Residential Nursing Care Research Articles

The Geographical Location Of Nursing Homes: How Accessible Is Care In Our Ageing Society

Abstract Background With ageing demographics, the demand for residential nursing care is increasing. Some evidence and anecdotal experience suggests that nursing home care is often not available locally, resulting in individuals moving from their homes, communities and psychosocial support systems. Methods To evaluate if residential care in Ireland meets demand the number of residential care beds per 1000 adults>65years were estimated from publicly available data. Persons who sought access to the nursing home support scheme over a 6month period were reviewed. Their home location and nursing home location were analysed with respect to locality (city/suburban/town/rural), distance (km), travel time (minutes) and public service networks. Ethically approved. Results Nationally, the lowest availability of nursing home beds was Wicklow and highest Longford. Galway has 0.90 nursing home beds per1000 adults >65years. Of 262 consecutive cases presented to one local placement forum between July–December2023, 133 availed of the scheme and were resident in a nursing home at 3month follow-up. Exclusions included remained at home, deceased, or unknown. Nursing home location was city 6%(n=8), suburb 21%(n=28), town 16.5%(n=22) or rural 56%(n=75). All city placements were public. Drving distance from home to nursing home was 15km (IQR7,31) with a car driving time of 18mins (IQR11,35). No public transport service link from home to nursing home for visiting purposes was available to 38%(n=51), and when available incurred more than one bus change in 65.2%. City dweller was residing in a city located nursing home in 13%(n=5). Of the 87%(n=33) relocated out of the city, over half (n=19) were to rural locations (p<0.001). Conclusion Nursing home availability is insufficient to meet demands. The location of public and private nursing homes is creating deficits in accessing care close to home and community. Current public transport services to nursing home locations is poor.

Implementation of a program for treatment of acute infections in nursing homes without hospital transfer.

Nursing care residents have high hospitalization rates. To address this, we established a unique virtual geriatric unit that has developed a program aimed at providing support to nursing homes. We aimed to evaluate effectiveness of in-house intravenous antibiotic treatment in nursing hospitals after the implementation of the specially designed training program. A cohort study of nursing home residents to evaluate a training program for providers, designed to increase awareness and give practical tools for in-house treatment of acute infections. Data obtained included types of infections, antibiotics used, hospital transfer, and length of treatment. Primary outcomes were in-house recovery, hospitalization and mortality. Univariate analysis and multivariable logistic regression analysis to assess association between different factors and recovery. A total of 890 cases of acute infections were treated with intravenous antibiotics across 10 nursing homes over a total of 4,436 days. Of these cases, 34.8% were aged 90 years or older. Acute pneumonia was the most prevalent infection accounted for 354 cases (40.6%), followed by urinary tract infections (35.7%), and fever of presumed bacterial infection (17.1%). The mean duration of intravenous antibiotic treatment was 5.09 ± 3.86 days. Of the total cases, 800 (91.8%) recovered, 62 (7.1%) required hospitalization and nine (1.0%) resulted in mortality. There was no significant difference observed in recovery rates across different types of infections. Appling a simple yet unique intervention program has led to more "in-house" residents receiving treatment, with positive clinical results. Treating in-house nursing home residents with acute infections resulted in high recovery rates. Special education programs and collaboration between healthcare organizations can improve treatment outcomes and decrease the burden on the healthcare system.

Room Type and Social Cohesion in Senior-living Facilities

Depression in older adults is associated with loss of functioning and increased mortality. While many factors contribute to depression among this population, activities of daily living (ADL) limitations and cognitive impairment have been identified as key risk factors. However, no study, to our knowledge, has examined the extent to which physical and cognitive limitations independently and jointly contribute to the risk of depression. The current study describes the prevalence and compares the independent and joint associations of these limitations with depression in a nationally representative sample of adults aged 51 and older in the US. Analyses are based on a sample of 17,044 repeated observations on 6,636 unique primary respondents from three waves of pooled data from the Health and Retirement Study. We estimate linear and logistic multivariate regression models investigating the association between ADL limitations (any limitation on Katz ADL scale), cognitive impairment (<12 on the TICS-27 scale), and depressive symptoms (8-item CES-D), controlling for a standard set of socioeconomic and health factors. First, we find that 66% of respondents report no limitations, 16% report only cognitive impairment, 11% report only ADL limitations, and 7% report both types of limitations. Multivariate analyses suggest that ADL limitations have a much stronger association with depression compared to cognitive impairment, and this association is robust across alternative specifications. In next steps, we will take advantage of the longitudinal nature of these data to estimate changes in these characteristics over time and within individuals and explore heterogeneity in associations across relevant groups.

Room Type and Social Cohesion in Senior-living Facilities

Abstract Private rooms are generally preferred by senior-living residents. However, having roommates may help residents to build and maintain social networks in the facility, leading to promoted social cohesion and mental health. The differences in social cohesion among senior-living residents who resided in private or shared rooms need investigation. This research collected empirical data from eight senior-living facilities in Beijing and Shanghai, China. Focusing on social cohesion, room type, and personal factors, on-site questionnaire surveys recruited 345 residents receiving independent living, assisted living, or nursing care services. Facility environments were measured and rated by researchers through on-site observation. Controlling for personal and facility factors, ANOVA tests were employed to investigate the differences in social cohesion among residents who resided in private, double, or triple rooms. Room type was found significant to the social cohesion in assisted-living and nursing care residents. At the assisted-living level, compared with private and double rooms, triple rooms were more likely to contribute to social cohesion (p&amp;lt;=0.01). At the nursing care level, residents with less numbers of roommates (private versus double and double versus triple) had stronger social cohesion (p&amp;lt;=0.05). At the independent-living level, no factors significant to social cohesion were found. These findings can be used to guide the new design, renovation, and modification of senior-living environments to promote social cohesion. Recommendations for future research and practice implications for senior-living professionals and facility designers are discussed. Senior-living facilities should be built to be social-friendly through design and planning and within the context of its cultural characteristics.

135. Influence of Prescribers on Antibiotic Use among Skilled Nursing Care Residents in 29 U.S. Nursing Homes

BackgroundIn nursing homes, federal mandates call for more judicious use of antibiotics and antipsychotics. Previous research indicates that practice patterns of nursing home practitioners, rather than resident’s signs and symptoms or overall medical conditions, drive antibiotic use. We hypothesized that nursing home practitioners who prescribe antibiotics more frequently than their peers may display a similar practice pattern for antipsychotics. Here, we examine similarities in prescribing patterns for antibiotics and antipsychotics among practitioners at 29 U.S. nursing homes. MethodsPrescription data came from 2016 invoices from a pharmacy common to all 29 nursing homes. We defined practitioners as individuals who prescribed ≥1% of systemic medications at a nursing home and excluded practitioners without no prescriptions for anti-hypertensive drugs assuming they were not treating a general nursing home population (i.e. treating hospice or dementia patients). Using anti-hypertensive starts for standardization, we calculated the expected number of starts for both antibiotics and antipsychotics. Using funnel plots with Poisson 99% control limits for the observed-to-expected ratio, we identified practitioners whose use of either class of drugs exceeded these control limits. Practitioners were classified as high, average, or low prescribers for each class of drugs. ResultsWe analyzed 129 practitioners who wrote for 113669 systemic medications. For antibiotics, 27 (20%) and 19 (15%) of practitioners were low and high prescribers, respectively. For antipsychotics, 53 (41%) and 14 (11%) were low and high prescribers, respectively (Figure 1). Among the low antibiotic prescribers, 59% (16/27) were also low antipsychotic prescribers. Among the high antibiotic prescribers, 21% (4/19) were also high antipsychotic prescribers (Figure 2). Figure 1. (a) Funnel plot for antibiotics (b) Funnel plot for antipsychotics Figure 2. Type of prescriber ConclusionPractitioners who were low prescribers for antibiotics were also likely to be low prescribers for antipsychotics, suggesting judicious use for both classes of medications. Further understanding of the behaviors of these individuals, as well as those who are high prescribers for both classes, has implications for improving antibiotic stewardship practices in nursing homes. Disclosures Robin L. Jump, MD, PhD, Pfizer (Individual(s) Involved: Self): Consultant

Room Arrangement and Social Cohesion in Senior Homes – A Study in China

ABSTRACT Private rooms are widely preferred by residents in senior homes. However, having roommates may help them to maintain social networks, leading to promoted social cohesion and health. The differences in social cohesion among senior-home residents who reside in private or shared rooms need investigation. Focusing on social cohesion and room arrangement, on-site questionnaire surveys recruited 345 residents from eight senior homes in Beijing and Shanghai, China. Controlling for personal and facility factors, ANOVA tests were employed to investigate the differences in social cohesion among residents who resided in private or shared rooms. Room arrangement was found significant to social cohesion in assisted-living and nursing-care residents. At the assisted-living level, triple-room (room shared by three) residents had stronger social cohesion than private-room or double-room (room shared by two) residents (p ≤ 0.01). At the nursing-care level, residents with less roommates had stronger social cohesion (p ≤ 0.05). At the independent-living level, no factors significant to social cohesion was found. The influences of room arrangement on social cohesion vary by care level and facility. To promote social cohesion, triple rooms are suggested for assisted-living care whereas private rooms are more appropriate for nursing care. Senior-living rooms should be social-friendly through appropriate arrangement in cultural contexts.

Should Deep Brain Stimulation Programs Be Halted During the COVID-19 Pandemic? Balancing the Risk of COVID-19 Infection Against the Survival Benefits of DBS

To the Editor: The COVID-19 pandemic has rapidly spread over the world. Numerous infections and fatalities have been reported in almost all countries. Facing the challenge of steadily increasing patients, limited amount of protection equipment and ventilators, resources have been relocated towards emergency departments and intensive care units. Nonemergency elective procedures such as deep brain stimulation (DBS) for patients with Parkinson’s disease have been postponed. It has been discussed that most functional neurosurgery patients are vulnerable to the COVID-19 pandemic and at a higher risk for becoming critically ill infected. Therefore, most centers have halted their DBS programs. Undisputed is that hardware infections and battery replacements require urgent action to prevent sepsis, neuroinfections or akinetic crisis and death, eventually (1.Miocinovic S Ostrem JL Okun MS Bullinger KL Riva-Posse P Gross RE Buetefisch CM. Recommendations for deep brain stimulation device management during a pandemic.J Parkinsons Dis. 2020; 10 (https://doi.org/10.3233/JPD-202072.): 903-910Crossref PubMed Scopus (34) Google Scholar,2.Gross RE et al.Letter: evaluation and surgical treatment of functional neurosurgery patients with implanted deep brain stimulation and vagus nerve stimulation pulse generators during the COVID-19 pandemic.Neurosurgery. 2020; 87: E222-E226Crossref PubMed Scopus (8) Google Scholar). We would like to highlight the fact that Parkinson’s disease (PD) itself is a condition with high mortality rate and complement the rationale that for any functional neurosurgery procedure, and DBS for PD in particular, we should always weigh the imminent risk of a COVID-19 infection against the long term clinical benefits of the procedure. As it remains unclear how long the pandemic will last, and if there will be a second peak, this becomes crucially important. Despite progress in medical management of PD, it does not appear to have altered the mortality rate nor significantly delayed the onset of nonmotor symptoms. Life expectancy remains decreased with the main cause of death being respiratory failure from aspiration pneumonia caused by dysphagia due to brady- or dyskinesia and rigidity of the muscles involved in the act of swallowing. Other causes of death include the deterioration of general condition, cardiovascular disease, traumatic injuries due to postural instability and sepsis. Co-evolving depression and dementia as well as the need for admittance to residential care facilities are associated with higher mortality and increased risk of suicide. All in all, 11 years is the median duration from the onset of PD until death (3.Duarte J García Olmos LM Mendoza A Clavería LE. The natural history of Parkinson’s disease in the province of Segovia: mortality in a longitudinal study (20-year follow-up).Acta Neurol. Scand. 2013; 127 (https://doi.org/10.1111/ane.12003.): 295-300Crossref PubMed Scopus (27) Google Scholar). DBS of the subthalamic nucleus has become an established pillar of the therapy continuum of patients with beginning motor fluctuations and suboptimal medical management, mainly improving motor symptoms (4.Deuschl G Schade-Brittinger C Agid Y EARLYSTIM Study GroupNeurostimulation for Parkinson’s disease with early motor complications.N Engl J Med. 2013; 368: 2038Google Scholar). Moreover, it has shown to improve survival rates in PD patients. A prospective, open-labeled, nonrandomized study by Ngoga et al. followed 147 patients who were offered a DBS procedure by a joint medical/surgical movement disorders clinic over the course of a 10 years period; 106 patients underwent DBS procedure whilst 41 patients prefered medical management. The mortality rate of patients who underwent DBS was significantly lower (17%) compared to patients who received medical management (41.5%), so was admittance to residential nursing care (5.7% vs. 36.6%) (5.Ngoga D Mitchell R Kausar J Hodson J Harries A Pall H. Deep brain stimulation improves survival in severe Parkinson’s disease.J Neurol Neurosurg Psychiatry. 2014; 85 (https://doi.org/10.1136/jnnp-2012-304715.): 17-22Crossref PubMed Scopus (69) Google Scholar). It has been widely discussed whether improvement of survival is related to ameliorated mobility and axial motor functions, perceived improvement in swallowing ability or reduction in dopaminergic medication and drug-related side effects. DBS could prevent the development of motor complications at a much earlier time-point and before long-term sequelae occur, such as psychosocial limitations and deterioration of quality of life. Given all these factors, we strongly believe that PD patients with motor fluctuations should not be treated as nonurgent but interdisciplinary teams of neurologists and neurosurgeons should carefully balance the risk of nosocomial COVID-19 infection against the long-term survival benefits. Conflict of Interest: None for all authors. Dr. Bara developed the idea and wrote the manuscript. Prof. Maciaczyk supervised the work and performed the revisions. Both authors approved the final manuscript.

Flexible and Affordable Methods of Paying for Long-Term Care Insurance

With the expected dramatic increase in the number of older people requiring care, and the tightening of public funding, individuals will be increasingly expected to contribute to, and plan for, their own care in later life. However, history shows us that people are very reluctant to save for their care to the extent that there are no longer any providers of traditional prefunded long-term care insurance products in the United Kingdom to help address this problem. In this article, we consider a a disability-linked annuity that provides benefit payments toward the cost of both domiciliary and residential nursing care. We investigate different ways in which individuals can purchase this product with the goal of minimizing the impact on their living standards, hence making the purchase of the product more palatable. In addition to the traditional methods of purchasing insurance out of income and savings, we show that this product can also be purchased by making use of assets such as residential property. This flexibility would allow individuals to have control over the timing of their payments to fit around their lifestyle, particularly for those with low retirement incomes. It follows that some people will be more attracted to particular payment methods than others, and a framework is presented that segments people according to individual circumstances. A model is developed showing how the annuity works and how premiums are calculated.

Prevalence of Meticillin-Resistant Staphylococcus aureus Colonisation amongst Residents in Maltese Nursing Homes

Since the 1960’s, meticillin-resistant Staphylococcus aureus (MRSA) has become a major pathogen with ever-increasing incidence rates of hospital-acquired and community-acquired infections. Malta has currently one of the highest rates of hospital-acquired and community-acquired infections in Europe. In addition, reports have estimated community carriage at more than 8%. MRSA carriage in homes for the elderly is very important because these residents are often hospitalized and therefore serve as a source of transmission. The aims of this study were to establish the prevalence of MRSA nasal carriage amongst residents in nursing homes in Malta, to determine their antibiotic susceptibility and to determine the significance of specific risk factors found in the literature. Nasal swabs were taken from 397 randomly chosen residents in 10 governmental nursing homes. A short questionnaire including possible risk factors reported to be associated with MRSA nasal carriage was also filled. MRSA carriage amongst nursing home residents was 19.4% (95% CI 17.6 – 21.2%) ranging from 0% to 25% amongst the nursing homes studied. Logistic regression analyses indicated that previous hospital admission was the only risk factor that was found to be significantly (OR: 1.956, p: 0.011; 95CI 1.163 - 3.290) associated with MRSA nasal colonization amongst nursing home residents. A high carriage rate of MRSA was identified in Maltese nursing care residents which can contribute to maintaining MRSA incidence in hospitals. Possible interventions include screening of these patients when they are admitted to an acute care facility and possible decolonization attempts in the nursing homes.

Prevalence of Meticillin-Resistant Staphylococcus aureus Colonisation amongst Residents in Maltese Nursing Homes

Since the 1960’s, meticillin-resistant Staphylococcus aureus (MRSA) has become a major pathogen with ever-increasing incidence rates of hospital-acquired and community-acquired infections. Malta has currently one of the highest rates of hospital-acquired and community-acquired infections in Europe. In addition, reports have estimated community carriage at more than 8%. MRSA carriage in homes for the elderly is very important because these residents are often hospitalized and therefore serve as a source of transmission. The aims of this study were to establish the prevalence of MRSA nasal carriage amongst residents in nursing homes in Malta, to determine their antibiotic susceptibility and to determine the significance of specific risk factors found in the literature. Nasal swabs were taken from 397 randomly chosen residents in 10 governmental nursing homes. A short questionnaire including possible risk factors reported to be associated with MRSA nasal carriage was also filled. MRSA carriage amongst nursing home residents was 19.4% (95% CI 17.6 – 21.2%) ranging from 0% to 25% amongst the nursing homes studied. Logistic regression analyses indicated that previous hospital admission was the only risk factor that was found to be significantly (OR: 1.956, p: 0.011; 95CI 1.163 - 3.290) associated with MRSA nasal colonization amongst nursing home residents. A high carriage rate of MRSA was identified in Maltese nursing care residents which can contribute to maintaining MRSA incidence in hospitals. Possible interventions include screening of these patients when they are admitted to an acute care facility and possible decolonization attempts in the nursing homes.

Caring in the wake of the rising tide: Moral distress in residential nursing care of people living with dementia.

Objective Moral distress is increasingly being recognized as a concern for health care professionals. The purpose of this study was to explore the nature and prevalence of moral distress among nursing staff who care for people living with dementia. Methods This study was focused on nursing staff caring for people with dementia in long-term care and assisted living sites. The Moral Distress in Dementia Care Survey instrument was distributed to 23 sites and nursing staff rated the frequency and severity of situations that were identified as potentially causing moral distress. Results Moral distress is prevalent in the nursing staff who provide dementia care. Nursing staff reported experiencing moral distress at least daily or weekly. Both frequency and severity of moral distress increased with proximity to (amount of time spent at) the bedside. Moral distress had negative psychological and physiological effects on nursing staff, and affected intention to quit.

Quality of life in nursing homes: results of a qualitative resident survey

The growing importance of residential nursing care has been accompanied by an increasing demand for instruments measuring quality of life in nursing homes. Quality of life is a complex construct with both subjective and objective aspects that does not lend itself to being determined by a single measure. The aim of this study was therefore to identify dimensions of life that nursing home residents perceive as having a particular impact on their overall quality of life. Data were obtained from 9 men and 33 women from eight nursing homes by means of semi-structured narrative interviews. The interviews were analyzed using the documentary method. Ten central dimensions of subjective quality of life were derived from the interview data: social contacts, self-determination and autonomy, privacy, peace and quiet, variety of stimuli and activities, feeling at home, security, health, being kept informed, and meaningful/enjoyable activity. Some of these dimensions are multifaceted and have further subdimensions. The aspects emerging as relevant to residents' subjective quality of life extend far beyond care- and health-related aspects. Nevertheless, some of the quality of life dimensions reconstructed are within the direct influence of the home (e.g., variety of stimuli and activities or being kept informed) and can possibly be improved by attending to the residents' objective situation.

PREVENTING FALLS IN OLDER PEOPLE: THE NEW ZEALAND EXPERIENCE

BackgroundNew Zealand researchers have made major contributions to the development of proven falls prevention programmes in older people. National strategies for falls and injury prevention have been implemented.ObjectivesTo review the...

Nutrition screening of older adults living in care homes

summary Risk and prevalence of malnutrition increases with old age. If left unrecognised and untreated, malnutrition can result in adverse effects such as disease, delayed recovery time and an increase in hospital stays. This study assessed the risk of malnutrition in older adults living in residential and nursing care, in the Leeds and West Yorkshire area using the Malnutrition Universal Screening Tool ‘MUST’. Five hundred and nine residents (375 residential care and 134 nursing care residents) from 25 care homes participated in the study. Participants’ BMI, unplanned weight loss and acute disease score were recorded, and overall MUST score calculated. Overall risk of malnutrition (medium or high) in care home residents was estimated at 41.6%. As expected the risk of malnutrition was significantly (p < 0.001) greater in nursing care (50%) compared to residential care (33.2%). It is important that awareness of malnutrition risk is increased so that methods to improve nutritional intakes can be implemented effectively where appropriate.

Nursing home-associated infections in Department of Veterans Affairs community living centers

Little is known about factors contributing to nursing home-associated infections (NHAIs). We conducted a survey of residents in 133 Department of Veterans Affairs community living centers to determine the roles of indwelling device use, bed locations, and treatment codes on NHAIs. A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted on November 14, 2007. Among 10,939 residents, 575 had at least one NHAI, for a point prevalence rate of 5.3%. Urinary tract infection, skin infection, asymptomatic bacteriuria, and pneumonia were the most prevalent NHAIs. A total of 2687 residents had one or more indwelling devices; 290 of these also had an NHAI, for a prevalence of 10.8%. In contrast, the prevalence of NHAIs in residents without indwelling devices was 3.5% (P < .0001). Indwelling urinary catheters, percutaneous gastrostomy tubes, peripherally inserted central catheters, and suprapubic urinary catheters were the most commonly used devices. There were 4027 residents in designated units and 6912 residents in dispersed units. The rate of device use was 21.4% in the designated units and 26.4% in the dispersed units (P < .0001). The prevalence of NHAIs was 4.5% in the designated units and 5.7% in the dispersed units (P < .001). Rates of NHAIs and device use varied greatly among the various treatment codes; however, there was a positive correlation between the rates of NHAIs and device use. Stepwise logistic regression analysis of data from long-stay and short-stay skilled nursing care residents revealed that only the presence of an indwelling device, not length of stay or bed location, affected the rate of NHAIs. Indwelling device use, but not bed location or treatment code, was found to be associated with increased rate of NHAIs.

Predictors of job strain in residential dementia care nursing staff

To identify predictors of job strain in residential nursing care staff working with people with dementia. It is well known that nursing staff experience high levels of stress, but less is known about how to predict job strain. The job strain of nursing care staff (n = 344) within residential dementia care settings was assessed. Standard linear regression analysis was used to explore predictors of job strain. Data from the study shows that nursing staff in residential dementia care have a demanding job and experience high levels of strain. The linear regression model with four predictor variables explained 19% of the variability in job strain scores. Perceived caring climate of the unit, staff education level, possibilities to have discussions of difficulties and ethics at work and staff age, had a statistically significant association with job strain. The caring climate, staff education, reflective practice and staff age can be used as screening variables when predicting job strain. These predictors can assist managers and directors to identify targeted strategies for supervision and support of nursing staff to secure their well-being, and by that securing the quality of care provided to residents.

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Abstract Is it possible to maintain or even enhance functional and cognitive independence in residents of nursing homes? Little is known about the potentials and limits of therapeutic methods designed to maintain independence in elderly people already in need of residential nursing care. The aim of the “Rehabilitation in Nursing Homes” research project was to determine the practicability and effectiveness of a rehabilitative approach targeting residents of nursing homes. The main objectives of the activation program were to maintain and enhance residents’ cognitive and functional autonomy. Data on psychological, functional, and medical variables were obtained from a sample of 294 nursing home residents (age range = 70–99 years) at three points of measurement over a 12-month period. The intervention approach draws on the theoretical and practical findings of the SimA Study (“Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter,” “conditions on maintaining and supporting independent living in old age”; Oswald et al., Z. Gerontopsychol. Psychiatr., 15:61–84, 2002, Z. Gerontopsychol. Psychiatr., 15:13–31, 2002) and incorporates the results of recent therapeutic and rehabilitative studies in the fields of geriatrics and gerontopsychiatry. The intervention involves a combined program of cognitive and physical activation. An alternative program based on biographical information was designed specifically for residents with dementia. Results show that the intervention had significant effects on cognitive and functional parameters. Moreover, transfer effects were observed with respect to activities of daily living and frequency of falls.

Konzeptionelle und rechtliche Varianten der Versorgung von Menschen mit Demenz zwischen ambulant und stationär

In Germany, there clearly appears to be a gap between care carried out at home and in in-patient settings (residential nursing care). Numerous innovative projects of alternatively structured care, like for instance shared flats or group care units for people with dementia are placed in between the traditional, either home-based or institutionalised care patterns. It seems imperatively necessary to overcome the rigid separation between the inpatient sector and care carried out at home. In this article, backgrounds, necessities and perspectives of projects placed in between the traditional structures are discussed.

Psychometric evaluation of a brief geriatric depression screen

This article is a psychometric evaluation of the experimental Geriatric and Extended Careline Depression Screen (GEDS) for geriatric nursing care residents. The GEDS is a five-item depression screen based on an abbreviated version of the Center for Epidemiological Studies Depression Scale (CES-D). A total sample of 91 male residents over the age of 60 were recruited from a Veterans Administration Nursing Home Care Unit. The Geriatric Depression Scale-Short Form (GDS-SF) was used as a gold standard test to examine the convergent validity of the GEDS. The Discriminant Trait Inventory was used to assess divergent validity and the confounding effects of method variance in this research design. Test-retest reliability, redundance and omission in item content validity were systematically evaluated. A receiver operating characteristics (ROC) curve was used to identify the most effective cut-off score for clinical selection. Reliability was significant, but moderate. Convergent validity with the Geriatric Depression Scale was high. No items were identified as redundant. A review of literature suggested that irritability is an important factor of geriatric depression that had not been included in the original screen. The inclusion of an experimental item to assess irritability, however, did not improve the psychometric properties of the GEDS.