Hospice Utilization Among Residents in Long-Term Care Facilities.

BACKGROUND: Hospice care can improve quality of life for persons nearing end of life, yet little is known about utilization of hospice care among persons residing in long-term care facilities (LTCFs). Given the increasing number of deaths that occur in LTCFs, it is important to examine hospice care practices in LTCFs. AIM: The aim of the cross-sectional study was to describe residents who received hospice care in LTCFs and explore factors that can predict hospice use in LTCFs across Canada. This study included 185 715 residents aged 19 years or older in LTCFs in Canada in 2015. RESULTS: Of all residents, 2.7% (n = 4973) received hospice care and 6.8% (n = 12 684) were profiled as having an end-stage disease. Among those who received hospice care, most were noted as end stage (89.5%) and had severe physical impairment (Activities of Daily Living Hierarchy Scale ≥ 5, 74.3%), mild-to-severe pain (Pain Scale ≥ 1, 76.0%), and moderate-to-severe health instability (Changes in Health, End-Stage Disease, Signs, and Symptoms Scale ≥3, 82.9%). Residents who received hospice care were in more severe and complex clinical conditions than those who did not receive hospice care. CONCLUSION: Only a small proportion of residents in LTCFs received hospice care. Further investigation of standardized assessment of terminal status is needed as accuracy of end-stage diagnosis continues to be challenging and criteria for hospice eligibility are narrow. Special attention should be paid to improve access to hospice care among residents with dementia or other progressive chronic diseases with severe and complex clinical needs.

A Cross-Sectoral Comparison of Prevalence and Predictors of Symptoms of Depression Over Time Among Older Adults in Ontario, Canada.

OBJECTIVES: Late-life depression, a common mental health issue, poses a significant burden of illness globally. We investigated factors associated with symptoms of depression among older adults across 3 health sectors in Ontario, Canada. METHOD: Electronic health assessment data on older adults aged 60 years+ in home care (HC; N = 359 217), long-term care (LTC; N = 125 496), and palliative care (PC; N = 29 934) were examined. Change in symptoms of depression, measured using the interRAI Depression Rating Scale (DRS), over time was examined, including predictors of the development of depression. RESULTS: At baseline, symptoms of depression were observed in 19.1% (HC), 24.2% (LTC), and 11.9% (PC). This increased to 20.6% (HC), 33.8% (LTC), and 13.2% (PC) at follow-up. For most older adults, DRS scores remained the same across sectors over time. Three independent variables emerged consistently across sectors as the main risk and protective factors for symptoms of depression. CONCLUSION: Although variations in the risk and protective factors for late-life depression were demonstrated across each sector, some commonalities emerged including unmanaged pain, symptoms of depression at baseline, social connectedness, and activity.

Spiritual Wellbeing of Cancer Patients: What Health-Related Factors Matter?

This study aimed to determine the predictors of spiritual wellbeing of non-terminal stage cancer patients hospitalized in oncology units in Lithuania. An exploratory cross-sectional study design was employed. During structured face-to-face interviews, 226 cancer patients hospitalized in oncology units responded about their spiritual wellbeing, perception of happiness, satisfaction with life, pain intensity, levels of education and physical functioning, and length of inpatient stay. A set of standardized tools were used: spiritual wellbeing scale SHALOM, brief multidimensional life satisfaction scale, Oxford Happiness Questionnaire, Barthel Index questionnaire, and verbal pain intensity scale. Additionally, social- and health-related factors were included in data analyses. Structural equation modeling was adapted for a comprehensive assessment of the mediating effect of spiritual wellbeing on the relationship between different health- and value-related factors. The overall fit of the structural model was generally good: [Formula: see text] = 66.94 (χ2/df = 2.31), CFI = 0.94, RMSEA = 0.08, and SRMR = 0.06. Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS Statistics) version 24.0 and Mplus version 8.2. Level of happiness, life satisfaction, and spiritual wellbeing scored in the moderate upper range. The communal domain of spiritual wellbeing rated with the highest mean score and transcendental domain with the lowest score. Education (b = 0.208, p = 0.004), physical functioning (b = 0.171, p = 0.025), and hospital duration (b = - 0.240, p = 0.001) were significant predictors of spiritual wellbeing. Happiness and life satisfaction were negatively influenced by pain intensity, which ranged from mild to moderate. Levels of education, physical functioning, and length of hospital stay predict spiritual wellbeing of non-terminally ill cancer patients. Happiness, as well as life satisfaction, was negatively predicted by pain intensity but had no direct influence on spiritual wellbeing of cancer patients. Spiritual wellbeing positively influences emotional wellbeing (happiness and life satisfaction), and its influence is stronger than the negative influence of physical pain has on emotional wellbeing.

Perceptions of Clergy Regarding the Provision of Spiritual Care in Lithuanian Hospitals for Cancer Patients.

This paper presents an analysis of narratives drawn from research that examined the views of clergy in regard to the provision of spiritual care in Lithuanian hospitals. The purpose of this research was to examine the shared responsibilities between what nurses do in the provision of holistic care and that of the clergy who are employed to provide spiritual care. A thematic analysis was undertaken, guided by questions related to how spirituality was perceived by the clergy; how spiritual care was defined; clergy's perceptions to nurses' provision of spiritual care, and whether there was a delineation between these two roles. Findings showed that although the clergy believed that their role was important in the provision of spiritual care, both nurses and clergy acknowledged that both played a role in spiritual support. However, scope of practice for each role was not yet defined. For nurses and clergy to understand their roles and the boundaries between them, clear standards of practice need to be developed.

Spiritual needs and their association with indicators of quality of life among non-terminally ill cancer patients: Cross-sectional survey.

PURPOSE: The study addresses the spiritual dimension of care of non-terminally ill cancer patients by measuring their spiritual needs in association with indicators of quality of life (i.e., happiness, satisfaction with life, pain intensity, functional capacity) and personal and illness characteristics. METHOD: A descriptive, cross-sectional survey included 227 patients with cancer. All patients that underwent treatment at a nursing and supportive treatment unit were interviewed face-to-face between January and November 2018. Regression models were used to control for gender, education, religiosity, pain intensity, functional capacity, life satisfaction and happiness. RESULTS: The non-terminally ill cancer patients experienced the exceptional importance of Inner Peace and Giving/Generativity and Forgiveness, while Religious and Existential needs were scored marginally lower, but nevertheless much higher as compared to patients with cancer from West-Europe. Correlation analysis revealed strong positive and in one case moderate interconnections among each of four spiritual needs, with the strongest association between Existential needs and the other three domains. Unmet Religious needs were positively associated with pain intensity and reduced physical capacity of patients, but less with life satisfaction. Pain intensity was the strongest predictor of cancer patients' Existential, Inner Peace and Giving/Generativity and Forgiveness needs. CONCLUSION: This study provides the first empirical evidence about the spiritual needs of cancer patients' care in Lithuania. Findings will serve as the basis for specific strategies to enhance the holistic well-being of these patients. The insights into oncology patients' unmet spiritual needs may be relevant to other Eastern European and former Soviet Union countries with similar developmental histories.

Translation, Cultural, and Clinical Validation of the Lithuanian Version of the Spiritual Needs Questionnaire among Hospitalized Cancer Patients.

Background and Objectives: The aim was to translate and validate the spiritual needs questionnaire for its use in the Lithuanian context. Materials and Methods: A descriptive, cross-sectional survey design was applied. Structural individual interview method (face-to-face) was employed to collect data on spiritual needs of cancer patients. Responses were obtained from 247 patients hospitalized in nursing and supportive treatment units at public hospitals. Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS Statistics) version 22.0. To assess the psychometric properties of the scale, Cronbach's alpha, split half test, average inter-item, and item-total correlations were calculated for internal consistency. Exploratory factor analysis was used to confirm the construct validity of the translated version of instrument. Results: Lithuanian version of The Spiritual Needs Questionnaire (27 items) had a good internal consistency (Cronbach's alpha = 0.94). The existential and connectedness with family needs factor had the lowest Cronbach's alpha (0.71) in relation to other factors: Religious needs (0.93), giving/generativity and forgiveness needs (0.88), and inner peace needs (0.74). Split-half test showed strong relationship between the both halves of the test. The item difficulty (1.47 (mean value)/3) was 0.49; while all values were in acceptable range from 0.20 to 0.80. Item-total correlations were inspected for the items in each of the four SpNQ-27 factors. Conclusions: The Lithuanian version of Spiritual needs questionnaire demonstrated adequate psychometric properties of the instrument. This instrument, as a screening tool and conversational model, is recommended for clinicians in health care practice to identify patients with spiritual needs.

Hospice use and one-year survivorship of residents in long-term care facilities in Canada: a cohort study.

BACKGROUND: Hospice care is designed for persons in the final phase of a terminal illness. However, hospice care is not used appropriately. Some persons who do not meet the hospice eligibility receive hospice care, while many persons who may have benefitted from hospice care do not receive it. This study aimed to examine the characteristics of, and one-year survivorship among, residents who received hospice care versus those who did not in long-term care facilities (LTCFs) in Canada. METHODS: This retrospective cohort study used linked health administrative data from the Canadian Continuing Reporting System (CCRS) and the Discharge Abstract Database (DAD). All persons who resided in a LTCF and who had a Resident Assessment Instrument Minimum Data Set Version 2.0 (RAI-MDS 2.0) assessment in the CCRS database between Jan. 1st, 2015 and Dec 31st, 2015 were included in this study (N = 185,715). Death records were linked up to Dec 31th, 2016. Univariate, bivariate and multivariate analyses were performed. RESULTS: The reported hospice care rate in LTCFs is critically low (less than 3%), despite one in five residents dying within 3 months of the assessment. Residents who received hospice care and died within 1 year were found to have more severe and complex health conditions than other residents. Compared to those who did not receive hospice care but died within 1 year, residents who received hospice care and were alive 1 year following the assessment were younger (a mean age of 79.4 [+ 13.5] years vs. 86.5 [+ 9.2] years), more likely to live in an urban LTCF (93.2% vs. 82.6%), had a higher percentage of having a diagnosis of cancer (50.7% vs. 12.9%), had a lower percentage of having a diagnosis of dementia (30.2% vs. 54.5%), and exhibited more severe acute clinical conditions. CONCLUSIONS: The actual use of hospice care among LTCF residents is very poor in Canada. Several factors emerged as potential barriers to hospice use in the LTCF population including ageism, rurality, and a diagnosis of dementia. Improved understanding of hospice use and one-year survivorship may help LTCFs administrators, hospice care providers, and policy makers to improve hospice accessibility in this target group.

Nutritional status of rural community-dwelling older people and changes after following nutritional recommendations.

BACKGROUND: It is crucial that community nurses in remote areas are competent to recognize the risk of malnutrition in older people and be able to help them to improve their nutritional status. AIM: To examine the factors associated with malnutrition and the impact of nutritional recommendations in rural community-dwelling older people. DESIGN: This was a cross-sectional descriptive study. METHOD: The study was conducted in 2014 in a rural primary health care setting in Lithuania with 169 older people. Nutritional status was assessed using the Mini Nutritional Assessment tool. Older people who were at risk of malnutrition or were already malnourished (n = 82) received written nutritional recommendations and were reassessed after 6 months. RESULTS: Nutritional status was normal for 51.5% of participants, 43.2% had risk of malnutrition, and 5.3% had malnutrition. Risk of malnutrition or malnutrition was associated with chronic and intermittent pain, chewing difficulties, swallowing disorders, dental problems, and medication use. The nutritional status of participants at risk of malnutrition or malnourished had improved 6 months later. CONCLUSIONS: Risk of malnutrition or malnutrition was prevalent among rural community-dwelling older. The study highlighted that positive health outcomes are achievable in undernourished or at risk of malnutrition older people when nutritional recommendations are applied with minimal resources.

Correction to: factors affecting residents transition from long term care facilities to the community: a scoping review.

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Factors affecting residents transition from long term care facilities to the community: a scoping review.

BACKGROUND: Long-term care facilities (LTCFs) are often places where persons with complex health needs that cannot be met in a community setting, reside and are cared for until death. However, not all persons experience continuous declines in health and functioning. For some residents who experience improvement in personal abilities and increased independence, transition from the LTCF to the community may be an option. This scoping review aimed to synthetize the existing evidence regarding the transition process from discharge planning to intervention and evaluation of outcomes for residents transitioning from LTCFs to the community. METHODS: This review followed a five-stage scoping review framework to describe the current knowledge base related to transition from LTCFs to community based private dwellings as the location of the discharge (example: Person's own home or shared private home with a family member, friend, or neighbour). Of the 4221 articles retrieved in the search of 6 databases, 36 articles met the criteria for inclusion in this review. RESULTS: The majority of studies focussed on an older adult population (aged 65 years or greater), were conducted in the USA, and were limited to small geographic regions. There was a lack of consistency in terminology used to describe both the facilities as well as the transition process. Literature consisted of a broad array of study designs; sample sizes ranged from less than 10 to more than 500,000. Persons who were younger, married, female, received intense therapy, and who expressed a desire to transition to a community setting were more likely to transition out of a LTCF while those who exhibited cognitive impairment were less likely to transition out of a LTCF to the community. CONCLUSIONS: Findings highlight the heterogeneity and paucity of research examining transition of persons from LTCFs to the community. Overall, it remains unclear what best practices support the discharge planning and transition process and whether or not discharge from a LTCF to the community promotes the health, wellbeing, and quality of life of the persons. More research is needed in this area before we can start to confidently answer the research questions.

Relationship between restraint use, engagement in social activity, and decline in cognitive status among residents newly admitted to long-term care facilities.

AIM: Declining cognitive function can negatively affect residents' quality of life (QOL) in long-term care facilities (LTCFs). The present study examined the role of physical restraint use, use of antipsychotic medications, and engagement in social activities to affect change in cognitive status and drive cognitive decline among residents newly admitted to a LTCF. METHODS: Secondary data analysis used interRAI Minimum Data Set 2.0 data gathered at admission and first follow-up assessment (n = 111,052). The interRAI Minimum Data Set 2.0 collects comprehensive information as part of regular clinical care, and is mandated for all LTCF in Ontario, Canada. Bivariate and logistic regression analyses investigated the roles of physical restraint use, antipsychotic medication use and social engagement affecting cognition, and were stratified based on the presence/absence of diagnosis of dementia. RESULTS: At follow up, 16.1% of residents (n = 16 414) showed decline in cognition. Residents with one or more physical restraints (chair, trunk and limb) were at increased risk for cognitive decline evidenced among residents with and without a diagnosis of dementia. Antipsychotic medication use did not emerge as a strong predictor of cognitive decline. Social engagement was protective against cognitive decline, and more pronounced for residents without a diagnosis of dementia. CONCLUSION: Physical restraint use should be avoided, or used as a last resort. LTCFs should prioritize resident engagement in social activities in either formal activities or ad hoc, as soon as possible on entry to the LTCFs. Prioritizing social networks and greater participation in activities might decrease the risk for cognitive decline, thereby improving or maintaining resident quality of life. Geriatr Gerontol Int 2017; 17: 246-255.

Resources of residents for potential transition from long-term care to community.

BACKGROUND AND OBJECTIVE: Transition from long-term care to the community can have positive effects on residents' health and quality of life and promote the feelings of happiness, safety, and independence. The aim of this study was to examine residents' resources for potential transition to the community after residing in long-term care facilities. MATERIAL AND METHODS: The study was conducted in 8 long-term care institutions for older persons of Kaunas county. The study population comprised 252 residents. The items contained in the interRAI Long-Term Care Facility assessment instrument were used to evaluate a consistent positive outlook, social activities, and discharge potential. Cognitive impairment was measured using the Cognitive Performance Scale. Activities of daily living were measured using the Activities of Daily Living Hierarchy Scale. RESULTS: More than 10% of the residents exhibited no cognitive impairment. One-third of the residents preferred to transition back to the community from their long-term care facility. Two-thirds expressed that they had familiar surroundings, which could be assumed to increase their feeling of safety at home. Social activities prevalent among residents included taking care of plants and walking outdoors. About 40% of the residents were physically independent in the activities of daily living. In spite of these resources, no residents were involved in a discharge process due to the lack of established nursing and social care services and transitional care plans. CONCLUSIONS: With well-organized community services, some residents in long-term care facilities may have enough resources to live in the community.

[Assessment of cognitive functions of the elderly in a hospital and long-term care institutions]. / Pagyvenusio amziaus zmoniu pazinimo funkciju ivertinimas stacionare ir ilgalaikes globos institucijose.

UNLABELLED: The aim of this study was to assess cognitive functions of the elderly in an acute care department and long-term care institutions. MATERIAL AND METHODS: A total of 151 hospitalized patients and 111 residents in long-term care facilities participated in the study; in total, 262 respondents. The general items of the inter RAI Questionnaires (Acute Care and Long-Term Care Facilities) were used to evaluate and compare cognitive functions. Hospitalized patients were examined on admission (during 24 hours) evaluating the patient's status before hospitalization (three days before admission to hospital) and 24 hours before planned discharge. The residents in long-term care institutions were examined once. RESULTS: The assessment of skills for daily decision-making showed that more patients made decisions independently at discharge (68.6%) comparing with admission day (53.0%). Impaired decision-making was more common on admission than at discharge, while the residents in long-term care institutions were more dependent than the hospitalized elderly. Procedural memory problems were more frequent among the residents in long-term care institutions (67.6%) than among the hospitalized elderly both on admission (34.7%) and discharge (21.9%) (P<0.001). The patients were able to express themselves clearly and understood others well at discharge more frequently (81.0% and 82.5%, respectively) than on admission (72.7% and 75.3%, respectively), while only 14.4% of the residents in long-term care institutions were able to express themselves clearly and understood others well (P<0.001). CONCLUSIONS: The residents in long-term care institutions had worse cognitive functions than the hospitalized patients. Cognitive functions of the hospitalized elderly were significantly more impaired on admission as compared to discharge, possibly due to impaired somatic and functional status on admission.

[The need of the elderly for nursing and social services in the community of Kaunas district]. / Pagyvenusiu zmoniu slaugos bei socialiniu paslaugu poreikis Kauno rajono bendruomeneje.

UNLABELLED: The aim of this study was to evaluate the need of the elderly for outpatient nursing and social services in Kaunas district. MATERIAL AND METHODS: The object of the study was elderly people (aged 65 years and more) living in Kaunas district. A questionnaire was used for interviewing. The sample was randomly selected from the lists of people registered at the primary health care centers (including outpatient departments and medical aid centers). A total of 390 inhabitants were investigated who represent all the elderly of Kaunas district. The independence of the respondents was evaluated by the standard tests (the Barthel Index and Mini-Mental State Examination). RESULTS: The respondents reported that 71.3% of them needed nursing and 58.2% social services. The need for the services was higher in older age group. The rural elderly reported higher need for social services (64.3%) than the urban elderly (49.6%). Less than half (45.9%) of respondents referred having problems visiting the general practitioner. Majority of the respondents (86.4%) pointed out that those who took care of them had no special medical training. Totally or almost totally dependent respondents (groups by Barthel Index) needed social (88.0%) and nursing (96.0%) services. Majority of respondents (79.2%) preferred to be cared at home. CONCLUSIONS: More than half of the elderly needed both nursing and social services. The need for social services differently from nursing services was influenced by the living place of the respondents; the rural elderly needed services more than the urban elderly.