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Objective: To identify how antimicrobials are prescribed in long-term care facilities from the perspective of nurses. Methods: This descriptive study was conducted using an online survey. Participants were selected through conventional sampling methods and online recruitment. Data were collected through a 2-section self-administered questionnaire: the first section characterized the respondent and the institution, while the second investigated the antimicrobial prescription and usage in the institution. Results: Thirty-five responses were received, representing institutions from every state in Brazil. Sixty percent of the institutions had a part-time physician. More than 90% of the respondents said they contacted a prescriber to report signs and symptoms suggestive of infection, which led to subsequent antimicrobial use. Conclusions: The opinion of nurses has a significant impact on the prescriber's decision to begin antibiotic therapy in long-term care facilities, which indicates that nurses need training about the rational use of antimicrobials. (AU)
Objetivo: Identificar como ocorre a indicação de antimicrobianos nas instituições de longa permanência na perspectiva do profissional enfermeiro. Metodologia: Foi realizado um estudo descritivo por meio de um Survey online. Os participantes foram selecionados por meio de amostra convencional e o recrutamento foi realizado por meio de convite online. A coleta de dados foi feita a partir de um questionário autoaplicável constituído de dois blocos: o primeiro contemplando itens para a caracterização do respondente e da instituição; e o segundo, questões relacionadas ao uso e à indicação de antimicrobianos na instituição. Resultados: Foram recebidas 35 respostas, representando instituições de todos os estados brasileiros. A presença de médico em tempo parcial foi apontada em 60% das instituições. Mais de 90% dos participantes apontaram que acontecia o contato com prescritor para o relato de sinais e sintomas sugestivos de infecção apresentados pelo residente, implicando em uso subsequente de antimicrobianos. Conclusões: A opinião do profissional da Enfermagem tem grande impacto na decisão do prescritor em iniciar a antibioticoterapia nas instituições de longa permanência, demonstrando a necessidade de qualificação desse profissional direcionada ao uso racional de antimicrobianos. (AU)
Subject(s)
Humans , Aged , Aged, 80 and over , Drug Resistance, Microbial , Homes for the Aged , Nursing , Antimicrobial StewardshipABSTRACT
Objective: To investigate the factors associated with urinary incontinence in older adults living in nursing homes. Methods: This was an exploratory, cross-sectional, observational, and quantitative study using exploratory and path analysis (PA). Eighty-six older adults living in nursing homes in the city of Salvador, Brazil, and the city of Brasília, Brazil, were included. Data were collected from January to March 2020, before the Covid-19 pandemic. The following variables were evaluated: sex, age group, functional performance, global cognitive function, comorbidities, and health conditions. Results: Urinary incontinence was associated with educational level, marital status, hypertension, one or more difficulties in basic activities of daily living, mood, insomnia, loss of appetite, fecal incontinence, and difficulty swallowing. In the PA, depression and difficulty swallowing were directly associated with urinary incontinence, and urinary incontinence was directly and significantly associated with insomnia and fecal incontinence. Conclusion: Given the variety of social and health components associated with urinary incontinence, it is necessary to assess, prevent, treat, and rehabilitate this condition in Brazilian nursing homes. Interventions in urinary incontinence demand integrated actions in functional, clinical, and mental health aspects to promote the well-being of older adults living in nursing homes. (AU)
Objetivo: Investigar os fatores associados à incontinência urinária em pessoas idosas institucionalizadas segundo a Análise de Caminhos. Metodologia: Trata-se de um estudo transversal. Foram avaliados 86 idosos em Instituições de Longa Permanência para Idosos brasileiras de Salvador (BA) e Brasília (DF), no período entre janeiro e março de 2020, período pré-pandemia de COVID-19. Os fatores analisados incluíram: sexo, faixa etária, desempenho funcional, desempenho cognitivo global, comorbidades e condições de saúde. Resultados: Observou-se que a incontinência urinária esteve associada ao nível de escolaridade, estado civil, hipertensão, uma ou mais dificuldades nas atividades básicas da vida diária, humor, insônia, perda de apetite, incontinência fecal e dificuldade de deglutição. Na Análise de Caminhos, os sintomas depressivos e as dificuldades de deglutição tiveram associação direta com a incontinência urinária, e a incontinência urinária teve associação direta e significativa com a insônia e a incontinência fecal. Conclusão: Dada a variedade de componentes sociais e de saúde associados à incontinência urinária, é necessário avaliar, prevenir, recuperar e reabilitar essa condição nas Instituições de Longa Permanência para Idosos brasileiras. Intervir na incontinência urinária requer ações integradas nos aspectos funcionais, clínicos e de saúde mental, que podem favorecer o bem-estar das pessoas idosas institucionalizadas. (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Urinary Incontinence , Homes for the Aged , Physical Functional PerformanceABSTRACT
Objective:To understand the pilot operation status of long-term care insurance system in Panjin City,and provide ideas and reference basis for improving the long-term care insurance system in Liaoning Province and the whole country.Methods:The protection content,fund raising,and treatment payment policies of long-term care insurance in Panjin City was systematically sorted out.And referring to other pilot cities combined with the actual situation in China,improvement suggestions were put forward.Result:After sorting and analyzing,it was found that the long-term care insurance system in Panjin City had a single financing channel,a small coverage of insurance coverage and insured objects,an unspecified payment service content,and an incomplete evaluation system.Conclusion:A long-term care special fund should be established,policy coverage should be expanded,and a scientific and reasonable evaluation system should be established.
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Objective To explore the research status and hot highlights in the field of Alzheimer's disease nursing,and provide reference and direction for future research.Methods The high-level articles on Alzheimer's disease nursing during 2012 to 2022 were collected from Web of Science core database,were analyzed and visualized by the CiteSpace 5.8.R3C software.Re-sults 956 articles were included in the Web of Science core database.The demand and focus on AD nursing research increased year by year.United States America had the largest number of articles(175 articles),followed by France(43 articles)and Chi-na(31 articles).Minnesota University and Harvard Medical School had the largest number of articles(11 articles).The authors'analysis shows that BRUNO VELLAS,an academician of the French Academy of Sciences,had the largest number of articles.Keyword co-occurrence analysis shows that the research in the past decade mainly focuses on"nursing home","people"and"quality of life","long-term care"and"exercise therapy"may become the key research directions in the future.Conclusion Domestic scholars should improve the social security system of long-term care,promote"people-oriented"humanistic nursing services and develop appropriate sports training programs in the future.
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Objective: With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan.Patients and Methods: A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures.Results: A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures.Conclusion: Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.
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In order to implement a"people-centered"service concept and promote the sustainability of long-term care systems,countries worldwide are increasingly focusing on benefit package design when allocating and using public long-term care funds.This emphasis is aimed at regulating and guiding long-term care demand and developing home and community-based care.Based on the purchasing theory,this study categorized the long-term care benefit package models in representative countries into two types:"Institutional Eligibility Restrictions Type"and"Home-care-focused Benefit Type",and further elaborated the specific benefit package design.In China,long-term care insurance are still in the initial stages of development.We should optimize the service utilization structure and promote a rational allocation of resources through purchasing,while incorporating diverse benefit designs such as eligibility restrictions,differential benefit levels,and supplementary support,to establish a robust,multi-tiered long-term care system based on home and community-based care.
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ABSTRACT More than 8 million older people in Latin America depend on long-term care (LTC), accounting for 12% of people aged ≥ 60 years and almost 27% of those aged ≥ 80. It is crucial to develop sustainable strategies for providing LTC in the area, including institutional care. This special report aims to characterize institutional LTC in four countries (Brazil, Chile, Costa Rica and Mexico), using available information systems, and to identify the strategies adopted to support institutional care in these countries. This narrative review used nationwide, open-access, public data sources to gather demographic estimates and information about institutional LTC coverage and the availability of open-access data for the proportion of people with LTC needs, the number of LTC facilities and the number of residents living in them. These countries have a larger share of older people than the average in Latin America but fewer LTC facilities than required by the demand. National surveys lack standardization in defining disability, LTC and dependency on care. Information about institutional care is mainly fragmented and does not regularly include LTC facilities, their residents and workers. Data are crucial to inform evidence-based decisions to favor prioritization and to support advances in promoting policies around institutional LTC in Latin America. Although information about institutional care in the region is fragmented and insufficient, this paper profiles the four selected countries. It highlights the need for a better structure for data-driven LTC information systems. The lack of information emphasizes the urgency of the need to focus on and encourage research into this topic.
RESUMEN En América Latina, más de 8 millones de personas mayores dependen de los cuidados a largo plazo (CLP), lo que representa el 12% de las personas de 60 años o más y casi el 27% de las de 80 años o más Resulta crucial elaborar estrategias sostenibles para la prestación de CLP en la región, incluida la atención en centros de CLP. Este artículo especial tiene como finalidad determinar las características de la atención prestada en centros de CLP en cuatro países (Brasil, Chile, Costa Rica y México), utilizando los sistemas de información disponibles, así como determinar cuáles son las estrategias adoptadas en estos países para brindar apoyo a la atención en centros de CLP. En esta revisión descriptiva se utilizaron fuentes de datos públicas, de libre acceso y de ámbito nacional para recopilar estimaciones demográficas e información sobre la cobertura de la atención en centros de CLP, así como sobre la disponibilidad de datos de libre acceso acerca de la proporción de personas con necesidades de CLP, el número de centros de CLP y su correspondiente número de residentes. Estos países tienen una proporción de personas mayores superior a la media de América Latina, pero menos centros de CLP de los necesarios para cubrir la demanda. En las encuestas nacionales no hay una definición estandarizada de la discapacidad, los cuidados a largo plazo y la dependencia. La mayor parte de la información sobre la atención en centros de CLP está fragmentada y no incluye datos periódicos sobre los centros de CLP existentes, sus residentes o sus trabajadores. Estos datos son cruciales para fundamentar decisiones basadas en la evidencia destinadas a propiciar la priorización y brindar apoyo a los avances en la promoción de políticas en materia de centros de CLP en América Latina. Aunque la información sobre la atención en centros de CLP en la región es fragmentaria e insuficiente, en este artículo se presenta el perfil de los cuatro países seleccionados. Se resalta la necesidad de mejorar la estructura de los sistemas de información sobre CLP basados en datos. Esta falta de información pone de relieve la necesidad urgente de centrarse en este tema y fomentar la investigación al respecto.
RESUMO Na América Latina, mais de 8 milhões de pessoas idosas dependem de cuidados de longa duração (CLD), o que representa 12% das pessoas com mais de 60 anos e quase 27% das pessoas com mais de 80 anos. É fundamental criar estratégias sustentáveis para oferecer CLD na região, inclusive cuidados institucionais. O objetivo deste relatório especial é caracterizar CLD institucionais em quatro países (Brasil, Chile, Costa Rica e México), usando os sistemas de informação disponíveis, e identificar as estratégias adotadas para apoiar os cuidados institucionais nesses países. Esta revisão narrativa usou dados públicos de acesso aberto de âmbito nacional para coletar estimativas demográficas e informações sobre a cobertura de CLD institucionais e a disponibilidade de dados de acesso aberto sobre a porcentagem de pessoas com necessidades de CLD, o número de instituições de CLD e o número de residentes nessas instituições. Esses países têm uma parcela maior de pessoas idosas do que a média da América Latina, mas menos instituições de CLD do que a demanda exige. Falta padronização na definição de incapacidade, CLD e dependência de cuidados nas pesquisas nacionais. Em sua maior parte, as informações sobre cuidados institucionais são fragmentadas e não incluem instituições de CLD, seus residentes e trabalhadores de maneira regular. É essencial usar dados para guiar decisões baseadas em evidências a fim de favorecer a priorização e apoiar avanços que promovam políticas para CLD institucionais na América Latina. Embora as informações sobre cuidados institucionais na região sejam fragmentadas e insuficientes, este documento traça o perfil dos quatro países selecionados, destacando a necessidade de uma estrutura melhor para sistemas de informações de CLD orientados por dados. A falta de informações ressalta a urgência de aumentar o foco no tópico e encorajar pesquisas sobre o assunto.
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Abstract Introduction The COVID-19 pandemic has disproportionately affected individuals residing in Long-Term Care Facilities (LTCFs), necessitating tailored strategies to manage outbreaks. This study examines the outcomes of the ILPI BH project, a collaborative effort between the Municipal Health Department and the Hospital das Clínicas of the Federal University of Minas Gerais, designed to mitigate COVID-19 spread within LTCFs. Methods Prospective cohort of secondary data: 1,794 old residents in 99 long-term care facilities of Belo Horizonte, Brazil, were followed from May 2020 to January 2021. The study analyzed the prevention strategies, residents' clinical data, and the characteristics of the long-term care facilities, correlating these variables with the number of infections, hospitalizations, and deaths from COVID-19. It checked absolute numbers and rates of incidence, hospitalization, mortality, and lethality. Results There have been 58 COVID-19 outbreaks in long-term care facilities. There were 399 cases among residents, 96 hospitalizations for COVID-19 and 48 deaths from COVID-19 (2.7 % of the cohort), with a case fatality rate of 12 %. After multivariate analysis, the intrinsic variables to residents associated with higher mortality risk were higher degree of frailty (OR=1.08; p = 0.004) and the fact of living in a long-term care facility with a considerable proportion of residents' coverage by health plans (OR = 1.01; p = 0.028). Early geriatric follow-up showed an association with a reduction in the number of hospitalizations due to COVID-19. Conclusion The correct classification of the degree of frailty of institutionalized older people seems to have been relevant for predicting mortality from COVID-19. The extensive assistance by private health plans, contrary to what is supposed, did not result in better health protection. Early geriatric follow-up was beneficial and may be an attractive strategy in the face of health emergencies that affect long-term care facilities to reduce hospital admissions.
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Abstract: In Mexico, the economically active population aged over 50 years has been increasing in recent years. Due to their age, these workers may experience health deterioration and require some form of care. However, only formal employment is associated with better access to health services and pensions. At the same time, these workers may also need to care for children, sick partners or dependent older adults, which limits their time available for employment. This study examined the association between disability, receiving and providing care and access to health services, and economic activity among adults aged 50 to 69 in Mexico in 2015 and 2018. Multilevel modeling was conducted using data from the Mexican Health and Aging Study (MHAS). The MHAS is a longitudinal panel study of adults aged 50 years and older. The study sample included data from 8,831 observations from 2015 and 10,445 observations from 2018. Those living with some degree of disability and receiving care were found to be less likely to be economically active than those living with disability and not receiving care. Similarly, individuals who care for someone were also found to be less likely to be employed. Furthermore, the data suggested that individuals without access to health services were more likely to be economically active. For individuals aged 50 to 69 years, health and care issues were factors that limited economic activity status. In family-oriented societies with weak welfare states, the right to health is partial for the population and care is traditionally the responsibility of women, which exacerbates gender inequalities and has a differential impact on paid work for men and women.
Resumen: La población de México económicamente activa mayor de 50 años de edad se ha incrementado en los últimos años. Estos trabajadores en esta edad pueden sentir empeorar su salud y requerir algún tipo de atención. Sin embargo, solamente el empleo formal dio un mejor acceso a los servicios sanitarios y las pensiones. Al mismo tiempo, esta población también puede necesitar cuidar a niños, a la pareja enferma o a una persona mayor dependiente, lo que limita su tiempo disponible para trabajar. Este estudio evaluó la asociación entre la discapacidad, recibir y brindar asistencia y acceso a los servicios sanitarios, y la actividad económica de adultos de entre 50 y 69 años en México en el período de 2015 y 2018. Se trata de un enfoque de modelado multinivel que utiliza datos del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). ENASEM es un estudio longitudinal con adultos de 50 años o más. La muestra del estudio estuvo conformada por 8.831 observaciones en 2015 y 10.445 en 2018. Las personas que viven con algún grado de discapacidad y reciben atención tienen menos probabilidades de ser económicamente activas en comparación con las que viven con discapacidades y no reciben atención. Del mismo modo, las personas que brindan atención también tienen menos probabilidades de tener un trabajo. Además, los datos destacan que las personas sin acceso a los servicios sanitarios tienen más probabilidades de ser económicamente activas. En las personas de entre 50 y 69 años, los problemas de salud y la atención son factores que restringen la condición de la actividad económica. En las sociedades orientadas a la familia con estados de bienestar débiles, el derecho a la salud es parcial a la población y el cuidado es tradicionalmente realizado por las mujeres, lo que empeora las desigualdades de género y tiene un impacto diferencial en el trabajo remunerado para hombres y mujeres.
Resumo: No México, a população economicamente ativa com mais de 50 anos tem crescido nos últimos anos. Devido à idade, estes trabalhadores podem apresentar piora da saúde e necessitar de algum tipo de cuidado. No entanto, apenas o emprego formal está atrelado a um melhor acesso aos serviços de saúde e aposentadorias. Ao mesmo tempo, indivíduos dessa população também podem precisar cuidar de crianças, um companheiro doente ou idoso dependente, o que limita seu tempo disponível para o trabalho. Este estudo examinou a associação entre deficiência, receber e fornecer cuidados e acesso a serviços de saúde e a atividade econômica entre adultos de 50 a 69 anos no México em 2015 e 2018. Trata-se de uma abordagem com modelagem multinível utilizando dados do Estudo Nacional sobre Saúde e Envelhecimento no México (ENASEM). O ENASEM é um estudo longitudinal painel com adultos com 50 anos ou mais. A amostra do estudo incluiu dados de 8.831 observações em 2015 e 10.445 em 2018. Aqueles que vivem com algum grau de incapacidade e recebem cuidados têm menor probabilidade de serem economicamente ativos em comparação com aqueles que vivem com incapacidades e não recebem cuidados. Da mesma forma, os indivíduos que prestam cuidados também são menos propensos a terem um emprego. Além disso, os dados sugerem que indivíduos sem acesso a serviços de saúde têm maior probabilidade de serem economicamente ativos. Em indivíduos na faixa etária de 50 a 69 anos, problemas de saúde e cuidados são fatores que restringem a condição de atividade econômica. Em sociedades orientadas para a família com estados de bem-estar social fracos, o direito à saúde é parcial para a população e o cuidado é tradicionalmente assumido pelas mulheres, o que agrava as desigualdades de gênero e tem um impacto diferencial no trabalho remunerado para homens e mulheres.
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Resumo Objetivo Desenvolver e realizar a validação de conteúdo de um instrumento de autoavaliação da qualidade do cuidado em Instituições de Longa Permanência para Idosos (ILPI), denominado QualificaILPI. Método Estudo metodológico realizado entre março e dezembro de 2021. O instrumento foi desenvolvido com base em modelo multidimensional de qualidade, legislação brasileira e pesquisa bibliográfica e contém padrões de qualidade para autoavaliação das ILPI nas dimensões: ambiente, lar, cuidado, envolvimento familiar e da comunidade, equipe de trabalho e gestão. Cada padrão é descrito e seguido por uma escala, com parâmetros para classificar o nível de qualidade da ILPI em incipiente, intermediário, consolidado. A Técnica Delphi modificada foi empregada para validação por um comitê de 10 especialistas quanto a pertinência do padrão para avaliação da qualidade da ILPI, da adequação dos objetivos e da escala de avaliação, clareza, podendo fazer comentários. O padrão foi mantido quando houve 75% de concordância entre os especialistas. O instrumento foi também avaliado pelo público-alvo, constituído por coordenadores de 10 ILPI, selecionadas por conveniência. Resultados No primeiro ciclo de avaliação, foram excluídos três padrões e dois novos foram criados. No segundo, alterou-se a dimensão de um padrão e dois padrões foram unidos. Ao final, permaneceram 29 padrões divididos em seis dimensões. O público-alvo, gestores de ILPI, sugeriu alterações na redação de alguns padrões. Houve consenso de 80% ou superior em todos os padrões. Conclusão O QualificaILPI poderá contribuir para o monitoramento das ILPI favorecendo a melhoria do cuidado ofertado aos residentes.
Abstract Objective To develop and validate the content of a self-assessment instrument for the quality of care in Long-Term Care Facilities for Older Adults (Instituições de Longa Permanência para Idosos - ILPIs), named QualificaILPI. Method A methodological study conducted between March and December 2021. The instrument was developed based on a multidimensional quality model, Brazilian legislation, and literature research. It contains quality standards for self-assessment of ILPIs in the dimensions of environment, home, care, family and community involvement, work team, and management. Each standard is described and followed by a scale with parameters to classify the level of ILPI quality as incipient, intermediate, or consolidated. The modified Delphi Technique was employed for validation by a committee of 10 experts regarding the relevance of the standard for ILPI quality assessment, the appropriateness of objectives, the evaluation scale, and clarity, allowing for comments. The standard was retained when there was 75% agreement among the experts. The instrument was also evaluated by the target audience, consisting of coordinators from 10 ILPIs selected for convenience. Results In the first assessment cycle, three standards were excluded, and two new ones were created. In the second cycle, the dimension of one standard was changed, and two standards were combined. In the end, 29 standards remained, divided into six dimensions. The target audience, ILPI managers, suggested changes in the wording of some standards. There was a consensus of 80% or higher for all standards. Conclusion QualificaILPI has the potential to contribute to monitoring ILPIs, promoting the improvement of care offered to residents.
Subject(s)
Brazilian Health Surveillance Agency , Medical Staff, HospitalABSTRACT
Resumo Objetivo O presente estudo objetivou conhecer os desejos e vontades de pessoas idosas residentes em Instituições de Longa Permanência para Idosos (ILPI) sobre a terminalidade de vida. Método Tratou-se de pesquisa qualitativa descritiva e exploratória, em que participaram 18 pessoas idosas de duas ILPI Resultados Emergiram cinco categorias: acolhimento e aceite da família: a morte na ILPI ou no domicílio e o medo de morrer só; final de um ciclo de vida: momento de resgate pessoal, despedida, afeto e fé; preservação da dignidade humana da pessoa idosa que se encontra institucionalizada na terminalidade da vida; não ser pressionado e não ser um peso para a família: desejos relacionados ao agir dos profissionais e familiares com a pessoa idosa; e a manutenção dos sentidos e consciência da morte: desejo de uma experiência benéfica, sem dor, de purificação e de entrega por meio da fé. Conclusão Os desejos e vontades expressados relacionaram-se a aspectos amplos de vida. A compreensão destes configurou-se como possibilidade de os profissionais de saúde introduzirem assuntos relacionados à finitude e que essas pessoas idosas possam ter suas vozes ouvidas, sentidas e respeitadas.
Abstract Objective The present study aimed to explore the desires and wishes of older adults residing in Long-Term Care Facilities (LTCFs) regarding end-of-life terminality. Method This was a descriptive and exploratory qualitative research, involving 18 older adults from two LTCFs in a city in the central region of the state of Rio Grande do Sul (RS), Brazil. Data collection took place from March to May 2022 through semi-structured interviews and using the "cards on the table" technique. The data were subjected to discursive textual analysis. Results Five categories emerged: Family welcoming and acceptance: death in LTCFs or at home and the fear of dying alone; End-of-a-life cycle: a moment of personal reflection, farewell, affection, and faith; Preservation of the human dignity of older adults who are institutionalized in the terminal phase of life; Not being pressured and not being a burden to the family: desires related to the actions of professionals and family members toward the older adult; and Maintenance of senses and awareness of death: desire for a beneficial experience with pain control, purification, and surrendering of life through faith. Conclusion The desires and wishes expressed were related to broad aspects of life. Understanding these desires has emerged as an opportunity for healthcare professionals to introduce topics related to finitude, allowing these older adults to have their voices heard, felt, and respected.
Subject(s)
Humans , Aged , Aged, 80 and over , Aged , Caregivers , Patient-Centered Care , Attitude to DeathABSTRACT
Introduction. Assessment and management of pain in older adults can be challenging, with persistent pain prevalence ranging from 25% to 80%, especially in long-term care homes (LTCH), where most seniors are unable to verbalize their pain. This article describes the implementation of the Registered Nurses' Association of Ontario (RNAO) Assessment and Management of Pain (Third Edition) best practice guideline (BPG) in a LTCH in Toronto, Canada. Methodology. Using mixed descriptive study methodology, this 391-bed home housing older adults over 80 years implemented the Pain guideline using the knowledge-to-action framework and audit procedures to evaluate the impact of implementing this guideline. Key implementation activities included educating residents, families, and staff about pain while integrating validated pain screening and assessment tools into practice. A mixed methods approach of qualitative and quantitative data was utilized to monitor improvements in clinical and organizational outcomes. Results. The impact of implementing Pain BPG is: improved utilization of pain assessment and management tools, reduced incidence of worsening pain, improved pain scores and improved resident quality of life. The structured and integrated, evidence-based approaches to pain assessment and management reflected that long-term care residents don't have to live with pain regularly, which leads to a better quality of life and resident/family satisfaction. Discussion. In conjunction with the structured approach of the knowledge-to-action framework and the Pain BPG, the LTCH utilized tailored approaches to meet the needs of their resident population. Recognizing the unique needs of seniors in a residential setting, organizational structural facilitators, and barriers and cultural needs, the LTCH developed multi-modal approaches based on a person and family-centred approach. This evidence-based and resident-focused approach was the key to the successful implementation and subsequent outcomes that were resultant. Conclusion. The systematic implementation of the RNAO pain BPG and the utilization of the knowledge-to-action framework was shown to improve resident outcomes, improve organizational processes and generate staff satisfaction. Participation and engagement of residents, their families and health professionals in the process was one of the greatest facilitators.
Introducción. La evaluación y el tratamiento del dolor en los adultos mayores puede constituir un desafío, con una prevalencia de dolor persistente que oscila entre el 25 al 80%, especialmente en residencias de cuidados a largo plazo (LTCH por sus siglas en inglés), donde la mayoría de los ancianos son incapaces de verbalizar su dolor. Este artículo describe la aplicación de la guía de buenas prácticas (BPG por sus siglas en inglés) de la Asociación de Enfermeras Registradas de Ontario (RNAO por sus siglas en inglés) para la Evaluación y el Tratamiento del Dolor (Tercera Edición) en un centro de cuidados a largo plazo de Toronto, Canadá. Metodología. Utilizando una metodología de estudio descriptivo mixto, esta residencia de 391 camas que alberga a adultos mayores de 80 años implementó la guía sobre el dolor, utilizando el marco de conocimiento a la acción, al igual que procedimientos de auditoría, para evaluar el impacto de la implementación de la guía. Entre las actividades clave de la implementación se incluyeron la educación de los residentes, las familias y el personal sobre el dolor, así como la integración en la práctica de herramientas validadas de detección y evaluación del dolor. Se utilizó un enfoque metodológico mixto de datos cualitativos y cuantitativos para supervisar las mejoras en los resultados clínicos y organizativos. Resultados. El impacto de la implementación de la BPG sobre el dolor es: mejoría de la utilización de las herramientas de evaluación y manejo del dolor, reducción en la incidencia de empeoramiento del dolor, mejoría en puntuaciones del dolor, así como en la calidad de vida de los residentes. Los enfoques estructurados e integrados basados en la evidencia, dirigidos a la evaluación y manejo del dolor reflejaron que los residentes del LTCH no deben vivir con dolor habitualmente, lo que conduce a una mejor calidad de vida y satisfacción del residente y/o familia. Discusión. Junto con el enfoque estructurado del marco del conocimiento a la acción y la BPG del dolor, la residencia de cuidados a largo plazo utilizó enfoques adaptados para satisfacer las necesidades de su población residente. Reconocer las necesidades únicas de los mayores en un entorno residencial, los facilitadores estructurales organizativos y las Este enfoque basado en la evidencia y centrado en el residente fue la clave del éxito de la implantación y de los subsecuentes resultados obtenidos. Conclusiones. Se evidenció que la implantación sistemática de la BPG del dolor de la RNAO y la utilización del marco del conocimiento a la acción mejoraron los resultados de los residentes, los procesos organizativos y generaron mayor satisfacción en el personal. La participación y el compromiso de los residentes, sus familias y los profesionales de salud fue uno de los mayores facilitadores en el proceso.
Introdução. A avaliação e o tratamento da dor em idosos podem ser desafiadores, com a prevalência de dor persistente variando de 25 a 80%, especialmente em hospitais de longa permanência (LTCH por suas siglas em inglês), onde a maioria dos idosos não consegue verbalizar sua dor. Este artigo descreve a aplicação do guia de boas práticas (BPG por suas siglas em inglês) da Associação de Enfermeiras Registradas de Ontário (RNAO por suas siglas em inglês) para Avaliação e Tratamento da Dor (Terceira Edição) em uma instituição de cuidados de longo prazo em Toronto, Canadá. Metodologia. Utilizando uma metodologia de estudo descritiva, essa casa com 391 leitos que acolhe idosos com mais de 80 anos de idade implementou o guía para o manejo da dor, utilizando a estrutura do conhecimento para a ação, bem como procedimentos de auditoria, para avaliar o impacto da implementação do guia. As principais atividades de implementação incluíram a educação dos residentes, famílias e funcionários sobre a dor, bem como a integração na prática de ferramentas validadas de detecção e avaliação da dor. Foi utilizada uma abordagem metodológica mista de dados qualitativos e quantitativos para monitorar melhorias nos resultados clínicos e organizacionais. Resultados. O impacto da implementação do BPG para o manejo da dor é: melhoria na utilização de ferramentas de avaliação e manejo da dor, redução na incidência de piora da dor, melhora nos escores de dor, bem como na qualidade de vida dos residentes. Abordagens estruturadas e integradas baseadas em evidências, destinadas à avaliação e manejo da dor refletiram que os residentes do LTCH não devem conviver rotineiramente com a dor, levando à melhoria da qualidade de vida e à satisfação dos residentes e/ou familiares. Discussão. Juntamente com a abordagem articulada da estrutura do conhecimento para a ação e o BPG para o manejo da dor, a cassa de cuidados de longo prazo utilizou abordagens adaptadas para satisfazer as necesidades da sua população residente. O reconhecimento das necessidades únicas dos idosos num ambiente residencial, dos facilitadores estruturais organizacionais e das barreiras e necessidades culturais, permite que os LTCH desenvolvam abordagens multimodais, centradas na pessoa e na família. Esta abordagem baseada em evidências e centrada no residente foi a chave para o sucesso da implementação e os resultados subsequentes obtidos. Conclusões. Ficou evidente que a implementação sistemática do BPG para o manejo da dor da RNAO e o uso da estrutura do conhecimento para a ação melhoraram os resultados dos residentes e os processos organizacionais, e geraram maior satisfação do pessoal. A participação e o comprometimento dos residentes, seus familiares e profissionais de saúde foi um dos maiores facilitadores do processo.
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Practice Guidelines as Topic , Pain Measurement , Frail Elderly , Long-Term Care , Quality Improvement , Pain Management , Implementation Science , Nursing HomesABSTRACT
Resumen Introducción: Alrededor del 50% de los pacientes hos pitalizados por injuria cerebral adquirida grave requie ren traqueostomía y cuidados a largo plazo. El objetivo principal de este estudio fue describir la evolución de enfermos con injuria cerebral adquirida grave (ICAg) traqueostomizados que ingresaron a rehabilitación. Se cundariamente se estudió el fracaso de la decanulación y la supervivencia a los 12 meses del alta. Métodos: estudio cuantitativo observacional prospec tivo de centro único. Se incorporó al estudio, de forma prospectiva y consecutiva, usuarios mayores de 18 años, traqueostomizados posterior a ICAg ingresados a un cen tro de rehabilitación entre abril de 2018 y marzo de 2020. Resultados: se incluyeron para el análisis 50 pacien tes. La estancia en el centro fue de 203 (RIQ 93-320) días. Al alta de la institución, 32 (64%) pacientes pudieron ser decanulados exitosamente. El tiempo transcurrido desde el ingreso al centro hasta la decanulación fue de 49 (12-172) días. No se observó fracaso de la decanula ción. La mortalidad a los 12 meses de seguimiento fue de 32%, cinco (16%) de los 32 pacientes que pudieron ser decanulados y 11 (61%) de los 18 que no lograron la decanulación fallecieron dentro de los 12 meses de seguimiento. La relación entre la decanulación y la mortalidad a los 12 meses de seguimiento resultó esta dísticamente significativa (p = 0.002). Discusión: La supervivencia global fue relativamente elevada, el proceso de decanulación resulta relevante ya que puede tener impacto en la supervivencia a largo plazo.
Abstract Introduction: About 50% of patients hospitalized for severe acquired brain injury require tracheostomy, and many of them need long-term care. The main objective of this study was to describe the evolution of patients with severe acquired brain injury (sABI) tracheotomized who entered rehabilitation. Secondarily, mortality re lated to the success or failure of decannulation and survival at 12 months of discharge were studied. Methods: A single-center prospective observational quantitative study. Users over 18 years of age were recruited prospectively and consecutively, tracheosto mized after sABI, and admitted to a rehabilitation center between April 2018 and March 2020. Results: Fifty patients were included for analysis. The stay in the center was 203 (RIQ 93-320) days. At discharge to the institution, 32 (64%) patients managed to be successfully decannulated. The median number of days from admission to the center to decannulation was 49 (12-172). No decannulation failure was observed. Mortality at 12 months follow-up was 32%, five (16%) of the 32 patients who managed to be decannulated, and 11 (61%) of 18 who failed to achieve decannulation died within 12 months of follow-up. The relationship between decannulation success and mortality at 12 months of follow-up was statistically significant (p= 0.002). Discussion: Addressing the decannulation process early and properly guided is relevant as it may impact long-term survival.
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RESUMO Objetivo: Desvelar as vivências de cuidadores de idosos que residem em instituições de longa permanência, durante o confinamento no contexto da pandemia de Covid-19. Método: Método: pesquisa qualitativa, descritiva, através de estudo de caso intrínseco. Amostra intencionada por critério e conveniência de seis cuidadores, Região de Los Ríos, Chile, entrevista semiestruturada foi realizada no ano de 2021. Análise através de comparação constante e redução progressiva. A validade foi garantida pelo cumprimento de critérios de rigor, triangulação por especialistas. Resultados: 489 unidades de significado deram origem a quatro grupos temáticos: Significado de ter vivido a experiência, fatores facilitadores, fatores dificultadores e recomendações. Emergiram dois domínios: Contribuição dos cuidadores para o reforço do seu papel durante a pandemia e Contribuição para o reforço da gestão. Conclusões: permite reconhecer e validar o vínculo afetivo, o empenho e a vocação dos prestadores de cuidados, aspectos fundamentais a reforçar através do aconselhamento e da formação para garantir a qualidade dos cuidados.
ABSTRACT Objective: Uncover the experiences of caregivers of elderly people living in long-term care institutions, during confinement in the context of the Covid-19 pandemic. Method: Qualitative, descriptive research, through an intrinsic case study. Intentional sample by criteria and convenience of six caregivers, Los Ríos Region, Chile; a semi-structured interview was carried out in 2021. Analysis applying the constant comparative method and progressive focusing approach. Validity was ensured by compliance with the criteria of rigor and researcher triangulation. Results: 489 units of meaning gave rise to four thematic groups: Meaning of having lived the experience, facilitating factors, hindering factors and recommendations. Two domains emerged: Contribution of caregivers to strengthening their role during the pandemic and Contribution to strengthening management. Conclusions: it allows recognizing and validating the emotional bond, commitment and vocation of care providers, key aspects to be reinforced through counseling and training to guarantee the quality of care.
RESUMEN Objetivo: develar las vivencias de cuidadores de personas mayores que residen en instituciones de larga permanencia, durante el confinamiento en contexto de pandemia por Covid-19. Método: investigación cualitativa, descriptiva, mediante estudio intrínseco de casos. Muestra intencionada por criterios y conveniencia de seis cuidadoras, Región de Los Ríos, Chile, se realizó entrevista semiestructurada, en el año 2021. Análisis a través de comparación constante y reducción progresiva. Se cauteló validez cumpliendo criterios de rigor, triangulación por expertos. Resultados: 489 unidades de significado originaron cuatro núcleos temáticos: Significado de haber vivido la experiencia, factores facilitadores del trabajo, factores que lo dificultan y recomendaciones. Emergieron dos dominios: Aportes de las cuidadoras para fortalecer su rol durante la pandemia y Contribución para fortalecer la gestión. Conclusiones: permite reconocer y validar el vínculo afectivo, compromiso y vocación de las cuidadoras, aspectos fundamentales a fortalecer mediante consejería y capacitación para asegurar la calidad de los cuidados.
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This paper interprets the content and recommendations of the guidelines on infection prevention and control in long-term care facilities put forward by the World Health Organization （WHO） during the 2019 coronavirus disease （COVID-19） pandemic， and actively explores the key points of nursing and infection prevention and control measures for the long-term care facilities under the background of repeated outbreaks， with the aim of providing care measures and infection prevention and control measures that suit our national conditions to improve the living standards of the elderly and protect them from viral infection amid the recurring pandemic.
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With the continuous increase of the elderly in China, the proportion of elderly with disabilities and dementia remains high. Long-term care, as a care system for elderly with disabilities and dementia, has some problems that misunderstanding of the concept of long-term care, the de-emotionalization of care behaviour, and the impact on family ethics. The care ethics grounds the universal caring experience, and provides an ethical norm with relationship as a pivot and emotion as a connection. Its characteristics of emphasis on contextual, relational and emotional have constructive implications for improving long-term care system. To realize care, it is significant to clarify the concept and improve the system in the ethical context, focus on both sides of the relationship based on demand, let care practice infiltrate into life through turning emotion into action, and build a long-term care system with a temperature to improve the overall quality of life of the elderly.
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【Objective】 To understand the status of COVID-19 vaccination among elderly adults in long-term care facilities and analyze the influencing factors so as to provide scientific basis for improving the policy of COVID-19 vaccination. 【Methods】 The socio-demographic characteristics, disease-related data, disability, and COVID-19 vaccination status of 575 elderly adults who resided in long-term care facilities in Shaanxi Province were collected via Sojumpin in January 2022. Factors that affected non-vaccinated elderly adults were analyzed by using the SPSS 25.0 software. 【Results】 Of the included 575 participants, 199 (34.6%) were not vaccinated against COVID-19. Univariate analysis showed that COVID-19 vaccination was associated with age, room type, length of stay, marital status, number of children, chronic diseases (i.e., diabetes, stroke, dementia), disability degree, and long-term medication use. Logistic regression analysis demonstrated that age of 90 years or above (OR=4.25), triple room (OR=6.17), moderate disability (OR=2.94), severe disability (OR=6.67), long-term medication use (OR=1.81), and stroke (OR=1.74) were independent risk factors for not injecting COVID-19 vaccine. 【Conclusion】 The COVID-19 vaccination coverage rate of elderly adults in long-term care facilities needs to be improved, and more attention should be paid to the high-risk groups (e.g., who are older, and have disability, long-term medication use, or stroke).
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BACKGROUND@#Individual-level social capital is an important determinant of older adults' long-term care needs; however, there is scant evidence regarding community-level social capital. Therefore, we investigated the association between community-level social capital and the prevalence of the need for long-term care among older adults.@*METHODS@#Between January and February 2018, a cross-sectional survey was conducted among all older adults (n = 13,558) aged 65 to 74 years in a rural municipality in Japan (total population, n = 72,833). A self-reported questionnaire was used to identify community-level social capital, comprising civic participation, social cohesion, and reciprocity. A multilevel logistic regression analysis was performed to estimate the odds ratios of the need for long-term care and a decline in social activity competence as assessed by instrumental activities of daily living. For the analysis, the community levels were divided into 76 voting districts and adjusted for daily life, lifestyle, socioeconomic status, health conditions, and the three social capital subscale scores at the individual level.@*RESULTS@#After adjusting for the covariates, we observed a tendency that a higher community level of reciprocity was associated with a lower prevalence of long-term care needs (OR: 0.86, 95% confidence interval: 0.75-1.00), whereas a high community level of social cohesion was associated with a significantly reduced decline in instrumental activities of daily living (OR per standard deviation increase: 0.87, 95% confidence interval: 0.79-0.96). No significant association was found with civic participation. Similarly, individual-level social capital was associated with the need for long-term care and decline in instrumental activities of daily living.@*CONCLUSIONS@#Our findings suggest that good community-level reciprocity or social cohesion as well as good individual social capital status may help prevent the need for long-term care among older adults.
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Humans , Aged , Interpersonal Relations , Activities of Daily Living , Social Participation , Social Capital , Multilevel Analysis , Cross-Sectional Studies , Long-Term Care , Japan/epidemiology , Social SupportABSTRACT
Introduction: The purpose of this study was to clarify the relationship between the available service information on small-scale multifunctional in-home nursing care (KANTAKI) and its operational status via text mining.Methods: We obtained nationwide textual information on KANTAKI from the Nursing Care Service Information Disclosure System and the Ministry of Health, Labour, and Welfare, and analyzed the characteristics of the word usage using KH Coder. The number of users and employees and the implementation of services were compared among the facilities that used terms relating to medical dependency and end-of-life care, which are KANTAKI characteristics, and with other facilities.Results: The facilities that used terms relating to medical dependency and end-of-life care showed significantly more users requiring nursing care level 5 and more full-time nursing staff than those not using such terms. Moreover, regarding service provision, the rate of procedures was significantly higher in 11 of 12 items, except for stoma.Conclusion: The facilities that use terms relating to medical dependency and end-of-life care in their information have more users and provide a greater variety of services. In the future, educational support is required to enable facility managers to understand the services and translate them into their work.
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Objective:To explore the mechanism of factors affecting the long-term care needs of disabled elderly in elderly care institutions, and provide basis for taking targeted nursing intervention.Methods:From July to November 2018, convenience sampling method was used to conduct cross-sectional survey of the current situation and influencing factors of long-term care needs of 508 disabled elderly people in 10 elderly care institutions in Baoding City by general information questionnaire, Barthel index, the Long-term Care Needs of the Disabled Elderly in elderly care institutions, the Questionnaire on the Factors Affecting the Long-term Care Needs of the Disabled Elderly in elderly care institutions. SPSS 21.0 was used for correlation analysis and multiple regression analysis, and AMOS 24.0 was used for model fitting, path and mediation effect analysis.Results:The score of long-term care needs of the disabled elderly in elderly care institution was (105.04 ± 21.68) points; the scores of intra-personal, interpersonal, and extra-personal factors were (16.93 ± 5.20) points, (10.51 ± 3.39) points, (19.80 ± 6.24) points, respectively. Intra-individual factors, interpersonal factors, extra-individual factors and care needs were all positively correlated ( r values were 0.222-0.645, P<0.05). Intra-individual, inter-personal and extra-individual factors could directly affect the long-term care needs of the disabled elderly ( β=0.455, 0.527, 0.403); intra-individual and inter-personal factors had independent mediating effects and chain mediating effects between extra-individual factors and the long-term care needs of the disabled elderly, and the effects were significant, with effect value of 0.078, 0.095 and 0.023, accounting for 15.15%, 18.45% and 4.47% of the total effect, respectively. Conclusions:Each influencing factor has a strong ability to predict and explain the long-term care needs of the disabled elderly, and nursing staff could meet the care needs of the disabled elderly according to different influencing factors.