Physicians’ practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes

2012 ◽  
Vol 25 (2) ◽  
pp. 236-244 ◽  
Author(s):  
Jiska Cohen-Mansfield ◽  
Atarah Juravel-Jaffe ◽  
Aaron Cohen ◽  
Iris Rasooly ◽  
Hava Golander
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Pharmacological Treatment ◽  
Psychotropic Medications ◽  
Actual Practice ◽  
Pharmacological Intervention ◽  
Personal Interview ◽  
Pharmacological Interventions ◽  
The Relationship ◽  
Current Guidelines

ABSTRACTBackground: To clarify physicians’ actual practice in treating agitation in the nursing home and to elucidate the relationship between background factors, familiarity with interventions, and practice.Methods: A survey of actual practice for agitation in persons with dementia was administered to 67 physicians aged 31–70+ working in nursing homes in Israel. Questionnaires were administered by personal interview, self-completed, or a combination of the two.Results: Psychotropic medications are prescribed by 92.5% of physicians for treating agitation, most notably, Haloperidol (39%). Non-pharmacological treatment was also reported to be common, though to a lesser extent, with environmental change being the most prevalent non-pharmacological intervention. Generally, physicians showed low familiarity levels with non-pharmacological interventions, with higher levels noted for physicians with a specialty in geriatrics compared to those who were non-specialized. Physicians who were non-Israeli and younger also reported higher familiarity levels compared to their respective counterparts (i.e. Israeli and older) but this difference did not reach significance.Conclusion: The findings indicate that, despite current guidelines, psychotropic medications are the treatment of choice among nursing home physicians in Israel. While rates of use of non-pharmacological interventions are substantial, their in-practice application may be hindered by lack of familiarity as well as system barriers. The results have implications for system and education changes.

Novel Pharmacotherapeutics for Stress-Related Disorders

2019 ◽  
pp. 642-672
Author(s):  
Jamie E. Mondello ◽  
Jenny E. Pak ◽  
Dennis F. Lovelock ◽  
Terrence Deak
Keyword(s):  
Mental Health Problems ◽  
Drug Efficacy ◽  
Careful Consideration ◽  
Pharmacological Intervention ◽  
Pharmacological Interventions ◽  
Diverse Range ◽  
Disease States ◽  
Efficacy Trials ◽  
Participant Selection ◽  
The Relationship

Most mental health problems associated with psychological distress originate with activation of centrally regulated stress pathways, yet a diverse range of central nervous system and somatic disease states can be influenced by exposure to severe or unrelenting stress. The goal of this chapter is to provide a conceptual framework to guide the development of pharmacological intervention strategies. We propose that careful consideration of the relationship between the timing of stressful life experiences, pharmacological intervention, and the ultimate expression of disease symptomatology is critical for the development of pharmacological interventions to treat stress-related disorders. We review a range of physiological systems that are known to be activated by stress, offering potentially new targets for drug development efforts, and argue that participant selection is a key predictor of drug efficacy trials. In doing so, we point toward inflammatory signaling pathways as a potential final common mediator of multiple stress-related disease states.

scholarly journals Analyzing Nursing Home Complaints: From Substantiated Allegation to Deficiency Citations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 82-83
Author(s):  
Kallol Kumar Bhattacharyya ◽  
Lindsay Peterson ◽  
John Bowblis ◽  
Kathryn Hyer
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Staff Training ◽  
Policy And Practice ◽  
Abuse And Neglect ◽  
The Relationship ◽  
Investigation Process

Abstract Complaints provide important information to consumers about nursing homes (NHs). Complaints that are substantiated often lead to an investigation and potentially a deficiency citation. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Because a complaint may contain multiple allegations, and the data do not identify which allegation(s) lead to a complaint’s substantiation, we identified all substantiated single allegation complaints for NHs in 2017. Our data were drawn from federally collected NH complaint and inspection records. Among the 369 substantiated single-allegation complaints, we found most were categorized as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Of the deficiency citations resulting from complaints in our sample, 27.9% were categorized as quality of care and 19.5% were in the category of resident behavior and facility practices, which includes abuse and neglect. While two-thirds (N=239) of the substantiated complaints generated from 1 to 19 deficiency citations, nearly one third had no citations. Surprisingly, 28% of substantiated abuse and neglect allegations resulted in no deficiency citations. More surprisingly, a fifth of complaints that were categorized as “immediate jeopardy” at intake did not result in any deficiency citations. We also found a number of asymmetries in the allegation categories suggesting different processes by Centers for Medicare and Medicaid Services (CMS) region. These results suggest that the compliant investigation process warrants further investigation. Other policy and practice implications, including the need for better and more uniform investigation processes and staff training, will be discussed.

scholarly journals Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

2018 ◽  
Vol 55 ◽  
pp. 004695801878799
Author(s):  
R. Tamara Konetzka ◽  
Hari Sharma ◽  
Jeongyoung Park
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Fixed Effects ◽  
Online Survey ◽  
Market Competition ◽  
Consumer Welfare ◽  
Data Sets ◽  
For Profit ◽  
The Impact ◽  
The Relationship

An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw’s Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.

scholarly journals The relationship of nursing home price and quality of life

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah Raes ◽  
Sophie Vandepitte ◽  
Delphine De Smedt ◽  
Herlinde Wynendaele ◽  
Yannai DeJonghe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Research Question ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Ownership Type ◽  
Cross Sectional ◽  
The Relationship

Abstract Background Knowledge about the relationship between the residents’ Quality of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes. Methods The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question. Results The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P <  0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes. Conclusion Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL.

Nursing home prices and market structure: the effect of assisted living industry expansion

2013 ◽  
Vol 9 (1) ◽  
pp. 95-112 ◽  
Author(s):  
John R. Bowblis
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Market Structure ◽  
Assisted Living ◽  
Nursing Home Care ◽  
Assisted Living Facilities ◽  
Home Market ◽  
Home Prices ◽  
The Relationship

AbstractSince the 1990s, there has been substantial expansion of facility-based alternatives to nursing home care, such as assisted living facilities. This paper analyzes the relationship between expansion of the assisted living industry, nursing home market structure and nursing home private pay prices using a two-year panel of nursing homes in the State of Ohio. Fixed effect regressions suggest that the expansion of assisted living facilities are associated with increased nursing home concentration, but find no effect on private pay nursing home prices. This would be consistent with assisted livings reducing demand for nursing homes by delaying entry into a nursing home, though assisted livings are not direct competitors of nursing homes.

Sleep and agitation in nursing home residents with and without dementia

2015 ◽  
Vol 27 (12) ◽  
pp. 1945-1955 ◽  
Author(s):  
Donnamay T. Brown ◽  
Juanita L. Westbury ◽  
Benjamin Schüz
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Poor Sleep ◽  
Moderation Effect ◽  
Significant Relationships ◽  
Study Results ◽  
Hypnotic Medication ◽  
Benzodiazepine Use ◽  
The Relationship

ABSTRACTBackground:The prevalence of dementia in Australian nursing homes is high. A large proportion of residents express themselves through agitated behaviors, with substantial interpersonal and day-to-day variance. One factor that may increase agitation is poor sleep. The current study aimed to determine if sleep influences symptoms of agitation in nursing home residents, and whether this effect differed by dementia status. As benzodiazepines are used widely as hypnotic medication, their impact was also considered.Methods:Actigraph devices worn on residents’ non-dominant wrists for three days were used to obtain objective measures of sleep. Symptoms of agitation were assessed using staff responses to two standardized questionnaires – the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory – nursing home version (NPI-NH). Presence of dementia and benzodiazepine use were obtained from resident medical charts.Results:Forty-nine residents (mean age: 85.57 years) from four nursing homes in Tasmania were included in the study. Results indicated that residents were in bed for an average of 11.04 h and slept for 10.14 h per day. Significant relationships between sleep and verbal as well as non-aggressive agitation were found. No relationships between sleep and aggressive agitation were detected. A significant moderation effect of dementia was found, in which residents without dementia expressed verbal agitation when obtaining less sleep, but not residents with dementia. Benzodiazepine use did not result in significantly more sleep.Conclusions:These results suggest that sleep could play an important role in explaining agitation, but more research is needed to explore the relationship between sleep and benzodiazepines in nursing home residents.

scholarly journals High-Minority Nursing Homes Disproportionately Affected by COVID-19 Deaths

2021 ◽  
Vol 9 ◽  
Author(s):  
Robert Weech-Maldonado ◽  
Justin Lord ◽  
Ganisher Davlyatov ◽  
Akbar Ghiasi ◽  
Gregory Orewa
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Ethnic Disparities ◽  
Nursing Facilities ◽  
Term Care ◽  
The Face ◽  
Facility Level ◽  
The Relationship ◽  
Racial Ethnic

Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Using the Centers for Medicare and Medicaid Services' Nursing Home COVID-19 Public File, this study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths [Incidence Rate Ratio (IRR) = 1.61; p &lt; 0.001] as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

2021 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n=31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals POLA PENATAAN RUANG PANTI JOMPO BERDASARKAN AKTIVITAS DAN PERILAKU PENGHUNINYA

2016 ◽  
Vol 1 (1) ◽  
pp. 31
Author(s):  
Evian Devi
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Architectural Design ◽  
Living Arrangement ◽  
The Elderly ◽  
The Other ◽  
Design Criteria ◽  
Physical Comfort ◽  
The Relationship

Title: Living Arrangement Pattern Nursing Home Occupants Based Activities and BehaviorPhysical comfort in a building can give an effect to the psychological inhabitans. In the design of nursing homes, where the residents are elderly, certainly they have a different physical comfort with a younger people. The degenerative disease on elderly cause the need for special attention in architecture, especially on safety and comfort. Currently the nursing homes, mostly do not noticed it well, so still discovered lots of the elderlies got an accident and depressed in a nursing home. This research purpose to know the relationship between the aspects of both comfort and safety for elderly in nursing home that can make the elderly feel comfortable and happy living in their residence. The methods of this research is as follows: first, understand the criteria of elderly in related literatures and observations regarding to the elderly and other related literatures that subscribe with safety and comfort. Second, the literatures study were used to analyze the case study such as Nursing Home Wisma Mulia (Jakarta), Nursing Home Senjarawi (Bandung), and Nursing Home Muara Kasih (Bogor). The results of analysis from the case studies based on the literature, produce an architectural design criteria for the review occupancy elderly. The results of this research concluded that the design of the comfortable and safe against risk of any accident that may occur to the elderly, provided a circulation which can be passes by two wheelchairs at once and freeway, provided handrail in the circulation, provided ramp in any difference level of floor, and using a contrast color but dominant in light and warm color. The other considerations are the availability nostalgic room, playroom for children and the other facility that make the frequency of their families, visiting more often.Keywords: Elderly , safety , comfort , nursing homes.

scholarly journals The Relationship of Nursing Home Price and Quality of Life

2020 ◽  
Author(s):  
Sarah Raes ◽  
Sophie Vandepitte ◽  
Delphine De Smedt ◽  
Herlinde Wynendaele ◽  
Yannai DeJonghe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Research Question ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Ownership Type ◽  
Cross Sectional ◽  
The Relationship

Abstract Background: Knowledge about the relationship between the residents’ Quality Of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes.Methods: The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question.Results: The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P < 0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes.Conclusion: Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL.

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