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1.
J Appl Gerontol ; : 733464820902632, 2020 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-32026743

RESUMEN

OBJECTIVES: Pain assessment and treatment is challenging among persons with dementia (PWDs). To better understand reports of pain interference, we examined ratings made by PWDs, as well as corresponding ratings about PWDs, as reported by the caregiver. We aimed to assess alignment between and predictors of caregiver and PWD report of pain interference. METHODS: The sample consisted of 203 veterans with pain and mild to moderately severe dementia and an informal caregiver. RESULTS: Most PWDs and their caregivers reported at least some pain interference and similar levels of pain interference. PWDs with greater cognitive impairment reported less pain interference, whereas caregivers who perceived the PWD to have greater depression reported more pain interference. CONCLUSIONS: PWD and caregiver characteristics were differentially associated with PWD versus caregiver report of pain interference. Results suggest the importance of caregiver reports to inform assessment, as well as factors complicating assessment. PAIN IN DEMENTIA: As one ages, the risk of developing both dementia and pain increases substantially (Scherder et al., 2009). It is estimated that 30% to 50% of persons with dementia (PWDs) experience persistent pain, a complex multifactor problem (Corbett et al., 2014). Despite the high prevalence of pain among older adults with dementia, and major advances in pain management, pain often remains unrecognized or undertreated (Hodgson et al., 2014).

2.
JBI Database System Rev Implement Rep ; 18(1): 146-153, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31483341

RESUMEN

OBJECTIVE: This scoping review aims to provide an overview of the current evidence on huddles in healthcare settings involving frontline staff. INTRODUCTION: Team-based models are gaining prominence as the preferred method for delivering coordinated, cost-effective, high-quality health care. Huddles are a powerful method for building relationships among frontline staff members. Currently, no reviews have described huddles used among frontline staff in clinical settings. There is therefore a need to identify gaps in the literature on evidence informing this practice for a greater understanding of the resources available for frontline staff to implement huddles. INCLUSION CRITERIA: This scoping review will consider qualitative studies, experimental and quasi-experimental studies, analytic observational studies and descriptive cross-sectional studies that explore the use of frontline staff huddles to improve quality of care in a clinical setting. METHODS: An initial limited search of PubMed and CINAHL Plus with Full Text will be performed, followed by analysis of the title, abstract and MeSH used to describe the article. Second, searches of PubMed, EBSCOhost and ProQuest will be conducted, followed by searches in reference lists of all articles that meet the inclusion criteria. Studies published in English from inception to the present will be considered. Retrieved papers will be screened for inclusion by at least two reviewers. Data will be extracted and presented in tabular form and a narrative summary that align with the review's objective.

3.
Fed Pract ; 36(5): 228-231, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31138976

RESUMEN

Through implementation of the LOCK bundle of practices, VA Community Living Center staff develop, pilot, and spread new systems for communication, teamwork, and collaborative problem solving as well as for developing skills to participate effectively in these systems.

4.
J Am Med Dir Assoc ; 20(7): 810-815, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30852172

RESUMEN

OBJECTIVES: Quality improvement (QI) may be a promising approach for staff to improve the quality of care in nursing homes. However, little is known about the challenges and facilitators to implementing QI interventions in nursing homes. This study examines staff perspectives on the implementation process. DESIGN: We conducted semistructured interviews with staff involved in implementing an evidence-based QI intervention ("LOCK") to improve interactions between residents and staff through targeted staff behavior change. The LOCK intervention consists of 4 practices: (1) Learn from the bright spots, (2) Observe, (3) Collaborate in huddles, and (4) Keep it bite sized. SETTING AND PARTICIPANTS: We interviewed staff members in 6 Veterans Health Administration nursing homes [ie, Community Living Centers (CLCs)] via opportunistic and snowball sampling. MEASURES: The semistructured interviews were grounded in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change and covered staff experience, challenges, facilitators, and lessons learned during the implementation process. The interviews were analyzed using thematic content analysis. RESULTS: Overall, staff accepted the intervention and appreciated the focus on the positives. Challenges fell largely within the categories of capability and opportunity and included difficulty finding time to complete intervention activities, inability to interpret data reports, need for ongoing training, and misunderstanding of study goals. Facilitators were largely within the motivation category, including incentives for participation, reinforcement of desired behavior, feasibility of intervention activities, and use of data to quantify improvements. CONCLUSIONS/IMPLICATIONS: As QI programs become more common in nursing homes, it is critical that interventions are tailored for this unique setting. We identified barriers and facilitators of our intervention's implementation and learned that no challenge was insurmountable or derailed the implementation of LOCK. This ability of frontline staff to overcome implementation challenges may be attributed to LOCK's inherently motivational features. Future nursing home QI interventions should consider including built-in motivational components.

5.
Pain Med ; 20(6): 1078-1092, 2019 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-30285252

RESUMEN

OBJECTIVE: The goal of this study was to identify a limited set of pain indicators that were most predicive of physical pain. We began with 140 items culled from existing pain observation tools and used a modified Delphi approach followed by statistical analyses to reduce the item pool. METHODS: Through the Delphi Method, we created a candidate item set of behavioral indicators. Next, trained staff observed nursing home residents and rated the items on scales of behavior intensity and frequency. We evaluated associations among the items and expert clinicians' assessment of pain intensity. SETTING: Four government-owned nursing homes and 12 community nursing homes in Alabama and Southeastern Pennsylvania. PARTICIPANTS: Ninety-five residents (mean age = 84.9 years) with moderate to severe cognitive impairment. RESULTS: Using the least absolute shrinkage and selection operator model, we identified seven items that best predicted clinicians' evaluations of pain intensity. These items were rigid/stiff body or body parts, bracing, complaining, expressive eyes, grimacing, frowning, and sighing. We also found that a model based on ratings of frequency of behaviors did not have better predictive ability than a model based on ratings of intensity of behaviors. CONCLUSIONS: We used two complementary approaches-expert opinion and statistical analysis-to reduce a large pool of behavioral indicators to a parsimonious set of items to predict pain intensity in persons with dementia. Future studies are needed to examine the psychometric properties of this scale, which is called the Pain Intensity Measure for Persons with Dementia.

6.
J Appl Gerontol ; 38(5): 673-693, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-28380720

RESUMEN

Alzheimer's disease and other dementias are often associated with a gradual loss of the ability to participate in rewarding activities. Caregivers may struggle with spending quality time with the person with dementia (PWD) when the demands of caregiving dominate. However, the importance of activity participation among PWDs is internationally recognized. The Pleasant Events Schedule-Alzheimer's Disease (PES-AD) Short Form measures frequency of engagement in pleasant events. It has been used to assess overall frequency of engagement in 20 activities. The current study involves a psychometric evaluation of the PES-AD Short Form and reveals two separate activity domains: active and social events, each with preliminary evidence of reliability and construct validity. Furthermore, the frequency with which the PWD enjoys social and active events are not uniformly related to PWD and caregiver characteristics and well-being, which has measure- and practice-focused implications that should be considered when engaging PWDs.

7.
PLoS One ; 13(9): e0203764, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30231033

RESUMEN

Ensuring quality of care in nursing homes is a public health priority, yet how nursing home quality relates to cost is not well understood. This paper addresses this relationship for 132 VA community living centers (nursing homes), for fiscal years 2014 and 2015. We estimated cost models using the VA Decision Support System which tracks total direct costs and nursing direct costs for individual resident segments of care. We summed residents' total costs and nursing costs to the community living center level for each year. Annual facility costs then were regressed on quality of care measured with composite scores based on 13 distinct adverse events. Results indicated that higher quality was associated with higher predicted cost. However, we did not find evidence that higher costs were driven by high nurse staffing levels.


Asunto(s)
Costos de la Atención en Salud , Calidad de la Atención de Salud/economía , United States Department of Veterans Affairs , Sistemas de Apoyo a Decisiones Clínicas , Humanos , Estados Unidos
8.
Gerontologist ; 58(2): e15-e24, 2018 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-28499032

RESUMEN

Purpose of Study: To develop a structured observational tool, the Resident-centered Assessment of Interactions with Staff and Engagement tool (RAISE), to measure 2 critical, multi-faceted, organizational-level aspects of person-centered care (PCC) in nursing homes: (a) resident engagement and (b) the quality and frequency of staff-resident interactions. Design and Methods: In this multi-method psychometric development study, we conducted (a) 120 hr of ethnographic observations in one nursing home and (b) a targeted literature review to enable construct development. Two constructs for which no current structured observation measures existed emerged from this phase: nursing home resident-staff engagement and interaction. We developed the preliminary RAISE to measure these constructs and used the tool in 8 nursing homes at an average of 16 times. We conducted 8 iterative psychometric testing and refinement cycles with multi-disciplinary research team members. Each cycle consisted of observations using the draft tool, results review, and tool modification. Results: The final RAISE included a set of coding rules and procedures enabling simultaneously efficient, non-reactive, and representative quantitative measurement of the interaction and engagement components of nursing home life for staff and residents. It comprised 8 observational variables, each represented by extensive numeric codes. Raters achieved adequate to high reliability with all variables. There is preliminary evidence of face and construct validity via expert panel review. Implications: The RAISE represents a valuable step forward in the measurement of PCC, providing objective, reliable data based on systematic observation.


Asunto(s)
Envejecimiento/psicología , Actitud del Personal de Salud , Técnicas de Observación Conductual/métodos , Hogares para Ancianos , Casas de Salud , Participación del Paciente , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica/métodos , Humanos , Masculino , Participación del Paciente/métodos , Participación del Paciente/psicología , Relaciones Profesional-Paciente , Psicometría/métodos , Reproducibilidad de los Resultados
9.
Gerontologist ; 58(3): 598-605, 2018 05 08.
Artículo en Inglés | MEDLINE | ID: mdl-28651351

RESUMEN

Purpose of the Study: Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development: The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results: The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications: The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.


Asunto(s)
Ciencia de la Implementación , Casas de Salud , Mejoramiento de la Calidad , Conducta Cooperativa , Humanos , Modelos Teóricos , Observación , Estudios de Casos Organizacionales , Calidad de la Atención de Salud , Calidad de Vida
10.
J Appl Gerontol ; 37(3): 349-370, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-27091880

RESUMEN

The purpose of this study was to identify structural, market, and administrator factors of nursing homes that are related to the implementation of person-centered care. Administrators of Medicare/Medicaid-certified nursing homes in the Deep South were invited to complete a standardized survey about their facility and their perceptions and attitudes regarding person-centered care practices (PCCPs). Nursing home structural and market factors were obtained from public websites, and these data were matched with administrator data. Consistent with the resource-based theory of competitive advantage, nursing homes with greater resources and more competition were more likely to implement PCCPs. Implementation of person-centered care was also higher in nursing homes with administrators who perceived culture change implementation to be feasible in their facilities. Given that there is a link between resource availability and adoption of person-centered care, future research should investigate the cost of such innovations.


Asunto(s)
Personal Administrativo , Actitud , Hogares para Ancianos/organización & administración , Cuidados a Largo Plazo/organización & administración , Casas de Salud/organización & administración , Atención Dirigida al Paciente/organización & administración , Adulto , Competencia Económica , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Cultura Organizacional , Innovación Organizacional , Sudeste de Estados Unidos , Encuestas y Cuestionarios
11.
Geriatr Nurs ; 39(3): 271-278, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29129450

RESUMEN

A central component of person-centered care, resident choice in daily life, has received little research attention in the U.S. CONTEXT: This study investigated nursing home staff experiences in realizing resident choice. Twenty-six qualitative staff interviews were conducted in an opportunistic sample from two Veterans Health Administration (VHA) Community Living Centers (CLCs, i.e., nursing homes) implementing the Green House Model. Thematic content analysis surfaced several key tensions at the intra-personal, inter-personal, and organizational levels. Most salient were staff mental models within the intra-personal level. Staff conveyed a lack of clarity on how to realize resident choice when faced with varying tensions, especially the competing goal of resident medical and safety needs. Staff-employed resolutions to resident choice-related tensions also emerged (e.g., preventive practices, staff reinforcement, and staff deliberation). This study offers specific and concrete insights on how resident choice in daily life, and thus resident quality of life, can be advanced.


Asunto(s)
Conducta de Elección , Disentimientos y Disputas , Casas de Salud/tendencias , Personal de Enfermería/psicología , Humanos , Entrevistas como Asunto , Calidad de Vida
12.
Psychol Serv ; 14(3): 337-346, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28805418

RESUMEN

Enhanced interpersonal relationships and meaningful resident engagement in daily life are central to nursing home cultural transformation, yet these critical components of person-centered care may be difficult for frontline staff to measure using traditional research instruments. To address the need for easy-to-use instruments to help nursing home staff members evaluate and improve person-centered care, the psychometric method of cognitive-based interviewing was used to adapt a structured observation instrument originally developed for researchers and nursing home surveyors. Twenty-eight staff members from 2 Veterans Health Administration (VHA) nursing homes participated in 1 of 3 rounds of cognitive-based interviews, using the instrument in real-life situations. Modifications to the original instrument were guided by a cognitive processing model of instrument refinement. Following 2 rounds of cognitive interviews, pretesting of the revised instrument, and another round of cognitive interviews, the resulting set of 3 short instruments mirrored the concepts of the original longer instrument but were significantly easier for frontline staff to understand and use. Final results indicated frontline staff found the revised instruments feasible to use and clinically relevant in measuring and improving the lived experience of a changing culture. This article provides a framework for developing or adapting other measurement tools for frontline culture change efforts in nursing homes, in addition to reporting on a practical set of instruments to measure aspects of person-centered care. (PsycINFO Database Record


Asunto(s)
Casas de Salud/organización & administración , Cultura Organizacional , Innovación Organizacional , Mejoramiento de la Calidad , Humanos , Estados Unidos , United States Department of Veterans Affairs , Salud de los Veteranos
13.
J Nerv Ment Dis ; 205(2): 106-111, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-27385475

RESUMEN

Recent research shows veterans with posttraumatic stress disorder (PTSD) are twice as likely as other veterans to develop dementia. However, no studies to date have examined the impact of co-existing PTSD and dementia on family caregivers, who provide the majority of care to these veterans. Using the Stress Process Model, the current investigation explored the similarities and differences in psychosocial, health, and service use outcomes among caregivers assisting veterans with PTSD and dementia compared with caregivers assisting veterans with dementia only. Caregivers of veterans with PTSD and dementia indicated that their relative exhibited more difficult behavior symptoms and used more community services. These caregivers also reported more difficulties understanding veterans' memory problems and more physical strain. Together, results suggested caregivers of veterans with both PTSD and dementia were at greater risk of negative caregiving consequences. Implications and suggestions for future research are discussed.


Asunto(s)
Cuidadores/psicología , Demencia/complicaciones , Familia/psicología , Trastornos por Estrés Postraumático/complicaciones , Estrés Psicológico/psicología , Veteranos/psicología , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad
14.
Pain Med ; 18(8): 1476-1484, 2017 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-27694534

RESUMEN

Objective: To identify factors associated with no analgesic treatment in community-dwelling older adults with mild-to-moderate dementia and moderate-to-severe pain. Design: Secondary analysis of a randomized controlled trial. Setting: Michael E. DeBakey Veterans Affairs Medical Center. Subjects: Two hundred and two older adults (mean age = 79.27 years). Methods: Guided by the Behavioral Model of Health Service Utilization, participants completed questionnaires regarding predisposing (age, gender, race, educational level, care partner relationship), enabling (income), and need (pain interference, depressive symptoms, cognitive functioning) characteristics. Results: Hierarchical logistic regression analyses revealed that participants with greater income (odds ratio [OR] = 0.79, 95% confidence interval [CI] = 0.63-0.99) and greater pain interference (OR = 0.79, 95% CI = 0.63-0.99) were less likely to have no analgesic treatment. We also examined whether other factors such as depressive symptoms influenced the relationship between pain interference and pain treatment. Those with less pain interference were more likely to have no analgesic treatment (OR = 1.04, 95% CI = 1.01-1.08), but only if they had lower levels of depressive symptoms (b = -0.52, P = 0.005). Conclusion: The initiation of analgesic trials is complicated for individuals with dementia and comorbid pain and depressive symptomology. Future research should focus on identifying the most effective assessment and treatment procedures to best direct clinical care for this population.


Asunto(s)
Analgésicos/uso terapéutico , Demencia/psicología , Mal Uso de los Servicios de Salud , Dolor/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Agresión/psicología , Terapia Cognitivo-Conductual , Femenino , Humanos , Masculino
15.
Am J Geriatr Psychiatry ; 25(2): 144-154, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27743840

RESUMEN

OBJECTIVES: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes). DESIGN: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months SETTING: Houston, TX. PARTICIPANTS: A total of 203 community-dwelling veterans with pain and dementia and their caregivers. INTERVENTION: PAVeD, 6 to 8 weekly sessions of 45-minute home visits with masters-level clinicians providing instruction to caregivers on recognizing pain, enhancing communication, and making daily activities pleasant and enjoyable, and at least two elective sessions. MEASUREMENTS: Cohen-Mansfield Agitation Inventory (primary outcome), Philadelphia Geriatric Pain Intensity Scale, Geriatric Depression Scale, Pleasant Events Schedule-AD, Burden Interview, Mutuality Scale (secondary outcomes), Client Satisfaction Questionnaire. RESULTS: There were no significant differences in aggression incidence between intervention and control groups, although the PAVeD group had significantly better mutuality than controls. CONCLUSIONS: PAVeD may need to address a broader range and more in-depth coverage of aggression risk factors with person-centered tailoring to target certain types of distress. Interventions to prevent aggression may also need to address medical providers in addition to caregivers.


Asunto(s)
Agresión/psicología , Cuidadores/educación , Demencia/complicaciones , Manejo del Dolor/métodos , Dolor/epidemiología , Veteranos/psicología , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Depresión/epidemiología , Femenino , Humanos , Incidencia , Vida Independiente , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Modelos de Riesgos Proporcionales , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Texas/epidemiología
16.
Aging Ment Health ; 20(8): 804-13, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-25923452

RESUMEN

OBJECTIVES: Disabled, homebound individuals tend to suffer both chronic pain and depression; however, low-income, homebound older adults have been underexposed in pain and depression research. We examined the extent of pain frequency, intensity, and interference; the relationship between pain and depressive symptoms; and prescription analgesic use and its association with use of antidepressant and anxiolytic medications among these older adults. METHOD: The data came from the baseline assessment of 215 homebound individuals aged 50+ who were referred to a clinical trial of depression treatment. Bivariate and multivariate analyses were used to examine the research questions. RESULTS: Almost 87% (n = 186) of the participants reported having had chronic pain in the preceding three months. Of the pain reporters, the mean frequency, intensity, and interference of pain were 8.65 ± 2.05, 7.71 ± 2.10, and 7.80 ± 2.82, respectively, on a 1-10 scale, and 61% were taking a prescription analgesic. Analgesic users and nonusers did not differ in depressive symptoms and in pain frequency and intensity, but analgesic users reported higher pain interference than nonusers (8.22 ± 2.46 vs. 7.14 ± 3.22; t = 2.44, df = 184, p = .016). Pain frequency and interference were significantly associated with depressive symptoms, and pain interference was significantly associated with analgesic use in multivariate analysis. Anxiolytic medication use was also correlated with analgesic use. CONCLUSION: The findings underscore the significant pain-related problems in these vulnerable individuals and the need for recognizing and treating both pain and depression more effectively using both pharmacologic and nonpharmacologic interventions.


Asunto(s)
Analgésicos/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/fisiopatología , Depresión , Personas Imposibilitadas , Pobreza , Anciano , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Índice de Severidad de la Enfermedad
17.
Bull Menninger Clin ; 79(2): 95-115, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26035086

RESUMEN

Dementia and Alzheimer's disease are associated with behavioral symptoms that can be costly and troublesome to caregivers. Behavioral strategies to prevent aggression in people with dementia (PWDs) are necessary to decrease caregiver burden and relieve other behavioral disturbances in PWDs, such as depression. On the basis of their previous study that identified pain as a possible cause of aggression, the authors developed a behavioral in-home intervention designed to teach caregiver(s) how to recognize signs of pain and distress in PWDs. The authors present a description of the Preventing Aggression in Veterans with Dementia (PAVeD) intervention and illustrate its use and results with three case studies. Results indicate that this intervention may help prevent the development of aggression and pain in PWDs, reduce caregiver burden, and help manage other behavioral symptoms associated with dementia.


Asunto(s)
Agresión , Terapia Conductista/métodos , Demencia/complicaciones , Trastorno Depresivo/complicaciones , Dolor/diagnóstico , Adaptación Psicológica , Anciano de 80 o más Años , Cuidadores , Femenino , Humanos , Masculino
18.
Pain Manag Nurs ; 16(5): 692-700, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25962546

RESUMEN

Research supports using nonverbal pain behaviors to identify pain in persons with dementia. It is unknown whether variations exist among ethnic groups in the expression of nonverbal pain behaviors in this special population. The purpose of this descriptive study was to examine ethnic differences in the presentation and intensity of nonverbal pain behaviors among African American, Caucasian, and Hispanic older adults with dementia when screened for pain by certified nursing assistants. Six certified nursing assistants were trained to review and score 28 video recordings of subjects with dementia for nonverbal pain behaviors using the Non-Communicative Patient's Pain Assessment Instrument. Chi-square was used to examine differences among ethnic groups with regard to the display of nonverbal pain behaviors, and ANOVA was used to evaluate differences in the intensity of overall pain across ethnic groups. Of the 168 assessments, pain words (28%), pain noises (29.8%), and pain faces (28%) were observed most often as indicators of pain. Rubbing, bracing, and restlessness were rarely noted. Chi-square analysis revealed ethnic differences in the expression of pain words (χ(2) = 19.167, p < .001). No significant differences were noted across ethnic groups with regards to overall pain intensity. These findings are the first to examine ethnic differences in nonverbal pain behaviors for older adults with dementia. However, future work should examine assessment tendencies of providers in a larger, more diverse sample.


Asunto(s)
Demencia/complicaciones , Grupos Étnicos , Expresión Facial , Comunicación no Verbal , Dimensión del Dolor , Dolor/diagnóstico , Sonido , Afroamericanos , Anciano , Grupo de Ascendencia Continental Europea , Femenino , Hispanoamericanos , Humanos , Masculino , Dolor/complicaciones
19.
J Gen Intern Med ; 30(6): 804-9, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25666216

RESUMEN

BACKGROUND: Dementia is a costly disease. People with dementia, their families, and their friends are affected on personal, emotional, and financial levels. Prior work has shown that the "Partners in Dementia Care" (PDC) intervention addresses unmet needs and improves psychosocial outcomes and satisfaction with care. OBJECTIVE: We examined whether PDC reduced direct Veterans Health Administration (VHA) health care costs compared with usual care. DESIGN: This study was a cost analysis of the PDC intervention in a 30-month trial involving five VHA medical centers. PARTICIPANTS: Study subjects were veterans (N = 434) 50 years of age and older with dementia and their caregivers at two intervention (N = 269) and three comparison sites (N = 165). INTERVENTIONS: PDC is a telephone-based care coordination and support service for veterans with dementia and their caregivers, delivered through partnerships between VHA medical centers and local Alzheimer's Association chapters. MAIN MEASURES: We tested for differences in total VHA health care costs, including hospital, emergency department, nursing home, outpatient, and pharmacy costs, as well as program costs for intervention participants. Covariates included caregiver reports of veterans' cognitive impairment, behavior problems, and personal care dependencies. We used linear mixed model regression to model change in log total cost post-baseline over a 1-year follow-up period. KEY RESULTS: Intervention participants showed higher VHA costs than usual-care participants both before and after the intervention but did not differ significantly regarding change in log costs from pre- to post-baseline periods. Pre-baseline log cost (p ≤ 0.001), baseline cognitive impairment (p ≤ 0.05), number of personal care dependencies (p ≤ 0.01), and VA service priority (p ≤ 0.01) all predicted change in log total cost. CONCLUSIONS: These analyses show that PDC meets veterans' needs without significantly increasing VHA health care costs. PDC addresses the priority area of care coordination in the National Plan to Address Alzheimer's Disease, offering a low-cost, structured, protocol-driven, evidence-based method for effectively delivering care coordination.


Asunto(s)
Conducta Cooperativa , Costos y Análisis de Costo , Demencia/economía , Costos de la Atención en Salud , United States Department of Veterans Affairs/economía , Anciano , Anciano de 80 o más Años , Cuidadores , Demencia/terapia , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estados Unidos
20.
Dement Geriatr Cogn Dis Extra ; 5(3): 459-70, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26955380

RESUMEN

BACKGROUND/AIMS: Despite pervasive and debilitating pain among elders, it is underassessed and undertreated; and cognitive impairment can add challenges. We assessed the quality of pain care for community-dwelling elderly patients with dementia. METHODS: We phone interviewed 203 Veterans Affairs primary care outpatients with dementia and pain and reviewed medical records to score 15 quality indicators of pain assessment and management. RESULTS: Pain assessment was documented for 98%, and a standard pain scale was used for 94%. Modified pain scales were rarely used. Though 70% self-reported pain of 'quite bad' or worse, charts documented no pain in 64%. When pain was identified, treatment was offered to 80%; but only 59% had a follow-up assessment within 6 months. Nonpharmacological interventions were underused. CONCLUSION: Community-dwelling elders with dementia are underdiagnosed and undertreated for pain.

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