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 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.

Advance Directives in Nursing Homes: Resident and Facility Characteristics

1996 ◽  
Vol 34 (4) ◽  
pp. 321-332 ◽  
Author(s):  
Nicholas G. Castle
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Advance Directives ◽  
Multinomial Logistic Regression ◽  
Nursing Home Residents ◽  
Living Wills ◽  
Do Not Resuscitate ◽  
Multinomial Logistic Regression Model ◽  
Future Time ◽  
Significant Factors

Advance directives are a means whereby competent individuals can guide treatment decisions, and in many cases their death, at a future time when they may be rendered incompetent of doing so. This article first examines the differences between nursing home residents who choose to use advance directives and those that do not. Second, the differences between nursing homes who choose to use advance directives and those that do not are examined. Also, advance directives are not investigated as homogeneous constructs, rather they are divided into residents with a do-not-resuscitate (DNR) status and those with other advance directives (i.e., do-not-hospitalize, living wills, and feeding restrictions). A multinomial logistic regression model with data representing 60,366 nursing home residents in ten states is used. Thirteen factors are significantly associated with a DNR status, whereas eleven factors are significantly associated with other advance directives. In both cases these significant factors include both resident characteristics and characteristics of the nursing homes. These results extend the scope of both facility and resident characteristics as important covariates in studies of advance directives.

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.

scholarly journals Nursing home staff’s perspective on end-of-life care of German nursing home residents: a cross-sectional survey

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Anke Strautmann ◽  
Katharina Allers ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Nursing Staff ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Hospital Death ◽  
Life Care ◽  
Cross Sectional

Abstract Background Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. Methods A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. Results 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. Conclusions Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.

scholarly journals The Prevalence of and Documented Indications for Antipsychotic Prescribing in Irish Nursing Homes

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 160
Author(s):  
Jayne E. Kelleher ◽  
Peter Weedle ◽  
Maria D. Donovan
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antipsychotic Medication ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Medication Use ◽  
Nursing Home Residents ◽  
Cross Sectional ◽  
Home Setting ◽  
Antipsychotic Prescribing

Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusion: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.

scholarly journals Motivational climate of group exercise sessions in nursing homes

2020 ◽  
Author(s):  
Alexia Charles ◽  
Fanny Buckinx ◽  
Alexandre Mouton ◽  
Jean-Yves Reginster ◽  
Olivier Bruyère
Keyword(s):  
Nursing Homes ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Motivational Climate ◽  
Exercise Group ◽  
Cognitive Status ◽  
Mutual Aid ◽  
Group Exercise ◽  
Cross Sectional ◽  
Or Task

Abstract BackgroundMotivational climate in exercise group environments would have an impact on adherence, effort and enjoyment. We examined the motivational climate among nursing home residents who were involved in group exercise sessions.Methods This cross-sectional study was conducted in 10 nursing homes of Liège area that offer group exercise sessions. Sociodemographic data (age, sex, body mass index), cognitive status (by the Mini Mental State Examination) and independence in activities of daily living (by the Katz Scale) were retrieved in the medical records. The “Abbreviated-Perceived Motivational Climate in Exercise Questionnaire” was translated into French and then administered face to face with a clinical researcher. This is composed of 6 ego-involving climate items (corresponding to rivalry, comparison and favoritism) and 6 task-involving climate items (corresponding to valorization, individual efforts, self-improvement and cooperation). Each item is ranged on a 5-point Likert scale ranging from 1 (not at all focused on ego or task) to 5 (totally focused on ego or task). Each subscale has a total score expressed as an average.ResultsA total of 102 subjects of exercise group sessions were included (84.3 ± 7.7 years and 83 (81.4%) women). The mean score of task-involving and ego-evolving motivational climate was respectively 3.57 (SD= 0.67) and 1.52 (SD=0.49), suggesting that the motivational climate was more focused on the task-involving climate than on ego-involving climate. Some items results were of particular interest: 55.9% of the respondents found that the instructor doesn’t remark/reward when they try hard, 63.7% said that the instructor doesn’t encourage mutual aid and 38.2% found that instructor doesn’t encourage to do new exercises.ConclusionsParticipants tended to perceive motivational climate as more task-involving than ego-involving. The absence of individual positive feedback, new exercises and mutual aid were also highlighted.

scholarly journals Nursing home residents’ ADL status, institution-dwelling and association with outdoor activity: a cross-sectional study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e10202
Author(s):  
Anne Marie Sandvoll ◽  
Ellen Karine Grov ◽  
Morten Simonsen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Performance Status ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Outdoor Activity ◽  
Cross Sectional ◽  
Outdoor Activities ◽  
Low Performance

Introduction The Norwegian regulations for nursing homes consider access to meaningful activities to be an indicator for the quality of nursing homes. Activities of daily living (ADL) provide important basic self-care skills for nursing home residents. Due to the physical changes caused by ageing and comorbidities, nursing home residents may experience functional decline over time, which may affect their ability to perform meaningful ADL, such as outdoor activity, which is considered a valuable and meaningful activity in Norwegian culture. This study aimed to investigate the association between ADL status, institution-dwelling and outdoor activity among nursing home residents. Methods This cross-sectional study included 784 residents aged >67 years living in 21 nursing homes in 15 Norwegian municipalities between November 2016 and May 2018. The Barthel Index was used to assess the nursing home residents’ ADL status. Other variables collected were age, gender, body weight and height, visits per month, institution, ward, and participation in weekly outdoor activities. Descriptive statistics were used to provide an overview of the residents’ characteristics. A Poisson regression model was used to test the association between the outdoor activity level as the dependent variable and ADL score, institution, and other control variables as independent variables. Results More than half (57%) of the nursing home residents in this sample did not go outdoors. More than 50% of the residents had an ADL score <10, which indicates low performance status. Further, we found that residents’ ADL status, institution, ward, and number of visits had an impact on how often the residents went outdoors. Discussion The nursing home residents in this study rarely went outdoors, which is interesting because Norwegians appreciate this activity. Differences in the number of visits might explain why some residents went outdoors more often than other residents did. Our findings also highlight that the institutions impact the outdoor activity. How the institutions are organized and how important this activity is considered to be in the institutions determine how often the activity is performed. Conclusion The low frequency of the outdoor activities might be explained by a low ADL score. More than 50% of the residents had an ADL score <10, which indicates low performance status. Despite regulations for nursing home quality in Norway, this result suggests that organizational differences matter, which is an important implication for further research, health policy and practice.

scholarly journals Contacts with general practitioners, dentists, and medical specialists among nursing home residents: a cross-sectional study in 44 German nursing homes

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jonas Czwikla ◽  
Annika Schmidt ◽  
Maike Schulz ◽  
Ansgar Gerhardus ◽  
Guido Schmiemann ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Dental Care ◽  
Nursing Home Residents ◽  
Median Number ◽  
Cross Sectional Study ◽  
Care Utilization ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical Specialists

Abstract Background Nursing home residents have high medical care needs. Their medical care utilization is, however, lower compared to community-dwelling elderly and varies widely among nursing homes. This study quantified the utilization of general practitioners (GPs), dentists, and medical specialists among nursing homes and residents, and investigated whether dentist utilization is associated with individual and nursing home characteristics. Methods Forty-four nursing homes invited 2124 residents to participate in a cross-sectional study. For 10 medical specialties, data on contacts in nursing homes, practices, and by telephone in the last 12 months were assessed at individual and nursing home level. The proportion of nursing homes and residents with any form of contact, and the median number and interquartile range (IQR) of contacts among individuals with contact were determined. Using multilevel logistic regression, associations between the probability of individual dental care utilization and sex, age, LTC grade, years of residence, sponsorship, number of nursing home beds, and transport and medical escort services for consultations at a practice were investigated. Results The proportion of nursing homes with any form of contact with physicians ranged from 100% for GPs, dentists, and urologists to 76.7% for gynecologists and orthopedists. Among the nursing homes, 442 residents participated (20.8% response). The proportion of residents with any contact varied from 97.8% for GPs, 38.5% for neurologists/psychiatrists, and 32.3% for dentists to 3.0% for gynecologists. Only for GPs, neurologists/psychiatrists, dentists, otorhinolaryngologists, urologists, and dermatologists, the proportion was higher for nursing home contacts than for practice and telephone contacts. Among residents with any contact, the median number of contacts was highest for GPs (11.0 [IQR 7.0-16.0]), urologists (4.0 [IQR 2.0-7.0]), and neurologists/psychiatrists (3.0 [IQR 2.0-5.0]). Dentist utilization varied widely among nursing homes (median odds ratio 2.5) and was associated with higher age. Conclusions Almost all residents had regular contact to GPs, but only one third had contact with dentists. Lower proportions with contact were found for medical specialists, except for neurologists/psychiatrists. Reasons for the large variations in dental care utilization among nursing homes should be identified. Trial registration DRKS00012383 [2017/12/06].

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.

scholarly journals De-implementing and sustaining an intervention to eliminate nursing home resident bed and chair alarms: interviews on leadership and staff perspectives

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Christine W. Hartmann ◽  
Christopher Gillespie ◽  
George G. Sayre ◽  
A. Lynn Snow
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Community Living ◽  
Position Change ◽  
Improvement Program ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Local Leadership ◽  
Positive Effects ◽  
Community Living Centers

Abstract Background Improving nursing home quality of care relies partly on reducing or stopping ineffective or harmful practices, a process known as de-implementation. We know little about de-implementation in this setting. Relatively recent policy changes reclassified resident position-change (bed and chair) alarms, which monitor resident movement, as restraints. This created an optimal environment in which to study impressions of an alarm de-implementation and sustainment intervention. Methods This cross-sectional interview study focused on understanding participants’ experience of a quality improvement program in the Department of Veterans Affairs Community Living Centers (nursing homes). The program’s goal was to improve resident outcomes and staff communication and teamwork through, among other foci, eliminating resident position-change alarms. The Community Living Centers were located in geographically dispersed areas of the continental United States. Interview participants were leadership and staff members from seven Community Living Centers. We conducted in-depth, semi-structured qualitative interviews using a convenience sample and used a thematic analytic approach. Results We conducted seventeen interviews. We identified five main themes: Initiating De-implementation (compelling participants with evidence, engaging local leadership, and site-level education and training), Changing Expectations (educating staff and family members), Using Contrasting Approaches (gradual or abrupt elimination of alarms), Witnessing Positive Effects of De-implementation (reduction in resident falls, improved resident sleep, reduction in distressing behaviors, and increased resident engagement), and Staying the Course (sustainment of the initiative). Conclusions Findings highlight how participants overcame barriers and successfully eliminated resident position-change alarms and sustained the de-implementation through using convincing evidence for the initiative, local leadership involvement and support, and staff and family member education and engagement. These findings and the resulting three-phase process to support nursing homes' de-implementation efforts expand the de-implementation science knowledge base and provide a promising framework for other nursing home-based de-implementation initiatives.

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