RESUMEN
Up to 80% of nursing home residents are affected by pain. Pain assessment aims to determine pain intensity, quality, and course of pain to underpin diagnostic decision making. In the nursing home population, pain assessment is frequently compromised by cognitive impairment. Characteristics of the nursing home setting, such as resident's age, staff skill mix, and overall aims of the care provided, also need to be taken into account. Therefore, an interdisciplinary evidence-based clinical practice guideline for pain assessment in the nursing home setting was developed. A systematic literature search was carried out covering publications between 2003 and 2015. Thirty-nine studies were included in the preparation of this guideline, supplemented by 12 international reference guidelines. Recommendations were subjected to a structured consensus-finding process with representatives from 37 scientific and professional organizations and patient representatives. The guideline underwent independent peer review before finalization. It comprises 62 recommendations that are grouped into 4 chapters: (1) context of pain assessment in nursing home care; (2) screening; (3) focused assessment; and (4) reassessment/monitoring of pain. Main recommendations stipulate that clinicians should assess the patient's ability to provide self-report of pain when screening for pain and that each resident should be screened for the presence of pain. A focused assessment of pain, performed during rest and activities, should include pain intensity, changed behaviors, general mobility, pain history, comorbidities, and pain medication. Pain should be re-assessed at regular intervals using the same instruments that were used for the focused assessment. Guideline development demonstrated that many aspects of pain assessment in older persons have not received adequate research attention so far. Available studies predominantly possess only low levels of evidence. Therefore, research into this area needs to be systematically developed to address questions of clinical relevance to support patient care.
Asunto(s)
Medicina Basada en la Evidencia , Casas de Salud , Dimensión del Dolor , Dolor , Anciano , Anciano de 80 o más Años , Práctica Clínica Basada en la Evidencia , Humanos , Dolor/diagnósticoRESUMEN
BACKGROUND: A model of assertive outreach (AO) in which office-based psychiatrists collaborate with ambulatory nursing services for providing intensive home-treatment is currently being implemented in rural areas of Lower Saxony, Germany. The costs of the model are reimbursed by some of the statutory health insurance companies active in Lower Saxony. Effectiveness and efficiency of this model for patients suffering from schizophrenia is evaluated in a pragmatic and prospective trial. METHODS: Quasi-experimental controlled trial: patients receiving the intervention are all those receiving AO; controls are patients not eligible for AO based on their health insurance affiliation. ELIGIBILITY CRITERIA: clinical diagnosis of schizophrenia (ICD-10 F.20), aged at least 18 years and being moderately to severely impaired in global functioning. PRIMARY OUTCOME: admission and days spent in psychiatric inpatient care; secondary outcomes: clinical and functional status; patient satisfaction with chronic care; health care costs. Follow-up time: 6 and 12 months. DISCUSSION: The study faces many challenges typical to pragmatic trials such as the rejection of randomisation by service providers, the quality of treatment as usual (TAU) to which the intervention will be compared, and the impairment of the study subjects. Solutions of how to deal with these challenges are presented and discussed in detail. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: http://ISRCTN34900108, German Clinical Trial Register: http://DRKS00003351.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Pacientes Ambulatorios/psicología , Esquizofrenia/terapia , Protocolos Clínicos , Servicios Comunitarios de Salud Mental/economía , Análisis Costo-Beneficio , Alemania , Humanos , Cuidados a Largo Plazo , Satisfacción del Paciente , Proyectos de Investigación , Esquizofrenia/economíaRESUMEN
OBJECTIVE: This study analyses deficits in outpatient care for depressed persons in Germany and seeks to identify possibilities for improvement. METHOD: Literature search and expert interviews. RESULTS: The outpatient depression care does not consider guidelines. A numerous possibilities to optimise outpatient treatment of depressive ill people were identified. CONCLUSIONS: Incentives should be systematically set to encourage services that are specific for treating chronic disorders. Systematic incentive for the improvement of the outpatient depression care should be given for example in particular for the achievements, which are important for the care of chronic disorders.
Asunto(s)
Atención Ambulatoria , Trastorno Depresivo/terapia , Medicina Basada en la Evidencia , Adhesión a Directriz , Programas Nacionales de Salud , Antidepresivos/uso terapéutico , Enfermedad Crónica , Conducta Cooperativa , Intervención en la Crisis (Psiquiatría) , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Alemania , Necesidades y Demandas de Servicios de Salud , Humanos , Comunicación Interdisciplinaria , Entrevistas como Asunto , Grupo de Atención al Paciente , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Prevención del SuicidioRESUMEN
Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample (n = 179) that met screening requirements, including subjects with and without mild cognitive impairment (Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale (HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective.
Asunto(s)
Actividades Cotidianas , Demencia/psicología , Hogares para Ancianos/organización & administración , Casas de Salud/organización & administración , Autonomía Personal , Calidad de Vida , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Envejecimiento/psicología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/terapia , Estudios Transversales , Demencia/diagnóstico , Demencia/terapia , Femenino , Evaluación Geriátrica/métodos , Alemania , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Pruebas Neuropsicológicas , Percepción , AutoinformeAsunto(s)
Dolor Crónico/enfermería , Hogares para Ancianos , Casas de Salud , Manejo del Dolor/enfermería , Anciano , Dolor Crónico/psicología , Terapia Cognitivo-Conductual , Terapia Combinada/enfermería , Terapia Combinada/psicología , Terapias Complementarias/enfermería , Terapias Complementarias/psicología , Terapia por Ejercicio/enfermería , Terapia por Ejercicio/psicología , Humanos , Masaje/enfermería , Masaje/psicología , Actividad Motora , Relaciones Enfermero-Paciente , Manejo del Dolor/métodos , Dinámica Poblacional , Terapia por Relajación/enfermería , Terapia por Relajación/psicologíaRESUMEN
PURPOSE: To explore different institutional barriers to and facilitators of physical activity (PA) in nursing homes. METHODS: Cross-sectional survey of 40 German nursing homes and 217 nursing-home residents (NHRs; M ± SD age 80 ± 10.2 yr, 55% women, MMSE ≥20). Quantitative data were collected on the structural characteristics of nursing homes and the PA services available. RESULTS: Forms of exercise available were not adequately communicated to residents. Overall participation was below 50%. Awareness was significantly higher in residents with informed relatives (p = .003). A broad range of forms of exercise was generally available (M ± SD 5 ± 2.22, range 0-10), but they were rarely tailored to NHRs' needs and their effectiveness remains questionable. CONCLUSION: Multidimensional opportunities to promote PA in NHRs are identified.
Asunto(s)
Accesibilidad a los Servicios de Salud , Actividad Motora/fisiología , Movimiento/fisiología , Casas de Salud , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Cognición , Estudios Transversales , Planificación Ambiental , Femenino , Alemania , Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Encuestas y CuestionariosAsunto(s)
Conducta Cooperativa , Hogares para Ancianos , Comunicación Interdisciplinaria , Evaluación en Enfermería , Casas de Salud , Dimensión del Dolor/enfermería , Guías de Práctica Clínica como Asunto , Anciano , Enfermería Basada en la Evidencia , Alemania , Humanos , Grupo de Atención al PacienteRESUMEN
PURPOSE: The current use of inappropriate medication in elderly nursing home residents (NHRs) in Germany is unclear. We therefore set out to analyse the frequency and patterns of potentially inappropriate drug prescriptions in elderly NHRs in Germany. METHODS: We utilised prescription data for NHRs 65 years or older from a large German health insurance company during a period of 3 months. Inappropriate drugs were identified from a recently reported French consensus list. RESULTS: Data for 7271 (83.7%) females and 1414 (16.3%) males were available for analysis. The average age was 83.6 ± 7.3 years. Overall 48 inappropriate drugs were prescribed resulting in a total of 3825 inappropriate drug prescriptions which accounted for 4.3% of all documented prescriptions (n = 88,695). One thousand nine hundred and three (21.9%) residents received at least one inappropriate drug prescription. Using logistic regression we detected no significant influence of gender or level of care on frequency of inappropriate prescriptions. However, age had a significant influence; with increasing age the frequency of residents receiving inappropriate medications decreased steadily (r = -0.92, p = 0.003) and ranged from a maximum of 32.8% in the group between 65 and 69 years to a minimum of 15.2% in residents older than 94 years. This observation was paralleled by a significant and continuous decrease of drug prescription rates with increasing age (r = -0.88, p = 0.009). CONCLUSION: The present analysis demonstrates that about one out of five elderly NHRs received at least one inappropriate drug prescription. Additional studies may aim to establish a list of frequently prescribed inappropriate drugs for Germany.