Pain Prevalence and Pain Management in Nursing Home Residents With Cognitive Impairment. Results From Five Multicenter Cross-Sectional Surveys in Germany Between 2014 and 2018.

BACKGROUND: Pain management depends on continuous pain assessment and a pain concept. In particular, pain assessment and treatment are major challenges for nursing home residents (NHR) with cognitive impairment (CI). Many caregivers often lack the knowledge to recognize and appropriately treat pain in this vulnerable group. Little is known about the proportion of NHR who are fundamentally dependent on external assessment for pain due to CI. OBJECTIVE: The aim of the study was to determine pain prevalence and management among NHR with and without CI. A second objective was to determine the proportion of NHR who are dependent on external assessment for pain. METHODS: Information on pain was collected from 3,437 NHR in multicenter cross-sectional surveys in 51 German nursing homes between 2014 and 2018. The presence of current pain in one-to-one interviews was determined as well as dependencies on third-party information, number of daily pain recordings, and administration of medication for pain. The analysis included a contingency table and log regression analyses. RESULTS: Pain prevalence was 24.9% among NHR with severe CI and 40.4% among NHR without CI. Overall, 19.8% of all NHRs relied on a third-party assessment of pain. Significantly, NHR with severe CI were less likely to be classified as having pain (OR 0.51), to be assessed for pain several times a day (OR 0.53) or to receive pain medication (OR 0.55) compared with NHR without CI. No influence on pain management was shown for the type of pain assessment. CONCLUSIONS: The study provides evidence of significant deficits in pain management among NHR with moderate and severe CI in nursing homes in Germany. NHR with moderate and severe CI are significantly less likely to be observed for pain or classified as pain sufferers and receive significantly less pain medication than NHR without CI. Intensive training of staff on pain management of NHR with severe CI is recommended.

[Support needs of care dependent individuals : Survey of general and specific needs for information, assistance and support of care dependent individuals and their relatives]. / Unterstützungsbedarfe pflegeempfangender Menschen : Erhebung allgemeiner und spezieller Informations­, Hilfe- und Unterstützungsbedarfe pflegeempfangender Menschen und ihrer Angehörigen.

BACKGROUND: In 2009, statutory regulations on information and counselling regarding nursing care needs, performed by so-called care advisors have been implemented for persons in need of long-term care and their relatives. In order to adequately prepare these care advisors, contemporary needs and requirements must be determined. The aim of the study was to determine the different needs of persons in need of long-term care and their relatives. METHOD: Care advisors were interviewed via an online survey tool using a standardized questionnaire. A 5-point Likert scale was used to determine the needs regarding information and advice on 16 specific topics. In general, overall needs regarding information and advice of care recipients and relatives were recorded using a 10-point scale (1 low and 10 high). Using classification and regression trees (CRT) and random forest, the correlation between the individual main topics and the general need for advice was analyzed. RESULTS: The participating care advisors (n = 276) rated the general demand for information of people in need of care and their relatives with a mean of 7.8 and 9.2, respectively. For those in need of care, the strongest association of general information needs was the topic of housing advice For the relatives, the topic social law aspects and benefits was the most relevant association. CONCLUSION: The general demand for information was rated very high. Since differences became obvious between those in need of care and their relatives, it is necessary to adjust care advice for these two groups.

[Sexual abuse of care-dependent patients : Results of a nationwide cross-sectional study among general practitioners on responsibility and subjective confidence in dealing with suspected abuse]. / Sexueller Missbrauch Pflegebedürftiger : Ergebnisse einer bundesweiten Querschnittsstudie bei Hausärzten/-ärztinnen zu Verantwortung und subjektiven Sicherheit im Verdachtsfall.

BACKGROUND: Violence against people in need of care is a challenge for long-term care situations. Sexual violence in particular, is subject to strong taboos and has so far been little researched. Family physicians can play a role in preventing violence against people in need of care. OBJECTIVE: The objective of this study was to examine family physicians' attitudes to their responsibilities in cases of sexual abuse of patients in need of care. At the same time, we also examined subjective confidence in relation to the procedure in cases of suspected abuse and family physicians' interests in further training on this topic. MATERIAL AND METHODS: A cross-sectional study addressed to 1700 family physicians in Germany with a written survey between September and November 2016. Questionnaires from 302 physicians could be evaluated for the study. FINDINGS: Almost all respondents saw it as part of their responsibility as doctors to intervene in cases of sexual abuse of patients in need of care. There is great uncertainty about how to proceed in cases of suspected sexual abuse of patients in need of care. Respondents' main interest in further training related to the differential diagnosis of sexual abuse and the correct procedure in cases where abuse is suspected. CONCLUSION: Further training provision, particularly on the signs of sexual abuse of people in need of care, could contribute to increasing family physicians' confidence to act.

Underweight in Nursing Homes: Differences between Men and Women.

OBJECTIVE: In Germany, there is an ongoing concern about the high prevalence of underweight on admission to health-care institutions. In order to assess possible sex-specific differences, the aim of this study is to provide valid figures about the prevalence and risk factors of underweight of men and women in German nursing homes. MATERIAL AND METHODS: A secondary data analysis of 8 annual consecutive cross-sectional studies of 19,686 residents from 280 nursing homes was conducted from 2009 to 2016. Underweight was defined as BMI < 18.5 (<20) for individuals <65 years (≥65 years). For statistical modeling, we used classification and regression trees (CRTs) and random forest in "R." RESULTS: Average prevalence of underweight in nursing home residents was 13.7% (13.2-14.2). Initial descriptive results showed that the prevalence of underweight among women was 15.6% (15.0-16.2) and the prevalence of underweight among men was 7.5% (6.7-8.2). The CRT-based modeling indicated that "loss of appetite" as the most important indicator for low BMI. If "loss of appetite" was present, prevalence of underweight increased from 13.5 to 39.1%. Other important indicators were "very large institutions" and the "resident/nurse ratio." The random forest analysis confirmed the importance of the CRT approach. DISCUSSION/CONCLUSION: The multivariate approach revealed that the role of sex for being underweight in nursing homes is marginal. To avoid higher morbidity and mortality in this group, nutritional intervention by clinical practitioners to increase appetite should be given high priority, especially in large long-term care institutions.

Smart@home - supporting safety and mobility of elderly and care dependent people in their own homes through the use of technical assistance systems and conventional mobility supporting tools: a cross-sectional survey.

BACKGROUND: The use of technical solutions and conventional mobility supporting aids can support the independence of people into old age in their own homes. However, we found relatively few empirical investigations on the effects and costs of these systems. METHODS: The aim of the study was to investigate usability, user satisfaction and the correlation between costs and benefits of different built-in smart home solutions and conventional mobility supporting tools in the home of elderly, partially care-dependent tenants (> 65 years). A cross-sectional survey was conducted from February to March 2018 with tenants of a housing association in apartments equipped with smart home technology and conventional mobility supporting tools. The response rate in the intervention group was n = 37 persons (out of 46 tenants with installed smart home and conventional solutions) and in the control group n = 64 persons (out of 100 tenants without built-in smart home and conventional solutions). Data were collected by a written questionnaire regarding usability and satisfaction of the tenants with the built-in smart home solutions and conventional mobility supporting tools. In addition, both the intervention and the control group were asked general questions about communication, safety and how to deal with the need for long-term care in their own living environment. RESULTS: Results showed that with regard to usability, satisfaction and price performance ratio of the installed smart home solutions, the installation of the corresponding solutions with an overall score of 1.41 (on a scale of 1 (very good) to 6 (unsatisfactory)) was mostly positively evaluated by the tenants. Overall, users rated the installed smart home solutions better than the conventional mobility supporting tools (such as handholds and increased balcony floor level). CONCLUSIONS: Analysis of the price performance ratio showed that smart home solutions are generally more expensive than conventional tools, but also contribute significantly to an increased security of the tenants, and thus may enable longer living in a familiar environment. We recommend modularized offers consisting of various components of smart home solutions, since this significantly reduces installation costs and allows for an individual composition according to requirements. Moreover, smart home solutions should be considered to be listed as medical aids.

Psychometric testing and evaluation of user acceptance of an automatic lateral turning device for the prevention of pressure ulcers.

INTRODUCTION: Repositioning of patients with reduced or impaired mobility could lessen pressure ulcers (PU). Automated preventive devices can support nurses, but user acceptance must be determined with valid and reliable tools. This study measured user acceptance of an automatic lateral turning device, using a self-developed questionnaire. METHOD: The study included 194 nurses in leadership positions from 75 institutions. A two-page user acceptance questionnaire was designed and tested for internal validity (exploratory factor analysis; EFA) and reliability (Cronbach's-α). A linear regression analysis was used to test the model's theoretical framework. RESULTS: The overall response rate was 74.9%. The EFA revealed five exploratory factors ("pain/well-being", "PU prevention", "handling", "nurse support", and "obese patient support") from the two outcomes ("general satisfaction" and "can replace manual repositioning"). The adjusted r2 was 0.607 for "general satisfaction", with the maximum standardized ß for "PU prevention" (0.476), "pain/well-being" (ß = 0.197) and "handling" (ß = 0.145). The adjusted r2 for "can replace manual positioning" was 0.458. The ß for "nurse support" was 0.264, followed by "pain-wellbeing" (ß = 0.224) and "obese patient support" (ß = 0.218). CONCLUSION: The psychometric testing results were satisfactory. Overall user acceptance of the automatic lateral turning device was high. A positive evaluation of the system's functionality, regarding the prevention of PU, is essential for patient and staff satisfaction, as well as user recommendation.

Sex-specific differences in prevention and treatment of institutional-acquired pressure ulcers in hospitals and nursing homes.

INTRODUCTION: Gender and/or sex have a major impact on staying healthy, becoming ill, or care dependent. Differences between men and women have been described for socioeconomic positions, health behaviors, courses and severities of diseases and mortality rates. Consequently, sex and/or gender need to be adequately taken into account while developing and implementing evidence-based healthcare. Evidence regarding differences between men and women in pressure ulcer care is limited. Our research aim was to measure possible differences between male and female hospital patients and nursing home residents in prevention and treatment of institutional-acquired pressure ulcers. METHODS: A secondary data analysis was conducted including data sets collected in nursing homes and hospitals in Germany annually from 2001 to 2016. Relevant variables were compared according to biological sex (men/woman). RESULTS: The study included 38,655 nursing home residents (mean age 85.4 years women, 77.3 years men) and 58,760 hospital patients (mean age 66.7 years women, 63.4 years men). More women were underweight and at pressure ulcer risk in both settings. The proportion of institutional-acquired pressure ulcers was higher for men in hospitals. Slightly more men had a PU category 2 to 4 (OR 0.87, 95% CI 0.76 to 0.99) in nursing homes or developed an institutional-acquired pressure ulcers category 2 to 4 in both settings (OR 0.85, 95% CI 0.76 to 0.95). Special mattresses were more often used by women at PU risk. More men with an institutional-acquired pressure ulcer in hospitals received counseling of relatives (OR 0.53, 95% CI 0.39 to 0.72). CONCLUSION: Although slightly more men had institutional-acquired pressure ulcers than women, overall differences regarding pressure ulcer occurrence were minor. Gender and/or sex can rather not be considered as an independent risk factor for pressure ulcer development and differences regarding pressure ulcer prevention interventions seem to be minor.

Prevalence and risk factors of chronic wounds in nursing homes in Germany: A Cross-Sectional Study.

The burdens caused by chronic wounds on the affected persons themselves and also on the health care system are well recognised. The aim of this study was to investigate the prevalence and risk factors of chronic wounds in German nursing homes. An annual cross-sectional study was conducted in nursing home residents from 2012 to 2018. The proportion of men affected by chronic wounds was to some extent higher than that of women, 9.0% males vs 7.5% females. In total, 7.8% of all residents were affected by chronic wounds. Of all residents with a chronic wound, 50.5% were affected by pressure ulcer. Male residents were twice as often affected by diabetic foot ulcer than female residents (18.0% vs 8.9%; P = 0.002). Bivariate analysis showed that chronic wounds were highly associated with poor nutrition, urinary incontinence, stool incontinence, diabetes mellitus, and limited mobility (P = 0.000). According to multivariate analysis, the strongest predictors for chronic wounds were limited mobility and diabetes mellitus. The highest prevalence of chronic wounds was in residents who were not restricted in their mobility, had diabetes, were male, and lived in a metropolitan region (23.7%). This study identified the prevalence and risk factors of chronic wounds in nursing home residents. Further research is needed to identify causal factors of the gender difference in the prevalence of chronic wounds. This may have an impact on the choice of prophylactic and therapeutic measures.

An international consensus on device-related pressure ulcers: SECURE prevention.

Catherine Milne and colleagues present the findings of their review, ccna2@juno.com.

Person-Centred Dermatology Self-care Index: a translation and validation study.

OBJECTIVE: Self-management is important to successfully managing chronic skin diseases. The Person-Centred Dermatology Self-care Index (PeDeSI) is a self-efficacy theory-based questionnaire tool to measure education and support needs of adults with long-term skin conditions. The aim of this research was to translate the PeDeSI into German (PeDeSI-G) and to explore the validity of this tool. METHODS: The instrument was translated by five translators working independently. User understanding and relevance were evaluated by nurses, patients and physicians. The translated version was modified and applied in a subsequent validation study. Demographic and other variables, PeDeSI-G and Dermatology Life Quality Index (DLQI) scores of dermatological patients were obtained. RESULTS: PeDeSi-G and DLQI scores were obtained from 100 patients. A conceptually and semantically equivalent German translation of the PeDeSI was developed. There was a statistically significant difference between in- and outpatients (p<0.001). PeDeSI-G scores were most strongly correlated with disease duration and DLQI scores. CONCLUSIONS: Validation results indicate that the PeDeSI-G is able to discriminate between patients with different educational and support needs for this patient group. Newly diagnosed patients and patients admitted to the hospital for the first time might benefit most from the PeDeSI-G assessment. The PeDeSI-G is a valid tool for assessing and evaluating the support needs of German-speaking patients with chronic skin disease.

TIME CDST: an updated tool to address the current challenges in wound care.

Despite the understanding that wounds are a common problem affecting the individual, the health service and society as a whole, there continues to be a lack of a systematic, structured, evidence-based approach to wound management. The TIME principle was first published in 2003, 1 and has since been integrated by many into clinical practice and research. However, this tool has been criticised for its tendency to focus mainly on the wound rather than on the wider issues that the patient is presenting with. At an expert meeting held in London in 2018, this conundrum was addressed and the TIME clinical decision support tool (CDST) was elaborated upon. This article introduces the TIME CDST, explains why it is required and describes how its use is likely to benefit patients, clinicians and health-service organisations. It also explores the framework in detail, and shows why this simple and accessible framework is robust enough to facilitate consistency in the delivery of wound care and better patient outcomes. Finally, it outlines the next steps for the rollout, use and evaluation of the impact of the TIME CDST.

Dementia-specific drug treatment in home care settings: A German multicentre study.

AIMS AND OBJECTIVES: The aim of this study was to identify and analyse factors influencing the use of drugs for dementia treatment in home care settings. BACKGROUND: While the number of care-dependent people with dementia is growing, it is not clear whether their medication follows the state of the art, especially in home care settings where over two-thirds of them are cared for in Germany. Although dementia is not curable, it is possible to reduce cognitive, behavioural and psychological symptoms of dementia with the appropriate use of medication. However, there is a lack of information concerning the drug treatment in home care settings. METHODS: The study was conducted as a multicentre cross-sectional survey, including 923 participants from 102 home care institutions throughout Germany. Medical diagnosis, medication, consultations with a specialist within the previous 12 weeks of the initial assessment and additional general information were assessed following a standardised study protocol. Data were analysed using univariate and multivariate statistical methods. The manuscript was developed utilising the STROBE checklist for cross-sectional studies. RESULTS: In home care, one in seven clients (14.8%) is diagnosed with some form of dementia. 52.6% (n = 72) of them were treated with dementia medication: AchEIs 16.1% (n = 22), memantine 9.5% (n = 13), antidepressants 23.4% (n = 32), antipsychotic medication 9.5% (n = 13), tranquilisers 16.8% (n = 23) and anticonvulsant drugs 6.6% (n = 9). Drug treatment for dementia was significantly associated with the consultation of a neurologist/psychiatrist in the previous 12 weeks. CONCLUSIONS: It has been demonstrated that the use of drugs as a component of home care treatment for dementia depends on many factors and therefore varies. RELEVANCE TO CLINICAL PRACTICE: It can be assumed that people living with dementia in home care settings are not sufficiently supplied with medication. Their medical care can be improved by establishing interdisciplinary care involving a neurologist/psychiatrist.

[The Epidemiology of Pressure Ulcer in Germany: Systematic Review]. / Die Epidemiologie des Dekubitus in Deutschland: eine systematische Übersicht.

BACKROUND: Pressure ulcers are considered as indicators of the quality of care. The aim of this study was to provide a systematic review of the incidence and prevalence of pressure ulcers in Germany between 2010 and 2015. METHODS: The databases PubMed, CINAHL, DIMDI, Web of Science, LIVIVO, Google, Google Scholar, as well as the publishers Springer and the Thieme were searched until the end of February 2016. The extracted data were monitored by two reviewers. A risk of bias assessment was conducted. RESULTS: 219 epidemiologic figures were found in 67 studies and documents. Most data were identified for the hospital setting. The majority of figures in long-term care was based on primary research. Considering sources of high methodological quality, prevalence in long-term care varied between 2% and 5% and between 2% to 4% in hospitals (category 2 and above). Routine data collections showed heterogeneous results from the hospital settings with prevalence from 0.07% to 4.37%. No incidence figures and no routine data collections were identified for ambulatory settings. Prevalence varied between 2 and 4% (including category 1). CONCLUSION: Review results indicate that pressure ulcers are frequent within all health care settings in Germany. Disregarding methodological limitations, pressure ulcer prevalence is between 2% and 5% in long-term care patients. Due to the heterogeneity of the available data, generalizable statements are not possible for the hospital settings. Pressure ulcer prevalence is most likely at least 2%. Results indicate that pressure ulcer preventive measures need to be improved in Germany.

[Structure Parameters and Quality Outcomes of Ambulant Home-care]. / Strukturparameter und pflegerische Ergebnisqualität in der ambulanten Pflege.

INTRODUCTION: So far, there are few data available on the changes of ambulant home-care in Germany over the last decades. Therefore, the aim of this research was to provide structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany. In addition, a possible association between structure parameters and quality outcomes for pressure ulcer and malnutrition was investigated. METHODS: In 2015, a multicenter cross-sectional study was conducted in home-care services in Germany. Structure data from 99 randomly selected home-care services as well as data on pressure ulcers and malnutrition of 903 care-dependent clients were analyzed. The median (<98 clients) was used as a cut-off to differentiate between small and large home-care services. From a cut-off of 20,000 inhabitants, a region was considered urban. The average prevalence for decubitus and malnutrition (BMI<20 Kg/m2) were determined for each home-care service, and possible associations with structure parameters were analyzed using a multiple linear regression model. RESULTS: The proportion of registered nurses in non-private (private) home-care services was 60.6% (52.3%). The proportion of employees with a 200- h basic qualification in nursing was higher in private (12.5 vs. 4.7%), small home-care services (14.0 vs. 5.8%) and in urban regions (11.5 vs 5.7%). In average, registered nurses working in small home-care services spent significantly more time per client than the ones working in large services (3.8 vs. 2.9 h/week). The highest need for further training was shown on the subjects of pain, medication and cognitive impairment. No statistically significant correlation could be found between the average decubitus prevalence and structure parameters. Only the association between malnutrition prevalence and the proportion of registered nurses was statistically significant. CONCLUSION: The present representative study provides structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany that could be used as a baseline for further investigations. No statistically significant association could be found between structure and outcome quality parameters. There is a need for further training of nursing personnel on the subjects of medication, pain and cognitive impairment.

Impaired Mobility and Urinary Incontinence in Nursing Home Residents: A Multicenter Study.

PURPOSE: The purpose of this study was to evaluate associations among use of walking aids, mobility status, and occurrence of urinary incontinence (UI) in geriatric patients residing in nursing homes, and to examine associations between UI severity (frequency and amount) and its impact on health-related quality of life (QoL). DESIGN: Multicenter descriptive cross-sectional prevalence study. SUBJECTS AND SETTING: A total of 2044 patients from nursing homes were included in the study. A majority were female (72.0%), the mean age of participants was 82.1 years (SD 11.2), their mean body mass index was 26.1 (SD 5.4), and their mean Care Dependency Scale score was 46.0 (SD 18.2), indicating a medium to high care dependency. The study setting was 30 nursing homes throughout Germany from 2014 to 2015. METHODS: Data were collected by trained nurses using a standardized data collection form to collect information about demographic characteristics, health conditions, mobility status measured according to the Elderly Mobility Scale (EMS), UI, and QoL measured using the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF). RESULTS: The prevalence of UI was 69.7% (n = 1804). Analysis of variance showed that, in 1659 nursing home residents with information on UI, 572 reported a medium amount of leakage with a mean impact on health-related QoL of 2.2 (SD 2.2, P < .001) on a scale from 0 (no impact) to 10 (very high impact). The mean of the impact on QoL in 235 residents who reported a large amount of leakage was 2.4 (SD 3.0, P < .001). In 1741 residents with information on the frequency of UI, 637 reported being urinary incontinent more than once a day with a mean impact on QoL of 2.2 (SD 2.1, P < .001) and 359 residents with permanent UI stated a mean impact on QoL of 2.1 (SD 2.8, P < .001). According to the bivariate association of UI with use of walking aids, the highest prevalence of UI (61.2%) was in patients who did not use any walking aids. The Chi-square Automatic Interaction Detector (CHAID) of the relationship between mobility according to the EMS and UI indicated that 71.1% of all patients with UI did not use any walking aids, although their mobility status had been reduced. CONCLUSIONS: Findings indicate a significant association between impaired mobility and UI in nursing home residents. Chronic, severe urinary incontinence exerted the greatest impact on health-related QoL. Therefore, we recommend measures to preserve or regain mobility to minimize or prevent UI in geriatric residents and patients and, thus, increase their health-related QoL.

Urinary incontinence in home care: a representative multicenter study on prevalence, severity, impact on quality of life, and risk factors.

OBJECTIVES: The objective of the study was to determine the prevalence and severity of urinary incontinence and associated factors in patients receiving home care nursing service. METHODS: From June to September 2015, a multicenter cross-sectional study was conducted in 923 patients from 102 home care services throughout Germany. The ICIQ-SF was used to determine the characteristics of UI and its impact on QoL. To determine the risks for UI, demographic and social risks, the Barthel Index and medical diagnoses were determined in descriptive and logistic regression analysis. RESULTS: The prevalence of UI was 62.5% (95% CI 59.3-65.6). The most common reasons for UI were before getting to the toilet 27.6% and when coughing or sneezing 27.3%. If the amount of leakage was medium (high), the mean of the impact on QoL was 4.9, SD 2.7 (5.0, SD 3.6). If the frequency of UI was higher than once a day (permanent), the mean of the impact on QoL was 4.2, SD 2.7 (4.8, SD 3.2). The results of the logistic regression analysis show the highest odds ratios for mobility-inability to walk (4.49), presence of dementia (2.59), and female sex (1.81). The metric variables age (1.02), Barthel Index (0.93), and BMI (1.05) were also statistically significant. CONCLUSIONS: The prevalence of UI in home care in Germany is high. Since UI is strongest associated with (im-) mobility, preserving or regaining patients' mobility should play a central role in providing care to avoid/minimize UI.

The effectiveness of lying surfaces in nursing care beds, a comparison of spring element systems versus conventional systems: A post marketing clinical follow-up pilot study.

BACKGROUND: Reduced mobility is a strong risk factor for pressure ulcer development in a nursing home setting. Despite this, there is a surprising lack of data regarding suitable nursing care beds in general and the prevention of pressure ulcers provided by lying surface systems in particular. In this context we aimed to assess the mobility of patients using lying surface systems either with spring elements (SES) and to compare these to conventional systems (CS; wooden slats or steel bars). METHODS: This was a prospective, randomized, controlled study in 29 patients with an age range of 54-95 years. Patients were randomly assigned to SES (n = 15) or CS (n = 14). The primary objective was to show a statistically significant difference in the proportion of patients with normal (up to 4 movements per hour) movements as evaluated by the Mobility Monitor®. Pressure distribution of the lying body weight was measured by a full body pressure mapping system XSensor®. Comfort, possibility of movement and recovery of sleep as well as pain at rest were self-rated. RESULTS: We screened a total of 39 patients of which 29 were eligible to be randomized into the two groups and 27 were finally analysed (SES = 14; CS = 13). The mean age was 81.7 ±â€¯9.5 years, 81.5% were female and the mean Braden Scale Score 22.4 ±â€¯1.3. We observed no statistically significant difference in the primary evaluation criterion (proportion of patients with a normal number of movements across 14 nights) between the SES group (81.4 ±â€¯10.8%) and the CS group (72.9 ±â€¯16.3%; p = 0.0757). There was a consistent trend for more movements in the normal range in the SES group however, which was observed when the number of hours with normal movement was plotted per night (p = 0.0004). Measured pressure values showed overall higher values for the lateral compared to the dorsal position with the SES but not the CS forming a "shoulder" between 35-55 mmHg in the dorsal position and between 35-45 mmHg in the lateral position. Self-rated comfort was significantly higher with the SES after night 14 (p = 0.0192) than with CS. CONCLUSIONS: The study is not aimed at the hard endpoint pressure ulcer, but at the physiological movement profile of patients in bed, which justifies a much smaller number of cases. For elderly nursing home patients it appears that beds with spring elements may be associated with higher normality of body movements and higher self-rated comfort. The presented study could be a contribution to reduce the care dependency of patients regarding mobility.

[Developing a framework for a public health monitoring of the population aged 65 years and older : Results of the IMOA workshop on concepts and indicators]. / Entwicklung eines Rahmenkonzepts für ein Public-Health-Monitoring der Bevölkerung ab 65 Jahren : Ergebnisse des IMOA-Workshops zu Konzepten und Indikatoren.

Main goal of the Improving Health Monitoring in Older Age (IMOA) project is to provide a framework for an indicator-based public health monitoring of the population aged 65 years and older. The workshop served as a forum to discuss and agree upon relevant concepts with gerontologists, nursing care and public health scientists.

Assessment of Topical Skin Care Practices in Long-Term Institutional Nursing Care from a Health Service Perspective.

Skin aging is associated with increased skin vulnerability and susceptibility to ulcerations and dermatoses, making intensive skin care required, especially for older adults. As part of a nationwide prevalence study, data of 3,385 residents 60 and older were collected to analyze skin care practices in German long-term care facilities. The objective of the current study was to gain detailed insights into frequencies of leave-on skin care product applications by nursing care professionals for older adults. The 10 most frequently treated body parts accounted for >94% of all skin applications. Variations related to gender, age, and skin areas indicate differences in perceived skin care needs, although the evidence base supporting basic skin care interventions in this setting is weak. Gender, age, and clinical status seem to influence skin care practices. These factors must be taken into account to improve topical skin care and health in long-term care. [Journal of Gerontological Nursing, 42(6), 18-24.].