Prevalence of psychotropic polypharmacy in nursing home residents with dementia: a meta-analysis

2021 ◽  
pp. 1-16
Author(s):  
Dylan J. Jester ◽  
Victor Molinari ◽  
Janice C. Zgibor ◽  
Ladislav Volicer
Keyword(s):  
Nursing Home ◽  
Sample Size ◽  
Meta Analysis ◽  
Nursing Home Residents ◽  
Well Being ◽  
Geographic Region ◽  
Psychotropic Medications ◽  
Influential Factors ◽  
Cross Sectional ◽  
Prevalence Estimates

ABSTRACT Objectives: Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence. Design: Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia. Setting and Participants: NH residents with dementia. Measurements: Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy. Results: Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07). Conclusions: Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.

scholarly journals Assessing the well-being of residents in nursing facilities

2021 ◽  
Author(s):  
Nadja Schott ◽  
Bettina Johnen ◽  
Thomas Jürgen Klotzbier
Keyword(s):  
Nursing Home ◽  
Convergent Validity ◽  
Assessment Tool ◽  
Nursing Home Residents ◽  
Reliability And Validity ◽  
Well Being ◽  
Nursing Home Population ◽  
Cross Sectional ◽  
Language Version ◽  
Cultural Adaption

Abstract Purpose Well-adapted and validated well-being (WB) instruments for the nursing home population are scarce. To our knowledge, the Laurens Well-Being Inventory for Gerontopsychiatry (LWIG) is a practical and reliable well-being assessment tool that has never been validated for German nursing home populations. Therefore, the purpose of our study was to (1) translate and cross-culturally adapt the LWIG to a German context and (2) test the reliability and validity of the German LWIG in a group of older nursing home residents using the Rasch model. Methods This study has a cross-sectional, descriptive study design. Cross-cultural adaption of the LWIG-GER from English to German was performed according to a standardized method. The data obtained from 104 long-term nursing home residents (57 women, 47 men) aged 60–99 years (mean 79.5, standard deviation ±9.11) were analyzed for psychometric testing (exploratory and confirmatory factor analysis, item fit, McDonald’s ω, convergent validity, and known-group validity, Rasch). Results The final LWIG-GER consists of 19 items with three subscales, including “psychological WB”, “social WB”, and “physical WB”. The LWIG-GER showed good overall reliability with McDonald’s ω of 0.83; the LWIG-GER dimensions’ scores were significantly correlated with depression, functional performance, activities, fear of falling, and education. Conclusions Our findings suggest that the German language version of the LWIG is a reliable and valid tool for measuring WB in nursing home residents. Furthermore, we propose that the LWIG-GER questionnaire can broaden and deepen our understanding of residents’ perception of quality of care and their environment.

scholarly journals Nursing Home Residents Aged over 80—A Cross-Sectional Analysis on Which Activity Traits Correlate to Positive Affect

2020 ◽  
Vol 17 (24) ◽  
pp. 9583
Author(s):  
Melanie Zirves ◽  
Holger Pfaff
Keyword(s):  
Nursing Home ◽  
Positive Affect ◽  
Nursing Home Residents ◽  
Care Facility ◽  
Well Being ◽  
Independent Effect ◽  
Activity Participation ◽  
Computer Assisted ◽  
Subjective Well Being ◽  
Cross Sectional

Admission to a care facility is assumed to enhance depressive symptoms and dependent behavior in old age. In this context, the relevance of participation in activities that make everyday life in a care facility more pleasant has been pointed out. This study examines if there is a relationship between participation in different activities as well as the frequency of this participation and the positive affect of nursing home residents aged over 80. Data from the unique cross-sectional representative study ‘Quality of life and subjective well-being of the very old in North Rhine-Westphalia’ in Germany (n = 150, aged 90.15 years in average) were used. The data were collected between 08/2017 and 02/2018 using computer-assisted personal interviewing. The variability in and frequency of activity participation functioned as independent, and positive affect as dependent variable. Multiple regression analysis was performed. Residents’ predicted positive affect significantly increased with a higher variability in activity participation. There was no independent effect of frequency in participation. Our findings indicate that there is a significant and positive relationship between participating in a high number of different activities and the overall positive affect of residents aged over 80 years. This does not hold true for the frequency of participation.

scholarly journals Besøk på sykehjem. En kvantitativ studie av sykehjemsbeboeres besøkshyppighet

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Joanna Galek ◽  
Morten Simonsen ◽  
Ellen-Karine Grov ◽  
Anne Marie Sandvoll
Keyword(s):  
Nursing Home ◽  
Nursing Students ◽  
Nursing Homes ◽  
Length Of Stay ◽  
Nursing Home Residents ◽  
Social Contact ◽  
Well Being ◽  
Cross Sectional ◽  
Visit Frequency ◽  
Number Of Visits

Social contact is essential for the well-being of the nursing home residents.Visiting frequency in nursing homes is rarely investigated. The purpose of this study was to map the number of visits for nursing home residents. Nursing students collected data during their nursing home practice. 355 residents were included in this cross-sectional study. We explored the association between visit frequency and age, gender, type of department, activities of daily living (ADL) and length of stay. Data was analyzed using statistical analysis. The average number of visits was 8,8 per month. However, there were differences in visit frequency among the 15 institutions. Residents in the long-term department received fewer visits compared to the dementia and short-term department. Significant correlations between ADL function, gender, length of stay, age and frequency of visits were not found. More research to identify causes for the differences in visit frequency between different institutions is needed.Keywords: nursing homes; visiting; visit frequency; sykehjem; besøk; besøkshyppighet

Positive Aging in Nursing Home Residents

GeroPsych ◽  
2017 ◽  
Vol 30 (2) ◽  
pp. 71-78 ◽  
Author(s):  
Ulrich Wiesmann ◽  
Marie-Luise Becker ◽  
Hans-Joachim Hannich
Keyword(s):  
Nursing Home ◽  
Sense Of Coherence ◽  
Psychological Health ◽  
Nursing Home Residents ◽  
Well Being ◽  
Cross Sectional Study ◽  
Subjective Well Being ◽  
Subjective Age ◽  
Cross Sectional ◽  
Positive Aging

Abstract. The main objective of nursing homes is to enable their residents a good life despite their existing physical, mental, and social health problems. In this cross-sectional study, we explored the mechanisms of positive aging in nursing-home residents from a salutogenic perspective. We interviewed 190 individuals (155 women) with a mean age of M = 84.3 years (SD = 7.60) and assessed selected resistance resources (subjective age, social network characteristics), the sense of coherence, and positive aging (psychological health and subjective well-being). The sense of coherence fully mediated perceived availability of social support and a younger age identification effects on positive aging. In line with salutogenic theory, it represents a superordinate concept which pools resource influences on positive aging.

scholarly journals Quality of Life, Person-Centred Care and Lived Experiences of Nursing Home Residents in a Developed Urban Asian Country: a cross-sectional study

2021 ◽  
pp. 1-8
Author(s):  
C.W. Tew ◽  
S.P. Ong ◽  
P.L.K. Yap ◽  
A.Y.C. Lim ◽  
N. Luo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Well Being ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Positive Potential ◽  
Cross Sectional

Background: Literature emphasises the benefits of person-centred approaches in nursing homes. Objectives: To describe the quality of life, well/ill being and person-centred care of residents, and explore relationship between person-centred care and well/ill being in 7 nursing homes. Design: A cross-sectional study. Setting: Seven nursing homes of different built period and design typologies in Singapore. Participants: 696 nursing home residents. Measurements: Measures used were EQ-5D for quality of life, Dementia Care Mapping for well/ill being, Resident Satisfaction Score and Person-Directed Dementia Care Assessment Tool as measure of person-centred care. Results: Mean EQ-5D-5L index was 0.096 (SD=0.45). Most residents had at least moderate problems in mobility (66.5%), self-care (63.6%) and usual activities (63.0%). Mean well/ill being score was 1.69 (SD=0.98). A state of neutrality (WIB=+1) (48%) was most observed, followed by well-being (WIB>+1) (29%) and ill-being (WIB<+1) (6%). High positive potential behaviors were recorded 37% of the time, while low/no positive potential behaviors amount to 39%. The overall resident satisfaction score was 3.43/5 with borderline satisfaction with environment, food and activities, and low satisfaction with lifestyle and quality of interaction. The overall level of person-centred care was modest 2.3/4. Activities scored highest while the weakest domain was Environment. The overall level of person-centred care was positively correlated with resident well/ill being score (F=4.43, p<0.001). Conclusions: A higher level of person-centred care is associated with better resident well-being. Beyond their physical and custodial needs, the residents’ psychosocial needs can be better fulfilled. The areas of person-centred care amenable to improvement relate to environment, staff knowledge and training. These findings can inform resident care planning, policy development, and future research to support nursing homes in their endeavour to move towards more holistic and person-centric care.

scholarly journals Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092879
Author(s):  
Katarina Fehir Šola ◽  
Iva Mucalo ◽  
Andrea Brajković ◽  
Ivona Jukić ◽  
Donatella Verbanac ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Therapy ◽  
Medication Management ◽  
Institutional Care ◽  
Nursing Home Residents ◽  
Median Number ◽  
Cross Sectional ◽  
High Prevalence ◽  
Care Facilities ◽  
Drug Therapy Problems

Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.

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.

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