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1.
Drugs Aging ; 36(8): 769-780, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31209735

RESUMEN

BACKGROUND AND OBJECTIVE: Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper. METHODS: The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016-November 2017). RESULTS: At baseline, participants' (n = 677) mean age was 85.6 years (range 54-109 years), with 72.6% female. Mean medication intake was 8.5 (range 1-22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522). CONCLUSIONS: The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months.


Asunto(s)
Utilización de Medicamentos/tendencias , Casas de Salud/tendencias , Psicotrópicos/uso terapéutico , Anciano , Anciano de 80 o más Años , Antidepresivos/administración & dosificación , Antidepresivos/uso terapéutico , Antipsicóticos/administración & dosificación , Antipsicóticos/uso terapéutico , Bélgica , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Psicotrópicos/administración & dosificación
2.
PLoS One ; 14(6): e0218244, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31216307

RESUMEN

INTRODUCTION: Safety climates are perceptions of safety culture shared by staff in organizational units. Measuring staff perceptions of patient safety culture by using safety climate surveys is a possible way of addressing patient safety. Studies have documented that patient safety climates vary significantly between work sites in hospitals. Across-ward variations in the measurements of safety climate factor scores may indicate ward-specific risk of adverse events related to patient care routines, work environment, staff behaviour, and patient results. Variation in patient safety climates has not yet been explored in nursing homes. OBJECTIVES: To investigate whether the Norwegian translation of the Safety Attitudes Questionnaire-Ambulatory Version is useful to identify significant variation in the patient safety climate factor scores: Teamwork climate, Safety climate, Job satisfaction, Working conditions, Stress recognition, and Perceptions of management, across wards in nursing homes. METHODS: Four hundred and sixty three employees from 34 wards in five nursing homes were invited to participate. Cronbach alphas were computed based on individual respondents' scores on the six patient safety climate factor scores. Intraclass correlation coefficients were calculated by multilevel analysis to measure patient safety climate variance at ward level. RESULTS: Two hundred and eighty eight (62.2%) returned the questionnaire. At ward level Intraclass correlation coefficients (ICCs) for the factors were 10.2% or higher for the factors Safety climate, Working conditions and Perceptions of management, 2.4% or lower for Teamwork climate, Job satisfaction, and zero for Stress recognition. ICC for variance at nursing home level was zero or less than one per cent for all factor scores. CONCLUSIONS: Staff perceptions of Safety climate, Working conditions and Perceptions of management varied significantly across wards. These factor scores may, therefore, be used to identify wards in nursing homes with high and low risk of adverse events, and guide improvement resources to where they are most needed.


Asunto(s)
Actitud del Personal de Salud , Hospitales/normas , Casas de Salud/normas , Seguridad del Paciente/normas , Empleo/normas , Femenino , Hospitales/tendencias , Humanos , Masculino , Noruega/epidemiología , Enfermeras y Enfermeros/psicología , Casas de Salud/tendencias , Factores de Riesgo , Encuestas y Cuestionarios
3.
BMC Geriatr ; 19(1): 103, 2019 04 11.
Artículo en Inglés | MEDLINE | ID: mdl-30975076

RESUMEN

BACKGROUND: Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. We sought to assess geographic variation in availability and quality of nursing home care. METHODS: Retrospective study using Medicaid/Medicare-certified nursing home data from the Centers for Medicare & Medicaid Services, 1996-2016. Outcomes were 1) availability of all nursing home care (1996-2016), measured by the number of Medicaid/Medicare-certified beds for a given county per 100,000 population aged ≥65 years, regardless of nursing home star rating; 2) availability of 5-star nursing home care, measured by the number of Medicaid/Medicare-certified beds provided by 5-star nursing homes; and 3) utilization of nursing home beds, defined as the rate of occupied Medicaid/Medicare-certified beds among the total Medicaid/Medicare-certified beds. RESULTS: From 1999 to 2016, availability of all nursing home care declined from 4882 (standard deviation: 931) to 3480 (912) beds, per 100,000 population aged ≥65 years. Persistent geographic variation in availability of nursing home care was observed; the correlation coefficient of county-specific availabilities from 1996 to 2016 was 0.78 (95% CI 0.77-0.79). From 2011 to 2016, availability of 5-star nursing home beds increased from 658 (303) to 895 (661) per 100,000 population aged ≥65 years. The correlation coefficient for county-specific availabilities from 2011 to 2016 was 0.54 (95% CI 0.51-0.56). Availability and quality of nursing home care were not highly correlated. In 2016, the correlation coefficient for county-specific availabilities between all nursing home and 5-star nursing home beds was 0.33 (95% CI 0.30-0.36). From 1996 to 2016, the utilization of certified beds declined from 78.5 to 72.2%. This decline was consistent across all census divisions, but most pronounced in the Mountain division and less in the South-Atlantic division. CONCLUSION: We observed persistent geographic variations in availability and quality of nursing home care. Availability of all nursing home care declined but availability of 5-star nursing home care increased. Availability and quality of nursing home care were not highly correlated.


Asunto(s)
Accesibilidad a los Servicios de Salud/tendencias , Hogares para Ancianos/tendencias , Casas de Salud/tendencias , Calidad de la Atención de Salud/tendencias , Anciano , Anciano de 80 o más Años , /tendencias , Femenino , Accesibilidad a los Servicios de Salud/normas , Hogares para Ancianos/normas , Humanos , Masculino , Medicaid/normas , Medicaid/tendencias , Medicare/normas , Medicare/tendencias , Casas de Salud/normas , Calidad de la Atención de Salud/normas , Estudios Retrospectivos , Instituciones de Cuidados Especializados de Enfermería/normas , Instituciones de Cuidados Especializados de Enfermería/tendencias , Estados Unidos/epidemiología
4.
BMC Geriatr ; 19(1): 105, 2019 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-30987588

RESUMEN

BACKGROUND: In geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics. METHODS: A cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated. RESULTS: The prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo. CONCLUSIONS: Every sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population. TRIAL REGISTRATION: This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.


Asunto(s)
Hogares para Ancianos/tendencias , Intertrigo/diagnóstico , Intertrigo/epidemiología , Casas de Salud/tendencias , Cuidados de la Piel/tendencias , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Alemania/epidemiología , Humanos , Intertrigo/terapia , Cuidados a Largo Plazo/tendencias , Masculino , Prevalencia , Cuidados de la Piel/métodos
5.
BMC Geriatr ; 19(1): 119, 2019 04 25.
Artículo en Inglés | MEDLINE | ID: mdl-31023243

RESUMEN

BACKGROUND: Little is known about the use of psychotropic drugs in older adults receiving domiciliary care. The first aim was to describe the prevalence and persistency of use of psychotropic drugs in older adults (≥ 70 years) with and without dementia receiving domiciliary care. Furthermore, the second aim was to explore factors associated with persistent drug use at two consecutive time-points. Lastly, we aimed to examine if use of psychotropic drugs changed after admission to a nursing home. METHODS: In total, 1001 community-dwelling older adults receiving domiciliary care at inclusion participated in the study. Information about psychotropic drug use was collected at baseline, after 18 months and after 36 months. The participants' cognitive function, neuropsychiatric symptoms (NPS) and physical health were assessed at the same assessments. Participants were evaluated for dementia based on all gathered information. Formal level of care (domiciliary care or in a nursing home) was registered at the follow-up assessments. RESULTS: Prevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care was high. Participants with dementia more often used antipsychotics and antidepressants than participants without dementia. The majority of the participants using antipsychotic drugs used traditional antipsychotics. Younger age was associated with higher odds for persistent use of antipsychotics and antidepressants, and lower odds for persistent use of sedatives. Severity of NPS was associated with persistent use of antidepressants. The odds for use of antipsychotics and antidepressants were higher in those admitted to a nursing home as compared to the community-dwelling participants at the last follow-up. CONCLUSION: There was a high prevalence and persistency of use of psychotropic drugs. The prevalence of use of traditional antipsychotics was surprisingly high, which is alarming. Monitoring the effect and adverse effects of psychotropic drugs is an important part of the treatment, and discontinuation should be considered when possible due to the odds for severe adverse effects of such drugs in people with dementia.


Asunto(s)
Demencia/tratamiento farmacológico , Demencia/epidemiología , Servicios de Atención de Salud a Domicilio/tendencias , Psicotrópicos/uso terapéutico , Anciano , Anciano de 80 o más Años , Cognición/efectos de los fármacos , Cognición/fisiología , Demencia/psicología , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Casas de Salud/tendencias , Prevalencia , Psicotrópicos/efectos adversos , Instituciones de Cuidados Especializados de Enfermería/tendencias
6.
BMC Med ; 17(1): 54, 2019 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-30827280

RESUMEN

BACKGROUND: Managing hearing communication for residents living with hearing loss and dementia in long-term care settings is challenging. This paper explores how care can be effective in optimising hearing communication for residents living with dementia. We argue that the underlying notion of permission or authorisation allows care staff to do what they know will be effective in providing person-centred care that enhances hearing communication. The paper also indicates that this notion of permission can usefully be applied to other areas of care home practice. METHODS: To address hearing-related communication in care homes, we conducted a realist synthesis (RS). As a theory-driven approach to reviewing literature, it also uses expert opinion to understand complex health situations. Using RS, we developed a theory surrounding the management of hearing-related communication in care homes. Applying formal processes to the literature search and data extraction, the analysis uncovered relevant mechanisms and contexts to help confirm, refute or refine our understanding of how hearing communication could be improved. RESULTS: Forty-three papers were selected for the realist synthesis. The documents were analysed to construct five context-mechanism-outcome configurations (CMOCs). The CMOCs represent possible care interventions to optimise hearing-related communication in care homes for person living with dementia and hearing loss (PLWDHL). They include leadership promoting positive regard and empathy through person-centred care, communication training for staff, 'knowing the person' and relationship building for responsive awareness of residents' hearing needs, maintaining and monitoring hearing communication through care planning, and managing noise in the care home environment. CONCLUSIONS: Leadership that provides appropriate training and resources is likely to enhance knowledge and skills, leading to staff feeling able and equipped to respond to the hearing-related communication needs of PLWDHL. Collaboration with local hearing services is likely to raise awareness of hearing loss among care home staff. Importantly, care staff require a sense of permission from leadership, to work with knowledge and autonomy in the interest of residents living with dementia and hearing loss.


Asunto(s)
Prestación de Atención de Salud/métodos , Demencia/psicología , Pérdida Auditiva/psicología , Casas de Salud/tendencias , Comunicación , Humanos
7.
Isr J Health Policy Res ; 8(1): 28, 2019 03 07.
Artículo en Inglés | MEDLINE | ID: mdl-30845988

RESUMEN

Fake bus stops are one strategy to keep persons with dementia (PwD) from wandering. By setting up authentic looking shelters and benches in hallways or gardens, nursing homes create the illusion of bus stops, for the purpose of preventing wandering PwD from leaving the facility and getting lost. By attracting wandering PwD to sit down and wait for the bus, they can be supervised more easily by caregivers. However, concerns are expressed that the use of fake bus stops could cause more harm than good for PwD, due to their deceptive nature and the potential stigmatisation of individuals seated at a fake bus stop. This article discusses the ethical aspects of using fake bus stops and outlines considerations prior to setting up fake bus stops in nursing homes in keeping with good clinical practice in dementia care. Moreover, the article assesses whether or not fake bus stops can be ethically justifiable, and if so, how they can be ethically justified and implemented in Israeli and other facilities for PwD.


Asunto(s)
Decepción , Demencia/psicología , Casas de Salud/tendencias , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/normas , Demencia/terapia , Humanos , Casas de Salud/organización & administración
8.
BMC Geriatr ; 19(1): 32, 2019 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-30717706

RESUMEN

BACKGROUND: Non-specific symptoms, such as confusion, are often suspected to be caused by urinary tract infection (UTI) and continues to be the most common reason for suspecting a UTI despite many other potential causes. This leads to significant overdiagnosis of UTI, inappropriate antibiotic use and potential harmful outcomes. This problem is particularly prevalent in nursing home settings. METHODS: A systematic review of the literature was conducted assessing the association between confusion and UTI in the elderly. PubMed, Scopus and PsychInfo were searched with the following terms: confusion, delirium, altered mental status, acute confusional state, urinary tract infection, urine infection, urinary infection and bacteriuria. Inclusion criteria and methods were specified in advance and documented in the protocol, which was published with PROSPERO (registration ID: CRD42015025804). Quality assessment was conducted independently by two authors. Data were extracted using a standardised extraction tool and a qualitative synthesis of evidence was made. RESULTS: One thousand seven hunderd two original records were identified, of which 22 were included in the final analysis. The quality of these included studies varied, with frequent poor case definitions for UTI or confusion contributing to large variation in results and limiting their validity. Eight studies defined confusion using valid criteria; however, no studies defined UTI in accordance with established criteria. As no study used an acceptable definition of confusion and UTI, an association could not be reliably established. Only one study had acceptable definitions of confusion and bacteriuria, reporting an association with the relative risk being 1.4 (95% CI 1.0-1.7, p = 0.034). CONCLUSIONS: Current evidence appears insufficient to accurately determine if UTI and confusion are associated, with estimates varying widely. This was often attributable to poor case definitions for UTI or confusion, or inadequate control of confounding factors. Future well-designed studies, using validated criteria for UTI and confusion are required to examine the relationship between UTI and acute confusion in the elderly. The optimal solution to clarify this clinical issue would be a randomized controlled trial comparing the effect of antibiotics versus placebo in patients with new onset or worsening confusion and presence of bacteriuria while lacking specific urinary tract symptoms.


Asunto(s)
Delirio/diagnóstico , Delirio/epidemiología , Medicina Basada en la Evidencia/métodos , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/epidemiología , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Bacteriuria/diagnóstico , Bacteriuria/tratamiento farmacológico , Bacteriuria/epidemiología , Delirio/tratamiento farmacológico , Medicina Basada en la Evidencia/tendencias , Femenino , Humanos , Masculino , Casas de Salud/tendencias , Riesgo , Infecciones Urinarias/tratamiento farmacológico
9.
BMC Geriatr ; 19(1): 38, 2019 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-30736737

RESUMEN

BACKGROUND: Constipation is a common condition among older people, particularly among people living in nursing homes, and the use of drugs such as opioids is one of many factors that contribute to its high prevalence. The aim of this study was to compare the prevalence of constipation and the use of laxatives between 2007 and 2013, to analyze constipation and laxative use among people who are prescribed opioids, and to identify factors associated with constipation. METHODS: In 2007 and 2013, two surveys were performed in the county of Västerbotten in Northern Sweden, comprising all those living in nursing homes. The Multi-Dimensional Dementia Assessment Scale was used to collect data regarding laxative, opioid and anticholinergic drug use, functioning in activities of daily living (ADL), cognition and symptoms of constipation. A comparison was made between 2820 people from 2007 and 1902 people from 2013. RESULTS: The prevalence of symptoms of constipation among people living in nursing homes increased from 36% in 2007 to 40% in 2013. After controlling for age, sex, ADL, cognitive impairment and use of opioid and anticholinergic drugs, this difference was found to be statistically significant. When controlled for demographic changes, there was a statistically significant difference in the regular use of laxatives between the respective years, from 46% in 2007 to 59% in 2013. People prescribed opioids and anticholinergic drugs were at increased risk of constipation, while people with a higher ADL score were at decreased risk. Further, among people prescribed opioids and rated as constipated, 35% in 2007 and 20% in 2013 were not prescribed laxatives for regular use, a difference that was found to be statistically significant. CONCLUSIONS: The prevalence of symptoms of constipation increased between 2007 and 2013. Although there was a decrease between the years, there were still a number of people being prescribed with opioids and rated as constipated who were not treated with laxatives. This study therefore indicates that constipation remains a significant problem among people in nursing homes and also indicates that those prescribed opioids could benefit from an increased awareness of the risk of constipation and treatment, if required.


Asunto(s)
Estreñimiento/inducido químicamente , Estreñimiento/epidemiología , Laxativos/uso terapéutico , Casas de Salud/tendencias , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/efectos adversos , Disfunción Cognitiva/tratamiento farmacológico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Estreñimiento/tratamiento farmacológico , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Suecia/epidemiología
10.
BMC Geriatr ; 19(1): 6, 2019 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-30626341

RESUMEN

BACKGROUND: The purpose of the Aging-ONDUAL-TASK study is to determine if a supervised dual-task program carried out in long-term nursing homes is able to attenuate frailty in a greater extent than the same multicomponent exercise program alone. METHODS: This multicenter randomized controlled trial will include 188 participants who will be randomly allocated to either a multicomponent exercise program or to the same multicomponent program with simultaneous cognitive training (dual-task training). Inclusion criteria are as follows: ≥ 70 years, ≥ 50 on the Barthel Index, ≥ 20 on the Mini Examen Cognoscitivo (MEC-35) who are able to stand up and walk independently for 10 m. Subjects in the multicomponent group will attend a twice-a-week multicomponent exercise program of 1-h duration per session, consisting of strength and balance exercises. Participants in the dual-task group will perform the same multicomponent exercise program with concurrent individually tailored cognitive tasks. Study assessments will be conducted at baseline and at 3 months. The primary outcome measure will be gait speed under dual-task conditions and secondary outcomes will include physical fitness measurements, gait spatiotemporal parameters, cognition and emotional assessments, several frailty scales and objectively measured physical activity. DISCUSSION: The present research will add valuable information to the knowledge around the effects of the dual-task program in long-term nursing home residents, taking altogether physical, cognitive and emotional variables linked to frailty. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR) with the identifier: ACTRN12618000536268 . Registration date: 11/04/2018.


Asunto(s)
Terapia por Ejercicio/métodos , Anciano Frágil , Fragilidad/terapia , Hogares para Ancianos , Casas de Salud , Anciano , Anciano de 80 o más Años , Australia , Terapia Combinada/métodos , Terapia Combinada/psicología , Terapia Combinada/tendencias , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Terapia por Ejercicio/psicología , Terapia por Ejercicio/tendencias , Femenino , Anciano Frágil/psicología , Fragilidad/epidemiología , Fragilidad/psicología , Hogares para Ancianos/tendencias , Humanos , Masculino , Nueva Zelanda/epidemiología , Casas de Salud/tendencias , Resultado del Tratamiento , Caminata/fisiología , Caminata/psicología , Velocidad al Caminar/fisiología
11.
BMC Geriatr ; 19(1): 7, 2019 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-30621606

RESUMEN

BACKGROUND: Dementia patients often show neuropsychiatric symptoms, known as behavioral and psychological symptoms of dementia (BPSD). These are a common motive for medical consultations, hospitalizations, and nursing home stays. Various studies have suggested that the high prevalence of psychotropic drug use to treat BPSD in institutionalized dementia patients may lead to impaired cognitive capacity, rigidity, somnolence, and other complications during the course of the illness. The aim of this study was to design a consensus-based intervention between care levels to optimize and potentially reduce prescription of psychotropic drugs in institutionalized patients with dementia and assess the changes occurring following its implementation. METHODS: Design: Prospective, quasi-experimental, pre/post intervention, multicenter study. SCOPE: 7 nursing homes associated with a single primary care team. INCLUSION CRITERIA: Institutionalized patients diagnosed with dementia and under treatment with 1 or more psychotropic drugs for at least 3 months. SAMPLE: 240 individuals; mean age, 87 years (SD: 6.795); 75% (180) women. INTERVENTION: Creation of evidence-based therapeutic guidelines for psychotropic drug use in the treatment of BPSD by consensus between reference professionals. Joint review (primary care and geriatric care nursing home professionals) of the medication based on the guidelines and focusing on individual patient needs. Primary variable: Number of psychotropic drugs used per patient. ASSESSMENT: Preintervention, immediate postintervention, and at 1 and 6 months. RESULTS: Overall, the number of psychotropic drugs prescribed was reduced by 28% (from 636 before to 458 after the intervention). The mean number of psychotropic drugs prescribed per patient decreased from 2.71 at baseline to 1.95 at 1 month postintervention and 2.01 at 6 months (p < 0.001 for both time points). Antipsychotics were the drug class showing the highest reduction rate (49.66%). Reintroduction of discontinued psychotropic drugs was 2% at 1 month following the intervention and 12% at 6 months. CONCLUSIONS: A consensus guidelines-based therapeutic intervention with a patient-centered medication review by a multidisciplinary team led to a reduction in prescription of psychotropic drugs in institutionalized dementia patients.


Asunto(s)
Demencia/tratamiento farmacológico , Medicina Basada en la Evidencia/tendencias , Hogares para Ancianos/tendencias , Conciliación de Medicamentos/tendencias , Casas de Salud/tendencias , Psicotrópicos/uso terapéutico , Anciano , Anciano de 80 o más Años , Antipsicóticos/uso terapéutico , Consenso , Demencia/psicología , Prescripciones de Medicamentos , Medicina Basada en la Evidencia/métodos , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Conciliación de Medicamentos/métodos , Estudios Prospectivos
12.
BMC Geriatr ; 19(1): 24, 2019 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-30683060

RESUMEN

BACKGROUND: Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR' health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists' medication reviews linked with measures to strengthen interprofessional co-operation on NHR' medication quality, health status and health care use. METHODS: Pragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist's medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a "toolbox" to facilitate implementation in daily practice. ANALYSIS: primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs. DISCUSSION: The trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany. TRIAL REGISTRATION: Registered in the German register of clinical studies (DRKS, study ID DRKS00013588 , primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.


Asunto(s)
Prescripción Inadecuada/prevención & control , Casas de Salud/normas , Grupo de Atención al Paciente/normas , Polifarmacia , Lista de Medicamentos Potencialmente Inapropiados/normas , Accidentes por Caídas/prevención & control , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Femenino , Estudios de Seguimiento , Médicos Generales/normas , Médicos Generales/tendencias , Alemania/epidemiología , Humanos , Prescripción Inadecuada/tendencias , Masculino , Casas de Salud/tendencias , Grupo de Atención al Paciente/tendencias , Farmacéuticos/normas , Farmacéuticos/tendencias , Lista de Medicamentos Potencialmente Inapropiados/tendencias , Calidad de Vida/psicología
13.
J Nurs Manag ; 27(3): 575-583, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30207405

RESUMEN

AIM: This study described and analyzed how older residents, professional nurses and unlicensed assistive personnel (UAP) perceive the meaning and content of the job carried out by UAP in nursing homes (NHs), as a basis for job analysis. BACKGROUND: Increasing numbers of NH beds and financial restraints have led UAP to become a significant part of the long-term care service system, yet in numerous contexts, the UAP job remains misunderstood and underexplored. METHOD: The research employed a qualitative phenomenological methodology. Data were collected from 50 semi-structured in-depth interviews with 18 UAP, 15 certified nurses and 17 older NH residents. RESULTS: We identified six content dimensions in the participants' descriptions regarding the meanings of the roles and duties of the UAP: (a) care for the physical environment, (b) bodily-physical care, (c) psycho-social interpersonal care, (d) professional hierarchy and boundaries, (e) UAP personal traits and (f) UAP skills, or the need for training and professional education. CONCLUSIONS: Future job definition and formal regulation of UAP should place more focus on the personal characteristics of UAP, as a prerequisite to enter the job. IMPLICATIONS FOR NURSING MANAGEMENT: The study takes a step forward toward better defining the professional boundaries delineating the meaning of the UAP position.


Asunto(s)
Perfil Laboral , Rol de la Enfermera , Asistentes de Enfermería/normas , Actitud del Personal de Salud , Humanos , Pacientes Internos/psicología , Entrevistas como Asunto/métodos , Concesión de Licencias , Enfermeras y Enfermeros/psicología , Asistentes de Enfermería/psicología , Casas de Salud/tendencias , Satisfacción del Paciente , Investigación Cualitativa , Calidad de la Atención de Salud/normas
14.
Nurs Ethics ; 26(3): 767-777, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-28893159

RESUMEN

BACKGROUND: A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients' relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. AIM: The aim of the study is to investigate relatives of persons with dementia's experiences with quality care in nursing homes. METHOD: The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological-hermeneutical method for the study of lived experiences. PARTICIPANTS AND RESEARCH CONTEXT: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. ETHICAL CONSIDERATIONS: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. FINDINGS: Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives' experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives experienced powerlessness, distrust and guilt. DISCUSSION: The results are discussed considering the concepts of trust, power and asymmetry. CONCLUSION: When asked about experiences with quality care, the relatives spoke both of expectations met and of expectations not met. Results in this study are important knowledge for developing units where performing quality care is the overall aim.


Asunto(s)
Demencia/complicaciones , Ética en Enfermería , Familia/psicología , Casas de Salud/normas , Calidad de la Atención de Salud/normas , Anciano , Anciano de 80 o más Años , Costo de Enfermedad , Demencia/psicología , Femenino , Humanos , Relaciones Interpersonales , Entrevistas como Asunto/métodos , Masculino , Noruega , Casas de Salud/tendencias , Relaciones Profesional-Paciente , Investigación Cualitativa
15.
Nurse Educ Pract ; 34: 161-166, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30551058

RESUMEN

This paper focuses on the experiences of nursing students on a student-managed ward, the purpose of which was to empower students for the nursing role. Five nursing students operated and managed a nursing home ward for eight weeks during their final year of nursing education. The students claimed that a group of five students was beneficial. However, a group of five was too large for one nurse to follow up. The students reported that they needed visible supervisors in order to develop professional nursing skills, both in terms of knowledge and practical implementation. The students argued that they became more independent through this form of organisation, since the supervisor was not constantly watching everything they did. The students felt more responsible for the daily running and follow-up of the patients because they were in charge. Peer-assistant learning was highly recommended in relation to self-esteem, and improved results and skills in the students' practice. Collaboration with some of the assistant nurses was challenging. The results indicate that this kind of clinical training can contribute to more empowerment and better preparation for the nursing role than the traditional way.


Asunto(s)
Modelos de Enfermería , Casas de Salud/tendencias , Estudiantes de Enfermería/psicología , Bachillerato en Enfermería/métodos , Humanos , Noruega , Rol de la Enfermera/psicología , Casas de Salud/organización & administración , Organización y Administración , Proyectos Piloto , Investigación Cualitativa
16.
BMC Geriatr ; 18(1): 279, 2018 11 14.
Artículo en Inglés | MEDLINE | ID: mdl-30428836

RESUMEN

BACKGROUND: No proven effective interventions on quality of life (QoL) are available for persons with dementia in a long-term care facility (LTCF). However, several interventions are effective in diminishing mediators of QoL (i.e. challenging behaviour, depressed mood, sleeping disorders), including pain treatment. Un(der)diagnosed and un(der)treated pain is a serious and frequent problem in persons with dementia. Also, although pain is difficult to assess in this group, the impact on QoL is probably considerable. There is evidence that pain has a negative impact on behaviour, mood, functioning and social participation, and benefit may be derived from use of paracetamol. Therefore, in LTCF residents with advanced dementia, this study aims to evaluate the effect of scheduled pain treatment with paracetamol on QoL, neuropsychiatric symptoms, ADL function, pain, care dependency, and (change in) use of psychotropic and pain medication. METHODS: This randomised, double-blind, placebo-controlled crossover trial will include 95 patients with: 1) age ≥ 65 years, 2) advanced dementia (Reisberg Global Deterioration Scale 5-7), and 3) QUALIDEM score ≤ 70. Exclusion criteria are the regular use of pain treatment, allergies to the study drugs, severe liver insufficiency or disease, use of > 4 units of alcohol/day, weight < 50 kg, and/or concomitant use of flucloxacillin. The two treatment periods of six weeks each (paracetamol and corresponding placebo) will be separated by a washout period of seven days. Primary outcome is effect on QoL (QUALIDEM and DS-DAT) and secondary outcome is effect on neuropsychiatric symptoms, ADL function, pain, care dependency, and (change in) use of psychotropic and pain medication (all compared to baseline). DISCUSSION: If regular treatment with paracetamol proves to be beneficial for QoL, this could have major implications for daily practice in long-term care. Information from this study may help professionals in their decision making regarding the prescription of pain medication to improve the QoL of persons with dementia and a low QoL. TRIAL REGISTRATION: The trial was registered on the Netherlands Trial Register ( NTR6766 ); Trial registration date: 20th October, 2017.


Asunto(s)
Acetaminofén/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Demencia/tratamiento farmacológico , Demencia/psicología , Calidad de Vida/psicología , Anciano , Estudios Cruzados , Demencia/epidemiología , Depresión/tratamiento farmacológico , Depresión/epidemiología , Depresión/psicología , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Cuidados a Largo Plazo/psicología , Cuidados a Largo Plazo/tendencias , Masculino , Países Bajos/epidemiología , Casas de Salud/tendencias , Dolor/tratamiento farmacológico , Dolor/epidemiología , Dolor/psicología , Manejo del Dolor/métodos , Manejo del Dolor/psicología , Manejo del Dolor/tendencias
17.
BMC Geriatr ; 18(1): 242, 2018 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-30314472

RESUMEN

BACKGROUND: The aim of this review is to describe the challenges and barriers to conducting research in long-term care facilities. METHODS: A literature search was conducted in Ovid MEDLINE, Embase, Cochrane Central, PsycINFO and CINAHL. Keywords used included "long term care", "nursing home", "research", "trial", "challenge" and "barrier", etc. Resulting references were screened in order to identify relevant studies that reported on challenges derived from first-hand experience of empirical research studies. Challenges were summarized and synthesized. RESULTS: Of 1723 references, 39 articles were selected for inclusion. To facilitate understanding we proposed a classification framework of 8 main themes to categorize the research challenges presented in the 39 studies, relating to the characteristics of facility/owner/administrator, resident, staff caregiver, family caregiver, investigator, ethical or legal concerns, methodology, and budgetary considerations. CONCLUSIONS: Conducting research in long-term care facilities is full of challenges which can be categorized into 8 main themes. Investigators should be aware of all these challenges and specifically address them when planning their studies. Stakeholders should be involved from an early stage and flexibility should be built into both the methodology and research budget.


Asunto(s)
Investigación Biomédica/métodos , Prestación de Atención de Salud/métodos , Cuidados a Largo Plazo/métodos , Casas de Salud , Instituciones de Cuidados Especializados de Enfermería , Investigación Biomédica/tendencias , Cuidadores/tendencias , Prestación de Atención de Salud/tendencias , Humanos , Cuidados a Largo Plazo/tendencias , Casas de Salud/tendencias , Instituciones de Cuidados Especializados de Enfermería/tendencias
18.
BMC Geriatr ; 18(1): 233, 2018 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-30285637

RESUMEN

BACKGROUND: Falls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the recommendation to use hip protectors and education of staff. The present study aimed to provide a comprehensive evaluation of the implementation process of the program regarding results of the implementation phase and the follow-up of 3-9 years after start of implementation. METHODS: Data from numerous sources were used, including data from published studies, statistical data, health insurance claims data and unpublished data from an online questionnaire. To incorporate different aspects, time periods and results, the RE-AIM framework was applied. RESULTS: The program was adopted by 942 of the 1150 eligible LTCFs and reached about 62,000 residents. During the implementation phase exercise classes and recommendation about environmental adaptations were offered in nearly all LTCFs. 13.5% of the residents participated in exercise classes. Hip protectors were available for 9.2% of all residents. In the first implementation wave, femoral fracture rate was significantly reduced by 18% in the first year. At follow-up nearly 90% of all LTCFs still offered exercise classes, which were attended by about 11% of residents. However, only 10% of the exercise classes completely fulfilled the requirements of an effective strength and balance training. Individual advice about environmental adaptations was provided in 74.3% of the LTCFs and nearly all LTCFs claimed to offer hip protectors to their residents. A long-term effect of the program on femoral fractures could not be detected. CONCLUSIONS: The program did not affect the femoral fracture rate in the long run. Possible reasons could be a high turn-over of the staff, a reduced fidelity of training components or a shift in daily priorities among the staff.


Asunto(s)
Accidentes por Caídas/prevención & control , Fracturas del Fémur/prevención & control , Cuidados a Largo Plazo/métodos , Equipos de Seguridad , Entrenamiento de Resistencia/métodos , Anciano , Femenino , Fracturas del Fémur/diagnóstico , Fracturas del Fémur/epidemiología , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Cuidados a Largo Plazo/normas , Masculino , Casas de Salud/normas , Casas de Salud/tendencias , Equipos de Seguridad/normas , Entrenamiento de Resistencia/normas , Instituciones de Cuidados Especializados de Enfermería/normas , Instituciones de Cuidados Especializados de Enfermería/tendencias
19.
BMC Geriatr ; 18(1): 254, 2018 10 22.
Artículo en Inglés | MEDLINE | ID: mdl-30348091

RESUMEN

BACKGROUND: Dementia and physical morbidity are primary reasons for nursing home admission globally. However, data on physical morbidity in nursing home residents with and without dementia are scarce. The first aim of the present study was to explore whether presence and severity of dementia were related to the number of physical diagnoses in nursing home residents. The second aim was to explore if the severity of dementia was associated with having registered the most frequent complexes of physical diagnoses when controlling for physical health and demographic factors. METHODS: A total of 2983 Norwegian nursing home residents from two cross-sectional samples from 2004/2005 and 2010/2011 were included in the analysis. By the use of assessment scales, the severity of dementia (Clinical Dementia Rating), physical health (General Medical Health Rating), activities of daily living (Physical Self-Maintenance Scale) and neuropsychiatric symptoms (Neuropsychiatric Inventory Nursing Home) were determined. Physical diagnoses and medications were assembled from the medical records. The physical diagnoses were categorized into complexes, using the ICD-10 chapters. Linear mixed models and generalized linear mixed models were estimated. RESULTS: Residents with dementia were registered with fewer physical diagnoses than residents without dementia. The frequency of physical diagnoses decreased with increasing severity of dementia. Cardiovascular, musculoskeletal and endocrine, nutritional and metabolic diagnoses were the most common complexes of physical diagnoses in individuals with and without dementia. The odds of having cardiovascular and musculoskeletal diagnoses increased for males and decreased for females with increasing severity of dementia, in contrast to endocrine diagnoses where the odds increased for both genders. CONCLUSION: Increasing severity of dementia in nursing home residents may complicate the diagnostics of physical disease. This might reflect a need for more attention to the registration of physical diagnoses in nursing home residents with dementia.


Asunto(s)
Demencia/diagnóstico , Demencia/psicología , Hogares para Ancianos/tendencias , Casas de Salud/tendencias , Examen Físico/tendencias , Índice de Severidad de la Enfermedad , Actividades Cotidianas/psicología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Demencia/epidemiología , Femenino , Humanos , Masculino , Noruega/epidemiología
20.
Med Care ; 56(12): 985-993, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30234764

RESUMEN

BACKGROUND AND OBJECTIVES: Given the dynamic nursing home (NH) industry and evolving regulatory environment, depiction of contemporary NH culture-change (person/resident-centered) care practice is of interest. Thus, we aimed to portray the 2016/2017 prevalence of NH culture change-related processes and structures and to identify factors associated with greater practice prevalence. RESEARCH DESIGN AND METHODS: We administered a nationwide survey to 2142 NH Administrators at NHs previously responding to a 2009/2010 survey. Seventy-four percent of administrators (1583) responded (with no detectable nonresponse bias) enabling us to generalize (weighted) findings to US NHs. From responses, we created index scores for practice domains of resident-centered care, staff empowerment, physical environment, leadership, and family and community engagement. Facility-level covariate data came from the survey and the Certification and Survey Provider Enhanced Reporting system. Ordered logistic regression identified the factors associated with higher index scores. RESULTS: Eighty-eight percent of administrators reported some facility-level involvement in NH culture change, with higher reported involvement consistently associated with higher domain index scores. NHs performed the best (82.6/100 weighted points) on the standardized resident-centered care practices index, and had the lowest scores (54.8) on the family and community engagement index. Multivariable results indicate higher index scores in NHs with higher leadership scores and in states having Medicaid pay-for-performance with culture change-related quality measures. CONCLUSIONS: The relatively higher resident-centered care scores (compared with other domain scores) suggest an emphasis on person-centered care in many US NHs. Findings also support pay-for-performance as a potential mechanism to incentivize preferred NH practice.


Asunto(s)
Liderazgo , Medicaid/economía , Casas de Salud/tendencias , Cultura Organizacional , Reembolso de Incentivo/normas , Ambiente , Humanos , Calidad de la Atención de Salud/normas , Encuestas y Cuestionarios , Estados Unidos
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