[Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis]. / Prävalenz von neuropsychiatrischen Symptomen bei Menschen mit Demenz in der stationären Langzeitpflege.

Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis Abstract: Background: In a progress of dementia, most people develop neuropsychiatric symptoms. However, there is little knowledge about the prevalence of these symptoms and their specific characteristics in long-term care. Aims: A differentiated investigation of the prevalence and characteristics of neuropsychiatric symptoms in people with dementia in a long-term care setting. Methods: The prevalence of neuropsychiatric symptoms of people with dementia in a long-term care setting was examined using a secondary analysis of cross-sectional data from the research projects LebenQD I and II and FallDem. The data were collected using the neuropsychiatric inventory - nursing home version. The analysis included data from 699 people with dementia from a total of 21 long-term care facilities in North Rhine-Westphalia. Results: The symptoms agitation/aggression (36%), depression/dysphoria (33%), apathy/indifference (33%), irritability/lability (30%) and aberrant motor behaviour show the highest prevalence. The symptoms hallucinations (9%) and euphoria/elation (6%) have the lowest prevalence. Conclusions: The high prevalence of specific neuropsychiatric symptoms and their characteristics in people with dementia illustrates the need for care-related or psychosocial interventions to counteract the reasons for the occurrence of the symptoms.

[Medical care with or without cooperative agreements? A cross-sectional study in nursing homes in Bremen and Lower Saxony]. / Ärztliche Versorgung mit oder ohne Kooperationsvertrag? Eine Querschnittsuntersuchung in stationären Pflegeeinrichtungen in Bremen und Niedersachsen.

BACKGROUND: Empirical studies in nursing homes show that people in need of long-term care have less contact with medical specialists (except for neurologists) compared to those of the same age who are not in need of long-term care, which can be an indication of insufficient health care provision. Against this background, a cooperative agreement between medical specialists and nursing homes was first made legally possible, then requested and finally made mandatory (section 119b SGB V [Social Code Book V] in the currently valid version). OBJECTIVE: The aim of this study is to investigate to what extent contact density to physicians and the needs-based medical treatment of nursing home residents in nursing homes with and without a cooperative agreement differ from each other and, hence, how effective such cooperation agreements are in this context. METHODOLOGY: Using data from 396 people in need of care from 44 nursing homes in Lower Saxony and Bremen we compared facilities with and without cooperative agreements with respect to the number of home visits, practice visits and telephone contacts and the realization of adequate specialist medical treatment. At the time of the survey, 26 of the 44 nursing homes had cooperative agreements with dentists, 17 with general practitioners and 7 with neurologists. RESULTS: The number of personal contacts to general practitioners tends to be higher if cooperation agreements between general practitioners and nursing homes exist. In nursing homes having cooperation agreements with dentists the number of home visits is twice as high as in nursing homes without such an agreement, whereas cooperation agreements with neurologists have no effect on the number of contacts with these specialists. Furthermore, cooperation agreements with dentists promote appropriate dental care. CONCLUSIONS: The results show that cooperation agreements can be a useful instrument to ensure medical care in nursing homes. To guarantee the effectiveness of the cooperation agreements, however, the number of medical visits should be stipulated in the agreements.

[Trends in place of death for nursing home residents in an urban district during the COVID-19 pandemic: An analysis of death registry data]. / Entwicklung der Sterbeorte von Pflegeheimbewohnern in einem städtischen Versorgungsbereich während der COVID-19-Pandemie ­ eine Auswertung von Daten des Sterberegisters.

BACKGROUND: The nursing home is a common place of death; however, little is known about the place of death with respect to the people living there. Was there a difference in the frequencies of the places of death of nursing home residents in an urban district and in the individual facilities before and during the COVID-19 pandemic? METHODS: Full survey of deaths by retrospective analysis of death registry data from the years 2018 to 2021. RESULTS: Over the four-year period 14,598 people died, with 3,288 (22.5%) being residents of 31 different nursing homes. Over the reference period before the pandemic (March 1, 2018 to December 31, 2019) 1,485 nursing home residents died: 620 (41.8%) in hospital, 863 (58.1%) in a nursing home. During the pandemic period (March 1, 2020 to December 31, 2021) 1,475 death were registered: 574 (38.9%) in hospital and 891 (60.4%) in a nursing home. The mean age over the reference period was 86.5 years (±8,6; median 88.4; 47.9 to 106.2), in the pandemic period it was 86.7 years (±8,5; median 87.9; 43.7 to 111.7). Before the pandemic 1,006 deaths (67.7%) occurred in females, during the pandemic it was 969 (65.7%). The relative risk (RR) as a measure for the increase in the probabilty for an "in-hospital" death during the pandemic period was 0.94. In different facilities, the number of deaths per bed during the reference and the pandemic period varied between 0.26 and 0.98, and the RR from 0.48 to 1.61. DISCUSSION: For all nursing home residents, the frequency of deaths was not increasing and no shift towards an "in-hospital" death was observed. Several nursing homes revealed substantial differences and opposing trends. The strength and the type of effects of facility-related circumstances remain unclear.

[Development of a qualification mix model (QMM) for inpatient long-term care as a basis for personnel assessment instruments]. / Entwicklung eines Qualifikationsmixmodells (QMM) für die stationäre Langzeitpflege als Grundlage für Personalbemessungsinstrumente.

The current staffing levels for nursing care in long-term care are too low. There are no empirically verified figures with regard to the exact quantitative and qualitative need for additional staff. In order to develop a scientifically based method that is able to determine the number and qualifications of the nursing staff required for nursing care based on a facility-specific resident structure, a qualification mix model (QMM) was needed that indicates the minimum level of qualification available for the professional provision of nursing interventions. Such a model has not yet existed. Due to a lack of normative or empirically based assignment of interventions and qualification levels, a theoretical approach was chosen for the conception of the QMM using existing qualification frameworks, competence models, legal stipulations, the new assessment tool and nursing studies. By differentiating the complexity of work requirements, a total of 10 intervention classes-some with sub-classes-were formed, each of which was linked to one of five qualification levels. The resulting QMM enables qualifications to be assigned to care-relevant interventions as a normative basis of measuring staffing requirements, and also provides orientation for a more competence-oriented distribution of work and responsibility in inpatient long-term care. Since the model is structurally conservative and based on current (i.e. at the time of development) legal stipulations, it is a minimum standard.

[Tracking systems in people with dementia in long-term care - Update of an integrative review]. / Tracking-Systeme bei Menschen mit Demenz in der stationären Langzeitpflege.

Tracking systems in people with dementia in long-term care - Update of an integrative review Abstract. Background: This article is an update of the article by Hülsken-Giesler et al. (2019) and describes the latest findings on tracking systems in inpatient long-term care. RESEARCH QUESTION: The research question also follows on from the underlying article and again deals with the application of tracking systems and their consequences for residents and nursing staff. METHODS: A systematic literature search in the databases MEDLINE via PubMed and CINAHL as well as a hand search for the period starting in August 2017 was performed. The included literature was evaluated by two independent persons regarding content and methodology. RESULTS: In addition to deductive categories from the underlying work, further inductive categories could be formed and thus ethical and implementation aspects could be included. CONCLUSION: Since the first analysis, the focus in nursing science studies on the use of tracking systems in inpatient long-term care has shifted to ethical aspects. Also, the successful and long-term integration into care practice is now relevant.

[Recognition of Psychiatric Symptoms in Inpatient Long-Term Care]. / Erkennung psychiatrischer Symptome in der stationären Langzeitpflege.

Recognition of Psychiatric Symptoms in Inpatient Long-Term Care Abstract. As part of the Swiss national strategy on dementia, we investigated to which extent the needs assessment instruments RAI and BESA can early detect symptoms of depression, delirium, and behavioral and psychological symptoms of dementia (BPSD) in long-term care facilities. While we decided that the RAI sufficiently detected depressive symptoms, we suggest to add the two-questions-test and the geriatric depression scale to the BESA assessment. The BESA evaluation had more targeted focused assessments, allowing for better identification of delirium. Neither RAI or BESA cover the whole spectrum of behavioral and psychological symptoms of dementia. We consider the continuous application of these assessment instruments an important step towards interdisciplinary exchange and a better treatment of residents with psychiatric symptoms.

[Improving psychosocial health of nursing home residents: a systematic review of interventions for prevention and health promotion]. / Stärkung der psychosozialen Gesundheit von Bewohnerinnen und Bewohnern der stationären Langzeitpflege: Systematische Übersicht zu Interventionen der Prävention und Gesundheitsförderung.

BACKGROUND: Long-term care insurance funds have been mandated by the German Prevention Act to support long-term care facilities in the implementation of health-promoting structures. One area of action is the promotion of the nursing home residents' psychosocial health. The objective of this systematic review was to describe and analyze interventions and intervention components related to the psychosocial health of nursing home residents. METHODS: First, we conducted a search for systematic reviews and meta-analyses in Medline via PubMed, the Cochrane Library, CINAHL, Gerolit, Embase, Psyndex, and Livivo, and hand-searched additional sources. Second, references of all relevant randomized controlled trials (n=86) were extracted from the identified systematic reviews (n=27). The original articles of the included primary studies were then analyzed using criteria for the evaluation of complex interventions. The GRADE approach was used to assess the quality of the evidence. RESULTS: Seventeen interventions for promoting the psychosocial health of nursing home residents were identified. The majority of the study participants were nursing home residents with dementia. Since the underlying evidence was predominantly very low, it was not possible to draw clear conclusions concerning the efficacy of the interventions for psychosocial health outcomes. The best indications of positive effects were found for reminiscence, mealtime interventions, music therapy, and special care staff training. CONCLUSION: The diversity and heterogeneity of the interventions made both classification and consistent judgments of the quality of the evidence difficult. From the perspective of promoting the psychosocial health of nursing home residents, the identified interventions should only be considered as suggestions or proposals for prevention and health promotion measures, and future studies should evaluate their implementation.

[Tracking systems in people with dementia in long-term care - an integrative review]. / Tracking-Systeme bei Menschen mit Demenz in der stationären Langzeitpflege.

Tracking systems in people with dementia in long-term care - an integrative review Abstract. Schlüsselwörter: Tracking-Systeme, Überwachungssysteme, Personenortung, Demenz, stationäre Langzeitpflege Tracking systems in people with dementia in long-term care - an integrative review Background: Tracking systems are used increasingly in long-term care settings. However, their use is controversial. AIM: This paper examines how tracking systems are used to monitor people with dementia in long-term care facilities and what the consequences are for both residents and staff. METHODS: A systematic literature review was conducted in the PubMed, CINAHL, Livivo, ScienceDirect data bases and a hand search also took place. Included were studies, reviews and research reports in German and English from 2013 onwards. RESULTS: A total of eight references were included in the analysis. The results point to an ambivalent use of tracking systems in nursing. Nursing professionals face challenges in the areas of trust and distrust as well as autonomy and security. For residents, this means new opportunities for mobility and self-determination, but also more pressure due to continuous monitoring. CONCLUSIONS: The results show that the current debate on the use of tracking systems for people with dementia in long-term care settings concentrates mostly on the economic aspects, whereas aspects of person-centered care, ethical conflicts or the experience of those affected are given less attention. A core finding is that the use of technology changes the work processes and roles of professional carers.

[Improving cognitive resources of nursing home residents: a systematic review of prevention and health promotion interventions]. / Stärkung kognitiver Ressourcen von Bewohnerinnen und Bewohnern der stationären Langzeitpflege: Systematische Übersicht zu Interventionen der Prävention und Gesundheitsförderung.

BACKGROUND: The German Prevention Act mandated long-term care insurance funds to support long-term care facilities in designing health-promoting structures. One area of action is the promotion of the cognitive resources of nursing home residents. The objective of this systematic review was to describe and analyze interventions and intervention components that improve cognitive resources of nursing home residents. METHODS: First, we conducted a search for systematic reviews to identify relevant randomised controlled trials in Medline via PubMed, the Cochrane Library, CINAHL, Gerolit, Embase, Psyndex, and Livivo; additional sources were hand-searched. Second, references of all relevant randomized controlled trials (n=43) were extracted from the identified systematic reviews (n=26). The original articles of the primary studies included were then considered and data extracted using criteria for the evaluation of complex interventions. The quality of evidence was assessed using the GRADE approach. RESULTS: Nine interventions to promote cognitive resources were identified: cognitive stimulation, cognitive training, physical training, art and music interventions, bright light, multicomponent stimulation, multisensory stimulation, care staff training and reminiscence. The quality of the underlying evidence in the inpatient long-term care setting was predominantly low, therefore, it was not always possible to draw clear conclusions regarding the efficacy of the interventions. The low quality of evidence was mainly due to the high heterogeneity as well as the low number and limited methodological quality of the primary studies. CONCLUSION: In general, a wide range of nonpharmacological interventions were reported. Due to the limited evidence, however, these may be regarded as ideas only or possible options for promoting the cognitive resources of nursing home residents.

[Potential analysis for research on Advanced Practice Nursing (APN) for persons with dementia living in long-term care facilities]. / Potenzialanalyse zu "Advanced Practice Nursing (APN)" für Bewohner mit dementiellen Erkrankungen in deutschen Einrichtungen der stationären Langzeitpflege.

HEALTH PROBLEM: The nursing Minimum Data Set 3.0 (MDS 3.0) and other nursing quality indices summarise relevant health and nursing outcomes for long-term care that are recommended as quality measures. These are measures like "Percent of High-Risk Residents with Pressure Ulcers", "Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder", "Percent of Residents Experiencing One or More Falls with Major Injury", "Percent of Residents Who Lose Too Much Weight" etc. Analyses of healthcare data in Germany showed a substantial higher risk for negative outcomes in the long-term care setting in persons with dementia compared to persons without dementia. There already exist evidence-based guidelines and recommendations for most of the quality measures and underlying health problems (e.g., the German "Expertenstandards in der Pflege"). Implementation and translation of evidence have not been systematically researched yet, and there is uncertainty about structures and processes that support implementation and eventually lead to improved nursing outcomes in people with dementia in long-term care. CORPUS OF EVIDENCE: Studies showed a potential benefit of master-level geriatric advanced practice nurses (GAPNs) concerning the implementation of evidence-based guidelines. This corresponds to the expectation that academic nursing staff positively influences research utilisation in practice. A systematic review identified four controlled trials that evaluated the effectiveness of GAPN on select quality measures. Both the internal and external validity of the trials require a thorough investigation into the intervention before translation and effectiveness research in Germany can be recommended. IMPLICATION FOR RESEARCH: In accordance with national and international recommendations on the development and clinical evaluation of complex interventions, we recommend a multistage model. Such a model comprises the conceptualisation and adaptation of the original intervention. In this way, the original concept of a GAPN has to be translated into the context of the German healthcare system. Furthermore, feasibility of the intervention in general has to be investigated. This includes acceptance of GAPNs in practice and the necessary prerequisites, especially concerning a comprehensive commitment of one APN to more than one long-term care facility.