scholarly journals Trends in antibiotics use among long-term US nursing-home residents

2020 ◽  
pp. 1-7
Author(s):  
Catherine C. Cohen ◽  
Andrew W. Dick ◽  
Mansi Agarwal ◽  
Tadeja Gracner ◽  
Susan Mitchell ◽  
...  
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Cognitive Status ◽  
Cross Sectional ◽  
Data Set

Abstract Objectives: Antibiotics are overly prescribed in nursing homes. Recent antibiotic stewardship efforts attempt to reduce inappropriate use. Our objective was to describe antibiotic use from 2012 to 2016 among nursing-home residents with various health conditions. Design: Retrospective, repeated cross-sectional analysis. Setting and participants: All long-term residents in a random 10% sample of national nursing homes: 2,092,809 assessments from 319,615 nursing-home residents in 1,562 nursing homes. Measurements: We calculated a 1-day antibiotic prevalence using all annual and quarterly clinical assessments in the Minimum Data Set (MDS) from April 2012 through December 2016. We calculated prevalence of antibiotic use overall and within conditions of interest: Alzheimer’s disease and related dementias (ADRD), advanced cognitive impairment (ACI), and infections likely to be treated with antibiotics. We applied logistic regressions with nursing-home cluster, robust standard errors to assess changes in conditions and antibiotic use 2012–2016. Results: Overall, antibiotic use did not change (2012 vs 2016, adjusted odds ratio [AOR], 1.00; 95% CI, 0.97–1.03). Antibiotic use was higher in 2016 versus 2012 among assessments with any infection (AOR, 1.10; 95% CI, 1.04–1.16), urinary tract infection (AOR, 1.18; 95% CI, 1.12–1.25), and no infection (AOR, 1.13; 95% CI, 1.09–1.17). Results were similar by cognitive status. Conclusions: The increased proportion of assessments recording antibiotics but no infection may not be clinically appropriate. Higher antibiotic use among infected residents with advanced cognitive impairment is also concerning. Further efforts to understand mechanisms driving these trends and to promote antibiotic stewardship in nursing homes are warranted.

A comparison of cognitive functioning in long-term care and short-stay nursing home residents

2015 ◽  
Vol 37 (1) ◽  
pp. 1-13 ◽  
Author(s):  
WILLIAM E. MANSBACH ◽  
RYAN A. MACE ◽  
KRISTEN M. CLARK ◽  
ISABELLA M. FIRTH
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Nursing Homes ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Short Stay ◽  
Severe Dementia ◽  
Term Care ◽  
Cognitive Levels

ABSTRACTIt can be challenging to provide person-centred care for individuals with cognitive impairment if they are unable to communicate their needs to facility providers clearly. The high base rates of dementia and mild cognitive impairment (MCI) in US nursing homes is well documented; however, our understanding of the unique prevalence of cognitive levels in long-term care and short-stay residents is limited. Our aim is to determine whether there are significant differences in specific cognitive levels between these two groups. Long-term care and short-stay residents (N = 579) were randomly selected from 18 Maryland, US skilled nursing facilities; 345 met inclusion criteria for participation (mean age 79.41) and completed a cognitive test (Brief Cognitive Assessment Tool (BCAT)). Based on BCAT scores, 78.9 per cent of the long-term care residents had dementia compared to 61.4 per cent for short-stay residents. The proportions of MCI, mild, and moderate to severe dementia were significantly different between the two groups (p = 0.00). The odds of residents having moderate to severe dementia were 2.76 times greater for long-term care compared to short-stay residents. BCAT total and factor scores were significantly different between long-term care and short-stay nursing home residents (p < 0.001). We discuss the implications of these empirical findings in terms of facilitating person-centred care in nursing homes.

scholarly journals Transfers among Long-term Nursing Home Residents during the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 733-733
Author(s):  
Ana Montoya ◽  
Chiang-Hua Chang ◽  
Pil Park ◽  
Julie Bynum
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Nursing Homes ◽  
Functional Decline ◽  
Nursing Home Residents ◽  
Data Set ◽  
Transfer Rates ◽  
Logistic Regression Models

Abstract Transferring long-term nursing home residents between facilities can compromise the quality of life and be associated with functional decline, hospitalizations, and even death. This study aimed to examine transfer rates and identify risk factors associated with transfers among long-term nursing home residents before (2018-2019) and during the COVID-19 pandemic (2020). Using the Michigan state Minimum Data Set data 2018-2020, we identified long-term residents as those who stayed in nursing homes for at least 100 days each year (N=39,693, 39,454, and 35,575, respectively). We defined a facility-to-facility transfer as a direct transfer between two nursing homes. We first examined the likelihood of transfer by year using logistic regression models, adjusting for residents’ age, sex, race, and marital status. We then examined two health statuses that could be associated with a transfer: activities of daily living (ADL) and cognitive impairment. Finally, we compared transfers that occurred before COVID-19 (2018-2019) and during COVID-19 (2020), adjusting for residents’ demographic characteristics and health statuses. After adjustment, age was the only factor associated with transfers for all three years (Age&gt;=80: AOR=0.61, 95% CI: 0.54-0.69; AOR=0.63, 95% CI: 0.55-0.72; AOR=0.71, 95% CI: 0.63-0.80, respectively). New risk factors in 2020 were Black race (AOR=1.22, 95% CI: 1.07-1.40) and requiring ADL assistance (AOR=1.24, 95% CI: 1.03-1.49). The COVID-19 period had higher transfer rate (unadjusted rates 2.9%, 2.7%, 3.5%, respectively) with 10% higher odds of transfer compared to before COVID-19 (AOR=1.10, 95% CI: 1.01-1.20). This finding suggests that COVID-19 has an impact on how nursing home transferred their long-term residents.

Predictors of advance directives among nursing home residents with dementia

2017 ◽  
Vol 30 (3) ◽  
pp. 341-353 ◽  
Author(s):  
Hsiu-Li Huang ◽  
Yea-Ing Lotus Shyu ◽  
Li-Chueh Weng ◽  
Kang-Hua Chen ◽  
Wen-Chuin Hsu
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Advance Directives ◽  
Advance Directive ◽  
Religious Affiliation ◽  
Nursing Home Residents ◽  
Cognitive Status ◽  
Do Not Resuscitate ◽  
Cross Sectional ◽  
Convenience Sample

ABSTRACTBackground:Advance directives are important for nursing home residents with dementia; for those with advanced dementia, surrogates determine medical decisions. However, in Taiwan, little is known about what influences the completion of these advance directives. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan.Method:Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. Documentation of residents’ advance directives, physical and cognitive status was obtained from medical charts. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Nursing home characteristics were obtained from each chief administrator.Results:Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider; nursing homes had policies for advance directives and a religious affiliation.Conclusions:Advance directives were uncommon for nursing home residents with dementia. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities; there was no association with characteristics of the nursing home resident. Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive.

scholarly journals The Prevalence of Cognitive Impairment on Admission to Nursing Home among Residents with and without Stroke: A Cross–Sectional Survey of Nursing Homes in Ireland

2020 ◽  
Vol 17 (19) ◽  
pp. 7203
Author(s):  
Nora-Ann Donnelly ◽  
Eithne Sexton ◽  
Niamh A. Merriman ◽  
Kathleen E. Bennett ◽  
David J Williams ◽  
...  
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Nursing Homes ◽  
Cognitive Status ◽  
Service Planning ◽  
Nursing Home Admission ◽  
Ageing Population ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Prevalence Estimates

Post–stroke cognitive impairment (PSCI) is a common consequence of stroke. Epidemiological evidence indicates that, with an ageing population, stroke and PSCI are likely to increase in the coming decades. This may have considerable implications for the demand for nursing home placement. As prevalence estimates of both cognitive impairment and dementia on admission to nursing home among residents with and without stroke have not yet been compared, they were estimated and compared in this study. We performed a cross–sectional survey to establish the admission characteristics of 643 residents in 13 randomly selected nursing homes in Ireland. The survey collected data on resident’s stroke and cognitive status at the time of nursing home admission. The survey found, among nursing home residents that experienced stroke prior to admission, prevalence estimates for cognitive impairment (83.8%; 95% CI = 76.9–90.6%) and dementia (66.7%; 95% CI = 57.9–75.4%) were significantly higher compared to residents that had not experienced stroke prior to admission (cognitive impairment: 56.6%; 95% CI = 52.4–60.8%; X2 (1) = 28.64; p < 0.001; dementia: 49.8%; 95% CI = 45.6–54.1%; X2 (1) = 10.47; p < 0.01). Since the prevalence of PSCI is likely to increase in the coming decades, the findings highlight an urgent need for health service planning for this increased demand for nursing home care to meet the care needs of these stroke survivors.

scholarly journals Multiple imputation to quantify misclassification in observational studies of the cognitively impaired: an application for pain assessment in nursing home residents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anthony P. Nunes ◽  
Danni Zhao ◽  
William M. Jesdale ◽  
Kate L. Lapane
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Observational Studies ◽  
Nursing Home Residents ◽  
Inverse Association ◽  
Cross Sectional ◽  
Data Set ◽  
Severe Cognitive Impairment ◽  
Differential Misclassification ◽  
The Difference

Abstract Background Despite experimental evidence suggesting that pain sensitivity is not impaired by cognitive impairment, observational studies in nursing home residents have observed an inverse association between cognitive impairment and resident-reported or staff-assessed pain. Under the hypothesis that the inverse association may be partially attributable to differential misclassification due to recall and communication limitations, this study implemented a missing data approach to quantify the absolute magnitude of misclassification of pain, pain frequency, and pain intensity by level of cognitive impairment. Methods Using the 2016 Minimum Data Set 3.0, we conducted a cross-sectional study among newly admitted US nursing home residents. Pain presence, severity, and frequency is assessed via resident-reported measures. For residents unable to communicate their pain, nursing home staff document pain based on direct resident observation and record review. We estimate a counterfactual expected level of pain in the absence of cognitive impairment by multiply imputing modified pain indicators for which the values were retained for residents with no/mild cognitive impairment and set to missing for residents with moderate/severe cognitive impairment. Absolute differences (∆) in the presence and magnitude of pain were calculated as the difference between documented pain and the expected level of pain. Results The difference between observed and expected resident reported pain was greater in residents with severe cognitive impairment (∆ = -10.2%, 95% Confidence Interval (CI): -10.9% to -9.4%) than those with moderate cognitive impairment (∆ = -4.5%, 95% CI: -5.4% to -3.6%). For staff-assessed pain, the magnitude of apparent underreporting was similar between residents with moderate impairment (∆ = -7.2%, 95% CI: -8.3% to -6.0%) and residents with severe impairment (∆ = -7.2%, 95% CI: -8.0% to -6.3%). Pain characterized as “mild” had the highest magnitude of apparent underreporting. Conclusions In residents with moderate to severe cognitive impairment, documentation of any pain was lower than expected in the absence of cognitive impairment. This finding supports the hypothesis that an inverse association between pain and cognitive impairment may be explained by differential misclassification. This study highlights the need to develop analytic and/or procedural solutions to correct for recall/reporter bias resulting from cognitive impairment.

Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 073346482110182
Author(s):  
Sainfer Aliyu ◽  
Jasmine L. Travers ◽  
S. Layla Heimlich ◽  
Joanne Ifill ◽  
Arlene Smaldone
Keyword(s):  
Systematic Review ◽  
Nursing Home ◽  
Antibiotic Stewardship ◽  
Meta Analysis ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Meta Analyses

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988–2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran’s Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

scholarly journals Advanced cognitive impairment among older nursing home residents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tadeja Gracner ◽  
Patricia W. Stone ◽  
Mansi Agarwal ◽  
Mark Sorbero ◽  
Susan L Mitchell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Cognitive Impairment ◽  
Mortality Risk ◽  
Advanced Disease ◽  
Nursing Home Residents ◽  
Functional Score ◽  
Data Set

Abstract Background Though work has been done studying nursing home (NH) residents with either advanced Alzheimer’s disease (AD) or Alzheimer’s disease related dementia (ADRD), none have distinguished between them; even though their clinical features affecting survival are different. In this study, we compared mortality risk factors and survival between NH residents with advanced AD and those with advanced ADRD. Methods This is a retrospective observational study, in which we examined a sample of 34,493 U.S. NH residents aged 65 and over in the Minimum Data Set (2011–2013). Incident assessment of advanced disease was defined as the first MDS assessment with severe cognitive impairment (Cognitive Functional Score equals to 4) and diagnoses of AD or ADRD. Demographics, functional limitations, and comorbidities were evaluated as mortality risk factors using Cox models. Survival was characterized with Kaplan-Maier functions. Results Of those with advanced cognitive impairment, 35 % had AD and 65 % ADRD. At the incident assessment of advanced disease, those with AD had better health compared to those with ADRD. Mortality risk factors were similar between groups (shortness of breath, difficulties eating, substantial weight-loss, diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and pneumonia; all p < 0.01). However, stroke and difficulty with transfer (for women) were significant mortality risk factors only for those with advanced AD. Urinary tract infection, and hypertension (for women) only were mortality risk factors for those with advanced ADRD. Median survival was significantly shorter for the advanced ADRD group (194 days) compared to the advanced AD group (300 days). Conclusions There were distinct mortality and survival patterns of NH residents with advanced AD and ADRD. This may help with care planning decisions regarding therapeutic and palliative care.

It Is Not Your Parents’ Long-Term Services System: Nursing Homes in a Changing World

2018 ◽  
Vol 39 (8) ◽  
pp. 898-901
Author(s):  
Robert Applebaum ◽  
Shahla Mehdizadeh ◽  
Diane Berish
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Length Of Stay ◽  
Older Person ◽  
Home Practice ◽  
Data Set ◽  
Study Results ◽  
Utilization Data ◽  
First Time

The long-term services system has changed substantially since the mid-1970s, when the landmark book Last Home for the Aged argued that the move to the nursing home was the last move an older person would make until death. Using detailed nursing home utilization data from the Minimum Data Set, this study tracks three cohorts of first-time nursing home admissions in Ohio from 1994 through 2014. Each cohort was followed for a 3-year period. Study results report dramatic reductions in nursing home length of stay between the 1994 and 2011 cohorts. Reduction in length of stay has important implications for nursing home practice and quality monitoring. The article argues that administrative and regulatory practices have not kept pace with the dramatic changes in how nursing homes are now being used in the long-term services system.

scholarly journals Factors Influencing the Deterioration from Cognitive Decline of Normal Aging to Dementia among Nursing Home Residents

2020 ◽  
Author(s):  
Audai A. Hayajneh ◽  
Mohammad Rababa ◽  
Alia A. Alghwiri ◽  
Dina Masha'al
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Bivariate Analysis ◽  
Medical Factors ◽  
Moderate Cognitive Impairment

Abstract Background: A dearth of differential research exists regarding the determinants of mild cognitive impairment (MCI) and moderate cognitive impairment or dementia among nursing home residents. This study aimed to identify and examine the association between medical factors (number of comorbidities, hospitalization, disability, depression, frailty and quality of life) and moderate cognitive impairment or dementia in nursing homes residents.Methods: A cross-sectional design was used in this study. Convenience sampling of 182 participants was conducted in nursing homes located in the central part of Jordan. Montreal cognitive assessment (MoCA) was used to screen both MCI and moderate cognitive impairment or dementia. Bivariate analysis, including t-test and ANOVA test, and logistic and linear regression models were used to examine and identify the medical factors associated with moderate cognitive impairment or dementia compared to mild cognitive impairment.Results: Most nursing home residents had MCI (87.4%) compared to a few with moderate cognitive impairment or dementia. Age (t = -2.773), number of comorbidities (t = -4.045), depression (t = -4.809), frailty (t = -4.038), and quality of life physical (t = 3.282) and mental component summaries (t = 2.469) were significantly different between the stages of cognitive impairment. Marital status (t = -4.050, p < 0.001), higher-income (t = 3.755, p < 0.001), recent hospitalization (t = 2.622,p = 0.01), depression (t = -2.737, p = 0.007), and frailty (t = 2.852, p = 0.005) were significantly associated with mental ability scores among nursing home residents.Conclusion: The coexistence of comorbidities and depression among nursing home residents with MCI necessitates prompt management by healthcare providers to combat depressive symptoms in order to delay the dementia trajectory among at-risk residents.Trail registration number: ClinicalTrials.gov Identifier: NCT04589637

scholarly journals The Interplay Between Infection Risk Factors of SARS-CoV-2 and Prognosis: A Cross-Sectional Study from a Cohort of Long-Term Care Nursing Home Residents

2021 ◽  
Author(s):  
Laura Soldevila ◽  
Núria Prat ◽  
Miquel À. Mas ◽  
Mireia Massot ◽  
Ramon Miralles ◽  
...  
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Risk Of Infection ◽  
Cross Sectional ◽  
Term Care ◽  
Facility Size ◽  
Care Nursing ◽  
Pcr Test

Abstract Background: Covid-19 pandemic has particularly affected older people living in Long-term Care settings. Methods: We carried out a cross-sectional analysis of a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at last one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered.Results: A total of 8021 participants were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = 0.03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < .001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). Conclusions: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

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