An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses.

WHAT IS KNOWN ON THE SUBJECT?: In the United States, 15.5% of nursing home residents without qualifying diagnoses of schizophrenia, Huntington's' Disease, and/or Tourette Syndrome receive antipsychotic medications. Antipsychotic medications are used off-label (i.e., used in a manner the United States Food and Drug Administration's packaging insert does not specify) to treat neuropsychiatric symptoms, often before attempting nonpharmacologic interventions, despite evidence that this drug class is associated with significant adverse events including death. Less than optimal staffing resources and lack of access to geropsychiatric specialists are barriers to reducing antipsychotic use. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Antipsychotic use occurred in 11.6% of nursing home residents without qualifying or potentially qualifying diagnoses (bipolar disorder and psychotic disorder); antipsychotic use was more prevalent in residents with a dementia diagnosis than those without. One additional registered nurse hour per resident day could reduce the odds of antipsychotic use by 52% and 56% for residents with and without a dementia diagnosis respectively. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given the influence of total staffing and professional staff mix on risk of antipsychotic use, nursing home administrators may want to consider aspects of facility operation that impact antipsychotic use. More stringent Unites States' survey and certification standards for dementia care implemented in 2017 demand proactive person-centered care that promotes maximal well-being and functioning without risk of harm from inappropriate psychoactive medications. Mental health nurses have requisite training to provide expert person-centered care to nursing home residents with mental illness and geropsychiatric disorders. ABSTRACT: Introduction Antipsychotic use in nursing homes varies widely across the United States; inadequate staffing, skill mix, and geropsychiatric training impede sustained improvement. Aim This study identified risk factors of antipsychotic use in long-stay residents lacking qualifying or potentially qualifying diagnoses. Method This secondary analysis used 2015 Minimum Data Set and cost report data from 458 Missouri nursing homes. The full sample (N = 29,679) was split into two subsamples: residents with (N = 15,114) and without (N = 14,565) a dementia diagnosis. Separate logistic regression models were run. Results Almost 15% of the dementia subsample and 8.4% of the nondementia subsample received an antipsychotic medication in the past week. Post-traumatic stress disorder, psychosis indicators, behavioral symptoms, anxiety medication with and without anxiety diagnosis, depression medication with and without depression diagnosis, and nurse staffing were among the strongest predictors of antipsychotic use in both subsamples. Simulation analyses showed decreased odds of receiving an antipsychotic in both subsamples when registered nurse hours matched the national average. Discussion Matching nurse staffing mix to the national average may improve antipsychotic use in nursing homes. Implications Knowledge of antipsychotic use risk factors use can inform care planning and staff education to minimize use of these medications in all but severe cases.

Assessment of Fall Characteristics From Depth Sensor Videos.

Falls are a major source of death and disability in older adults; little data, however, are available about the etiology of falls in community-dwelling older adults. Sensor systems installed in independent and assisted living residences of 105 older adults participating in an ongoing technology study were programmed to record live videos of probable fall events. Sixty-four fall video segments from 19 individuals were viewed and rated using the Falls Video Assessment Questionnaire. Raters identified that 56% (n = 36) of falls were due to an incorrect shift of body weight and 27% (n = 17) from losing support of an external object, such as an unlocked wheelchair or rolling walker. In 60% of falls, mobility aids were in the room or in use at the time of the fall. Use of environmentally embedded sensors provides a mechanism for real-time fall detection and, ultimately, may supply information to clinicians for fall prevention interventions. [Journal of Gerontological Nursing, 43(7), 13-19.].

Enhanced registered nurse care coordination with sensor technology: Impact on length of stay and cost in aging in place housing.

BACKGROUND: When planning the Aging in Place Initiative at TigerPlace, it was envisioned that advances in technology research had the potential to enable early intervention in health changes that could assist in proactive management of health for older adults and potentially reduce costs. PURPOSE: The purpose of this study was to compare length of stay (LOS) of residents living with environmentally embedded sensor systems since the development and implementation of automated health alerts at TigerPlace to LOS of those who are not living with sensor systems. Estimate potential savings of living with sensor systems. METHODS: LOS for residents living with and without sensors was measured over a span of 4.8 years since the implementation of sensor-generated health alerts. The group living with sensors (n = 52) had an average LOS of 1,557 days (4.3 years); the comparison group without sensors (n = 81) was 936 days (2.6 years); p = .0006. Groups were comparable based on admission age, gender, number of chronic illnesses, SF12 physical health, SF12 mental health, Geriatric Depression Scale (GDS), activities of daily living, independent activities of daily living, and mini-mental status examination scores. Both groups, all residents living at TigerPlace since the implementation of health alerts, receive registered nurse (RN) care coordination as the standard of care. DISCUSSION: Results indicate that residents living with sensors were able to reside at TigerPlace 1.7 years longer than residents living without sensors, suggesting that proactive use of health alerts facilitates successful aging in place. Health alerts, generated by automated algorithms interpreting environmentally embedded sensor data, may enable care coordinators to assess and intervene on health status changes earlier than is possible in the absence of sensor-generated alerts. Comparison of LOS without sensors TigerPlace (2.6 years) with the national median in residential senior housing (1.8 years) may be attributable to the RN care coordination model at TigerPlace. Cost estimates comparing cost of living at TigerPlace with the sensor technology vs. nursing home reveal potential saving of about $30,000 per person. Potential cost savings to Medicaid funded nursing home (assuming the technology and care coordination were reimbursed) are estimated to be about $87,000 per person. CONCLUSIONS: Early alerts for potential health problems appear to enhance the current RN care coordination care delivery model at TigerPlace, increasing LOS for those living with sensors to nearly twice that of those who did not. Sensor technology with care coordination has cost saving potential for consumers and Medicaid.

Physical activity interventions with healthy minority adults: meta-analysis of behavior and health outcomes.

This meta-analysis is a systematic compilation of research focusing on various exercise interventions and their impact on the health and behavior outcomes of healthy African American, Hispanic, Native American, and Native Hawaiian adults. Comprehensive searching located published and unpublished studies. Random-effects analyses synthesized data to calculate effect sizes (ES) as a standardized mean difference (d) and variability measures. Data were synthesized across 21,151 subjects in 100 eligible samples. Supervised exercise significantly improved fitness (ES=.571-.584). Interventions designed to motivate minority adults to increase physical activity changed subsequent physical activity behavior (ES=.172-.312) and anthropometric outcomes (ES=.070-.124). Some ES should be interpreted in the context of limited statistical power and heterogeneity. Attempts to match intervention content and delivery with minority populations were inconsistently reported. Healthy minority adults experienced health improvements following supervised exercise. Interventions designed to motivate subjects to increase physical activity have limited magnitude heterogeneous effects.

Evaluation of aging in place model with home care services and registered nurse care coordination in senior housing.

A state-sponsored evaluation of aging in place (AIP) as an alternative to assisted living and nursing home has been underway in Missouri. Cost, physical, and mental health assessment data reveal the cost-effectiveness and positive health measures of AIP. Findings of the first four years of the AIP evaluation of two long-term care settings in Missouri with registered nurse care coordination are compared with national data for traditional long-term care. The combined care and housing cost for any resident who received care services beyond base services of AIP and who qualified for nursing home care has never approached or exceeded the cost of nursing home care at either location. Both mental health and physical health measures indicate the health restoration and independence effectiveness of the AIP model for long-term care.

Illness perceptions and related outcomes among women with fibromyalgia syndrome.

PURPOSE: Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain, multiple tender points, and fatigue, and affects 3-6 million Americans, 75% of whom are female. The purpose of the present study was to examine the illness perceptions of women with FMS using Leventhal's common sense self-regulation model. DESIGN: Ninety-one women with FMS took part in this study. Pearson correlations and stepwise multiple regressions were used to assess relationships among variables and explanation of variance in the outcomes of health behaviors, FMS impact, and subjective physical and mental health. RESULTS: Participants viewed their FMS as chronic with a somewhat fluctuating course, having serious consequences in their lives, and difficult to understand in a coherent fashion. The women tended to find their FMS emotionally distressing and unamenable to personal control or efficacious treatment. Emotional representations explained 41% of the variance in mental health scores and 17% in reported health behaviors. CONCLUSIONS: Overall, this sample of women with FMS had fairly negative perceptions of their illness. As suggested by Leventhal's model, cognitive and emotional representations predicted different outcomes. Interventions that address psychological as well as the physical components of the illness experience may offer benefits for women with FMS.

Better reproductive healthcare for women with disabilities: a role for nursing leadership.

This paper examines the reproductive healthcare experiences of women with disabilities in the light of commonly accepted principles of biomedical ethics. Recommendations are made for nursing to assume a leadership role in reducing gender and disability inequity in health care.