Well-being Of Nursing Home Residents Research Articles

Longitudinal Analysis of Functional Capacity in Nursing Home Residents During the COVID-19 Pandemic.

The COVID-19 pandemic has raised concerns about nursing home (NH) residents' well-being, with recent studies indicating a significant increase in functional decline rate during this critical period. However, a comprehensive exploration of functional capacity trajectories in NH residents during the pandemic remains unexplored. This study aims to address this research gap by conducting an in-depth analysis of the impact of the COVID-19 pandemic on NH residents' functional capacity. A 24-month multicenter prospective study involving 123 NH residents from Spain, with data collected at 6-month intervals over 5 waves, starting just before the pandemic's onset. Functional capacity was assessed using the Modified Barthel Index, and data were analyzed employing the actuarial method, log-rank test, and Cox's regression. The likelihood of maintaining functional capacity was unfavorable, with only a 19.3% chance of preservation for a 1-point decline (FD-1) in Barthel scores and a 50.5% probability for a 10-point decline (FD-10). Personal hygiene, eating, and toilet use were identified as the most affected activities of daily living. Urinary continence decline emerged as a risk factor for FD-1, while fecal continence decline was associated with FD-10. The probability of maintaining functional capacity in the initial 6months of a pandemic was comparable to a 2-year non-pandemic follow-up. Pandemic-induced isolation strategies significantly impacted toileting and personal hygiene. Urinary decline was associated with minor functional decline (FD-1), while fecal decline correlated with major functional decline (FD-10). Notably, the number of days spent in room confinement did not significantly contribute to the observed decline. A substantial increase in the risk of FD among NH residents during the COVID-19 pandemic compared to the pre-pandemic period was found. It is crucial to implement urgent, targeted interventions that prioritize promoting physical activity and the implementation of mobility and toileting programs. These measures are pivotal for mitigating functional decline and enhancing the overall health and well-being of NH residents in a pandemic context.

Predicting Change in Depressive Symptoms in the Nursing Home

Depressive symptoms are common among nursing home (NH) residents. Important predictors of depression to tease apart include demographic characteristics, physical status, functional ability, and chronic pain. A challenge to addressing depression is that a majority of NH residents have some level of dementia. Nonpharmacological management of depression in the NH is a recommended first line of treatment including: personalized activities, music therapy, repositioning, and attention to personal care needs (toileting, resting, and hydration). A holistic approach to the well-being of NH residents is the adoption of person directed (PDC) care models. In this study, predictors of decreased depression over time was examined in residents (N=144) living in two communities featuring PDC models, and those living in traditional care communities within the same NH. Care in the two PDC communities focused on provision of comfort care for persons with advancing dementia at-risk of not having their care needs met largely due to their inability to clearly communicate these needs. Care practices focused on knowing each elder deeply, and anticipating their needs. Care practices also included an emphasis on staff empowerment and meaningful life activities for residents. Traditional communities are those where PDC practices had not yet been incorporated. Data on demographic characteristics, cognitive status, physical and functional status, behavioral symptoms, and pain were extracted from the MDS. Results showed that being in the PDC group, less time in the nursing home, having less pain, and fewer behavioral symptoms were significant predictors of decreased depressive symptoms over a six-month period.

Nursing Home Facility-Initiated Involuntary Discharge.

Involuntary discharge of nursing home (NH) residents is a prominent reason for NH complaints in the United States, but little is known about facility-initiated involuntary discharge (FID). A literature review was conducted to improve understanding of FID. The findings distinguish between six types of FID, identify populations at risk of FID, and differentiate between legal and unlawful FID practices and processes. The findings also characterize common FID destinations; show how policy, regulatory, and financial factors impact FID; and indicate that FID outcomes are commonly detrimental to the health and well-being of NH residents. Findings highlight challenges with understanding FID, including differentiating legal from unlawful FID. Although more research about NH FID is needed, the current study indicates that FID outcomes are regularly adverse, protections against unlawful FID are needed for Medicaid beneficiaries and NH residents with dementia, and stronger enforcement of existing policies and regulations regarding NH FID-including NH bed-hold requirements-are needed. [Journal of Gerontological Nursing, 45(8), 23-31.].