[Patients with pain in outpatient care. A nationwide cross-sectional survey with path model]. / Schmerz bei Patienten in der ambulanten Pflege. Eine bundesweite Querschnittsstudie mit Pfadmodell.

BACKGROUND: There is limited knowledge on the degree of pain and pain-related impairments in home care clients. This study was carried out to provide data on the prevalence of pain and pain-related impairments in home care patients and to investigate the impact on activities of daily living and on classification into the three levels of care as defined by the statutory German long-term care insurance. MATERIAL AND METHODS: In 2012 a representative cross-sectional multicenter study was conducted among clients of 100 German home care services. The stepwise sampling procedure included a random selection of 9 home care services in each of the 16 federal states and a randomized sampling among the clients of the participating home care services. The total sample consisted of 878 home care clients (inclusion criteria ≥ 18 years). The subjective pain intensity was measured using an 11-step Likert scale ranging from 0 (no pain) to 10 (most severe pain). Pain-related impairments were rated on a 6-step Likert scale (0 = no impairments to 5 = complete impairment) assessing the level of independence in household chores, mobility, personal hygiene, dressing and social participation. Furthermore, multimorbidity (number of diagnoses) and level of care according to the current classification in the German long-term care insurance were registered. The predictive significance of latent variables was determined by structural equation modelling. RESULTS: Of the subjects surveyed 68.5 % (n = 672) reported suffering from pain. The average intensity of pain was 2.9 (standard deviation SD 2.8) and pain-related impairments had the greatest effect on mobility (78.2 %). Path analysis revealed that a higher degree of pain-related impairments (ß = + 0.31) and a higher number of diagnoses (ß = + 0.19) were associated with classification to higher levels of care as defined in the German long-term care insurance. However, stronger pain and higher age were related to a classification to a lower level of care (ß = - 0.21). No relevant gender differences were identified except for the finding that old age in women had no significant effect on the classification to the level of care, whereas in men both old age and pain intensity did have an impact. CONCLUSION: Even though the majority of home care clients in this representative study suffered from pain, the degree of pain intensity only becomes an issue in home care if it concurs with impairments in daily living and a corresponding classification to higher levels of care dependency. These findings suggest that pain and pain management should receive more attention in home care, irrespective of observable impairments in daily living. In practice, nurses in home care services should regularly assess the level of pain intensity among home care clients and the results of these regular pain assessments should be taken into account for the identification of individual care needs.

[Nursing homes versus assisted living facilities: Outcome quality regarding pressure ulcers, falls and malnutrition]. / Vollstationäre Pflegeeinrichtungen vs. "betreutes Wohnen mit ambulanter Versorgung": Ergebnisqualität bezogen auf Dekubitus, Sturz und Mangelernährung.

BACKGROUND: Assisted living has become more popular among individuals who are care-dependent or are threatened with care dependency as an attractive alternative to a standard nursing home. As differences regarding nursing care quality in both settings are so far unknown, the aim of the study was to compare the quality indicators occurrence of pressure ulcers, falls and malnutrition in both settings. MATERIAL AND METHODS: In spring 2010 a multicentre cross-sectional study on the prevalence of care problems was conducted including 3610 individuals in 31 nursing homes (NH) and 21 assisted living facilities (ALF) following a standardized study protocol. Comparative analyses of raw and adjusted prevalence of the care problems occurrence of pressure ulcers, falls and malnutrition were conducted. RESULTS: Individuals in the ALFs were on average older than those in the NHs (89.5 years vs. 83.2 years) but were more mobile and less care-dependent. The prevalence of care problems in the NHs compared to those in the ALFs showed the following results: pressure ulcers (NH = 3.9%, ALF = 2.3%), nosocomial pressure ulcer prevalence (NH = 2.3%, ALF = 0.2%), incidence of falls within 3 months (NH = 12.5%, ALF = 20.4%) and malnutrition according to a body mass index (BMI) ≤ 18.5 kg/m(2) (NH = 5.6%, ALF = 11.4%). CONCLUSION: Due to the population differences, no final conclusions about the quality of care according to the analysed indicators can be made. While the prevalence of pressure ulcers was remarkably lower, falls and malnutrition had a higher prevalence in ALFs. Ongoing and systematic outcome quality surveys in different long-term care facilities are recommended.

[Falls in German hospitals and nursing homes 2006-2013. Frequencies, injuries, risk assessment, and preventive measures]. / Stürze in deutschen Krankenhäusern und Pflegeheimen 2006-2013. Häufigkeiten, Verletzungen, Risikoeinschätzung und durchgeführte Prävention.

BACKGROUND: In Germany, a nationwide systematic collection of data regarding fall incidents within health-care facilities is lacking. The objective of the study was to provide valid and robust data on fall rates, the severity of the fall and its resulting injuries, fall risk assessment, and preventive measures offered by professional caregivers in German hospitals and nursing homes. MATERIALS AND METHODS: Each spring from 2006 to 2013, cross-sectional studies were conducted in 124 hospitals (n = 22,493 patients) and 332 nursing homes (25,384 residents) throughout Germany. Fully trained nurses obtained information on the recent history (< 14 days) of the fall and its consequences. Further, they assessed the individual fall risk by clinical judgment and recorded ongoing preventive measures. RESULTS: The total fall rate was 3.9 % (95 % CI 3.6-4.2) in the hospitals and 4.6 % (95 % CI 4.3-4.9) in the nursing homes. Of the fall victims, 6.4 % of the nursing home residents and 8.8 % of the hospital patients were badly injured (i.e., fracture). The fall risk was considered high for residents, with two thirds of all residents being affected, while it was lower for the patients, at one third. The following factors were associated with fall risk: limited mobility, cognitive impairment, recent history of falls for nursing home residents, and additionally urinary incontinence and higher age in hospital patients. The most common preventive measure was counseling of the individual in both settings. CONCLUSION: Although most falls have no severe consequences, the study shows that every 20-25th individual has a falling event in hospitals and nursing homes within 14 days. Despite the slight variance, the trend of the rates remains largely stable. Because specific fall risks were determined, preventive measures can be applied in a more personalized manner and care can be improved. Finally, the study provides valid and durable figures for national and international comparisons.

[Pressure ulcers in German nursing homes: frequencies, grades, and origins]. / Dekubitus in deutschen Pflegeheimen: Häufigkeiten, Grade und Entstehungsorte.

BACKGROUND: The occurrence of pressure ulcers in long-term care facilities is regarded as a nursing-sensitive indicator of care. The aim of this study was to measure the frequency, categories, and points of origin of pressure ulcers in German nursing homes. METHODS AND SAMPLE: In spring 2010, a nationwide prevalence study was conducted in 52 nursing homes (n=3610 residents). According to a standardized study protocol, trained nurses collected data about pressure ulcer risk and pressure ulcers. RESULTS: The prevalence of pressure ulcers was 3.9% (95% CI 3.3-4.6). Excluding skin redness, the proportion of pressure ulcers of nursing home origin was 1.2% (95% CI 0.9-1.6). Risk-adjusted (adjusted for immobility) results showed no statistically significant differences between institutions. CONCLUSION: Compared to international figures, the prevalence of pressure ulcers in German nursing homes is very low.