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1.
Arch Gerontol Geriatr ; 86: 103955, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31561064

RESUMO

BACKGROUND: Increased awareness of the clinical course of nursing home residents with advanced dementia and advance care planning (ACP) has become the cornerstone of good palliative care. OBJECTIVE: The aim of our study is to describe changes in ACP in the form of physician treatment orders (PTOs), symptom prevalence and possible burdensome interventions among nursing home (NH) residents who died between 2004-2009 and 2010-2013 METHODS: Retrospective study RESULTS: The number of PTOs regarding forgoing antibiotics or parenteral antibiotics, forgoing artificial nutrition or hydration or forgoing hospitalisation doubled between 2004-2009 and 2010-2013 (38.1% vs. 64.9%, p < 0.001; 40.0% vs. 81.7%, p < 0.001; 28.1% vs. 69.5%, p < 0.001, respectively). PTOs were also done significantly earlier in 2010-2013 than in 2004-2009. The prevalence of distressing symptoms and possible burdensome interventions remained unchanged, although the prevalence of consistency with the PTOs was high. CONCLUSION: Despite the increased number of PTOs, this had little effect on symptom prevalence and possible burdensome interventions experienced by NH residents in the last days of life.


Assuntos
Planejamento Antecipado de Cuidados/tendências , Diretivas Antecipadas/estatística & dados numéricos , Demência/terapia , Casas de Saúde/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Morte , Demência/mortalidade , Demência/psicologia , Feminino , Finlândia/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Hospitalização , Humanos , Masculino , Prevalência , Estudos Retrospectivos
2.
Artigo em Inglês | MEDLINE | ID: mdl-31717812

RESUMO

The oral health of an ageing population, especially that of the institutionalized elderly population, constitutes a significant concern because it is closely linked to general health and the quality of life. Shared common risk factors drive the development and worsening of poor oral health and non-communicable diseases, which eventually lead to self-care inability. Several studies have reported on the poor oral health of the institutionalized elderly population. However, few comprehensive reports exist regarding the relationship between poor oral health, the oral health-related quality of life (OHRQoL) and the associated factors in this specific population. Objective: The objective is to describe recently reported oral health levels, the OHRQoL and the associated factors among older institutional residents. Methods: Studies published between July 2009 and June 2019 in MEDLINE, EMBASE and CINAHL were searched. The population, intervention, comparison and outcome (PICO) strategy was used as a guide. The reported factors related to poor oral health were identified (i.e., age, gender, educational level, acquired systemic conditions or dementia/cognitive impairment). Results: Twenty-five surveys (or study series) from 19 countries were included. The level of evidence reported by these studies was generally moderate to strong. The reported oral cleanliness and health of the surveyed institutionalized elderly were poor (>50% of residents had calculus; denture hygiene index > 80%). Gum (approximately 30% of dentate residents had moderate to severe periodontitis), teeth (decayed, missing or filled teeth >20), mucosa (>10% had mucosal lesions) and denture problems (up to 40%) were prevalent and were associated with a poor OHRQoL, especially in females, socially deprived residents or those with mild or above cognitive impairment. Those with a poor OHRQoL might show signs of poor nutrition. Conclusions: This report reviewed evidence-based knowledge on oral health, the OHRQoL and the associated factors among elderly institutional residents. Further research is needed to confirm these observations. For improved oral health, a better OHRQoL and the general well-being of older residents, clinical trials are needed, targeting modifiable factors, such as social inequality, oral healthcare accessibility, and/or nursing home service quality. The relationship between oral health, the OHRQoL and nutrition in this at-risk population also warrants exploration.


Assuntos
Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Idoso , Humanos , Qualidade de Vida
3.
Nutr. hosp ; 36(5): 1074-1080, sept.-oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184629

RESUMO

Antecedentes: la definición y metodología recomendadas para diagnosticar sarcopenia ha ido evolucionando. El consenso más utilizado es el del Grupo Europeo de Trabajo en Sarcopenia en Personas Mayores publicado en 2010 (EWGSOP1), que ha sido actualizado en 2019 (EWGSOP2). Objetivos: determinar la prevalencia de sarcopenia en personas mayores institucionalizadas usando el algoritmo del EWGSOP2 y comparar dichos resultados con los obtenidos en el Granada Sarcopenia Study al aplicar el algoritmo del EWGSOP1. Métodos: para evaluar la sarcopenia se midieron la masa muscular con un impedanciómetro, la fuerza muscular con un dinamómetro y la velocidad de la marcha en un recorrido de cuatro metros. Para la comparación de los resultados se realizó un análisis de sensibilidad y especificidad utilizando la versión 20 de SPSS. Resultados: según el EWGSOP2, el 60,1% tenía sarcopenia y el 58,1% tenía sarcopenia grave, resultados sin diferencias estadísticamente significativas al compararlos con los obtenidos según el EWGSOP1 (63% tenía sarcopenia y 61,2%, sarcopenia grave). Tampoco se hallaron diferencias significativas al comparar los sujetos con baja masa muscular según las fórmulas propuestas en uno y otro consenso, mientras que sí las hubo al comparar los sujetos con baja fuerza muscular debido a la variación en los puntos de corte. Conclusiones: la prevalencia de sarcopenia en personas mayores institucionalizadas es alta, destacando una gran mayoría de sujetos con baja fuerza muscular y bajo rendimiento físico. La utilización de la metodología propuesta por el EWGSOP2 no influyó en los resultados de prevalencia de sarcopenia obtenidos al aplicar el EWGSOP1


Background: the definition and methodology recommended for the diagnosis of sarcopenia has been changing. The mostly applied consensus is the one published by the European Working Group in Older People in 2010 (EWGSOP1), which was updated in 2019 (EWGSOP2). Objectives: assessing the prevalence of sarcopenia in institutionalized older adults using the EWGSOP2 algorithm and comparing these results with the EWGSOP1 algorithm results. Methods: in order to diagnose sarcopenia, muscle mass was assessed using an impedanciometer, muscle strength with a dynamometer and walking speed over a four-meter course. For the comparison of the results, a sensitivity and specificity analysis were performed with the version 20 of SPSS. Results: according to the EWGSOP2, 60.1% of the participants had sarcopenia and 58.1% had severe sarcopenia, results with no statistical differences when they are compared to the results according to the EWGSOP1 (63% had sarcopenia and 61.2%, severe sarcopenia). Neither were statistical differences found when comparing subjects with low muscle mass according to the formulas suggested by both consensus, while there were differences when comparing subjects with low muscle strength due to the variation of cut-off points. Conclusions: the prevalence of sarcopenia in institutionalized older adults is high, being remarkable that the majority of the participants had low muscle strength and low physical performance. The utilization of the methodology proposed by the EWGSOP2 did not have influence in the results of prevalence of sarcopenia obtained when the EWGSOP1 recommendations were applied


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Consenso , Índice de Massa Corporal , Algoritmos , Força Muscular , Absorciometria de Fóton , Estudos Transversais , Antropometria , Desempenho Físico Funcional , Repertório de Barthel
4.
Artigo em Inglês | MEDLINE | ID: mdl-31546837

RESUMO

The oral health state plays an important role in the concept of 'elderly frailty', since institutionalized older people are prone to suffering from bad oral conditions. The aim of this study is to assess the state of oral health in the older residents of nursing homes and to measure its potential association with the cognitive state, the degree of functional autonomy, and the malnutrition risk. Methods: We enrolled 176 subjects from 292 residents in five nursing homes in Florence. For each subject, we performed the Malnutrition Universal Screening Tool, the Pfeiffer test, the Minimum Data Set-Long Form, a dental examination, and the Geriatric Oral Health Assessment Index questionnaire. The results show that the oral condition was poor in 43.8% of cases, medium in 38.1%, and good in 18.2%. A worse oral health state was significantly associated (p < 0.05) with a worse cognitive state and with a higher dependency in daily living activities. The malnutrition score among the older people was unrelated to the oral health condition (p = 0.128). It can be concluded that the oral health condition in older institutionalized subjects is an open challenge for the public healthcare system, since the maintenance of adequate good oral health is an essential element of good physical as well as cognitive and psychological health.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Itália , Masculino
5.
Artigo em Inglês | MEDLINE | ID: mdl-31394752

RESUMO

Public involvement (PI) is of great interest. However, little is known about this topic in the design, development, and/or implementation of health interventions in geriatric facilities. This study aimed to provide a critical overview of the involvement of caregivers and end-users in interventions in these facilities, based on Rifkin's analytical framework. This systematic review, supplemented by a questionnaire to the corresponding authors, covered non-drug intervention reports targeting nurses, doctors, residents, and their relatives. Articles were published in Pubmed, Medline, Scopus, and Cinahl, from January 2016 to April 2018. Ninety-seven articles were included. The review shows a low level or partial PI in geriatric facilities where it exists. These results are further supported by the authors' responses to the questionnaire. PI remains uncommon in geriatric institutions and consists of a consumerist model, suggesting the need for improved practices. More efforts are needed to experiment with recommendations to meet the challenges of PI and enhance the public ownership of interventions. The protocol was registered on Prospero under the number CRD42018098504.


Assuntos
Cuidadores/estatística & dados numéricos , Assistência à Saúde/métodos , Serviços de Saúde para Idosos/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Protocolos Clínicos
6.
BMC Res Notes ; 12(1): 508, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412910

RESUMO

OBJECTIVE: Care homes are a common place of death for older adults, especially those with complex health needs or dementia. Representative, internationally comparable data on care home facilities and their residents is needed to monitor health and wellbeing in this population. Identification and collection of data from care homes can be challenging and often underreported. This paper draws on the experiences of the PACE study, a cross sectional mortality follow back study conducted in six European countries. RESULTS: Multiple challenges were encountered in creating a sampling framework and contacting, recruiting and retaining care homes in the PACE study. Recruiting a randomly identified, representative cohort from a stratified sampling framework was problematic, as was engaging with care homes to ensure high response rates. Variation in the funding of care homes across the six countries involved in the study may explain the additional challenges encountered in England. Awareness of the challenges encountered in England in implementing an international study in care homes can inform the design and implementation of future studies within care homes. Further discussion is needed to determine the barriers and facilitators to conducting research in care homes, and how this is shaped by the focus of the study.


Assuntos
Demência/terapia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Demência/diagnóstico , Demência/mortalidade , Europa (Continente) , Feminino , Humanos , Masculino , Cuidados Paliativos/métodos , Projetos de Pesquisa , Taxa de Sobrevida
7.
BMC Health Serv Res ; 19(1): 607, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464630

RESUMO

BACKGROUND: Most health care services are provided in the primary health care sector, and an increasing number of elderly is in need of these services. Nonetheless, the research on patient safety culture in home care services and nursing homes remains scarce. This study describes staff perceptions of patient safety culture in Norwegian home care services and nursing homes, and assesses how various patient safety culture dimensions contribute to explaining overall perceptions of patient safety. METHODS: Cross-sectional surveys were conducted among healthcare professionals in Norwegian home care services (N = 139) and nursing homes (N = 165) in 2018, response rates being 67.5% and 65%, respectively. A Norwegian version of the international recognized Nursing Home Survey on Patient Safety Culture was used. Descriptive statistics and t-tests were used to explore staff perceptions of patient safety culture. We used multiple regression analyses to explore the degree to which patient safety culture dimensions could explain overall perceptions of patient safety. RESULTS: The number of patient safety dimensions having an average score of more than 60% positive responses was seven out of 10 in nursing homes, and nine out of 10 in home care. Staffing had the lowest scores in both health care services. Home care services scored significantly higher than nursing homes on teamwork (eta squared = .053), while nursing homes scored somewhat higher on handover (eta squared = .027). In home care, total explained variance of overall perceptions of patient safety was 45%, with teamwork, staffing, and handoffs as significant predictors. The explained variance in nursing homes was 42.7%, with staffing and communication openness as significant predictors. CONCLUSIONS: There are differences in perceptions of patient safety culture between nursing homes and home care services. Staffing is important for patient safety perceptions in both health care services. In home care, teamwork seems to be a significant contributing factor to patient safety, and building sound teams with mutual trust and collaboration should therefore be an essential part of managers' work with patient safety. In nursing homes, the main focus when building a good patient safety culture should be on open communication, ensuring that staff's ideas and suggestions are valued.


Assuntos
Serviços de Assistência Domiciliar/normas , Instituição de Longa Permanência para Idosos/normas , Casas de Saúde/normas , Segurança do Paciente/normas , Gestão da Segurança/normas , Adulto , Idoso , Atitude do Pessoal de Saúde , Comunicação , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Serviços de Saúde , Serviços de Assistência Domiciliar/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Casas de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
8.
J Clin Nurs ; 28(23-24): 4504-4512, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31429131

RESUMO

AIMS AND OBJECTIVES: This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). BACKGROUND: A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. DESIGN: Cross-sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. METHODS: In total, 226 older adults with dementia were recruited through convenience sampling at 15 long-term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen-Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini-Mental State Examination and the Barthel Index, respectively. RESULTS: Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. CONCLUSION: Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. RELEVANCE TO CLINICAL PRACTICE: The findings could serve as a valuable reference for long-term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.


Assuntos
Atividades Cotidianas , Demência/epidemiologia , Incontinência Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Demência/psicologia , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Casas de Saúde/estatística & dados numéricos , Prevalência , Testes Psicológicos , Qualidade de Vida , Taiwan , Incontinência Urinária/psicologia
9.
Z Evid Fortbild Qual Gesundhwes ; 146: 7-14, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31375396

RESUMO

BACKGROUND: Reducing adverse drug events in nursing homes is a central patient safety concern. The aim of this study was to assess how often selected medication processes to increase medication safety are already implemented in Swiss nursing homes and to examine how nursing homes that have not yet implemented these processes can be characterized based on their organizational features. METHODS: Cross-sectional survey study among directors of nursing in Swiss nursing homes. RESULTS: 420 of 1,525 invited individuals participated in the survey (response rate: 27.5 %). Of these, 65.0 % stated that regular systematic medication reviews have been provided in their institution. 9.5 % of the nursing homes use a list to identify potentially inappropriate medication, and 6.7 % of the nursing homes have a standardized process to monitor side effects of medications. 66.0 % of the participating nursing homes have implemented at least one of these three processes, 34.0 % of the participating nursing homes have not implemented any of the three processes. Statistically significant differences in process implementation were found according to the geographical location of the nursing home, the type of documentation used for medications, the physician model, the number of external general practitioners, as well as the medication supply channel and the legal obligation to cooperate with pharmacists. No differences were found with regard to the nursing home size. CONCLUSION: In Swiss nursing homes, central safety-relevant medication processes have not yet been implemented nationwide. In particular, implementation is not widespread in nursing homes where medical care for their residents is provided by many different external general practitioners. The organizational features need to be taken into account to successfully implement quality improvement measures.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Prescrição Inadequada/estatística & dados numéricos , Casas de Saúde , Segurança do Paciente , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Alemanha , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Erros de Medicação/prevenção & controle , Casas de Saúde/estatística & dados numéricos
10.
Health Qual Life Outcomes ; 17(1): 111, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31255183

RESUMO

BACKGROUND: Self-rated health (SRH) is a health measure used in studies of older adults. The objective of this study is to analyze SRH as a predictor of mortality in the institutionalized older population and the characteristics of those who do not provide information about their SRH on health questionnaires. METHODS: This is a 15-year follow-up study of older adult residents in nursing or care homes in of Madrid, Spain. SRH was measured on a 5-point Likert type scale. The association between answering the SRH question and socio-demographic and health characteristics was evaluated through prevalence ratio (PR), estimated by Poisson regression models. Survival rates associated with SRH were studied through a multivariate Cox regression. RESULTS: The sample has a mean age of 83.4 (standard deviation, SD = 7.3), with 75.7% women. Twelve percent did not answer the SRH item. Those who did not answer showed a higher probability of disability (Barthel index, PR = 0.76, 95% confidence interval = 0.67-0.86) and/or dementia (PR = 8.03, 3.38-19.03). A trend for higher mortality was observed in those persons who did not respond (adjusted hazard ratio HR = 1.26, 0.75-2.11). The mortality rate was 32% higher for those who declared poor SRH in comparison with those who reported good SRH (adjusted HR = 1.32, 1.08-1.6). CONCLUSIONS: There is an elevated number of people who do not respond to the SRH item, mainly those with disabilities and cognitive deterioration. Lack of response to SRH is a good indicator of 15-year mortality for persons institutionalized in care or nursing homes.


Assuntos
Nível de Saúde , Qualidade de Vida , Autorrelato/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Seguimentos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Espanha , Análise de Sobrevida
11.
Cien Saude Colet ; 24(5): 1895-1902, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31166522

RESUMO

This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.


Assuntos
Anti-Inflamatórios/efeitos adversos , Interações de Medicamentos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Estudos Transversais , Feminino , Humanos , Masculino , Polimedicação , Espanha
12.
BMC Health Serv Res ; 19(1): 349, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151437

RESUMO

BACKGROUND: The Targeted Intervention Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a three-month cluster randomised controlled trial demonstrated reduction in agitation in nursing home residents with dementia. To ease replication and future implementation, and to clarify possible causal mechanisms, we performed a process evaluation of the intervention based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). METHODS: An exploratory and a quasi-experimental design with mixed methods were used. The RE-AIM dimensions were explored by questionnaires to 807 staff members and 46 leading ward nurses in both the intervention nursing homes (INH) and the control nursing homes (CNH), before the start of the trial (baseline), and six and 12 months later. These questionnaires assessed data regarding the reach, effectiveness (staff level) and adoption dimensions. To assess implementation, we used a checklist for performance of the main components in TIME and analysed the minutes from 84 case conferences in the INH. To explore adoption and maintenance, five focus group interviews with 32 participants from the staff in the INH were conducted three to 6 months after the end of the trial. RESULTS: Reach: On average 61% (SD 22) of the staff in each ward in the INH attended the training sessions. Effectiveness at staff level: There were no between-group differences throughout the study period for attitudes towards dementia, perceived competence or perception of mastery and social interaction. Adoption: 16 of the 17 INH completed the intervention. IMPLEMENTATION: 75% or more of the components of TIME were performed for 91% of the included residents. Maintenance: Most of the nursing homes used TIME three to 6 months after the end of the trial. An easy to grasp model and an engaged leadership facilitated the intervention and maintenance. CONCLUSIONS: A high degree of reach, adoption, implementation and maintenance contributed to the effectiveness of TIME at resident level. One other causal assumption of the effectiveness of TIME is the development in the staff of a new, shared and situated knowledge about each individual resident, not reflected by measurements in general knowledge and attitudes. TRIAL REGISTRATION: The trial was registered January 6, 2016 with ClinicalTrials.gov ( NCT02655003 ).


Assuntos
Demência/psicologia , Agitação Psicomotora/etiologia , Adulto , Idoso , Atitude do Pessoal de Saúde , Análise por Conglomerados , Demência/terapia , Feminino , Grupos Focais , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Projetos de Pesquisa
14.
An. sist. sanit. Navar ; 42(1): 19-30, ene.-abr. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183043

RESUMO

Fundamento. La evaluación del dolor crónico se realiza con frecuencia en los centros de atención sanitaria. El objetivo de este estudio es analizar las propiedades psicométricas de la escala del grado de dolor crónico (CPGS) -que incluye tanto una medición del dolor como sus efectos incapacitantes en las actividades de la vida diaria- en personas de la tercera edad. Material y Método. Estudio transversal en 185 personas con dolor crónico de dos residencias de la tercera edad. El cuestionario CPGS, adaptado por traducción inversa, se administró como entrevista estructurada; se evaluó su fiabilidad, consistencia interna, validez de constructo, validez convergente y divergente (respecto a las puntuaciones del SF-12) y validez discriminante. Se compararon las variables del estudio entre los grupos derivados de la aplicación de la escala. Resultados. La escala mostró una fiabilidad adecuada (alfa=0,90), bidimensionalidad (intensidad y discapacidad), buena validez convergente y divergente y adecuada validez discriminante. Las personas de los grados I y II mostraron mejor salud física que las de los grados III y IV, pero las del grado II no se diferenciaron en salud mental respecto del grado IV (discapacidad muy alta o limitante). Este grado IV fue más frecuente entre hombres, personas sin estudios y jubilados. Conclusiones. La versión española del CPGS ha demostrado ser válida y fiable para evaluar tanto la intensidad del dolor crónico como la discapacidad asociada en personas de la tercera edad


Background. Assessment of chronic pain is frequently done in care centers. The aim of this study was to analyze the psychometric properties of the Chronic Pain Grade Scale (CPGS) - that measures both the intensity of chronic pain and its incapacitating effects on the everyday activities of the elderly. Method. Cross-sectional study of 185 people with chronic pain from two nursing homes. The questionnaire was adapted by back-translation and administered as a structured interview. It was assessed for reliability, internal consistency, construct validity, convergent and divergent validity (regarding the SF-12 score) and discriminant validity. Studied variables were compared among the pain groups derived from applying the scale. Results. The scale showed sufficient reliability (alfa=0.90), bidimensionality (intensity and disability), good convergent and divergent validity and sufficient discriminant validity. Elderly people in groups I and II had better physical health than those in groups III and IV, but group II people had similar mental health to those from group IV (highest/limiting disability). Males, people with no education and pensioners were more frequently classified as group IV. Conclusion. The Spanish version of the CPGS has proved to be valid and reliable for evaluating both intensity and disability related to chronic pain in older people living in nursing homes


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Medição da Dor/métodos , Dor Crônica/epidemiologia , Manejo da Dor/métodos , Atividades Cotidianas/classificação , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , População Institucionalizada , Estudos Transversais , Escala Visual Analógica , Psicometria/métodos
15.
BMC Geriatr ; 19(1): 62, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30823874

RESUMO

BACKGROUND: Frail individuals are at risk of significant clinical deterioration if their frailty is not identified and managed appropriately. Research suggests that any interaction between an older person and a health or social care professional should include an assessment for frailty. Many older care home residents are frail when admitted, but we have little knowledge of whether or how this is assessed. The aim of this paper is to understand and establish the characteristics of the reported 'assessments for frailty' used in care homes with nursing (nursing homes) across North-West London. This will help understand what an 'assessment for frailty' of care home residents mean in practice in North-West London. METHODS: Telephone contact was made with every Care Quality Commission (CQC) (independent regulator of health and adult social care in England) regulated nursing home across North-West London [n = 87]. An online survey was sent to all that expressed interest [n = 73]. The survey was developed through conversations with healthcare professionals, based on literature and tested with academics and clinicians. Survey responses were analysed using descriptive statistics. The Mann-Whitney U test was used for statistical analyses. RESULTS: 24/73 nursing homes completed the survey (33%). Differences in the characteristics of reported 'assessments for frailty' across nursing homes were evident. Variation in high level domains assessed (physical, social, mental and environmental) was observed. Nurses were the most common professional group completing assessments for frailty, with documentation and storage being predominantly paper based. A statistically significant difference between the number of assessments used in corporate chain owned nursing homes (3.9) versus independently owned nursing homes (2.1) was observed (U = 21, p = .005). CONCLUSIONS: Great variation existed in the characteristics of reported 'assessments for frailty' in nursing homes. Our study suggests that not all physical, social, mental and environmental domains of frailty are routinely assessed: it appears that frailty is still primarily viewed only in terms of physical health. The consequences of this could be severe for patients, staff and healthcare settings. Research illustrates that frailty is a broad, multifactorial health state and, as such, an overall 'assessment for frailty' should reflect this.


Assuntos
Fragilidade/diagnóstico , Avaliação Geriátrica/estatística & dados numéricos , Instituição de Longa Permanência para Idosos , Casas de Saúde , Qualidade da Assistência à Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fragilidade/epidemiologia , Inquéritos Epidemiológicos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Londres , Masculino , Casas de Saúde/estatística & dados numéricos , Relações Profissional-Paciente
16.
Osteoporos Int ; 30(7): 1363-1370, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30877349

RESUMO

Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home. INTRODUCTION: Fall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture. METHODS: Data was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied. RESULTS: Crude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture. CONCLUSIONS: The risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.


Assuntos
Institucionalização/estatística & dados numéricos , Fraturas por Osteoporose/reabilitação , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Fraturas do Quadril/mortalidade , Fraturas do Quadril/reabilitação , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Vida Independente/estatística & dados numéricos , Masculino , Casas de Saúde/estatística & dados numéricos , Fraturas por Osteoporose/mortalidade , Medição de Risco/métodos
17.
PLoS One ; 14(3): e0197789, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30822307

RESUMO

BACKGROUND AND OBJECTIVES: Nursing or care home characteristics may have a long-term impact on the residents' mortality risks that has not been studied previously. The study's main objective was to assess the association between facility ownership and long-term, all-cause mortality. RESEARCH DESIGN AND METHODS: We conducted a mortality follow-up study on a cohort of 611 nursing-home residents in the city Madrid, Spain, from their 1998-1999 baseline interviews up to September 2013. Residents lived in three types of facilities: public, subsidized and private, which were also sub-classified according to size (number of beds). Residents' information was collected by interviewing the residents themselves, their caregivers and facility physicians. We used time-to-event multivariable models and inverse probability weighting to estimate standardized mortality risk differences. RESULTS: After a 3728 person-year follow-up (median/maximum of 4.8/15.2 years), 519 participants had died. In fully-adjusted models, the standardized mortality risk difference at 5 years of follow-up between medium-sized private facilities and large-sized public facilities was -18.9% (95% confidence interval [CI]: -33.4 to -4.5%), with a median survival (95% CI) of 3.6 (0.5 to 6.8) additional years. The fully-standardized 5-year mortality difference (95% CIs) between for-profit private facilities and not-for-profit public institutions was -15.1% (-31.1% to 0.9%), and the fully-standardized median survival difference (95% CIs) was 3.0 (-1.7 to 7.7) years. DISCUSSION AND IMPLICATIONS: These results are compatible with an association between factors related with the ownership of facilities and the long-term mortality risk of their residents. One of these factors, the facility size, could partly explain this association.


Assuntos
Instituições Privadas de Saúde/organização & administração , Instituição de Longa Permanência para Idosos/organização & administração , Mortalidade , Casas de Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Instituições Privadas de Saúde/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Casas de Saúde/estatística & dados numéricos , Propriedade , Espanha/epidemiologia
18.
Int J Geriatr Psychiatry ; 34(7): 1029-1040, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30907450

RESUMO

OBJECTIVES: Little is known about the use of antidementia medications in Australia. Other countries have reported sociodemographic disparities in use. Our objective was to estimate prevalence, duration, and time to initiation of antidementia medication (cholinesterase inhibitors or memantine) among Australians with dementia in residential aged care facilities and to evaluate resident and facility factors associated with use. METHODS: Dynamic retrospective cohort study of people with dementia in 68 residential aged care facilities during 2014 to 2017 using electronic health record and medication administration data. Regression evaluated relationships between medication use (prevalence, duration, and time to initiation) and resident and facility characteristics. RESULTS: Five thousand three hundred fifty-four residents with dementia were included in the analyses. Annual prevalence of antidementia medication use was less than 10% each year and decreased during the study period by 2-percentage points by 2017 (relative to 2014). Antidementia medication use varied by sociodemographic characteristics (3-points lower for single, 4-points lower for divorced relative to married residents, and 3-points higher for Australian-born). Each point in ADL score was associated with 0.1-point lower medication use. Antidementia medication use was lower in outer regional facilities. Most comorbidities were associated with lower antidementia medication use (myocardial infarction, cerebrovascular disease and heart failure 3-points lower, respiratory disease, and diabetes 2-points lower). Age had a complex relationship with antidementia medication use that varied by sex and if medication was started before or after admission. After admission, males initiated antidementia medication earlier than females. CONCLUSIONS: Antidementia medication use in Australian facilities was lower than in other countries and varied by clinical and sociodemographic factors.


Assuntos
Inibidores da Colinesterase/uso terapêutico , Demência/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Memantina/uso terapêutico , Análise de Regressão , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 98(7): e14546, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762799

RESUMO

Little is known about the prognostic value of the strength, assistance walking, rise from a chair, climb stairs, and falls questionnaire (SARC-F) and SARC-F combined with calf circumference (SARC-CalF) among elderly nursing home residents.To compare the prognostic value of SARC-F and SARC-CalF for mortality in this population.We conducted a prospective study in four nursing homes in western China. Sarcopenia was estimated using SARC-F and SARC-CalF, respectively. Nutrition status, activities of daily living, and other covariates were evaluated. The survival status was collected via medical records and telephone interviews at the 12th month after the baseline investigation. We used multivariate Cox proportional-hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) for 1-year all-cause mortality by SARC-F-defined sarcopenia and SARC-CalF-defined sarcopenia, separately.We included 329 participants (median age: 85 years). The prevalences of SARC-F-defined sarcopenia and SARC-CalF-defined sarcopenia were 39.8% and 46.8%, respectively. During the 1-year follow-up period, 73 participants (22.7%) died. The mortality was 29.0% and 18.3% in the participants with or without SARC-F-defined sarcopenia, respectively (P = .025). The mortality was 26.6% and 19.0% in the participants with or without SARC-CalF-defined sarcopenia, respectively (P = .105). After adjusted for the relevant confounders including malnutrition, SARC-F-defined sarcopenia was independently associated with an increased risk of 1-year mortality (adjusted HR: 2.08; 95% CI: 1.27-3.42). However, SARC-CalF-defined sarcopenia was not an independent predictor of 1-year mortality (adjusted HR: 1.54; 95% CI: 0.95-2.47).Sarcopenia is highly prevalent in Chinese elderly nursing home residents according to SARC-F or SARC-CalF. SARC-F-defined sarcopenia appears to be better for predicting the 1-year mortality of Chinese nursing home residents than SARC-CalF-defined sarcopenia.


Assuntos
Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Mortalidade/tendências , Sarcopenia/epidemiologia , Inquéritos e Questionários/estatística & dados numéricos , Inquéritos e Questionários/normas , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , China/epidemiologia , Comorbidade , Feminino , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Casas de Saúde/estatística & dados numéricos , Estado Nutricional , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores Sexuais
20.
Perspect Psychiatr Care ; 55(3): 527-532, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30779143

RESUMO

PURPOSE: To examine sleep disturbances in older adults in Macau and Guangzhou, China and their associated factors. DESIGN AND METHODS: Four-hundred and thirty seven subjects in Guangzhou and 244 subjects in Macau were interviewed. FINDINGS: In total, 681 older adults participated in the study, and 27.8% reported sleep disturbance, with 43.9% in Macau and 18.8% in Guangzhou. Physical quality of life was negatively associated with sleep disturbances. Severe depressive symptoms were positively related but living in Guangzhou was negatively related to sleep disturbances. Sleep disturbances are more common in Macau compared to Guangzhou. PRACTICE IMPLICATIONS: Appropriate screening and treatment strategies are needed to address sleep disturbance in this population.


Assuntos
Depressão/epidemiologia , Qualidade de Vida , Transtornos do Sono-Vigília/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Modelos Logísticos , Macau/epidemiologia , Masculino , Casas de Saúde/estatística & dados numéricos , Fatores Sexuais
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