent of HAART. Analysis of causes of deaths as recorded on the death certificates of 232 AIDS patients. The overall mortality rate declined from 75.6 deaths per 100 person-years in 1995 to 33.2 deaths per 100 person-years in 1998-1999 (P < .001). The number of AIDS patients who expired because of sepsis and opportunistic infections, which included Pneumocystis carinii pneumonia (PCP), decreased significantly from 30 (26.1%) and 24 (20.9%) in 1995 to 15 (12.8%) and 10 (8.5%) in 1998-1999, respectively (P < .05). In contrast, deaths from hepatic failure increased from 0 (0%) in 1995 to 7 (6%) in 1998-1999 (P < .05). Increases, although not significant statistically, were associated with pneumonias excluding PCP, end-stage AIDS, renal failure, and malignancies. Analysis of cause-specific mortality by gender between 1995 and 1998-1999 revealed very little difference between men and women. This analysis showed, however, that the infectious processes taken together (pneumonias excluding PCP, sepsis, and opportunistic infections including PCP) were significantly less frequent causes of death in 1998-1999 than in 1995 (P < .01). These findings indicate that HAART affected the causes of deaths in patients with AIDS, with "traditional" opportunistic infections diminishing in importance relative to chronic medical conditions and malignancies.