Under-detection of pain in elderly nursing home residents with moderate to severe dementia

Abstract Nursing home (NH) residents with dementia commonly experience low food intake leading to negative consequences. While multilevel factors influence intake, evidence is lacking on how intake is sequentially associated. This study examined the temporal association between previous and current solid and fluid intake in NH residents with dementia. We analyzed 160 mealtime videos involving 27 residents and 36 staff (53 dyads) in 9 NHs. The dependent variable was the current intake state (fluid, solid, no-intake). Independent variables included the prior intake state, technique of current intake state (resident-initiated, staff-facilitated), duration between previous and current intakes. Covariates included resident and staff characteristics. Two-way interactions of duration and technique with the prior intake state, and resident comorbidity and dementia severity were examined using Multinomial Logit Models. Interactions were significant for technique by comorbidity, technique by dementia severity, technique by prior fluid and solid intake, and duration by prior fluid intake. Successful previous intake increased odds of current solid and fluid intake. Staff-facilitation (vs. resident-initiation) reduced odds of solid and fluid intake for residents with moderately severe (vs. severe) dementia. Higher morbidity decreased odds of solid intake (vs. no-intake) for staff-facilitated intake. Resident with severe dementia had smaller odds of solid and fluid intake for resident-initiated intake. Longer duration increased odds of transition from liquid to solid intake. Findings supported strong sequential dependencies in intake, indicating the promise of intervening behaviorally to modify transitions to successful intake during mealtime. Findings inform the development and implementation of innovative mealtime assistance programs to promote intake.

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TRENDS IN OPIOID USE IN LONG-TERM CARE NURSING HOME RESIDENTS WITH DEMENTIA

Innovation in Aging ◽

10.1093/geroni/igz038.2605 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S709-S709

Author(s):

Hemalkumar B Mehta ◽

Yong-Fang Kuo ◽

Jordan Westra ◽

Mukaila Raji ◽

James S Goodwin

Keyword(s):

Nursing Home ◽

Long Term Care ◽

Nursing Home Residents ◽

Opioid Use ◽

Severe Dementia ◽

Term Care ◽

Dementia Patients ◽

Moderate Dementia ◽

Long Acting

Abstract We examined opioid use in long-term care nursing home residents with dementia. This retrospective cohort study used Minimum Data Set linked Medicare data, 2011-2016, and included long-term care episodes for residents 65+ years who survived 100+ days each year (592,211 episodes for 256,207 residents). Cognitive status at first annual assessment was classified as none/mild, moderate and severe impairment. Overall opioid use, prolonged opioid use (prescription supply 90+ days) and long-acting opioid use were identified from Medicare part D. Descriptive statistics were used to describe opioid use by cognitive impairment. Cochrane Armitage trends test was used to determine trends in opioid use. 114,622 (19%) patients had severe and 129,257 (22%) had moderate dementia. Overall opioid (none/mild=15.4%, moderate=13.9%, severe=9%), prolonged opioid (none/mild=5.2%, moderate=4.5%, severe=3.2%) and long-acting opioid use (none/mild=1.1%, moderate=0.9%, severe=0.3% ) were lower in patients with advanced dementia. Opioid use was significantly higher in females and Whites and varied by states. Substantial increase was found in overall opioid and prolonged opioid use from 2011 to 2016, with greater increase in none/mild and moderate dementia patients. For example, prolonged opioid use increased by 69% in none/mild and 71% in moderate dementia patients compared to 52% in severe dementia patients (p<0.0001). Long-acting opioid use decreased, with a greater decline in none/mild (69%) and moderate (71%) dementia patients compared to severe dementia patients (58%) (p<0.0001). Contrary to decreasing opioid use in community setting, overall and prolonged opioid use increased in nursing home residents. Future studies should identify the reasons behind increased use.

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Mood and behavioral problems are important predictors of quality of life of nursing home residents with moderate to severe dementia: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0223704 ◽

2019 ◽

Vol 14 (12) ◽

pp. e0223704 ◽

Cited By ~ 1

Author(s):

Marinda Henskens ◽

Ilse M. Nauta ◽

Susan Vrijkotte ◽

Katja T. Drost ◽

Maarten V. Milders ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Behavioral Problems ◽

Nursing Home Residents ◽

Cross Sectional Study ◽

Sectional Study ◽

Severe Dementia ◽

Cross Sectional

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Factors Associated With Deprescribing Acetylcholinesterase Inhibitors in Older Nursing Home Residents With Severe Dementia

Journal of the American Geriatrics Society ◽

10.1111/jgs.15985 ◽

2019 ◽

Vol 67 (9) ◽

pp. 1871-1879 ◽

Cited By ~ 7

Author(s):

Joshua D. Niznik ◽

Xinhua Zhao ◽

Meiqi He ◽

Sherrie L. Aspinall ◽

Joseph T. Hanlon ◽

...

Keyword(s):

Nursing Home ◽

Nursing Home Residents ◽

Acetylcholinesterase Inhibitors ◽

Severe Dementia ◽

Factors Associated

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Prescribing pattern of psychotropic drugs in nursing home residents with dementia

International Psychogeriatrics ◽

10.1017/s1041610211000755 ◽

2011 ◽

Vol 23 (8) ◽

pp. 1249-1259 ◽

Cited By ~ 57

Author(s):

R. B. Wetzels ◽

S. U. Zuidema ◽

J. F. M. de Jonghe ◽

F. R. J. Verhey ◽

R. T. C. M. Koopmans

Keyword(s):

Nursing Home ◽

Psychotropic Drug ◽

Anatomical Therapeutic Chemical ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Severe Dementia ◽

Prescribing Pattern ◽

Antidementia Drugs ◽

Utilization Patterns ◽

To Receive

ABSTRACTBackground: The goal of this study is to determine patterns of psychotropic drug use (PDU), the association with neuropsychiatric symptoms (NPS), and the variability across dementia types in nursing home residents with dementia. In addition, PDU was analyzed across multiple indications.Methods: This was a prospective cohort study over a two-year period from 2006 to 2008, which involved 14 dementia special care units in nine nursing homes. A total of 117 residents with dementia participated in the study, of whom 35% had Alzheimer's dementia (AD) and 11% vascular dementia (VaD). PDU was classified according to anatomical therapeutic chemical-classification as either “present” or “absent”.Results: The majority of residents had moderately severe to severe dementia. At all successive assessments, almost two-thirds of residents received any psychotropic drug (PD) and almost one-third continued to receive any PD. Of all PDs, antipsychotics (APs) were prescribed most frequently. Fewer residents started with antidepressants, but continued to receive antidepressants at higher percentages. Anxiolytics showed an intermittent course, but a subgroup of 9% showed two-year continuation. Once started on PDs at baseline, residents continued to use PDs at high percentages: three-quarters continued to receive APs for at least six months. Half of residents received at least one PD; one-fifth received at least two PDs simultaneously. Residents with AD received more hypnotics and antidementia drugs; residents with VaD received more antipsychotics, antidepressants, anxiolytics and anticonvulsants.Conclusions: PDs have different utilization patterns, but overall, consistently high continuation rates were found. These results warrant scrutiny of continuous PDU.

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Using dolls for therapeutic purposes: A study on nursing home residents with severe dementia

International Journal of Geriatric Psychiatry ◽

10.1002/gps.4872 ◽

2018 ◽

Vol 33 (7) ◽

pp. 915-925 ◽

Cited By ~ 6

Author(s):

A. Cantarella ◽

E. Borella ◽

S. Faggian ◽

A. Navuzzi ◽

R. De Beni

Keyword(s):

Nursing Home ◽

Nursing Home Residents ◽

Severe Dementia

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Is the Tinetti Performance Oriented Mobility Assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?

International Psychogeriatrics ◽

10.1017/s1041610209991347 ◽

2009 ◽

Vol 22 (2) ◽

pp. 254-263 ◽

Cited By ~ 41

Author(s):

Carolyn S. Sterke ◽

Sawadi L. Huisman ◽

Ed F. van Beeck ◽

Caspar W. N. Looman ◽

Tischa J. M. van der Cammen

Keyword(s):

Regression Analysis ◽

Nursing Home ◽

Predictive Validity ◽

Nursing Home Residents ◽

Area Under The Curve ◽

Short Term ◽

Severe Dementia ◽

Mobility Assessment ◽

Specific Objective

ABSTRACTBackground:The feasibility and predictive validity of balance and gait measures in more severe stages of dementia have been understudied. We evaluated the clinimetric properties of the Tinetti Performance Oriented Mobility Assessment (POMA) in nursing home residents with dementia with a specific objective of predicting falls in the short term.Methods:Seventy-five ambulatory nursing home residents with dementia, mean age 81 ± 8 years, participated in a prospective cohort study. All participants underwent the full POMA-test. Fall statistics were retrieved from incident reports during a three-months follow-up period. The predictive validity was expressed in terms of sensitivity and specificity. Loglinear regression analysis was used to examine the relationship between POMA scores and the occurrence of a fall.Results:The POMA showed several feasibility problems, with 41% of patients having problems in understanding one or more instructions. The inter-rater reliability of the instrument was good. The predictive validity was acceptable, with a sensitivity of 70–85% and a specificity of 51–61% for the POMA and its subtests, and an area under the curve (AUC) of 0.70 for POMA-Total (95% CI: 0.53–0.81), 0.67 for POMA-Balance (95% CI: 0.52–0.81), and 0.67 for POMA-Gait (95% CI: 0.53–0.81). After loglinear regression analysis, only POMA-T was significant in predicting a fall (adjusted HR = 1.08 per point lower; 95% CI 1.00–1.17).Conclusions:Application of the POMA in populations with moderate to severe dementia is hampered by feasibility problems. Its implementation in clinical practice cannot therefore be recommended, despite an acceptable predictive validity. To refine our findings, large prospective studies on the predictive validity of the POMA in populations with mild, moderate and severe dementia are needed. In addition, the performance of mobility assessment methods that are less dependent on cognition should be evaluated.

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Associations between Pain and Quality of Life in Severe Dementia: A Norwegian Cross-Sectional Study

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000468923 ◽

2017 ◽

Vol 7 (1) ◽

pp. 109-121 ◽

Cited By ~ 8

Author(s):

Hanne Marie Rostad ◽

Martine T.E. Puts ◽

Milada Cvancarova Småstuen ◽

Ellen Karine Grov ◽

Inger Utne ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Depressive Symptoms ◽

Daily Living ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Severe Dementia ◽

Cross Sectional ◽

The Relationship

Background/Aims: Many variables influence the quality of life in older adults with dementia. We aim to quantify how the relationship between pain and quality of life in nursing home residents with severe dementia can be explained by neuropsychiatric symptoms, depressive symptoms, and activities of daily living. Methods: This article presents cross-sectional baseline data from a cluster randomised controlled trial. Results: The total and direct effects of pain on quality of life were statistically significant. Both neuropsychiatric and depressive symptoms partially mediated the relationship between pain and quality of life. Activities of daily living acted as a mediator only when modelled together with depressive symptoms. Conclusion: Pain, neuropsychiatric symptoms, and depressive symptoms appear to be important factors that influence the quality of life for nursing home residents with severe dementia. Therefore, multidimensional interventions may be beneficial for maintaining or improving quality of life in this population.

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The Effects of Evacuation on Nursing Home Residents With Dementia

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317512454709 ◽

2012 ◽

Vol 27 (6) ◽

pp. 406-412 ◽

Cited By ~ 30

Author(s):

Lisa M. Brown ◽

David M. Dosa ◽

Kali Thomas ◽

Kathryn Hyer ◽

Zhanlian Feng ◽

...

Keyword(s):

At Risk ◽

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Steady Increase ◽

Cognitively Impaired ◽

Severe Dementia ◽

Data Set ◽

Percent Increase ◽

Resident Assessment

Background: In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired. Methods: Nursing homes in counties located in the path of Hurricane Gustav were identified. The Minimum Data Set resident assessment files were merged with the Centers for Medicare enrollment file to determine date of death for residents in identified facilities. Difference-in-differences analyses were conducted adjusting for residents' demographic characteristics and acuity. Results: The dataset included 21,255 residents living in 119 at risk nursing homes over three years of observation. Relative to the two years before the storm, there was a 2.8 percent increase in death at 30 days and a 3.9 percent increase in death at 90 days for residents with severe dementia who evacuated for Hurricane Gustav, controlling for resident demographics and acuity. Conclusions: The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility.

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