Ideação suicida e risco de depressão entre idosos residentes em instituições de longa permanência / Ideación suicida y riesgo de depresión entre adultos mayores residentes en establecimientos de larga estadía / Suicidal ideation and risk of depression among older adults residing in long-stay institutions

Objetivo: identificar o estado depressivo e ideação entre idosos em Instituições de Longa Permanência dos municípios da região do Seridó/RN, Brasil. Método: estudo transversal e descritivo, desenvolvido entre os meses de agosto a novembro de 2020, nas Instituições de Longa Permanência para Idosos. Resultados: a amostra final foi composta por 45 idosos, predominando idosos do sexo feminino, com idade maior ou igual a 80 anos, solteiros, não alfabetizados, brancos, aposentados e com tempo de institucionalização maior do que 1 ano. Observou-se um maior quantitativo do sexo feminino, 64,4% com idade maior ou igual a 80 anos. Quanto ao estado depressivo, visto que houve significância e as variáveis "grau de depressão" e "ideação suicida" com p-valor < 0,1 (p-valor = 0,07). Considerações finais: observa-se uma considerável ocorrência de graus de depressão e ideação suicida na população estudada.

Objetivo: identificar el estado depresivo y la ideación entre las personas mayores residentes en los Establecimientos de Larga Estadía de los municipios de la región de Seridó/RN, Brasil. Método: estudio transversal y descriptivo, desarrollado entre los meses de agosto y noviembre de 2020, en los Establecimientos de Larga Estadía para Adultos Mayores. Resultados: la muestra final fue compuesta por 45 adultos mayores, predominantemente del sexo femenino, con edad igual o superior a 80 años, solteros, analfabetos, blancos, jubilados y con tiempo de institucionalización superior a 1 año. Se observó un mayor número de mujeres, 64,4%, con 80 años o más. En cuanto al estado depresivo, hubo significación y las variables "grado de depresión" e "ideación suicida" con p-valor < 0,1 (p-valor = 0,07). Consideraciones finales: se observa una considerable ocurrencia de grados de depresión e ideación suicida en la población estudiada.

Objective: to identify the depressive state and ideation among older adults in Long-Stay Institutions in the cities of the Seridó/RN region, Brazil. Method: cross-sectional and descriptive study, developed between the months of August and November 2020, in the Long Stay Institutions for Older Adults. Results: the final sample was composed of 45 older adults, predominantly females, aged 80 years old or more, single, non-literate, white, retired and with a time of institutionalization longer than 1 year. We observed a higher number of females, 64.4%, aged 80 years or older. As for the depressive state, there was significance and the variables "degree of depression" and "suicidal ideation" with p-value < 0.1 (p-value = 0.07). Final considerations: a considerable occurrence of degrees of depression and suicidal ideation is observed in the population studied

Aplicação da estimulação cognitiva no cuidado ao idoso institucionalizado com demência / Application of cognitive stimulation in the care of institutionalized elderly people with dementia / Aplicación de la estimulación cognitiva en el cuidado de personas mayores institucionalizadas con demência

Objetivo: identificar as evidências científicas sobre os cuidados de enfermagem aos idosos institucionalizados com demência. Método: trata-se de uma revisão integrativa da literatura, com a utilização da estratégia PICo. Foram incluídos estudos publicados no intervalo de 2009 a 2018, nas bases de dados LILACS, CINAHL, a MEDLINE e a SCOPUS. Os artigos tiveram sua análise de qualidade realizada a partir do instrumento Mixed Methods Appraisal Tool. Resultado: de 6.144 textos inicialmente obtidos foram selecionados 7 artigos, sendo 54% publicados em 2010 e 14% no ano de 2016. As intervenções identificadas estão relacionadas à prática de atividades físicas e de estimulação cognitiva, as quais demonstram ser bastante positivas no cuidado ao idoso com demência, pois permite estimular funções cerebrais ainda preservadas, promovendo uma melhora na sua qualidade de vida. Conclusão: a maioria das intervenções identificadas podem ser aplicadas pela equipe multiprofissional e podem ser associadas, quando necessário, aos recursos farmacológicos

Objective: to identify the scientific evidence on nursing care for institutionalized elderly people with dementia. Method: this is an integrative literature review, using the PICo strategy. Studies published from 2009 to 2018 were included in the LILACS, CINAHL, MEDLINE and SCOPUS databases. The articles were analyzed for quality using the Mixed Methods Appraisal Tool. Result: of 6,144 texts initially obtained, 7 articles were selected, 54% of which were published in 2010 and 14% in 2016. The identified interventions are related to the practice of physical activities and cognitive stimulation, which prove to be quite positive in the care of the child. elderly with dementia, as it allows to stimulate brain functions still preserved, promoting an improvement in their quality of life. Conclusion: most of the identified interventions can be applied by the multiprofessional team and can be associated, when necessary, with pharmacological resources

Objetivo: identificar la evidencia científica sobre el cuidado de enfermería para personas mayores institucionalizadas con demencia. Método: esta es una revisión de literatura integradora, utilizando la estrategia PICo. Los estudios publicados de 2009 a 2018 se incluyeron en las bases de datos LILACS, CINAHL, MEDLINE y SCOPUS. La calidad de los artículos se analizó utilizando la Herramienta de evaluación de métodos mixtos. Resultado: de 6.144 textos obtenidos inicialmente, se seleccionaron 7 artículos, el 54% de los cuales se publicaron en 2010 y el 14% en 2016. Las intervenciones identificadas están relacionadas con la práctica de actividades físicas y la estimulación cognitiva, que resultan ser bastante positivas en el cuidado del niño. ancianos con demencia, ya que permite estimular las funciones cerebrales aún preservadas, promoviendo una mejora en su calidad de vida. Conclusión: la mayoría de las intervenciones identificadas pueden ser aplicadas por el equipo multiprofesional y pueden asociarse, cuando sea necesario, con recursos farmacológicos

A puertas cerradas: La vejez en instituciones en Buenos Aires y el Interior: 1850-1950 / Behind closed doors: Old age in institutions in Buenos Aires and in the country: 1850-1950

Un aspecto clave de la historia de la vejez es el de la asistencia a los ancianos pobres, enfermos o sin familia, sobre todo durante el siglo XIX y principios del XX que constituyen la edad de oro del asilo de ancianos. Partiendo de esa constatación y de los principales problemas historiográficos involucrados, se propone como objetivo principal reconstruir la oferta de instituciones existentes y la proporción de personas atendidas. Para ello explora, en primer lugar las posibilidades y límites de las escasas fuentes estadísticas disponibles. En segundo término, propone una comparación exploratoria con el interior del país y con la asistencia a otros grupos de edad, en particular los niños. Tanto por la centralidad de los procesos históricos involucrados (crecimiento urbano, impacto de la inmigración, desarrollo de políticas sociales), como por la consecuente disponibilidad de fuentes, el caso porteño constituye el eje central de la indagación. (AU)

Polypharmacy in Assisted Living and Impact on Clinical Outcomes.

OBJECTIVE: The purpose of this study was to describe medication use and polypharmacy in assisted living settings. We hypothesized that: 1) age, gender, race, setting, multi-morbidity, and cognitive status would influence polypharmacy; and 2) polypharmacy would be associated with falls, emergency room visits, and hospitalizations. DESIGN: This was a descriptive study using data from a larger study testing the Dissemination and Implementation of Function Focused Care for Assisted Living (FFC-AL-EIT). SETTING: Participants were recruited from 26 assisted living settings. PARTICIPANTS: A total of 242 individuals for cohort 1 consented and completed baseline data collection. INTERVENTIONS: Data were obtained from participant medical records, observations, and input from staff. MAIN OUTCOME MEASURE(S): Age, gender, race, ethnicity, comorbidities, cognitive status, medications, falls, emergency room visits, hospitalizations, function based on the Barthel Index and physical activity using the MotionWatch 8. RESULTS: Participants had a mean age of 86.86 (standard deviation [SD] = 7.0), the majority were women (n = 179, 74%) and white (n = 233, 96%), with five (SD = 2) diagnoses. The mean number of drugs was seven (SD = 3.56), and 51% were exposed to polypharmacy. The mean Barthel Index score was 63.06 (SD = 20.20), and they engaged in 111,353 (SD = 87,262) counts of activity daily. Fifty-eight residents fell at least once (24%), 22 were sent to the hospital (9%), and 32 (13%) to the emergency room. Neither hypothesis was supported. CONCLUSION: Continued research is needed to explore the factors that influence polypharmacy. Identification of these factors will help guide deprescribing so that medication management does not harm older adults physically or cause unnecessary financial burden.

Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team's perspective.

BACKGROUND: Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team's perspective. METHODS: The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. RESULTS: The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category "Going into a bubble" illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category "The body begins to shut down" illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. CONCLUSIONS: This study conveys new knowledge concerning the multidisciplinary team's collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.

Velhice e Institucionalização: Cenas da vida no abrigo / Old Age and Institutionalization: Life scenes in the shelter / Vejez e Institucionalización: Escenas de la vida en el refugio

O presente relato apresenta uma atividade de pesquisa desenvolvida em uma Instituição de Longa Permanência para Idosos (ILPI). Esta pesquisa de mestrado buscou abordar as narrativas acerca da vida antes e durante a institucionalização de oito residentes, quatro homens e quatro mulheres, com idade entre 66 e 89 anos, residentes de dois a sete anos na ILPI. Com base no referencial teórico da Psicanálise e da teoria artaudiana de teatro, foi possível pensar a existência do ponto de vista da encenação, cuja palavra é elemento central para a existência. Por fim, conclui-se que a experiência vivida com a tessitura da dissertação de mestrado, que se encontra aqui resumida, traz a importância de ser sujeito quando inserido em processos de institucionalização. Há possibilidades. Há caminhos. Há construções a serem feitas e que permitem que, mesmo dentro de normas rígidas e coletivizadas, o sujeito possa se fazer sujeito. Uma dessas formas é dar-lhe voz e autonomia para contar sua história da forma que quiser, ou que acredita ser. Outra é uma transformação da ILPI como é dada para a construção de um lugar aberto a possibilidades, a escolhas, mesmo que limitadas, por meio da escuta. As pessoas que lá se encontram precisam sentir-se pessoas. Precisam de voz e de ouvidos que as escutem. Precisam de meios de representação. Precisam de plateia.

This report is a research activity developed in a Long Term Care Institutions for Elderly (ILPI). This master's research sought to bring the narratives about life before and during the institutionalization eight residents, four men and four women, aged between 66 and 89 years, residents of two to seven years in ILPI. Based on the theoretical framework of psychoanalysis and the Artaud's theory theater it was possible to think of the existence of the point of view of staging, whose word is central to existence. Finally, it is concluded that the experience with the fabric of the dissertation, which is summarized here, brings the importance of being subject when inserted into institutionalization processes. There are possibilities. There are ways. There is one construction work being done and that allow even within strict rules and collectivized the subject can be made subject. One of those ways is to give voice and autonomy to tell your story the way they want, or believed to be. Another is a transformation of ILPI is given as for the construction of an open place to possibilities, the choices, though limited, by listening. People who are there need to feel people. They need voice and ears that listen. They need representation means. They need audience.

El presente relato presenta una actividad de investigación desarrollada en una Institución de Larga permanencia para ancianos (ILPI). Esta investigación de maestría buscó abordar las narrativas acerca de la vida antes y durante la institucionalización de ocho residentes, cuatro hombres y cuatro mujeres, con edad entre 66 y 89 años, residentes de dos a siete años en la ILPI. Con base en el referencial teórico del psicoanálisis y la teoría artaudiana de teatro fue posible pensar la existencia del punto de vista de la escenificación, cuya palabra es elemento central para la existencia. Por último, se concluye que la experiencia vivida con la tesitura de la disertación de la disertación que se encuentra aquí resumida, trae la importancia de ser sujeto cuando se inserta en procesos de institucionalización. Hay posibilidades. Hay caminos. Hay construcciones a ser hechas y que permiten que incluso dentro de normas rígidas y colectivizadas el sujeto pueda hacerse sujeto. Una de esas formas es darle voz y autonomía para contar su historia de la forma que quiera, o que cree ser. Otra es una transformación de la ILPI como se da para la construcción de un lugar abierto a posibilidades, a elecciones, aunque limitadas, por medio de la escucha. Las personas que allí se encuentran necesitan sentirse personas. Necesitan voz y oídos que las escuchen. Necesitan medios de representación. Necesitan una audiencia.

Palliative care in residential aged care: An overview.

OBJECTIVE: To measure how care needs, health and length of stay in permanent residential aged care differs by assessed need for palliative care. METHODS: On entry into permanent residential aged care, people's care needs and health conditions are assessed on the Aged Care Funding Instrument. Data for the period 2008-2009 and 2015-2016 were analysed for trends in care needs, health conditions, length of stay and separation reason across assessed need for palliative care. RESULTS: Assessed care needs have increased for all people in residential aged care over this period, and people appraised for palliative care were more likely to be rated 'high' in need for support in activities of daily living. People appraised for palliative care had a higher prevalence of cancer and shorter length of stays. CONCLUSION: Palliative care appraisal is associated with increased complexity in assessed care needs, different profiles of health and shorter length of stays in permanent residential aged care.

Promoción de una convivencia saludable en un hogar de personas adultas mayores de Costa Rica / Promoting healthy living in a home older adults in Costa Rica

ResumenEste artículo presenta los resultados del Proyecto educativo denominado “Convivencia de Oro”, dirigido a personas adultas mayores residentes del Hogar del Adulto Mayor de Curridabat, realizada entre los meses de agosto a diciembre del 2014. Se planteó como objetivo fortalecer la convivencia saludable mediante las relaciones interpersonales positivas. Se utilizó una metodología cualitativa, haciendo uso del método fenomenológico, se realizaron dos sesiones educativas y tres espacios de convivencia para el desarrollo interacción de los veintisiete adultos mayores. El enfoque pedagógico que sustenta el diseño del proyecto correspondió al enfoque socio-reconstruccionismo, elección tomada de acuerdo a la idoneidad, pertinencia y características que presentaba el grupo poblacional. Entre los hallazgos, se destaca la importancia de la intervención en los espacios mencionados que impulsaban el desarrollo de las personas adultas mayores, el bienestar y la inclusión en la sociedad de manera más activa. El proyecto contó con una estructuración evaluativa en tres fases debidamente definidas para alcanzar los objetivos propuestos, así como la viabilidad administrativa, profesional y de recurso humano.

Abstract:This article presents the results of the educational project called “Convivencia de Oro”, aimed at older adult residents of the Home of the Elderly in Curridabat, conducted between August and December 2014. It was considered the objective of strengthening healthy living through positive interpersonal relationships. A qualitative methodology was used, using the phenomenological method, two educational sessions and three living spaces for developing interaction of the twenty-seven seniors were performed. The pedagogical approach underlying the project design corresponded to the socio-reconstructionist choice made according to suitability, relevance and characteristics presented by the population group approach. Among the findings, the importance of intervention in these spaces that drove the development of the elderly, welfare and inclusion in society more actively stands. The project had an evaluative structure in three phases properly defined to achieve the proposed objectives and administrative feasibility, professional and human resource

Instituições de longa permanência como alternativa no acolhimento das pessoas idosas / Long stay institutions as an alternative for protecting the elderly / Entidades de larga permanencia como alternativa para acoger adultos mayores

RESUMO Estudo reflexivo que enfatiza a Instituição de Longa Permanência para Idosos. Considerando a carga contextual em que se dá o processo de institucionalização em uma Instituição de Longa Permanência para Idosos, o qual é escoltado por transformações na vivência da pessoa idosa. Nessa perspectiva este estudo tem como propósito refletir sobre as Instituições de Longa Permanência como alternativa no acolhimento das pessoas idosas brasileiras. Primeiramente, expõe-se sobre o envelhecimento populacional, seguido por uma breve perspectiva histórica das Instituições de Longa Permanência e o finaliza com o processo de institucionalização da pessoa idosa nas mesmas. Embora existam definições a respeito das funções e obrigações da Instituição de Longa Permanência, a influência dos aspectos negativos na vivência das pessoas idosas institucionalizadas encontra-se implícita na maioria delas, solicitando uma reestruturação desse ambiente que tem se tornado o mundo-vida de uma demanda crescente de pessoas idosas. O processo de institucionalização e a vivência do idoso na instituição são elementos de estudo fundamentais para o alcance de um entendimento aprofundado da realidade intrínseca dessa pessoa que está escrevendo o epílogo da sua história de vida.(AU)

ABSTRACT This is a reflective study on long stay institutions for elderly population. Considering the context in which the process of institutionalization in a long-stay institution for the elderly occurs, which is escorted by changes in every-day life of the elderly population, this study aims to reflect on the long-stay institutions as an alternative of sheltering for the Brazilian elderly. First, demographic aging is analyzed, followed by a brief historical account regarding long-stay institutions, and an approach to the institutionalization process of the elderly population in these places. Although the functions and duties of long-stay institutions have been previously defined, the negative aspects that influence the experience of institutionalized elderly are evident; therefore, restructuring the environment of these type of places is necessary considering the growing demand. The institutionalization process and the experience of the elderly population admitted to these institutions are key study elements to comprehend the intrinsic reality of this population.(AU)

RESUMEN El presente es un estudio reflexivo sobre las instituciones de larga permanencia para adultos mayores. Con base en la carga contextual que se genera alrededor del proceso de institucionalización de estas personas, el cual implica una serie de cambios en su vida cotidiana, este estudio tiene como objetivo hacer una reflexión sobre la pertinencia de estos lugares como alternativa para acoger adultos mayores brasileños. En primer lugar, se hace un análisis sobre el proceso de envejecimiento de la población, seguido de un breve recuento histórico de las instituciones de larga permanencia, para finalizar con una descripción sobre el proceso de institucionalización. Si bien hay definiciones acerca de las funciones y obligaciones de este tipo de instituciones, los aspectos negativos que influyen en las experiencias de las personas mayores ya institucionalizadas son evidentes. En este sentido, es necesario reestructurar ese ambiente que se convierte en el diario vivir de estas personas, de el cual tiene una demanda cada vez mayor. El proceso de institucionalización y las experiencias de las personas mayores dentro la institución son elementos de estudio fundamentales para comprender a profundidad la realidad intrínseca de esta población.(AU)

Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents.

OBJECTIVE: The incidence of epilepsy is highest in the elderly and the prevalence of epilepsy is higher in nursing home residents than in other cohorts. Co-medications that act in the central nervous system (CNS) are frequently prescribed in this population. The objective was to identify the most commonly prescribed antiseizure drugs (ASDs) and determine the frequency of use of antipsychotic and antidepressant medications in elderly nursing home residents receiving ASDs. METHODS: Data were obtained from a pharmacy database serving 18,752 patients in Minnesota and Wisconsin nursing homes. Prescribing information was available on ASD, antidepressant, and antipsychotic drugs on one day in October 2013. The frequency distribution by age, formulation, trademarked/generic drugs, route of administration, and multiple drug combinations were determined. RESULTS: Overall, 66.8% of 18,752 residents received at least one CNS-active drug as classified by the Generic Product Identifier classification system. For those 65years and older, ASDs were prescribed for 14.3% residents. Gabapentin comprised 7.3%; valproate 3.0%; levetiracetam 1.8%; and phenytoin 0.9%. An antidepressant was used in 64.2% of persons prescribed an ASD. Antidepressant use varied for specific ASDs and ranged from 50 to 75%. An antipsychotic medication was used in 30% of persons prescribed an ASD and ranged from 16.8 to 54.2% for specific ASDs. Both antidepressant and antipsychotic use occurred in 22.2% of persons prescribed an ASD, respectively. SIGNIFICANCE: The pattern of CNS-active drug use has changed from previous years in this geographic region. Use of phenytoin has declined markedly, but antidepressant use has increased substantially. The CNS side effect profile of these medications and the possible long-term consequences in this population can greatly complicate their therapy.

Diurnal and seasonal patterns in presentations with hip fracture-data from the national hip fracture database.

PURPOSE: we set out to examine diurnal and seasonal variation in hip fracture presentations to question their origin and to consider their implications for the organisation of health services for older people. METHODS: we used the National Hip Fracture Database to identify the time of presentation and surgery for 64,102 patients; all those older than 60 years who sustained this injury in England, Wales and Northern Ireland during 2014. RESULTS: we found marked diurnal variation in rates of presentation, increasing sharply after 0800 hours and decreasing only after 1800 hours. Among people who sustained their hip fracture in hospital (n = 2,761) or in a care home (n = 12,141), there were peaks in presentations around 0900 and 1800 hours. Time of presentation had a very marked effect on whether surgery was delayed by more than 24 hours but less against the national guidelines of surgery within 36 hours or by the next day. There were 15.6% more presentations during December compared to all other months (9.5% versus 8.2%, P < 0.001), a pattern also found among people living in care homes (9.1% versus 8.3%, P < 0.001). CONCLUSIONS: we have identified morning and evening peaks of presentation for inpatients and care home residents and a December increase in overall hip fracture numbers. These patterns warrant further investigation if those organising health services are to prevent this injury, and to provide appropriate beds and prompt operations for the people who sustain it.

The optimal study: describing the key components of optimal health care delivery to UK care home residents: a research protocol.

Long-term institutional care in the United Kingdom is provided by care homes. Residents have prevalent cognitive impairment and disability, have multiple diagnoses, and are subject to polypharmacy. Prevailing models of health care provision (ad hoc, reactive, and coordinated by general practitioners) result in unacceptable variability of care. A number of innovative responses to improve health care for care homes have been commissioned. The organization of health and social care in the United Kingdom is such that it is unlikely that a single solution to the problem of providing quality health care for care homes will be identified that can be used nationwide. Realist evaluation is a methodology that uses both qualitative and quantitative data to establish an in-depth understanding of what works, for whom, and in what settings. In this article we describe a protocol for using realist evaluation to understand the context, mechanisms, and outcomes that shape effective health care delivery to care home residents in the United Kingdom. By describing this novel approach, we hope to inform international discourse about research methodologies in long-term care settings internationally.

Natural course of care dependency in residents of long-term care facilities: prospective follow-up study.

BACKGROUND: Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality. METHODS: A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79-88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15-75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months. RESULTS: At baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P < 0.001); participants in the low CDS group stayed longer, had more frequent urine incontinence and more dementia. They had also the highest mortality rate (log rank 32.2; df = 2; P for trend <0.001). Per point lower in CDS score, the mortality risk increased with 2% (95% CI 1%-3%). Adjustment for age, gender, cranberry use, LTCF, length of stay, comorbidity and dementia showed similar results. A one point decrease in CDS score between 0 and 6 months was related to an increased mortality risk of 4% (95% CI 3%-6%).At the 6-month follow-up, 10% improved to a higher CDS group, 65% were in the same, and 25% had deteriorated to a lower CDS group; a similar pattern emerged at 12-month follow-up. Gender, age, urine incontinence, dementia, cancer and baseline care dependency status, predicted an increase in care dependency over time. CONCLUSION: The majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

Residential aged care: the de facto hospice for New Zealand's older people.

AIM: To describe short-term mortality among residential aged care (RAC) residents in Auckland, New Zealand. METHOD: Prospective follow-up, 6828 residents (median age 86 years, 69.8% women) from census-type survey (10/9/2008); 152 facilities. Mortality data from central sources. RESULTS: Eight hundred and sixty-one (12.6%) died by 6 months. Survival related to RAC length of stay before the survey: those resident <1 month (subgroup, n = 380) having 80.0% survival, 1-6 months 83.2% and >6 months 87.4% (P < 0.0001). In those admitted to private hospital from acute hospital (n = 104 of the subgroup of 380), 6-month mortality was 36.5% (P < 0.0001 vs other 'short stayers'). Significant mortality predictors were: private hospital admission from acute hospital (hazard ratio (HR) = 2.02), unscheduled GP visit during the prior 2 weeks (HR = 1.90), personal care disability (HR = 1.90) and acute hospital admission number during the previous 2 years (≥3; HR = 5.40). CONCLUSIONS: RAC mortality (especially post admission) is high. Training and resource in the sector should reflect this.

Heart failure--related mortality and hospitalization in the year following admission to a long-term care facility: the geriatric outcomes and longitudinal decline in heart failure (GOLD-HF) study.

BACKGROUND: Heart failure (HF) is common in long-term care facilities (LTCs). This study compared mortality and hospitalization rates and examined predictors of these outcomes among new LTC residents with and without HF. METHODS AND RESULTS: This prospective cohort study followed 546 newly admitted residents from 42 LTCs for up to 1 year. Health information was collected from participant and caregiver interviews, physicians' records, diagnostic procedures, and hospitalization records. Multivariate logistic regression modeling determined predictors of hospitalization among residents, and Cox proportional hazards regression determined predictors for time to mortality. HF prevalence was 21.4%. The sample was predominantly (>70%) female, and individuals with HF were significantly older with higher prevalence of reduced left ventricular ejection fraction. Overall annual mortality and hospitalization rates were 24% and 27%, respectively. Among residents with HF, 42% died and 31% were hospitalized within 1 year. Among residents with HF, use of major tranquilizers was the strongest predictor of sooner mortality; use of anticoagulants and major tranquilizers also increased mortality risk, whereas higher baseline function was associated with longer time to mortality. History of peripheral vascular disease was the strongest predictor of hospitalizations among residents with HF, and use of antiplatelet agents and history of any smoking exposure increased this risk. CONCLUSIONS: Among LTC residents, HF is associated with high mortality and hospitalization rates. Many factors contribute to mortality and hospitalizations among residents with HF, and comprehensive HF management programs are needed to improve outcomes.

Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes.

BACKGROUND: The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. METHODS: We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. RESULTS: Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). CONCLUSIONS: The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.

Factors associated with falls among older adults living in institutions.

BACKGROUND: Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions. METHODS: Data were obtained from a survey on a probabilistic sample of residents aged ≥65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomial regression models, including age, sex, cognitive status, functional dependence, number of diseases, and polypharmacy. RESULTS: The final sample comprised 733 residents. The fall rate was 2.4 falls per person-year (95% confidence interval [CI], 2.04-2.82). The strongest risk factor was number of diseases, with an adjusted rate ratio (RR) of 1.32 (95% CI, 1.17-1.50) for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR = 2.56 [95% CI, 1.32-4.94]); antidepressant use (RR = 2.32 [95% CI, 1.22-4.40]); arrhythmias (RR = 2.00 [95% CI, 1.05-3.81]); and polypharmacy (RR = 1.07 [95% CI, 0.95-1.21], for each additional medication). The attributable fraction for number of diseases (with reference to those with ≤ 1 condition) was 84% (95% CI, 45-95%). CONCLUSIONS: Number of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/3916151157277337.

Hospitalisation of high-care residents of aged care facilities: are goals of care discussed?

BACKGROUND: Residents of residential aged care facilities (RACF) are commonly hospitalised towards the end of life. Determining the hospitalisation experiences, including the discussion of goals of treatment, is essential to best plan care including planning for end-of-life care for this population. AIM: To document hospital presentation characteristics, course, outcomes and care planning for high-care residents of RACF. METHODS: A retrospective review of medical records was conducted for all high-care residents aged >64 years presenting to a metropolitan hospital over a 6-month period. RESULTS: One hundred and eighty-six high-care residents of RACF presented to hospital 228 times. Transfer paperwork documented resuscitation status for 49 (21%) presentations, and a medical enduring power of attorney or advanced care plan for 85 (37%). Patients had high rates of comorbidities (average Charlson comorbidity index score = 3), polypharmacy (93%), impaired mobility (89%), impaired cognition (81%) and incontinence (76%). Resuscitation status was documented in 50 (55%) and family discussion in 38 (42%) of 91 admissions exceeding 48 h. Documented family discussion was significantly associated with complications or new events occurring during admission (odds ratio 1.56, 95% confidence interval 1.07-2.26). CONCLUSION: There were low rates of documentation of resuscitation status or family discussion for this highly vulnerable population. Neither hospitals nor community providers appear to take responsibility for future care planning. Acute hospitals could play a greater role in care planning because discussion around course of illness and goals of treatment may enhance patient management, satisfaction and reduce hospitalisations.