Avoidable and Unavoidable Pressure Injuries Among Residents Living in Nursing Homes: A Retrospective Study.

PURPOSE: The aim of this study was to describe the prevalence of unavoidable pressure injuries (UPIs) in residents of nursing homes (NHs) and characteristics associated with UPIs. DESIGN: A retrospective study. SUBJECTS AND SETTING: Residents 65 years or older residing in any of 105 NHs in the Friuli Venezia Giulia region of Italy between January and December 2013. METHODS: Database search comprised of a multidimensional assessment of NH residents. RESULTS: Data from 7950 residents were reviewed, 925 (11.6%) of whom had 1 or more documented pressure injuries (PIs). Among these, 221 (23.9%) residents met criteria for avoidable PIs (APIs) and 704 (76.1%) for UPIs. Residents with UPIs were more frequently hemodynamically unstable, terminally ill, and had medical devices (all Ps < .001) than residents with APIs. Moreover, residents with UPIs showed higher functional, cognitive, and mood impairments compared to residents with APIs (all Ps < .001). CONCLUSIONS: Our findings suggest a high prevalence of UPIs compared to APIs among residents residing in NHs in one region of Italy. Additional research is needed to establish the prevalence of UPIs among NH residents country-wide, as well as determine specific criteria that identify UPIs in long-term care settings and increase consistency in prevalence and incidence measurement models.

Self-feeding dependence incidence and predictors among nursing home residents: Findings from a 5 year retrospective regional study.

The aim of this regionally-based, retrospective study was to describe the incidence of self-feeding dependence and predictors among elderly patients admitted from 2008 to 2013 to 105 Italian nursing homes. Data reported in a regional database collected at the time of nursing home admission and every 6 months up to the resident's death were accessed. The self-feeding degree of dependence was the dependent variable; at the individual and nursing home levels, explanatory variables were those collected at nursing home admission and every 6 months. The structural equation model and the ordinal polynomial logit regression analysis were performed. A total of 13 175 records of residents when admitted to the nursing home and their following 69 341 records, were included. At the time of nursing home admission, 6496 residents (49.3%) reported a certain degree of dependence in self-feeding and showed slight worsening in their dependence every 6 months. At the individual level, the increased functional dependence raised the proportional odds ratios of approximately 4.36 times of an increased dependence in self-feeding; the degree of cognitive impairment, the lack of social interactions, the occurrence of pressure sores, comorbidities, as well as the clinical instability and time all raised the risk of self-feeding dependence progression. At the nursing home level, an increased number of beds emerged as a factor also increasing the proportional odds of dependence in self-feeding. Factors affecting self-feeding dependence are multi-faceted at the individual and at the nursing home levels.

High feeding dependence prevalence in residents living in Italian nursing homes requires new policies: Findings from a regionally based cross-sectional study.

OBJECTIVES: An increased amount of functional dependence has been reported among residents living in nursing homes. Among others, feeding dependence is one of the most complex needs to satisfy: behind the attempt to personalise meals with individual preferences and clinical regimens, all residents require help at the same moment and for long periods of time, three or more times a day. With the intent of debating policy implications, the aims of this study were to advance the knowledge in the field of feeding dependence prevalence and predictors in Italy, a country where life expectancy is among the highest in the World. METHOD: A large retrospective regionally-based study approaching all nursing homes (n = 105) was performed in 2014; all residents (n = 10,900) were eligible and those with a completed assessment recorded in the regional database and aged >65 years (n = 8875) were included. RESULTS: 1839 residents (20.7%) were in total need of help in feeding on a daily basis. At the multilevel analysis, predictors were moderate/severe dementia (OR 4.044, CI 95% 3.213-5.090); dysphagia (OR 4.003 CI 95% 3.155-5.079); pressure sores (OR 2.317 CI 95% 1.803-2.978); unintentional weigh loss (OR 2.197 CI 95% 1.493-3.233); unsociability (OR 1.561 CI 95% 1.060-2.299); and clinical instability (OR 1.363 CI 95% 1.109-1.677). CONCLUSIONS: The feeding dependence prevalence emerged seem to be unique compared to that documented at the international levels. Modifiable and unmodifiable predictors found require new policies regarding workforce skills-mix and shifts schedules; as well as alliances with families, associations and communities' stakeholders. According to the complexity of the resident profile emerged, staff education and training is also recommended.

Identifying longitudinal sustainable hierarchies in activities of daily living.

Activities of daily living serve as an indicator of progression in disability and rehabilitation. It is know that some of the measurement scales used show hierarchical properties indicating that activities of daily living are lost and gained in a consistent pattern. Few studies have investigated the extent to which these patterns are sustained across time and across a range of disability. The study aimed to investigate the hierarchical properties of the activity of daily living items in the ValGraf functional ability scale, to establish if there is a hierarchy of items in the scale and to study the sustainability of the hierarchy over time. Secondary analysis of a retrospective database from 13,113 people over 65 years in 105 nursing homes in northern Italy, between 2008 and 2013 was conducted. Data were gathered 6-monthly and analysed using Mokken scaling to identify a hierarchy of items in the scale and if this was sustainable over time. A sustainable hierarchy of items was observed running in difficulty from urinary incontinence to feeding. The hierarchical structure of the activities of daily living observed in the present study is stable over time meaning that changes in total score for these items can be compared meaningfully across time.

Inactive Residents Living in Nursing Homes and Associated Predictors: Findings From a Regional-Based, Italian Retrospective Study.

OBJECTIVES: It has been amply reported that nursing home (NH) residents are largely inactive, a condition that may further increase functional decline, behavioral disorders, and risk of death. To date, studies have mainly focused on individual characteristics that may decrease residents' involvement in activities. Therefore, the aim of this study is to describe the prevalence of inactive NH residents in an Italian context, identifying predictors of inactivity at the individual and NH levels. DESIGN: Retrospective regional-based study performed in 2014. SETTING: All NHs (n = 105) located in the Friuli Venezia Giulia Region, northeastern region of Italy. PARTICIPANTS: A total of 8875 residents with at least 1 nursing assessment and living in an NH for at least 1 year. MEASUREMENTS: The dependent variable was inactivity in the last week, defined as the resident not being involved in any socially or individually based, or meaningful recreational (eg, gardening) activities. The independent variables were set at individual and NH levels. Aiming at identifying predictors of inactivity, a hierarchical generalized linear (mixed-effects) model incorporating both fixed-effect parameters and random effects, was performed. RESULTS: A total of 4042 (45.6%) residents were inactive during the week before the evaluation. At the resident level, those with severe cognitive impairment [odds (OR) 4.462, 95% confidence interval (CI) 3.880-5.132], unsociable behavior (OR 2.961, 95% CI 2.522-3.473), night restlessness (OR 1.605, 95% CI 1.395-1.853), lack of cooperation in daily care (OR 1.408, 95% CI 1.199-1.643), pressure sores (OR 1.314, 95% CI 1.065-1.622), depressive disorders (OR 1.242, 95% CI 1.089-1.416), and clinical instability (OR 1.110, 95% CI 1.037-1.188) reported an increased risk of being inactive. At the NH level, for each additional hour of care offered by professional educators, there was 1% less likelihood of inactive residents (OR .964, 95% .933-.996). CONCLUSIONS: Approximately one-half of the residents in this study living in Italian NHs are inactive. Inactivity is significantly associated with the presence of severe cognitive impairment, behavioral disorders (eg, unsociability, night restlessness, and lack of cooperation in daily care), pressure sores, depressive symptoms, and clinical instability. Moreover, receiving care from professional educators whose aim in their training program and professional mission is to improve individual and social engagement, decreased the likelihood of resident inactivity.

Description and validation of a geriatric multidimensional graphical instrument for promoting longitudinal evaluation.

The debate about the adoption of standard multidimensional geriatric assessment instruments is mainly due to the lack of consensus on the feasibility and requirements for such instruments by both the health and the social care professions. A tool called ValGraf was developed in the attempt to give an original answer to these and other controversial issues. The aim of this study was to evaluate the ValGraf for acceptability, concurrent validity and factorial structure. The functional and cognitive impairments as ascertained by the ValGraf were compared with Katz index and Folstein's Mini Mental State Examination (MMSE). Subjects (N=210) of four nursing homes were assessed by two independent teams of nurses. The factorial validity study involved 8280 subjects living in nursing homes. Assessments were conducted throughout the 2001 by 20 geriatricians. The agreement between the ValGraf sections concerning independence in daily living and Katz's index was almost total (r=0.96) and that between ValGraf items on cognition and MMSE was very good (0.73). Factor analysis revealed that 13 coherent factors explained 53% of total variance. ValGraf was proved to be acceptable and comprehensive, criterion valid, at least as daily activities and cognitive status are concerned, and to have a coherent factorial structure.