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1.
BMC Palliat Care ; 21(1): 132, 2022 Jul 20.
Article in English | MEDLINE | ID: mdl-35854375

ABSTRACT

BACKGROUND: There has been a global increase in the number of people who are dying of old age. This development implies a need for good palliative care among older persons at the end of life. Here nursing homes have an important role to play. However, the principles of palliative care have not been sufficiently applied in nursing homes, and there is a need to increase the implementation of palliative care in these settings. Therefore the project named Implementation of Knowledge-Based Palliative Care in Nursing Homes (the KUPA project, to use its Swedish acronym) was started as a contribution to filling this knowledge gap. The aim of the present study was to investigate the professionals' experiences of readiness for change to knowledge-based palliative care at nursing homes after the educational intervention within the KUPA project. METHODS: The focus group method was used to interview 39 health-care professionals with the aid of semistructured questions based on the Organizational Readiness for Change theoretical framework. Six focus groups were formed at six nursing homes in two counties in southern Sweden. The groups included different types of professionals: assistant nurses, nurses, occupational therapists, physiotherapists and social workers. The analysis was conducted with an abductive approach and included deductive and inductive content analysis. RESULTS: The analysis revealed one overarching theme: hopeful readiness for change in palliative care despite remaining barriers. The main categories were increased knowledge facilitating development, enhanced team spirit, uncertainty about future plans connected with hopeful readiness and remaining organizational barriers. CONCLUSIONS: This study adds knowledge and understanding concerning professionals' readiness for change palliative care in nursing homes and shows how ready nursing home settings undertake these changes in practice. The Organizational Readiness for Change theory proved suitable for application in nursing homes to assess the professionals' experiences and to evaluate educational interventions regardless of the organization's readiness for change. TRIAL REGISTRATION: ClinicalTrials NCT02708498 , first registration 15/03/2016.


Subject(s)
Attitude of Health Personnel , Health Personnel , Hospice and Palliative Care Nursing , Nursing Homes , Aged , Aged, 80 and over , Focus Groups , Follow-Up Studies , Health Personnel/education , Health Personnel/psychology , Hospice and Palliative Care Nursing/methods , Hospice and Palliative Care Nursing/organization & administration , Humans , Nursing Homes/organization & administration , Qualitative Research , Sweden
2.
J Am Geriatr Soc ; 70(3): 701-708, 2022 03.
Article in English | MEDLINE | ID: mdl-35195276

ABSTRACT

An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.


Subject(s)
Clinical Trials as Topic/organization & administration , Nursing Homes/organization & administration , Aged , COVID-19/epidemiology , Female , Humans , Male , Pandemics , SARS-CoV-2 , United States/epidemiology
3.
J Nurs Adm ; 52(3): 146-153, 2022 Mar 01.
Article in English | MEDLINE | ID: mdl-35179142

ABSTRACT

OBJECTIVE: This study investigates practices that may help retain certified nursing assistants (CNAs) and address the staffing challenges faced in long-term care. BACKGROUND: CNAs are critical to quality care and retention has never been more challenging. To solve this staffing crisis, understanding the unique perspective of CNAs is imperative. METHODS: In semistructured interviews, 5 nursing assistants, the director of nursing, and the nursing home administrator at 59 long-term care facilities answered 4 questions, providing multiple perspectives about causes and solutions to CNA staffing challenges. RESULTS: Key responses for each stakeholder group were identified. CNAs highlighted the nature of the job as a bigger challenge than leadership recognized. Although pay is a top concern, emotional support, training, relationship-building, communication, and the work culture can be equally important in reducing turnover. CONCLUSION: When organizational leaders understand how to meet the needs and interests of CNAs, they can reduce turnover.


Subject(s)
Attitude of Health Personnel , Long-Term Care/organization & administration , Nursing Assistants/organization & administration , Nursing Homes/organization & administration , Personnel Management , Adult , Female , Humans , Long-Term Care/psychology , Male , Middle Aged , Nursing Assistants/psychology
4.
PLoS One ; 17(1): e0261523, 2022.
Article in English | MEDLINE | ID: mdl-35061710

ABSTRACT

BACKGROUND: The COVID-19 epidemic in Italy has severely affected people aged more than 80, especially socially isolated. Aim of this paper is to assess whether a social and health program reduced mortality associated to the epidemic. METHODS: An observational retrospective cohort analysis of deaths recorded among >80 years in three Italian cities has been carried out to compare death rate of the general population and "Long Live the Elderly!" (LLE) program. Parametric and non-parametric tests have been performed to assess differences of means between the two populations. A multivariable analysis to assess the impact of covariates on weekly mortality has been carried out by setting up a linear mixed model. RESULTS: The total number of services delivered to the LLE population (including phone calls and home visits) was 34,528, 1 every 20 day per person on average, one every 15 days during March and April. From January to April 2019, the same population received one service every 41 days on average, without differences between January-February and March-April. The January-April 2020 cumulative crude death rate was 34.8‰ (9,718 deaths out of 279,249 individuals; CI95%: 34.1-35.5) and 28.9‰ (166 deaths out of 5,727 individuals; CI95%:24.7-33.7) for the general population and the LLE sample respectively. The general population weekly death rate increased after the 11th calendar week that was not the case among the LLE program participants (p<0.001). The Standardized Mortality Ratio was 0.83; (CI95%: 0.71-0.97). Mortality adjusted for age, gender, COVID-19 weekly incidence and prevalence of people living in nursing homes was lower in the LLE program than in the general population (p<0.001). CONCLUSIONS: LLE program is likely to limit mortality associated with COVID-19. Further studies are needed to establish whether it is due to the impact of social care that allows a better clients' adherence to the recommendations of physical distancing or to an improved surveillance of older adults that prevents negative outcomes associated with COVID-19.


Subject(s)
COVID-19/epidemiology , Community Health Services/organization & administration , Homes for the Aged/organization & administration , Monitoring, Physiologic/methods , Nursing Homes/organization & administration , SARS-CoV-2/pathogenicity , Aged, 80 and over , COVID-19/mortality , COVID-19/psychology , Cities , Community Health Services/ethics , Female , Homes for the Aged/ethics , Humans , Incidence , Italy/epidemiology , Male , Nursing Homes/ethics , Physical Distancing , Retrospective Studies , Social Isolation/psychology , Survival Analysis
5.
Medicine (Baltimore) ; 100(48): e28023, 2021 Dec 03.
Article in English | MEDLINE | ID: mdl-35049214

ABSTRACT

BACKGROUND: In this study, an intensive review of pharmaceutical care for elderly patients was conducted in a Veterans Administration nursing home in Taiwan and its effects were evaluated. METHODS: One hundred participants were enrolled in this randomized controlled study with even distribution. The inclusion criteria were age 65 years or older, prescriptions for at least 5 oral medicines daily, and ≥2 chronic diseases, for the period May 2013 to October 2014. Subjects were excluded if they had previously been included in an intensive medication review conducted by a pharmacist. The primary outcomes were numbers of drugs prescribed, potential inappropriate medications, and numbers of drug-related problems. The secondary outcomes were self-reported medical usages, measurements of quality of life, results of a satisfaction survey, and health status. RESULTS: A total of 80 cases (42 in the intervention group with medication reconciliation and 38 in the control group without medication reconciliation) completed the study. Baseline characteristics were not statistically different between the 2 groups. The overall prevalence of potential inappropriate medication was 74.3%. There were no differences between the 2 groups, with the exception of "medical problems," which showed a significantly higher prevalence in the intervention group (P < .05). The intervention group reported greater satisfaction regarding pharmacist visits and medication compliance (P < .01). The mean number of drug-related problems was significantly lower after the intervention (P < .01). CONCLUSION: In this study, the intensive review of the elderly patients' medications revealed that the only significant effect of pharmaceutical care was on "all outcomes." A possible reason for this is the rather advanced ages of some patients who needed a considerable number of medications to treat several chronic diseases. Another reason may be the small sample size. However, participants who received the pharmacist intervention did have higher satisfaction with medication reconciliation and fewer drug-related problems.


Subject(s)
Medication Reconciliation , Medication Review , Nursing Homes/organization & administration , Pharmacists , Aged , Aged, 80 and over , Female , Humans , Male , Quality of Life
6.
PLoS Comput Biol ; 18(1): e1009780, 2022 01.
Article in English | MEDLINE | ID: mdl-35020731

ABSTRACT

Although system dynamics [SD] and agent-based modelling [ABM] have individually served as effective tools to understand the Covid-19 dynamics, combining these methods in a hybrid simulation model can help address Covid-19 questions and study systems and settings that are difficult to study with a single approach. To examine the spread and outbreak of Covid-19 across multiple care homes via bank/agency staff and evaluate the effectiveness of interventions targeting this group, we develop an integrated hybrid simulation model combining the advantages of SD and ABM. We also demonstrate how we use several approaches adapted from both SD and ABM practices to build confidence in this model in response to the lack of systematic approaches to validate hybrid models. Our modelling results show that the risk of infection for residents in care homes using bank/agency staff was significantly higher than those not using bank/agency staff (Relative risk [RR] 2.65, 95% CI 2.57-2.72). Bank/agency staff working across several care homes had a higher risk of infection compared with permanent staff working in a single care home (RR 1.55, 95%CI 1.52-1.58). The RR of infection for residents is negatively correlated to bank/agency staff's adherence to weekly PCR testing. Within a network of heterogeneous care homes, using bank/agency staff had the most impact on care homes with lower intra-facility transmission risks, higher staff-to-resident ratio, and smaller size. Forming bubbles of care homes had no or limited impact on the spread of Covid-19. This modelling study has implications for policy makers considering developing effective interventions targeting staff working across care homes during the ongoing and future pandemics.


Subject(s)
COVID-19/transmission , Computer Simulation , Health Personnel , Nursing Homes/organization & administration , Systems Analysis , COVID-19/virology , Humans , SARS-CoV-2/isolation & purification
7.
Nurs Res ; 71(1): E1-E9, 2022.
Article in English | MEDLINE | ID: mdl-34620773

ABSTRACT

BACKGROUND: Frailty is a major cause of adverse health outcomes, such as hospitalization, falls, disability, and morbidity, among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions. OBJECTIVES: This study aimed to examine the trend of frailty over time (at baseline, 6-month follow-up, and 12-month follow-up) among Chinese nursing home residents and identify associated resident- and institutional-level factors. METHODS: This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, and staff turnover rate). These data were subjected to a multilevel linear analysis. RESULTS: Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities. DISCUSSION: Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.


Subject(s)
Frailty/diagnosis , Nursing Homes/classification , Aged , Aged, 80 and over , China/epidemiology , Female , Frailty/epidemiology , Geriatric Assessment/methods , Humans , Longitudinal Studies , Male , Middle Aged , Nursing Homes/organization & administration , Nursing Homes/statistics & numerical data , Self Report/statistics & numerical data
9.
J Am Geriatr Soc ; 69(10): 2766-2777, 2021 10.
Article in English | MEDLINE | ID: mdl-34549415

ABSTRACT

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. DESIGN: Systematic review. SETTING: Long-term care facilities (nursing homes and assisted living communities). PARTICIPANTS: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. MEASUREMENTS: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. RESULTS: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. CONCLUSION: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers.


Subject(s)
COVID-19 , Homes for the Aged/organization & administration , Long-Term Care , Nursing Homes/organization & administration , Risk Adjustment , Skilled Nursing Facilities/organization & administration , Aged , COVID-19/mortality , COVID-19/prevention & control , Civil Defense/organization & administration , Humans , Infection Control/methods , Infection Control/standards , Long-Term Care/methods , Long-Term Care/trends , Outcome Assessment, Health Care , SARS-CoV-2
12.
Nutrients ; 13(12)2021 Dec 17.
Article in English | MEDLINE | ID: mdl-34960075

ABSTRACT

Reducing the climate impact of food provided for residents in nursing homes is challenging, as the diets for older, frail adults must be high in protein content and energy density while at the same time ensuring that the meals are palatable and recognizable. This study aimed at providing guidance on healthy and more climate-friendly diets for nursing homes in the City of Copenhagen. The goal was to decrease greenhouse gas emissions (GHGE) by at least 25% while at the same time providing nutritionally adequate and recognizable menus. First, food purchase data were compiled with datasets matching each food item to a proxy food item and then to databases containing GHGE and nutrient information. Secondly, two diet scenarios were modelled based on current procurement practices, i.e., an energy- and protein-dense diet and a standard protein-dense diet, and converted into guidelines for menu planning. The diets contained less total meat, especially beef, and significantly more pulses, nuts and seeds in order to increase protein content according to recommendations for older adults. Finally, a combined scenario was calculated to reflect the joint climate impact reduction. This kind of innovation in food procurement is required in order to achieve the necessary transition to a sustainable food system.


Subject(s)
Diet, Healthy , Diet/standards , Food Services , Food Supply , Nursing Homes/organization & administration , Nutrition Policy , Aged , Cities , Greenhouse Gases , Humans , Models, Theoretical , Nutritive Value
14.
Am J Nurs ; 121(8): 68-69, 2021 08 01.
Article in English | MEDLINE | ID: mdl-34819482
15.
Am J Nurs ; 121(11): 69, 2021 Nov 01.
Article in English | MEDLINE | ID: mdl-34673701

ABSTRACT

According to this study: A higher number of nursing home staff members was associated with a higher number of COVID-19 cases, independent of the size of the facility.Decreasing the number of staff members but not the number of direct care hours could help improve patient safety.


Subject(s)
COVID-19/epidemiology , Nursing Homes/organization & administration , Nursing Staff/organization & administration , COVID-19/prevention & control , COVID-19/transmission , Humans
17.
Infect Dis Clin North Am ; 35(3): 803-825, 2021 09.
Article in English | MEDLINE | ID: mdl-34362545

ABSTRACT

Patients increasingly receive care from a large spectrum of different settings, placing them at risk for exposure to pathogens by many different sources. Each health care environment has its own specific challenges, and thus infection control programs must be tailored to each specific setting. High-turnover outpatient settings may require additional considerations, such as establishing patient triage and follow-up protocols, and broadened cleaning and disinfection procedures. In nursing homes, infection control programs should focus on surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs.


Subject(s)
Delivery of Health Care/organization & administration , Disinfection , Hand Hygiene , Infection Control , Antimicrobial Stewardship , Disinfection/trends , Drug Resistance, Multiple, Bacterial , Health Promotion , Humans , Infection Control/organization & administration , Infection Control/trends , Long-Term Care/organization & administration , Nursing Homes/organization & administration
18.
J Nurs Scholarsh ; 53(6): 762-771, 2021 11.
Article in English | MEDLINE | ID: mdl-34331390

ABSTRACT

PURPOSE: Organizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their interrelationships is often impractical. Big Data analytics can automatically detect patterns within the data. We applied the chi-squared automatic interaction detection (CHAID) algorithm and classification tree technique to explore the dynamic and interdependent relationships between the implementation science concepts-context, facilitation, and research use. DESIGN: Observational, cross-sectional study based on survey data collected from a representative sample of nursing homes in western Canada. METHODS: We assessed three major constructs: (a) Conceptual research utilization (CRU) using the CRU scale; (b) facilitation of research use measured by the frequency of contacts between the frontline staff and a clinical educator, or person who brings new ideas to the care unit; and (c) organizational context at the unit level using the Alberta Context Tool (ACT). CHAID analysis was performed to detect the interactions between facilitation and context variables. Results were illustrated in a classification tree to provide a straightforward visualization. FINDINGS: Data from 312 care units in three provinces were included in the final analysis. Results indicate significant multiway interactions between facilitation and various aspects of the organizational context, including leadership, culture, evaluation, structural resources, and organizational slack (staffing). Findings suggested the preconditions of the care settings where research use can be maximized. CONCLUSIONS: CHAID analysis helped transform data into usable knowledge. Our findings provide insight into the dynamic relationships of facilitators' efforts and organizational context, and how these factors' interplay and their interdependence together may influence research use. CLINICAL RELEVANCE: Knowledge of the combined effects of facilitators' efforts and various aspects of organizational context on research use can contribute to effective strategies to narrow the evidence-practice gap in care settings.


Subject(s)
Long-Term Care , Nursing Homes , Nursing Research/organization & administration , Canada , Cross-Sectional Studies , Humans , Implementation Science , Leadership , Long-Term Care/organization & administration , Nursing Homes/organization & administration
20.
N Z Med J ; 134(1537): 56-65, 2021 06 25.
Article in English | MEDLINE | ID: mdl-34239162

ABSTRACT

AIM: This study aimed to quantify use of antipsychotic and sedative medications in residents with dementia in long-term care facilities in the Waikato District Health Board (DHB) catchment and to identify factors associated with the prescription of these medications. METHODS: Resident records and the medication charts of 271 residents with a diagnosis of dementia from 13 dementia units in the Waikato DHB catchment, as well as the psychogeriatric (PG) unit, were reviewed for current prescriptions for any antipsychotic or sedative medication and the date those medications were most recently prescribed. RESULTS: Antipsychotics were prescribed for 133 (49.1%) residents, with a mean (95% CI) of 401 (354-448) days since the most recent prescription was made. Only 16.8% of antipsychotic prescriptions were prescribed in the preceding 12 weeks, with 31.3% of prescriptions prescribed more than a year prior. Residents were more likely to be prescribed an antipsychotic if they were male (56.9% vs 42.6%, p=.019) or had an incident form completed (30.8% vs 19.6% p=.03). Regression analysis showed only gender (OR 1.79, 95%CI 1.07-2.98, p=.026) was associated with antipsychotic medication prescription. Sedatives were prescribed for 60 (22.1%) residents, with a mean (95%CI) of 487 (431-544) days since the most recent prescription was made, and 44.8% of prescriptions were dated more than a year prior. Residents were more likely to be prescribed a sedative if they entered the facility at a younger age (76.9 vs 79.5, p=.042) or had been in the current facility longer (980 vs 734 days, p=.048). Following regression analysis, no individual factors were significantly associated with sedative prescription. CONCLUSION: With clear evidence of the risks of antipsychotics to patients with dementia, the proportion of residents prescribed an antipsychotic or sedative in this study, in conjunction with the prolonged duration of prescription, is cause for concern and needs addressing.


Subject(s)
Antipsychotic Agents/therapeutic use , Dementia/drug therapy , Drug Prescriptions/statistics & numerical data , Hypnotics and Sedatives/therapeutic use , Long-Term Care/methods , Nursing Homes/organization & administration , Aged , Aged, 80 and over , Geriatric Assessment , Humans , Male , New Zealand
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