Association between Type of Residence and Clinical Signs of Neglect in Older Adults.

BACKGROUND: Studies have demonstrated that measures of lower quality of care and associated adverse health effects are more prevalent in for-profit nursing homes compared to not-for-profit facilities. However, these studies omit persons who receive care in the community setting, and exclusively focus on isolated clinical signs that may obscure the true effect size, since these clinical signs rarely occur in isolation. OBJECTIVE: In this study, we use the Clinical Signs of Neglect Scale (CSNS), which is an aggregate measure of clinical signs of neglect and substandard care, to evaluate the association of residence type on health outcomes among individuals living in both private community residences and for-profit and not-for-profit long-term care facilities. METHODS: In a multicenter, retrospective data analysis of 1,149 patients identified from an inpatient hospital registry, we assessed the relationship between residence type (community dwelling, not-for-profit, and for-profit facilities) and clinical signs of neglect. Adjusted parameter estimates and 95% CIs were estimated with linear regression in 3 models using different reference groups. RESULTS: The most serious clinical signs were consistently more prevalent among residents of for-profit facilities, as were measures of poor institutional quality. Relative to low-functioning community-dwelling patients, the mean difference in CSNS scores was higher among patients residing in not-for-profit facilities by 1.99 (p = 0.012) and 3.55 (p ≤ 0.001) among patients in for-profit facilities. In a separate model, the mean difference in CSNS scores among patients living in for-profit facilities compared to not-for-profit facilities was 1.90 (p = 0.035). CONCLUSIONS: Using an aggregate measure, our findings support prior studies demonstrating an association between residence type and adverse health outcomes for disabled elderly.

Using clinical signs of neglect to identify elder neglect cases.

Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual's residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%.

Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

BACKGROUND: Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. OBJECTIVES: To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families. PARTICIPANTS: Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge. DESIGN: Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems. MEASUREMENTS AND MAIN RESULTS: Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member. CONCLUSIONS: Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.

A descriptive analysis of 10 years of research published in the Journal of Health Communication.

This article describes the contents of the articles from the first decade of The Journal of Health Communication (JOHC). Three hundred and twenty-one published articles were reviewed and coded to determine the characteristics of the researchers, the types of research presented, the common health topics covered, and the research designs used. The results led to the following profile of a typical article. Its primary author is a U.S. academic. It probably focuses on smoking, HIV/AIDS, or cancer. It is an empirical research study, more likely to use quantitative, specifically survey methods, rather than qualitative methods. It probably is not driven by theory. It is much more likely to examine mass media communication than interpersonal communication. Its purpose is just as likely to be audience analysis as message design, as evaluation of a planned communication intervention. If its purpose is to evaluate a planned communication intervention however, that intervention is almost certainly a successful one.