Long-Term Care medicines formularies: any reasons for pharmacists' concern?

Abstract This study aimed to characterize and compare medicines formularies (MFs) used in Long-Term Care (LTC) facilities in Portugal, and to identify the prevalence of Potentially Inappropriate Medicines (PIMs). A systematic contact with LTC facilities was undertaken in December 2021. MFs were systematized according to the Anatomical Therapeutical Chemical classification system (ATC), followed by descriptive content analysis. A structured comparison between MFs developed by public organizations and private LTC facilities was performed. After duplicate removal and exclusion of medicines not for systemic use, two explicit criteria - the Algorithm of medication review in frail older people and the EU(7)-PIM list - were employed for PIMs identification. Five MFs were obtained and assessed. The three MFs developed by private institutions covered 23% of the national LTC facilities and approximately 34% of the national total of beds. Heterogeneity was particularly high for the Alimentary tract and metabolism, Blood and blood-forming organs, Musculoskeletal system, and Respiratory system ATC groups. A PIM prevalence of 29,4% was identified. Medicines distribution between the MFs suggests the need to develop national guidelines towards harmonizing medicines usage in LTC. The prevalence of PIMs found highlights the importance of a particular optimized use of this health technology in aged sub-populations

Quality of Life of Elderly People Living in Different Types of Long-term Care Facilities

Abstract Population aging is a worldwide occurrence that has become urgent in developing countries. Quality of life can be measured to identify functional capacity and determine the degree of impact on quality of life exerted on an individual. This study aimed to measure the quality of life of elderly people who have been living in different long-term care facilities for the elderly. Therefore, this research was developed with a qualitative and descriptive approach. Data were obtained from medical records and interviews, and were analyzed in R language interpreter software on the Ubuntu Linux operating system. Seventy-nine elderly people participated in the study. Eleven lived in Home Marista, and 68 lived in Home Jesus Maria José. A socioeconomic questionnaire was used to collect data on the socioeconomic characteristics of the participants. The Mini-Mental State Exam was used to measure degree of cognition. The Short Form-36 Questionnaire was used to measure quality of life. The present study suggests that the results found can clarify the individual vulnerability of the elderly in the age group studied regardless of the type of residence. Despite the discrepancy found regarding the care provided at the long-term care facilities, the scores, obtained with the quality of life assessment, did not show significant differences.

Effect of Hurricane Irma on daily direct-care nurse staffing in nursing homes.

OBJECTIVES: To examine the effect of Hurricane Irma on staff-related financial expenditures and daily direct-care nurse staffing levels. DESIGN: Retrospective cohort study. SETTING: September 3-24, 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10, 2017. PARTICIPANTS: Six hundred and fifty-three nursing homes (NHs), 81 evacuated facilities, and 572 facilities that sheltered-in-place. MEASUREMENTS: This study used data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida's health providers' emergency reporting system. PBJ provided estimates of daily direct-care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility-level characteristics such as profit status, chain membership, and special care unit availability. Florida's emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed-effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3 to 10. RESULTS: Among all facilities, we found significant increases in staffing for licensed practical nurses (p = 0.02) and certified nursing assistants (p < 0.001), but not for registered nurses (p = 0.10) before Hurricane Irma made landfall. From 1 week before landfall to 2 weeks after landfall (September 3-24), an additional estimated $2.41 million was spent on direct-care nurse staffing. In comparison to facilities that sheltered-in-place, evacuated facilities increased staffing levels of all nurse types (all p < 0.001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident whereas facilities that sheltered-in-place spent $76.10 on nurse staffing per resident. CONCLUSION: NHs face unprecedented challenges during hurricanes, including maintaining adequate direct-care nurse staffing levels to meet the needs of their residents. NHs that evacuated residents had an increase in direct-care nurse staffing that was greater than that seen in NHs that sheltered-in-place.

[Liaison geriatrics with nursing homes in COVID time. A new coordination model arrived to stay]. / La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse.

Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.

Dementia care worker stress associations with unit type, resident, and work environment characteristics: a cross-sectional secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP).

BACKGROUND: Although caring for residents with dementia in nursing homes is associated with various stressors for care workers, the role of the unit type, and particularly the proportion of residents with dementia, remains unclear. This study aimed to explore associations between unit type and care worker stress, taking into account additional potential stressors. METHODS: This cross-sectional study was a secondary data analysis in the Swiss Nursing Homes Human Resources Project, which included data from 3,922 care workers from 156 Swiss nursing homes. Care workers' stress was measured with a shortened version of the Health Professions Stress Inventory. Generalized estimating equation models were used to assess care worker stress and its relationships with three unit types (special care units and others with high or low proportions of residents with dementia), work environment factors, and aggressive resident behavior. RESULTS: After including all potential stressors in the models, no significant differences between the three unit types regarding care worker stress were found. However, increased care worker stress levels were significantly related to lower ratings of staffing and resources adequacy, the experience of verbal aggression, and the observation of verbal or physical aggression among residents. CONCLUSIONS: Although the unit type plays only a minor role regarding care worker stress, this study confirms that work environment and aggressive behavior of residents are important factors associated with work-related stress. To prevent increases of care worker stress, interventions to improve the work environment and strengthen care workers' ability to cope with aggressive behavior are suggested.

Impact of the nursing home scale on residents' social engagement in South Korea.

BACKGROUND: This study aimed to describe the levels of social engagement and to examine the relationship between the nursing home scale groups and social engagement in nursing homes in South Korea. METHODS: A total of 314 residents were randomly selected from rosters provided by 10 nursing homes located in three metropolitan areas in South Korea. The outcome variable was social engagement measured by the Revised Index of Social Engagement (RISE), and the key independent variable was the nursing home scale (small, medium, and large). Individual factors (age, gender, activities of daily living and cognitive function, and depressive symptoms) and organizational factors (location, ownership, and staffing levels) were controlled in the model as covariates. Multilevel logistic regression was used in this study. RESULTS: About half of the residents (46%) in this study were not socially engaged in the nursing home (RISE=0) where they resided. Controlling for individual- and organizational-level factors, the nursing home facility size was a significant factor to predict the likelihood of residents' social engagement, with that the residents in large-scale nursing homes being less likely to be socially engaged than those in medium-scale nursing homes (odds ratio = 0.457; p-value = 0.005). CONCLUSION: This study supports evidence from previous studies that smaller-scale nursing homes are likely to provide more person-centered care compared to larger-scale nursing homes. Subsequent quality studies are needed to examine how the mechanisms for how smaller-scale nursing homes can enhance residents' social engagement in terms of care delivery processes.

[Age-Wohnmatrix. Using basic needs rather than defined terms]. / Age-Wohnmatrix. Bedürfnisse statt Begriffe ins Zentrum stellen.

BACKGROUND: The variety of living possibilities for ageing people has increased in the past few years. This vast range of housing arrangements does not make orientation any easier for individuals. The definition of housing and caring arrangements not only differs from one country to another but also within countries. MATERIAL AND METHOD: To develop a framework describing different housing offers, we started to work with a positioning matrix, which is known in economic sciences. The matrix turned into the Age-Wohnmatrix which is defined by two basic needs of elderly people: the importance of being autonomous and the desire to be integrated and secure. RESULTS: On the autonomy axis, there are three different types of housing arrangements: private living arrangements, special housing offers for elderly people, and institutional living. The security axis starts by offering apartments, followed by social integration, assistance, and care. CONCLUSION: The Age-Wohnmatrix should be a helpful tool to analyze and define the character of housing options for elderly people.

Does the Aged Care Funding Instrument provide increased funding in residential care? Comparisons with the Residential Classification Scale.

AIM: To determine whether the Aged Care Funding Instrument (ACFI) provides more funding than the Residential Classification Scale (RCS) for residents in the Hellenic Residential Care Facility. METHODS: All residents within the care facility were assessed over a six 6-month period using ACFI, RCS and Clifton Assessment Procedures for the Elderly (CAPE) scores. Differences in funding levels were calculated using ACFI and RCS instruments against a standardised CAPE score. RESULTS: CAPE dependency RCS funding per resident per day varied from $32.20 for grade A to $116.20 for grade E4 residents. CAPE ACFI funding varied from $20.20 for grade A to $127.50 for grade E4. There was no significant difference in mean overall funding between the two scales (ACFI $92.50 vs RCS $90.35, P = 0.76). CONCLUSIONS: The ACFI does provide a small but not significant increase in funding to residents in residential care. It redirects funding to higher dependency residents.

[Development and validation of a Quebec classification of private residences with services welcoming of older persons]. / Développement et validation d'une classification québécoise des résidences privées avec services accueillant des personnes âgées.

Private Residential Care Facilities (RCFs) fill the gap between independent community living and institutional settings for seniors. There are marked differences between RCFs which make them difficult to compare. To address this issue, the objective of this study was to develop and validate a classification of RCFs based on their physical and organizational environments. RCF owners across Quebec were invited to complete a questionnaire that described the setting's physical and organizational environment. Different combinations of cluster analysis methods and statistical parameters were used to identify plausible classifications. The final choice was made by an expert committee. Overall, 552 owners returned the questionnaire. Three plausible classifications were submitted to the committee. The selected classification included five clusters that differed with regard to admission criteria, services offered and recreational activities. This classification could help health professionals select the RCF that best responds to older adults' needs.

Identification of inappropriate prescribing in a Brazilian nursing home using STOPP/START screening tools and the Beers' Criteria

The objective of this study was to determine the prevalence of Potentially Inappropriate Medication (PIM) use and associated factors, as well as the prevalence of Prescribing Omissions (PO). A cross-sectional study was conducted in a philanthropic Brazilian nursing home involving 46 individuals aged 60 years or older. The following information was collected from medical records and drug prescriptions: gender, age, health conditions and drugs used in the past thirty days. PIM and PO were identified according to the Beers' Criteria and the STOPP/START screening tools. Over one third (37%) of the population used at least one PIM according to the Beers' Criteria (n=17) and 60.9% according to the STOPP tool. A significant association was found between polypharmacy (use of five or more drugs) and use of PIM according to the Beers' Criteria, but not according to the STOPP. Eight residents (17.4%) were exposed to eight PO. This study allowed the diagnosis of a concerning drug utilization profile with use of a high number of PIMs. Thus, there is an evident need to implement strategies for improving geriatric prescription.

O objetivo deste estudo foi determinar a prevalência de uso de medicamentos potencialmente inadequados (MPI) e fatores associados, bem como a prevalência de omissões farmacoterapêuticas (OF). Trata-se de um estudo transversal realizado em uma instituição filantrópica brasileira de longa permanência com 46 indivíduos com 60 anos ou mais. As seguintes informações foram coletadas a partir de prontuários e prescrições: sexo, idade, condições de saúde e medicamentos utilizados nos últimos trinta dias. MPI e OF foram identificados pelo Critério de Beers e as ferramentas de triagem STOPP/START. Mais de um terço (37%) da população utilizou pelo menos, um MPI de acordo com os critérios de Beers (n=17) e 60.9% de acordo com a ferramenta STOPP. Associação estatisticamente significante foi detectada entre a polifarmácia (consumo de cinco ou mais medicamentos) e uso de MPI de acordo com os critérios de Beers, mas não de acordo com o STOPP. Oito residentes (17,4%) foram expostos a oito OF. Este estudo permitiu o diagnóstico de um perfil de utilização de medicamentos preocupante com número elevado de utilização de MPI. Isso indica a necessidade de implementar estratégias para melhorar a qualidade da prescrição geriátrica.

[Hygiene ranking in residential homes for the aged in Frankfurt--conception and first results]. / Das Hygiene-Ranking der Frankfurter Altenpflegeheime--Konzept und erste Erfahrungen.

Public health departments are obliged by law to survey hygienic procedures and condition in residential homes for the aged. Based on the annual hygiene control visits, a standardised hygiene ranking was established with the aggregation of more than 60 detailed single observations in the following fields: building, organisation, training of the staff, actual hygiene situation, repeated deficits, food and kitchen hygiene, and drinking water. This hygiene ranking enables not only intra-institutional comparisons in different years but also the comparison between different homes. The data obtained in 2004 to 2006 demonstrated that this method was very well accepted by the institutions and was readily appreciated as a tool for external quality assessment.

Definition and classification of assisted living.

PURPOSE: The purpose of this article is to discuss the benefits and limitations of, and considerations in, developing a typology of assisted living (AL). DESIGN AND METHODS: We conducted a review and comparison of nine AL typologies drawn from the literature. RESULTS: Typologies addressed matters related to the structure, process, population, and philosophy of AL to varying degrees. A lack of available data and different sampling frames hindered attempts to quantitatively compare the typologies. IMPLICATIONS: Typologies are potentially useful for consumers, practitioners, policy makers, and researchers. It is advisable to identify state-based typologies and then empirically determine types that have national representation. Stakeholders should consider the tradeoff between sensitivity and specificity and allow any resulting typology to anticipate ongoing evolution in the field of AL.

The primary care physician's role in nursing facility care.

As more care is shifted from the acute care hospital and other sites to nursing facilities, and as the complexity of nursing facility care increases, more is expected of attending physicians. Physicians play an important role in helping patients and their families in this setting and in working with the facility staff in caring for these patients. Structuring visits to address patient and family needs and staff concerns; reviewing resident assessment instruments, care plans, and orders for care; and carefully documenting and coding those visits in such a way as to represent the purpose and complexity of the visit and the patient's clinical circumstances not only helps to improve the overall care provided to the patient but also helps others such as payors and regulators who are concerned about quality of care to have a better understanding of the patient's situation and future plans and expectations. Thus, as nursing facility care becomes more complex, the role of physicians in the nursing facility becomes even more essential.

Recruiting and screening older, transitional to frail adults in congregate living facilities.

Historically older adults have been recruited from the community or from long-term care facilities. The research study, The Effects of Intense Tai Chi Training in the Older Adult, targeted adults 70 years and older who were residing in congregate living facilities and transitioning to frailty according to the Speechley/Tinetti scale. This article describes the strategies that were designed and implemented to recruit and screen the 287 older adults who entered the randomized, single-blinded clinical trial.

Una aproximación a la situación de los adultos/as mayores y de las Asociaciones, Clubes y Grupos Parroquiales que los nuclea

Estudio exploratorio de la situación de los adultos/as mayores para analizar sus organizaciones, normasy procedimientos. Describe la creencias, prejuicios y estereotipos de la población urbana paraguaya hacia los adultos mayores, resaltando a aquellos que mantienen nuestra cultura y determinan su estilo de vida. Presenta el análisis del anteproyecto de Ley que estaba en estudio en la Cámara de Senadores

[The "Duisgurg model" of intensified control of nursing homes and homes for the aged by the Duisberg public health services in cooperation with the Duisburg social welfare offices]. / Duisburger Modell--intensivierte Heimaufsicht des Gesundheitsamtes in Zusammenarbeit mit dem Sozialamt.

This is a report on the joint cooperative control of nursing and old-age homes by the Public Health and Social Welfare Offices in Duisburg, Germany. A total of 40 of such homes were inspected and checked jointly by the physician and pharmacist of the local Public Health Office within a one-year period while collecting data on the intensity and quality of care in these homes. A total of 3883 inmates were covered. These data included, inter alia, information on the intensity of care, prevalence of urinary and fecal incontinence, feeding by means of percutaneous endoscopic gastrostomy, prevalence of bedridden patients and of cases of pressure sores. The data conveyed information on the overall situation (frequencies for all the Duisburg nursing and old-age homes) on the one hand, and for each individual home on the basis of its particular data on the other hand. It became evident that two-thirds of all the inmates of nursing homes were classified as belonging to nursing stages II and III. Urinary incontinence was present in 63 per cent of the cases, fecal incontinence in 43 per cent, whereas 32 per cent were severely confused. Of a total of 447 permanently bedridden patients (11.5 per cent of all the inmates) 131 had pressure sores or necroses of the heels (3.37 per cent of the total population). More than one-half of the pressure sores had been acquired by the patients during their hospital stay, i.e. before their referral to a home, whereas 56 inmates developed their pressure sores in the homes concerned.

[Consideration of mental symptoms and physical disabilities in deciding upon placement in a residential home versus a nursing home]. / De indicatie voor een verzorgingshuis of verpleeghuis. De weging van psychische klachten en lichamelijke beperkingen.

This study analysed 235 applications of elderly people for residential home and nursing home care. The applications were submitted to a Dutch municipal care allocation board. Based on the 1994 registration data from this board the impact of physical restrictions and mental problems on the care allocation for residential or nursing homes and connected care was studied. Physical complaints were measured with an adl and an hdl scale (Activities of Daily Living and Household Activities of Daily Living), mental problems were assessed by means of the Reality, Orientation and Restlessness Scales. Persons with an admission allocation for a nursing home (both psychogeriatric and somatic) had the highest scores on all scales; persons allocated to the residential home and related care had significantly lower scores. Above-mentioned scales have been combined into care level categories. Fifty seven persons, however, appeared not to have any physical or mental problems despite a care allocation to the residential home or related care. Contextual problems (housing, social contacts, endurance-capacity of relatives and friends) were particularly decisive in this case. Moderately severe problems, both physical and mental, generally resulted in an allocation to the residential home or related care. Serious problems usually result in allocation to the somatic or the psychogeriatric nursing home. Combined serious problems (75%) tended to result in an allocation to the psychogeriatric nursing home. This study is preliminary to the development of a care allocating instrument.

Identifying older people with dementia: the effectiveness of a multiservice census.

A census of all relevant services in an area can be used to identify people with mental impairment suggestive of dementia. Two censuses in Tayside, Scotland, were used to test the effectiveness of this method. False positives accounted for 12% of returns. After excluding false positives, by comparison with expected dementia prevalence based on EURODEM, 66% of all sufferers and 50% of those living in the community were identified by the censuses. By pro-rating for non-response, the proportion of sufferers known to services was estimated as 72%. The characteristics of those not known to services are unclear and further research is needed on this. The cost of a census in an area of 250,000 population is under pounds 3000. A multiservice census offers a simple, inexpensive, practicable method of constructing a sample frame for population needs assessment.

Identification of elderly in particular need: results of a survey undertaken in residential homes in the Manchester area.

OBJECTIVES: This paper aims to identify which groups of elderly people living in residential institutions are in particular need of dental care and advice. Comparison of different types of residential institution allows identification of elderly in greatest need of dental assistance. METHODS: A postal survey of carers in 250 residential homes for elderly people in Manchester, UK, was undertaken to determine the frequency of dental visits, arrangements for dental care of the residents' teeth and denture cleansing and appliance-wearing patterns and, also, the carers' knowledge and practice of simple dental and oral maintenance procedures for residents. Comparisons were undertaken using the SPSS software package of: social service and private homes, large and small homes, homes where regular visits were undertaken and those not regularly visited, and also homes which maintained records of their clients' dental state with those which did not. RESULTS: Residents' oral health tended to be more at risk in smaller or privately managed homes, in those where no dentist visited regularly and where no records of dental care were kept. CONCLUSION: The dental profession needs to especially target homes where care is less well organized, not only to examine and treat residents, but also to instruct carers in simple mouth care techniques, in order that dental disability in an increasingly dentate population can be minimized.