Additional value of a triggerlist as selection criterion in identifying patients at high risk of medication-related hospital admission: a retrospective cohort study.

BACKGROUND: Of all hospital admissions in older patients, 10-30% seem to be medication-related. However, medication-related admissions are often unidentified in clinical practice. To increase the identification of medication-related hospital admissions in older patients a triggerlist is published in the Dutch guideline for polypharmacy. AIM: To assess whether the triggerlist has value as selection criterion to identify patients at high risk of medication-related hospital admissions. METHOD: This retrospective cohort study was carried out in 100 older (≥ 60 years) patients with polypharmacy and having two triggers from the triggerlist. The admissions were assessed as either possibly or unlikely medication-related according to the Assessment Tool for identifying Hospital Admissions Related to Medications. RESULTS: Of all the admissions 48% were classified as possibly medication-related. Patients with a possible medication-related hospital admission were more likely to have an impaired renal function (p = 0.015), but no differences with regard to age, sex, comorbidity or number of medicines were found. CONCLUSION: The high prevalence of medication-related hospital admissions, suggests the triggerlist may have added value as selection criterion in a cohort of older patients with polypharmacy and can be used to improve the identification of a population at high risk of medication-related hospital admissions.

[Basic care in nursing homes: longitudinal presentation of care problems measured with the National Prevalence Measurement of Care Problems (LPZ)]. / Basiszorg in het verpleeghuis: longitudinale weergave van zorgproblemen gemeten door de Landelijke Prevalentiemeting Zorgproblemen.

Since 1998, the National Prevalence Measurement of Care Problems (LPZ) has annually measured the prevalence, prevention and treatment of a number of care problems in many health care organisations. These problems include pressure ulcers, incontinence, intertrigo, malnutrition, falls and the use of restraints. This article describes trends in the prevalence of these problems during the past few years and the preventive and treatment measures taken for clients residing in psychogeriatric and/or somatic wards of nursing homes. The results show that the prevalence of these care problems has declined in general. Nevertheless, the individual interventions (preventive measures and treatment) have not really changed in recent years. It is concluded that the extra attention paid to these care problems might already have had a positive effect on their prevalence. This must be further investigated. In any case, extra follow-up steps need to be taken to bring about a further decline. The article describes which steps the project group has already taken in this respect.

[Malnutrition and dementia in the elderly in German nursing homes. Results of a prevalence survey from the years 2008 and 2009]. / Mangelernährung und Demenz bei Bewohnern in Einrichtungen der stationären Altenpflege in Deutschland : Ergebnisse von Prävalenzerhebungen aus den Jahren 2008 und 2009.

BACKGROUND AND OBJECTIVE: Dementia is one of most challenging problems for the care of older people in Germany. Although malnutrition in nursing homes is also associated with dementia, few systematic studies have described health care structures in German nursing homes for people with dementia and their individual nutritional status. Therefore, the aim of this study was to determine dementia-specific differences concerning the nutrition situation for the elderly in German nursing homes. METHODS: A cross-sectional multicenter study was performed using a standardized multilevel instrument (observation, questionnaire) developed at the University of Maastricht. Variables are indicators for malnutrition and its risks, quality indicators, care dependency and types of interventions. RESULTS: In the 2008 and 2009 surveys, 53% of 4,777 participants (77.9% women, 22.1% men, mean age 82 years) were identified (based on care documentation) as having dementia. More than one third of this population (n = 759, 85.1% women, 14.1% men, mean age 85 years) was probably malnourished; thus, the prevalence rate in the group of people with dementia was 10% higher compared to the group without dementia. People with dementia showed a higher risk in all relevant risk indicators (weight history, body mass index, and food intake) for malnutrition compared to those without dementia. Furthermore, people with dementia had higher care dependency rates and required more assistance for eating and drinking. CONCLUSION: The study results confirm the relationship between malnutrition and dementia. The use of standardized nutrition screening tools is not common practice in German nursing homes yet. However, the results suggest that with an increasing risk for malnutrition combined with dementia the proportion of nursing interventions also increases, which means that nurses must react adequately. Nevertheless, the interventions concerning malnutrition should be improved especially with respect to preventive measurements.

[Prevalence of malnutrition, interventions and quality indicators in German nursing homes - first results of a nationwide pilot study]. / Prävalenz von Mangelernährung, Maßnahmen und Qualitätsindikatoren in deutschen Altenpflegeheimen - erste Ergebnisse einer landesweiten Pilotstudie.

AIM OF THE STUDY: The aims of this study were to test the transfer and feasibility of a Dutch annual survey on malnutrition into German nursing homes and to gather first data about the prevalence of malnutrition, treatment and quality indicators in German resident homes. METHODS: A cross-sectional multicentre study, using a standardised multilevel instrument (observation, questionnaire) developed in the University of Maastricht was applied. Variables are indicators for malnutrition and its risks, quality indicators, care dependency and treatment initiatives. RESULTS: The sample consisted of 32 nursing homes with 2,444 participating residents. 26% of the residents show indicators of malnutrition, a risk of malnutrition can be found in another 28%. Only one quarter of the nursing homes use a standardised nutritional screening instrument. Significantly more people with dementia have indicators of malnutrition. Most facilities provide a protocol or a guideline for the prevention and treatment of malnutrition. Also most are training their staff regularly in questions of malnutrition, half the institutions employ dieticians or nutritionists. Special treatment was initiated in half of all residents having indicators of malnutrition or showing a risk. CONCLUSION: The Dutch instrument is applicable in German nursing homes. Its utilisation shows that malnutrition is still a problem in German nursing homes. The standardised assessment of nutritional status is the exception; the interventions carried out should be improved.