Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data.

BACKGROUND: Older adults remain the highest utilization group with unplanned visits to emergency departments and hospital admissions. Many have considered what leads to this high utilization and the answers provided have depended upon the independent measures available in the datasets used. This project was designed to further understanding of the reasons for older adult ED visits and admissions to acute care hospitals. METHODS: A secondary analysis of data from a cross-national sample of community residing elderly, 60 years of age or older, and most of whom received services from a local home-care program was conducted. The assessment instrument used in this study is the interRAI HC (home care), designed for use in assessing elderly home care recipients. The model specification stage of the study identified the baseline independent variables that do and do not predict the follow-up measure of hospitalization and ED use. Stepwise logistic regression was used next to identify characteristics that best identified elders who subsequently entered a hospital or visited an ED. The items generated from the final multivariate logistic equation using the interRAI home care measures comprise the interRAI Hospital-ED Risk Index. RESULTS: Independent measures in three key domains of clinical complications, disease diagnoses and specialized treatments were related to subsequent hospitalization or ED use. Among the eighteen clinical complication measures with higher, meaningful odds ratios are pneumonia, urinary tract infection, fever, chest pain, diarrhea, unintended weight loss, a variety of skin conditions, and subject self-reported poor health. Disease diagnoses with a meaningful relationship with hospital/ED use include coronary artery disease, congestive heart failure, cancer, emphysema and renal failure. Specialized treatments with the highest odds ratios were blood transfusion, IV infusion, wound treatment, radiation and dialysis. Two measures, Alzheimer's disease and day care appear to have a protective effect for hospitalization/ED use with lower odds ratios. CONCLUSIONS: Examination into "preventable" hospitalizations and re-hospitalizations for older adults who have the highest rates of utilization are occurring beneath an umbrella of assuring the highest quality of care and controlling costs. The interRAI Hospitalization-ED Risk Index offers an effective approach to predicting hospitalization utilization among community dwelling older adults.

Three essentials for successful fall management: communication, policies and procedures, and teamwork.

Falls among older adults, especially within the nursing home setting, can be challenging for health care providers. Attention to the basic processes of communication, policy and procedure, and teamwork proved to be necessary steps to facilitate successful fall management within this pilot program. This article provides an overview of the specified areas, along with examples of techniques developed to address identified needs in each of the three areas. A focused examination of these three essentials could prove instructive to any facility working to improve its fall management process.

Leading nurses: emotional intelligence and leadership development effectiveness.

Purpose The purpose of this paper is to examine the effectiveness of an emotional intelligence (EI) and leadership development education program involving 20 nurse leaders at nursing homes. Also, it investigates the relationship between EI and transformational leadership. Design/methodology/approach Three research questions are posed. Correlation analysis and t-tests were conducted to answer the questions posed. Findings The findings of this paper indicate that the EI educational development was effective, while the personal leadership development was not. The data also showed a positive significant relationship between EI and transformational leadership. Research limitations/implications This paper is limited by the small sample size; thus, a causal relationship between EI and leadership could not be investigated. Additionally, the sample was not randomly selected because of the commitment needed from the participants. Furthermore, the paper was focused on nurse leaders in nursing homes, so it may not be generalizable to other populations. Practical implications With the increasing need for nursing home facilities and the limited training generally provided to nurses who move into managerial roles in these facilities, it is critical for organizations to understand the effectiveness of educational programs that exist. Moreover, the findings of this paper may provide information that would be useful to others who wish to develop EI and/or leadership education for nurses. Originality/value While much research exists on EI and transformational leadership, little of this research focuses on nurses in nursing home facilities. Thus, this paper fills a gap in the literature.

Using the community health assessment to screen for continued driving.

This project used the interRAI based, community health assessment (CHA) to develop a model for identifying current elder drivers whose driving behavior should be reviewed. The assessments were completed by independent housing sites in COLLAGE, a non-profit, national senior housing consortium. Secondary analysis of data drawn from older adults in COLLAGE sites in the United States was conducted using a baseline assessment with 8042 subjects and an annual follow-up assessment with 3840 subjects. Logistic regression was used to develop a Driving Review Index (DRI) based on the most useful items from among the many measures available in the CHA assessment. Thirteen items were identified by the logistic regression to predict drivers whose driving behavior was questioned by others. In particular, three variables reference compromised decision-making abilities: general daily decisions, a recent decline in ability to make daily decisions, and ability to manage medications. Two additional measures assess cognitive status: short-term memory problem and a diagnosis of non-Alzheimers dementia. Functional measures reflect restrictions and general frailty, including receiving help in transportation, use of a locomotion appliance, having an unsteady gait, fatigue, and not going out on most days. The final three clinical measures reflect compromised vision, little interest or pleasure in things normally enjoyed, and diarrhea. The DRI focuses the review process on drivers with multiple cognitive and functional problems, including a significant segment of potentially troubled drivers who had not yet been publicly identified by others. There is a need for simple and quickly identified screening tools to identify those older adults whose driving should be reviewed. The DRI, based on the interRAI CHA, fills this void. Assessment at the individual level needs to be part of the backdrop of science as society seeks to target policy to identify high risk drivers instead of simply age-based testing.

Commentary: Barriers to a sustained restraint-free environment.

A restraint-free culture is becoming a standard practice in the provision of long-term care services for older people, a standard by which licensure and accreditation agencies evaluate providers. Although most health care providers initiate restraint-elimination processes, many fail to achieve the intended result or sustain the practice because of a variety of barriers. Faltering organizations find themselves faced with monumental changes in administrative and supervisory staff, substantial recruitment and retention crises, and inadequate attention to a culture of continuous learning, teamwork, and leadership skill building. This article informs policy makers about the barriers to achieving and sustaining a restraint-free environment and suggests public policy agendas and processes to improve conditions for the aging population.

Nurse educators are key to a best practices implementation program.

In a statewide Best Practices Project, the involvement of nurse educators in the implementation process improved the overall success of participating long-term care facilities in improving the quality of resident care. Two nurse educators provided consultation and training to nursing facility staff on three best practice protocols: prevention of decline in the activities of daily living of eating and dressing, pain, and depression. Facility staff were given protocols to follow, together with documentation forms to assist in determining resident appropriateness for participation in the assigned best practice, assessing resident involvement in the protocol over time, and tracking staff progress with the implementation. The success of the 2-year first phase of the project in significantly improving measurable resident quality of care in best practice protocol areas has resulted in a second phase involving additional facilities and protocols.