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2.
Gut ; 69(2): 201-223, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31776230

RESUMO

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.


Assuntos
Pólipos do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Vigilância da População/métodos , Colonoscopia/normas , Medicina Baseada em Evidências/métodos , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Recidiva Local de Neoplasia/diagnóstico , Seleção de Pacientes , Período Pós-Operatório
3.
J Nurs Adm ; 49(12): 586-590, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31725518

RESUMO

OBJECTIVE: The aim of this study was to describe the transition-to-practice experience of new-graduate nurses (NGNs) in long-term-care (LTC) settings. BACKGROUND: Transitioning to professional practice is a challenging time for an NGN. This experience is scarcely described for RNs outside of acute care settings and not described for the LPN. METHODS: A qualitative case study was used to explore the described transition-to-practice experience of new-graduate RNs and LPNs in LTC. RESULTS: This study revealed that the transition-to-practice experience of new-graduate LPNs was similar to the experience described by RNs. Differences in experience were related to leadership roles in the setting. CONCLUSIONS: Findings contribute to new understanding of the experience of the NGN in LTC settings. This study reinforces the need for greater support for nursing graduates in this setting.


Assuntos
Técnicos de Enfermagem/psicologia , Técnicos de Enfermagem/normas , Assistência de Longa Duração/normas , Papel do Profissional de Enfermagem , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/normas , Enfermagem Prática/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
4.
Clin Interv Aging ; 14: 1783-1795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695348

RESUMO

Objective: To explore variation in medication regimen complexity in residential aged care facilities (RACFs) according to resident age, length of stay, comorbidity, dementia severity, frailty, and dependence in activities of daily living (ADLs), and compare number of daily administration times and Medication Regimen Complexity Index (MRCI) as measures of regimen complexity. Methods: This study was a cross-sectional analysis of baseline data from the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial. The SIMPLER study recruited 242 residents with at least one medication charted for regular administration from 8 RACFs in South Australia. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Dementia severity was assessed using the Dementia Severity Rating Scale. Frailty was assessed using the FRAIL-NH scale. Dependence in ADLs was assessed using the Katz ADL scale. Results: The median age of participants was 87 years (interquartile range 81-92). Over one-third of participants (n=86, 36%) had 5 or more daily medication administration times. The number of daily administration times and MRCI scores were positively correlated with resident length of stay (rs=0.19; 0.27), FRAIL-NH score (rs=0.23; 0.34) and dependence in ADLs (rs=-0.21; -0.33) (all p<0.01). MRCI was weakly negatively correlated with CCI score (rs=-0.16; p=0.013). Neither number of daily administration times nor MRCI score were correlated with age or dementia severity. In multivariate analysis, frailty was associated with number of daily administration times (OR: 1.13, 95% CI: 1.03-1.24) and MRCI score (OR: 1.26, 95% CI: 1.13-1.41). Dementia severity was inversely associated with both multiple medication administration times (OR: 0.97, 95% CI: 0.94-0.99) and high MRCI score (OR: 0.95, 95% CI: 0.92-0.98). Conclusion: Residents with longer lengths of stay, more dependent in ADLs and most frail had the most complex medication regimens and, therefore, may benefit from targeted strategies to reduce medication regimen complexity.


Assuntos
Demência , Fragilidade , Preparações Farmacêuticas , Atividades Cotidianas , Fatores Etários , Idoso de 80 Anos ou mais , Moradias Assistidas , Comorbidade , Estudos Transversais , Demência/complicações , Feminino , Fragilidade/complicações , Humanos , Tempo de Internação , Assistência de Longa Duração , Masculino , Sistemas de Medicação , Preparações Farmacêuticas/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Austrália do Sul
5.
Clin Interv Aging ; 14: 1797-1815, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695349

RESUMO

Purpose: The main objective of this study was to investigate abuse of residents with either dementia or Alzheimer's disease in long-term care settings, to identify facilitators and barriers surrounding implementation of systems to prevent such occurrences, and to draw conclusions on combating the issue of abuse. Patients and methods: A systematic review was conducted using the Medline, CINAHL, and Academic Search Ultimate databases. With the use of key terms via Boolean search, 30 articles were obtained which were determined to be germane to research objectives. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Residents with dementia or Alzheimer's disease are at greater risk of abuse. The growing population could increase this problem exponentially. The most common facilitators were the introduction of policies/programs in the facility, education, and working conditions. The most cited barriers were poor training, lack of research, and working conditions in the long-term care setting. Conclusion: The examples given would be useful in minimizing the potential for abuse in the long-term care setting. Leadership can take an active role in the prevention of abuse of the elderly through their actions, education of employees, and changes in the work environment.


Assuntos
Doença de Alzheimer , Maus-Tratos ao Idoso/prevenção & controle , Pessoal de Saúde/educação , Política Organizacional , Local de Trabalho/organização & administração , Idoso , Doença de Alzheimer/psicologia , Demência/psicologia , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Assistência de Longa Duração , Casas de Saúde/organização & administração , Fatores de Proteção , Fatores de Risco
6.
Spec Care Dentist ; 39(6): 557-563, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31633206

RESUMO

AIM: To survey long-term residences' health care personnel's opinions and attitudes toward maintenance of older adults' daily oral hygiene. METHODS AND RESULTS: The survey was directed to the health care personnel of three long-term care facilities in Helsinki, Finland. We analyzed the survey responses focusing on opinions and attitudes toward older adults' daily oral hygiene. To measure this aspect, a scoring system was developed. When the analysis was based on two specific statements, 60% of responding members of health care personnel had a negative attitude toward older adults' oral hygiene. They tended to experience more refusals when assisting oral hygiene measures, more often experienced a lack of time, and were willing to get more training related to the task. CONCLUSION: The health care personnel of long-term care facilities considered older adults' oral health important. Members of the health care personnel who showed a negative attitude with our scoring system toward older adults' daily oral hygiene indicated in their questionnaire responses the need for additional training and additional time for the task.


Assuntos
Assistência de Longa Duração , Higiene Bucal , Idoso , Atitude do Pessoal de Saúde , Finlândia , Humanos , Saúde Bucal , Inquéritos e Questionários
7.
Pflege ; 32(6): 353-363, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31640470

RESUMO

Tracking systems in people with dementia in long-term care - an integrative review Abstract. Schlüsselwörter: Tracking-Systeme, Überwachungssysteme, Personenortung, Demenz, stationäre Langzeitpflege Tracking systems in people with dementia in long-term care - an integrative review Background: Tracking systems are used increasingly in long-term care settings. However, their use is controversial. AIM: This paper examines how tracking systems are used to monitor people with dementia in long-term care facilities and what the consequences are for both residents and staff. METHODS: A systematic literature review was conducted in the PubMed, CINAHL, Livivo, ScienceDirect data bases and a hand search also took place. Included were studies, reviews and research reports in German and English from 2013 onwards. RESULTS: A total of eight references were included in the analysis. The results point to an ambivalent use of tracking systems in nursing. Nursing professionals face challenges in the areas of trust and distrust as well as autonomy and security. For residents, this means new opportunities for mobility and self-determination, but also more pressure due to continuous monitoring. CONCLUSIONS: The results show that the current debate on the use of tracking systems for people with dementia in long-term care settings concentrates mostly on the economic aspects, whereas aspects of person-centered care, ethical conflicts or the experience of those affected are given less attention. A core finding is that the use of technology changes the work processes and roles of professional carers.


Assuntos
Demência/terapia , Sistemas de Identificação de Pacientes , Humanos , Assistência de Longa Duração
9.
BMC Health Serv Res ; 19(1): 745, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651314

RESUMO

BACKGROUND: The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar. METHODS: The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support. RESULTS: Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention. CONCLUSIONS: There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts.


Assuntos
Casas de Saúde/normas , Cuidados Paliativos/normas , Melhoria de Qualidade/normas , Comparação Transcultural , Europa (Continente) , Humanos , Assistência de Longa Duração/normas , Assistência Terminal/normas
10.
Z Gerontol Geriatr ; 52(Suppl 4): 212-221, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31628613

RESUMO

BACKGROUND: Older general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). METHODS: A cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients' cognitive status. RESULTS: Care challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations. CONCLUSION: The findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.


Assuntos
Disfunção Cognitiva/epidemiologia , Serviços de Saúde para Idosos/organização & administração , Hospitais Gerais/estatística & dados numéricos , Assistência de Longa Duração , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/terapia , Cuidados Críticos , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino
13.
Nihon Koshu Eisei Zasshi ; 66(9): 582-592, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31588094

RESUMO

Objective Many preventive care supporter (e.g. kaigo-yobo supporter) training programs, conducted to train community residents, are developed by municipalities. However, it is not necessary that only municipalities can train people effectively or efficiently. In this paper, we initially reviewed the relevant literature and clarified the definitions of concepts like "program contents" and "evaluation indicators," while also planning our own training programs. Later, we developed a program based on the review and examined the results.Methods The literature of the training program was examined, and the training program was developed based on the result. Four researchers and three public health nurses from a community general support center, in the Otsuchi Town of Iwate Prefecture, developed a training program from June to September 2017. The training program developed was then conducted from October to November 2017. To evaluate the participants' satisfaction with the program, a self-report survey was conducted. To evaluate the outcomes of the program, we measured their degree of comprehension of their community's challenges, before and after the program.Results The training program was divided into two parts following the literature review. In the first part, the content of the supporters' activities following the program was determined (Type A), and, in the second, the same content was evaluated by the participants within the program (Type B). Type A consisted of various aspects including both concrete knowledge and skills needed to conduct care preventiveactivities after the program. In Type B, there were many aspects-including both lectures and exercises-that aimed to increase the participants' awareness of community challenges, as well as inspection to learn about pioneering activities which helped them consider concrete care preventive activities following the program. In Otsuchi Town, we found it to be imperative for participants to consider how to respond to various situations and accordingly plan the training program for use in Type B. To evaluate the results, 12 participants were analyzed. Participants included two men and ten women, with an average age of 71.4±10.0 years [range: 53-88]. Comprehension levels of community challenges (3.1→4.1, P=0.046), as well as the confidence to actively involve themselves in their own preventive care strategies (3.4→4.0, P=0.035), significantly increased after involvement in the program. However, their confidence to work for community preventive care support groups (3.1→3.5, P=0.227) did not increase significantly.Conclusion We clarified certain viewpoints, such as the purpose, content, and evaluation indices of community care training programs, by reviewing the relevant literature. Based on the discovered viewpoints, we were then able to obtain certain results through implementing our own training programs, thereby significantly increasing participant comprehension and confidence levels.


Assuntos
Serviços de Saúde Comunitária , Educação em Saúde/métodos , Assistência de Longa Duração , Serviços Preventivos de Saúde/métodos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Voluntários/educação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revisão Sistemática como Assunto
14.
Expert Opin Drug Saf ; 18(11): 1091-1098, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31524003

RESUMO

Objectives: Inappropriate prescription is a problem related to aging and deprescription could be a possible strategy. The aim of this study was to adapt the available evidence on deprescribing to the medication management of older people living in long-term care facilities. Methods: The authors carried out a bibliographic search based on the most prevalent drugs in our context to develop a specific deprescribing intervention. A committee of experts reviewed this intervention which was later validated through an interobserver variability study. Finally, the authors evaluated it in a sample of patients through a controlled before-after study. Results: The authors included 119 subjects living in a public elderly long-term care center and 122 controls living in a center with similar clinical characteristics. The authors evaluated 852 medications, identifying a total of 175 (20.5%) potentially inappropriate medications and 162 (92.5%) drugs were deprescribed (1.4 per patient). The application of the intervention meant an annual saving of 9.525.25 €. Conclusion: The implementation of a deprescribing intervention aimed at the most prevalent drugs prescribed in a particular setting improves the appropriateness of pharmacotherapy in the patients.


Assuntos
Desprescrições , Prescrição Inadequada/prevenção & controle , Conduta do Tratamento Medicamentoso/organização & administração , Lista de Medicamentos Potencialmente Inapropriados , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Custos de Medicamentos , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Prescrição Inadequada/economia , Assistência de Longa Duração/normas , Masculino , Casas de Saúde , Padrões de Prática Médica/normas
15.
Eur J Oncol Nurs ; 42: 126-133, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31522057

RESUMO

PURPOSE: Breast cancer patients have many needs, including strategies to cope with the associated distress, during and after cancer treatment. Establishing and implementing adequate social and emotional support for these women, to reduce the detrimental effects of stress resulting from their treatment and disease, is the need of the hour. This study aims to assess how women, diagnosed and treated for breast cancer, combat emotional stress using mechanisms of coping and control and emotional defense, as well as to identify potential groups among them, with different long-term patterns and needs. METHODS: 98 patients belonging to a local breast cancer support association (ALMOM), were enrolled in this study. A questionnaire specifically designed for them was administered, and its internal consistency and reliability assessed. A hierarchical clustering was employed to classify the women. The questionnaire focused on four sections, including personal feelings, coping strategies, environmental influences and maladaptive coping. RESULTS: An adequate internal reliability was obtained with Cronbach's α near or greater than 0.60. Personal feelings were significant and clearly correlated with coping strategies and maladaptive coping. Three groups of women with different patterns of emotional characteristics and needs were identified: positivist, unsafe, and hopeless women, with different long-term emotional needs to be satisfied. CONCLUSIONS: Psychological therapeutic interventions should be maintained in many breast cancer patients over time, even after treatment completion, in order to consolidate adaptive and sustainable responses.


Assuntos
Neoplasias da Mama/psicologia , Estresse Psicológico/prevenção & controle , Adaptação Psicológica , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Estudos Transversais , Emoções , Feminino , Humanos , Assistência de Longa Duração , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
16.
BMC Public Health ; 19(1): 1230, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488100

RESUMO

BACKGROUND: The technical efficiency (TE) of care among the elderly in long-term care facilities (LTCF) have become increasingly crucial policy concerns faced by developing countries and Asia, especially China. The purpose of this study was to evaluate the TE and the quality of care and identify its influencing factors among LTCF. METHODS: A total of 32 registered LTCF in Xiamen of China were surveyed in 2016. The Banker-Charnes-Cooper (BCC) model and Slacks-Based Measure (SBM) model of Data Envelopment Analysis (DEA) were used to evaluate the TE of LTCF. The TE has been decomposed into pure technical efficiency and scale efficiency. Utilization of DEA with human, financial, and material resources as inputs and quantity, quality of nursing care as outputs allowed estimation of the relative TE of care in LTCF. In addition, this study applied SBM to measuring the efficiencies and slacks. Furthermore, Tobit model was performed to explore factors associated with TE. RESULTS: There were 7 public and 25 private LTCF respectively, with a total of 6729 beds and 3154 elderly people. 17 LTCF were technically efficient (53.1%). In the BCC model, the average TE was 0.963. The average pure technical efficiency and scale efficiency of LTCF were 0.979, 0.984, respectively. There were 5 LTCF with increasing returns to scale, 8 LTCF with decreasing returns to scale. In the SBM model, the average TE was 0.813, and it had the same effective decision-making unit with SBM model. Depending on TE score from high to low, the top eight are private LTCF, and the last four were public LTCF. The slack analysis showed that they can be reduced in 8 LTCF with decreasing returns to scale such as 53.31% administrative staffs, 67.73% medical staffs, 33.1% caregivers, 51.66% paramedical staffs and 4.1% beds on average. The TE of private LTCF was higher than that of public LTCF. The LTCF in urban were more effective than rural. The TE of LTCF raised by increasing of working hours, training frequency and institutional occupancy. CONCLUSIONS: The overall TE of LTCF in Xiamen of China was relatively high, especially in private institutions. However, LTCF still needs to further improve the utilization of physical resources and the management and training of human resources. The TE of LTCF was associated to their location, institutional nature, allocation of human resources and occupancy rate. It was needed to focus on promoting the efficiency and quality of LTCF in order to achieve sustainability.


Assuntos
Eficiência , Instalações de Saúde , Qualidade da Assistência à Saúde , Idoso , China , Interpretação Estatística de Dados , Humanos , Assistência de Longa Duração , Modelos Estatísticos
17.
Psychiatr Danub ; 31(Suppl 3): 345-353, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488751

RESUMO

BACKGROUND: Elder abuse and neglect can be defined as refusing or failing to fulfil a caregiver's obligation to meet the needs of elderly individuals in order to punish or hurt them. We aimed to explore perceptions of elder mistreatment of both caregivers and residents during long-term care, and highlight significant differences in the overall mistreatment perception regarding socio-demographic variables, as well as the type of care facility. SUBJECTS AND METHODS: The study involved 171 caregivers and 245 elderly individuals in stationary facilities. Two structured questionnaires were used - one for caregivers and the other for institutionalized elderly residents, whose initial validation concerning question and factor selection has been based upon exploratory factor analysis and discriminant validity. Parametric and nonparametric tests were employed in the statistical analysis, and statistical significance was set at p<0.05 (two-sided). RESULTS: We found significant differences in the perception of elder abuse and neglect between caregivers and elderly residents. More specifically, caregivers tend to recognize unnecessary or inappropriate medical/care procedures as indicators of elder mistreatment, while the elderly residents emphasize the removal of their personal belongings and inappropriate physical contact. According to the care facility, residents reported abuse/neglect more frequently in extended care units (21.4%), compared to the county-owned nursing home (11.4%) and private nursing home (12.1%) (p=0.001). Similarly, caregivers reported abuse/neglect more frequently in extended care units (75.4%), in comparison to county-owned nursing home (24.6%) and private nursing home (0%) (p=0.039). Shift work was also a significant predictor, as the morning nursing staff perceived abuse/neglect more frequently (p=0.011). CONCLUSIONS: This study has shown that residents and caregivers have contrasting vantage points in relation to elder abuse/neglect perception, which underlines the need for evidence-based standardization of procedures to prevent any type of elder mistreatment.


Assuntos
Cuidadores/psicologia , Maus-Tratos ao Idoso/psicologia , Assistência de Longa Duração/normas , Idoso , Maus-Tratos ao Idoso/prevenção & controle , Humanos , Assistência de Longa Duração/estatística & dados numéricos , Casas de Saúde/normas , Casas de Saúde/estatística & dados numéricos , Inquéritos e Questionários
18.
Z Gerontol Geriatr ; 52(8): 737-742, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31501926

RESUMO

BACKGROUND-OBJECTIVE: In 2015 almost 2.9 million people in Germany received nursing care insurance benefits. More than 27% of those in need of long-term care lived in inpatient care facilities. Of the residents 6% included in the examination by the Medical Services of the Leading Association of Healthcare Insurances (MDS) had chronic wounds or bedsores requiring treatment. The aim of the study was to gain insights into care decisions and the research question was: what is the process of wound care in nursing homes? METHODS: The study used a qualitative design. Based on four inpatient nursing facilities of different ownership, the data were collected with 19 guideline-based interviews, the average duration being 62 min. All interviews were transcribed and analyzed using the qualitative MAXQDA 18 software. RESULTS: The exclusively resident-related rule processes with the known interface problems pose challenges for general practitioners and nursing homes and reach their limits. They promote the emergence of additional players, so-called homecare companies, which are not provided for in the German healthcare system and thus also not in the remuneration system. In new care structures, homecare companies are taking over the wound care process almost completely. They are financed through prescription business, i.e. through discounts granted by drug manufacturers. CONCLUSION: For nursing homes and general practitioners, homecare companies offer a welcome opportunity to meet the complex requirements of the care process while simultaneously saving their own resources. The financing of services from manufacturer discounts gives rise to fears that products with a higher cost margin will be preferentially used, thus counteracting the economic viability requirement for services provided by statutory healthcare insurance.


Assuntos
Aconselhamento , Casas de Saúde , Prescrições , Alemanha , Humanos , Assistência de Longa Duração
19.
BMC Res Notes ; 12(1): 557, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481129

RESUMO

BACKGROUND: Excessive and patterned ambulation is associated with falls, urinary tract infections, co-occurring delirium and other acute events among long-term care residents with cognitive impairment/dementia. This study will test a predictive longitudinal data model that may lead to the preservation of function of this vulnerable population. METHODS/DESIGN: This is a single group, longitudinal study with natural observations. Data from a real-time locating system (RTLS) will be used to objectively and continuously measure ambulation activity for up to 2 years. These data will be combined with longitudinal acute event and functional status data to capture patterns of change in health status over time. Theory-driven multilevel models will be used to test the trajectories of falls and other acute conditions as a function of the ambulation activity and demographic, functional status, gait quality and balance ability including potential mediation and/or moderation effects. Data-driven machine learning algorithms will be applied to run screening of the high dimensional RTLS data together with other variables to discover new and robust predictors of acute events. DISCUSSION: The findings from this study will lead to the early identification of older adults at risk for falls and the onset of acute medical conditions and interventions for individualized care.


Assuntos
Disfunção Cognitiva/fisiopatologia , Demência/fisiopatologia , Assistência de Longa Duração , Modelos Teóricos , Projetos de Pesquisa , Caminhada/fisiologia , Adulto , Humanos , Estudos Longitudinais , Tamanho da Amostra
20.
BMC Neurol ; 19(1): 220, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492151

RESUMO

BACKGROUND: Stroke patients are often affected by long-term disabilities with needs concerning social issues. There is relatively little consideration of social recovery of patients and the support required to return to work, receive social benefits, participate in daily life activities, maintain contact with family and friends and to organize financial affairs. In our study we aimed to investigate if existing tools record social needs adequately. We analyzed the current provision of social support provided in long-term care after stroke and whether unmet social needs were associated with quality of life, caregiver burden, overall function and degree of disability. METHODS: Our analysis is part of the Managing Aftercare of Stroke study (MAS-I), a cross-sectional exploratory study of patient needs 2-3 years after initial stroke. Assessment tools included the Nikolaus-score (social situation), the EuroQoL (quality of life), the German Burden Scale for Family Caregivers (caregiver burden), the modified Rankin Scale (disability / dependence), Stroke Impact Scale (function and degree of disability) and the Stroke Survivor Needs Questionnaire (unmet needs). RESULTS: Overall 57 patients were included in MAS-I, with ten patients classified in urgent need of socio-economic support according to the Nikolaus-score. Patients with lower than normal Nikolaus-score had a higher degree of disability. Thirty percent of all patients had never received professional social support. Social worker contact happened mostly during the stay in acute hospital or rehabilitation institution. Only four patients (11%) reported long-term support after discharge. Apart from social worker contact during acute care, 43% of patients had unmet needs in the long-term aftercare. Forty percent of all patients included in MAS-I were recommended for social work intervention after an in-depth analysis of their situation. Finally, we saw that unmet social needs were associated with lower quality of life and higher caregiver burden. CONCLUSIONS: Our data suggest significant unmet needs in social care in long-term stroke patients. Screening tools for unmet social needs such as the Nikolaus-score do not holistically report patients' needs. TRIAL REGISTRATION: Clinicaltrials.Gov NCT02320994 . Registered 19 December 2014 (retrospectively registered).


Assuntos
Qualidade de Vida , Apoio Social , Serviço Social , Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Estudos Transversais , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Reabilitação do Acidente Vascular Cerebral , Inquéritos e Questionários , Sobreviventes
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