Reply to Letter to the Editor – The impact of weight loss and low BMI on mortality of nursing home residents – Results from the nutritionDay in nursing homes

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

Download Full-text

Association of care workers’ job satisfaction and global happiness with change of functional performance of severely disabled elderly residents in nursing homes: a cohort and questionnaire study in Japan

BMJ Open ◽

10.1136/bmjopen-2019-033937 ◽

2020 ◽

Vol 10 (10) ◽

pp. e033937

Author(s):

Shino Ikeda-Sonoda ◽

Nao Ichihara ◽

Jiro Okochi ◽

Arata Takahashi ◽

Hiroaki Miyata

Keyword(s):

Job Satisfaction ◽

Nursing Home ◽

Nursing Homes ◽

Functional Performance ◽

Nursing Home Residents ◽

Care Staff ◽

Lower Probability ◽

Disabled Elderly ◽

The Impact

ObjectivesThere is growing concern regarding quality of work life (QWL) among care staff in nursing homes. However, little is known about the impact of QWL on nursing home residents’ functional performance. Recent literature suggests that job satisfaction and happiness of healthcare workers reflect their perceived QWL and impact the quality of their care. This study examined the association between job satisfaction and global happiness with change in functional performance of severely disabled elderly residents in nursing homes.DesignA retrospective cohort study of nursing home residents combined with a questionnaire survey of their care staff.SettingEighteen nursing homes in Japan.ParticipantsData were collected from 1000 residents with a required care level of 3–5 and from 412 care staff in nursing homes between October 2017 and March 2018.Outcomes and explanatory variablesFunctional performance was structurally assessed with ICF (International Classification of Functioning, Disability and Health) staging, composed of 52 items concerning activities of daily life, cognitive function and social participation, at baseline and 6 months later. Deterioration and improvement of functional performance were dichotomously defined as such change in any of the items. QWL of care staff was evaluated with a questionnaire including questions about job satisfaction and global happiness.ResultsFunctional performance deteriorated and improved in 23.0% and 12.7% of residents, respectively. Global happiness of care staff was associated with lower probability of residents’ deterioration (adjusted OR, 0.61; CI 0.44 to 0.84). There was no significant correlation between job satisfaction or happiness of care staff and improvement of residents’ functional performance.ConclusionThese results suggest that QWL of care staff is associated with changes in functional performance of elderly people with severe disabilities in nursing homes.

Download Full-text

Public reporting of antipsychotic prescribing in nursing homes: population-based interrupted time series analyses

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-007840 ◽

2018 ◽

Vol 28 (2) ◽

pp. 121-131 ◽

Cited By ~ 8

Author(s):

Noah M Ivers ◽

Monica Taljaard ◽

Vasily Giannakeas ◽

Catherine Reis ◽

Evelyn Williams ◽

...

Keyword(s):

Time Series ◽

Nursing Home ◽

Nursing Homes ◽

Mass Media ◽

Nursing Home Residents ◽

Public Reporting ◽

Increased Risk ◽

Antipsychotic Prescribing ◽

The Impact ◽

Newspaper Articles

BackgroundAlthough sometimes appropriate, antipsychotic medications are associated with increased risk of significant adverse events. In 2014, a series of newspaper articles describing high prescribing rates in nursing homes in Ontario, Canada, garnered substantial interest. Subsequently, an online public reporting initiative with home-level data was launched. We examined the impact of these public reporting interventions on antipsychotic prescribing in nursing homes.MethodsTime series analysis of all nursing home residents in Ontario, Canada, between 1 October 2013 and 31 March 2016. The primary outcome was the proportion of residents prescribed antipsychotics each month. Balance measures were prescriptions for common alternative sedating agents (benzodiazepines and/or trazodone). We used segmented regression to assess the effects on prescription trends of the newspaper articles and the online home-level public reporting initiative.ResultsWe included 120 009 nursing home resident admissions across 636 nursing homes. Following the newspaper articles, the proportion of residents prescribed an antipsychotic decreased by 1.28% (95% CI 1.08% to 1.48%) and continued to decrease at a rate of 0.2% per month (95% CI 0.16% to 0.24%). The online public reporting initiative did not alter this trend. Over 3 years, there was a net absolute reduction in antipsychotic prescribing of 6.0% (95% CI 5.1% to 6.9%). Trends for benzodiazepine prescribing did not change as substantially during the period of observation. Trazodone use has been gradually increasing, but its use did not change abruptly at the time of the mass media report or the public reporting initiative.InterpretationThe rapid impact of mass media on prescribing suggests both an opportunity to use this approach to invoke change and a warning to ensure that such reporting occurs responsibly.

Download Full-text

Accuracy of influenza vaccination rate estimates in United States nursing home residents

Epidemiology and Infection ◽

10.1017/s0950268814003434 ◽

2014 ◽

Vol 143 (12) ◽

pp. 2588-2595 ◽

Cited By ~ 2

Author(s):

J. M. GROSHOLZ ◽

S. BLAKE ◽

J. D. DAUGHERTY ◽

E. AYERS ◽

S. B. OMER ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Influenza Vaccination ◽

Long Term Care ◽

Nursing Home Residents ◽

Term Care ◽

Vaccination Rates ◽

Vaccination Recommendations ◽

The Impact

SUMMARYThe US Center for Medicare and Medicaid Services (CMS) requires nursing homes and long-term-care facilities to document residents' vaccination status on the Resident Assessment Instrument (RAI). Vaccinating residents can prevent costly hospital admissions and deaths. CMS and public health officials use RAI data to measure vaccination rates in long-term-care residents and assess the quality of care in nursing homes. We assessed the accuracy of RAI data against medical records in 39 nursing homes in Florida, Georgia, and Wisconsin. We randomly sampled residents in each home during the 2010–2011 and 2011–2012 influenza seasons. We collected data on receipt of influenza vaccination from charts and RAI data. Our final sample included 840 medical charts with matched RAI records. The agreement rate was 0·86. Using the chart as a gold standard, the sensitivity of the RAI with respect to influenza vaccination was 85% and the specificity was 77%. Agreement rates varied within facilities from 55% to 100%. Monitoring vaccination rates in the population is important for gauging the impact of programmes and policies to promote adherence to vaccination recommendations. Use of data from RAIs is a reasonable approach for gauging influenza vaccination rates in nursing-home residents.

Download Full-text

Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident’s Place of Death

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120956650 ◽

2020 ◽

pp. 104990912095665

Author(s):

Aluem Tark ◽

Mansi Agarwal ◽

Andrew W. Dick ◽

Jiyoun Song ◽

Patricia W. Stone

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

National Level ◽

Nursing Home Residents ◽

Place Of Death ◽

Positive Health ◽

Life Sustaining Treatment ◽

High Standards ◽

Positive Health Outcomes ◽

The Impact

The Physician Orders for Life-Sustaining Treatment (POLST) program was developed to enhance quality of care delivered at End-of-Life (EoL). Although positive impacts of the POLST program have been identified, the association between a program maturity status and nursing home resident’s likelihood of dying in their current care settings remain unanswered. This study aims to evaluate the impact of the POLST program maturity status on nursing home residents’ place of death. Using multiple national-level datasets, we examined total 595,152 residents and their place of death. The result showed that the long-stay residents living in states where the program was mature status had 12% increased odds of dying in nursing homes compared that of non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes. The findings demonstrate that a well-structured and well-disseminated POLST program, combined with a continued effort to meet high standards of quality EoL care, can bring out positive health outcomes for elderly patients residing in care settings.

Download Full-text

Statin Intake and All-Cause Mortality among Older Nursing Home Residents

Gerontology ◽

10.1159/000516862 ◽

2021 ◽

pp. 1-5

Author(s):

Anton De Spiegeleer ◽

Jordi Van Migerode ◽

Antoon Bronselaer ◽

Evelien Wynendaele ◽

Milan Peelman ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Older People ◽

Absolute Risk ◽

Nursing Home Residents ◽

Absolute Risk Reduction ◽

Cross Sectional Study ◽

Cross Sectional ◽

All Cause Mortality ◽

The Impact

Background: Statins are progressively accepted as being associated with reduced mortality. However, few real-world statin studies have been conducted on statin use in older people and especially the most frail, that is, the nursing home residents. Objective: The aim of this study was to evaluate the impact of statin intake in nursing home residents on all-cause mortality. Method: This is a cross-sectional study of 1,094 older people residing in 6 nursing homes in Flanders (Belgium) between March 1, 2020 and May 30, 2020. We considered all residents who were taking statins for at least 5 days as statin users. All-cause mortality during the 3 months of data collection was the primary outcome. Propensity score overlap-weighted logistic regression models were applied with age, sex, functional status, diabetes, and cardiac failure/ischemia as potential confounders. Results: 185 out of 1,094 residents were on statin therapy (17%). The statin intake was associated with decreased all-cause mortality: 4% absolute risk reduction; adjusted odds ratio 0.50; CI 0.31–0.81, p = 0.005. Conclusions: The statin intake was associated with decreased all-cause mortality in older people residing in nursing homes. More in-depth studies investigating the potential geroprotector effect of statins in this population are needed.

Download Full-text

Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident’s Place of Death

10.21203/rs.2.18816/v1 ◽

2019 ◽

Author(s):

Aluem Tark ◽

Mansi Agarwal ◽

Andrew Dick ◽

Jiyoun Song ◽

Patricia Stone

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Treatment Program ◽

Nursing Home Residents ◽

Vital Statistics ◽

Short Stay ◽

Data Set ◽

Significant Difference ◽

Life Sustaining Treatment ◽

The Impact

Abstract Background: The Physician Orders for Life-Sustaining Treatment program was developed to enhance quality of care delivered at end-of-life. Although positive impacts of the Physician Orders for Life-Sustaining Treatment Program use have been identified, the association between a state’s program maturity status and nursing home resident’s likelihood of dying in their current care settings, nursing homes, remain unanswered. Objective: Examine the impact of the Physician Orders for Life-Sustaining Program maturity status on nursing home residents’ odds of dying in nursing homes.Methods: Program maturity status data were linked with multiple datasets: Minimum Data Set, Vital Statistics Data, Master Beneficiary Summary File, Certification and Survey Provider Enhanced Reports, and Area Health Resource File. Stratifying residents on long-stay and short-stay, we used descriptive statistics and multivariable logistic regression models for total 595,152 individuals.Results: Controlling for individual and contextual variables, long-stay nursing home residents living in states where the program was mature status had 20% increased odds of dying in nursing homes (OR: 1.20; CI 1.02-1.43) compared to those who resided in states with non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes (OR: 1.12; CI 1.02-1.24) compared to non-conforming status. No significant difference was noted for short-stay nursing home residents.Conclusion: Mature and developing maturity status were associated with greater likelihood of dying in nursing homes among long-stay residents. Our findings inform that a well-structured advance care planning program such as Physician Orders for Life-Sustaining Program enhances care outcomes among older adults living in nursing homes.

Download Full-text

The prior infection with SARS-CoV-2 study (PICOV) in nursing home residents and staff - study protocol description and presentation of preliminary findings on symptoms.

Archives of Public Health ◽

10.1186/s13690-021-00715-z ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Maria E. Goossens ◽

Kristof Y. Neven ◽

Pieter Pannus ◽

Cyril Barbezange ◽

Isabelle Thomas ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

The Elderly ◽

Population Characteristics ◽

Past Infection ◽

Geriatric Population ◽

Staff Members ◽

Tract Infections ◽

The Impact

Abstract Background The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented itself as one of the most important health concerns of the 2020’s, and hit the geriatric population the hardest. The presence of co-morbidities and immune ageing in the elderly lead to an increased susceptibility to COVID-19, as is the case for other influenza-like illnesses (ILI) or acute respiratory tract infections (ARI). However, little is known, about the impact of a previous or current infection on the other in terms of susceptibility, immune response, and clinical course. The aim of the “Prior Infection with SARS-COV-2” (PICOV) study is to compare the time to occurrence of an ILI or ARI between participants with a confirmed past SARS-CoV-2 infection (previously infected) and those without a confirmed past infection (naïve) in residents and staff members of nursing homes. This paper describes the study design and population characteristics at baseline. Methods In 26 Belgian nursing homes, all eligible residents and staff members were invited to participate, resulting in 1,226 participants. They were classified as naïve or previously infected based on the presence of detectable SARS-CoV-2 antibodies and/or a positive RT-qPCR result before participation in the study. Symptoms from a prior SARS-CoV-2 infection between March and August 2020 were compared between previously infected residents and staff members. Results Infection naïve nursing home residents reported fewer symptoms than previously infected residents: on average 1.9 and 3.1 symptoms, respectively (p = 0.016). The same effect was observed for infection naïve staff members and previously infected staff members (3.1 and 6.1 symptoms, respectively; p <0.0001). Moreover, the antibody development after a SARS-CoV-2 infection differs between residents and staff members, as previously infected residents tend to have a higher rate of asymptomatic cases compared to previously infected staff members (20.5% compared to 12.4%; p <0.0001). Conclusions We can postulate that COVID-19 disease development and symptomatology are different between a geriatric and younger population. Therefore, the occurrence and severity of a future ILI and/or ARI might vary from resident to staff.

Download Full-text

RACIAL DISPARITIES IN COMMUNITY- AND INSTITUTION-BASED LONG-TERM SERVICES AND SUPPORTS

Innovation in Aging ◽

10.1093/geroni/igz038.2867 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S779-S780

Author(s):

Chanee D Fabius

Keyword(s):

Older Adults ◽

Nursing Home ◽

Nursing Homes ◽

Health Outcomes ◽

Racial Disparities ◽

Nursing Home Residents ◽

Home Health ◽

Services And Supports ◽

The Impact

Abstract Long-term services and supports (LTSS) are services provided to individuals with functional limitations and chronic conditions who need assistance to perform daily activities such as bathing, dressing, preparing meals, and administering medications, and can be provided in community settings via services such as home health, as well as institutions such as nursing homes. Racial disparities are persistent across systems of LTSS, with older adults of color receiving lower quality care and experiencing worse health outcomes than their white counterparts. Given the increasing diversity of the aging population, and the need to ensure equity in quality and health outcomes in LTSS, there is a greater need for more understanding of how experiences of care vary across multiple settings for diverse groups of older adults and the people who help them. This symposium will feature 5 presentations that provide novel insight regarding racial disparities in community- and institution-based LTSS. We focus on racial differences in functional needs and disparities among those receiving home health services and living in nursing homes. Individual presentations will describe 1) race and gender differences in physical functioning needs of older adults; 2) disparities in home health quality across racially diverse and low income geographic areas; 3) racial disparities in nursing home residents overtime; 4) racial and ethnic disparities in rates of 30-day rehospitalization from skilled nursing facilities among Medicare Fee-For-Service and Medicare Advantage patients; and 5) the impact of the unequal burden of care provided to minority nursing home residents by staff of color.

Download Full-text