Hearing Loss and Cognitive-Communication Test Performance of Long-Term Care Residents With Dementia: Effects of Amplification

2016 ◽  
Vol 59 (6) ◽  
pp. 1533-1542 ◽  
Author(s):  
Tammy Hopper ◽  
Susan E. Slaughter ◽  
Bill Hodgetts ◽  
Amberley Ostevik ◽  
Carla Ickert
Keyword(s):  
Hearing Loss ◽  
Test Performance ◽  
Speech Intelligibility ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Hearing Ability ◽  
The Relationship

Purpose The study aims were (a) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and (b) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were (a) What is the effect of amplification on cognitive-communication test performance of LTC residents with early- to middle-stage dementia and mild-to-moderate hearing loss? and (b) What is the relationship between measured hearing ability and hearing ability recorded by staff using the Resident Assessment Instrument–Minimum Data Set 2.0 (RAI-MDS; Hirdes et al., 1999)? Method Thirty-one residents from 5 long-term care facilities participated in this quasiexperimental crossover study. Residents participated in cognitive-communication testing with and without amplification. RAI-MDS ratings of participants' hearing were compared to audiological assessment results. Results Participants' speech intelligibility index scores significantly improved with amplification; however, participants did not demonstrate significant improvement in cognitive-communication test scores with amplification. A significant correlation was found between participants' average pure-tone thresholds and RAI-MDS ratings of hearing, yet misclassification of hearing loss occurred for 44% of participants. Conclusions Measuring short-term improvement of performance-based cognitive communication may not be the most effective means of assessing amplification for individuals with dementia. Hearing screenings and staff education remain necessary to promote hearing health for LTC residents.

scholarly journals Evidence for Publicly Reported Quality Indicators in Residential Long-Term Care: A Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 181-181
Author(s):  
Franziska Zúñiga ◽  
Magdalena Osinska ◽  
Franziska Zuniga
Keyword(s):  
New Zealand ◽  
Quality Indicators ◽  
Long Term Care ◽  
Grey Literature ◽  
Public Reporting ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Residential Long Term Care

Abstract Quality indicators (QIs) are used internationally to measure, compare and improve quality in residential long-term care. Public reporting of such indicators allows transparency and motivates local quality improvement initiatives. However, little is known about the quality of QIs. In a systematic literature review, we assessed which countries publicly report health-related QIs, whether stakeholders were involved in their development and the evidence concerning their validity and reliability. Most information was found in grey literature, with nine countries (USA, Canada, Australia, New Zealand and five countries in Europe) publicly reporting a total of 66 QIs in areas like mobility, falls, pressure ulcers, continence, pain, weight loss, and physical restraint. While USA, Canada and New Zealand work with QIs from the Resident Assessment Instrument – Minimal Data Set (RAI-MDS), the other countries developed their own QIs. All countries involved stakeholders in some phase of the QI development. However, we only found reports from Canada and Australia on both, the criteria judged (e.g. relevance, influenceability), and the results of structured stakeholder surveys. Interrater reliability was measured for some RAI QIs and for those used in Germany, showing overall good Kappa values (>0.6) except for QIs concerning mobility, falls and urinary tract infection. Validity measures were only found for RAI QIs and were mostly moderate. Although a number of QIs are publicly reported and used for comparison and policy decisions, available evidence is still limited. We need broader and accessible evidence for a responsible use of QIs in public reporting.

scholarly journals Depressive symptoms in long term care facilities in Western Canada: a cross sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Matthias Hoben ◽  
Abigail Heninger ◽  
Jayna Holroyd-Leduc ◽  
Jennifer Knopp-Sihota ◽  
Carole Estabrooks ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Western Canada ◽  
Cross Sectional ◽  
Term Care ◽  
Data Set ◽  
For Profit

Abstract Background The main objective is to better understand the prevalence of depressive symptoms, in long-term care (LTC) residents with or without cognitive impairment across Western Canada. Secondary objectives are to examine comorbidities and other factors associated with of depressive symptoms, and treatments used in LTC. Methods 11,445 residents across a random sample of 91 LTC facilities, from 09/2014 to 05/2015, were stratified by owner-operator model (private for-profit, public or voluntary not-for-profit), size (small: < 80 beds, medium: 80–120 beds, large > 120 beds), location (Calgary and Edmonton Health Zones, Alberta; Fraser and Interior Health Regions, British Columbia; Winnipeg Health Region, Manitoba). Random intercept generalized linear mixed models with depressive symptoms as the dependent variable, cognitive impairment as primary independent variable, and resident, care unit and facility characteristics as covariates were used. Resident variables came from the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 records (the RAI-MDS version routinely collected in Western Canadian LTC). Care unit and facility variables came from surveys completed with care unit or facility managers. Results Depressive symptoms affects 27.1% of all LTC residents and 23.3% of LTC resident have both, depressive symptoms and cognitive impairment. Hypertension, urinary and fecal incontinence were the most common comorbidities. Cognitive impairment increases the risk for depressive symptoms (adjusted odds ratio 1.65 [95% confidence interval 1.43; 1.90]). Pain, anxiety and pulmonary disorders were also significantly associated with depressive symptoms. Pharmacologic therapies were commonly used in those with depressive symptoms, however there was minimal use of non-pharmacologic management. Conclusions Depressive symptoms are common in LTC residents –particularly in those with cognitive impairment. Depressive symptoms are an important target for clinical intervention and further research to reduce the burden of these illnesses.

scholarly journals Characteristics of Socially Isolated Residents in Long-Term Care: A Retrospective Cohort Study

2020 ◽  
Vol 6 ◽  
pp. 233372142097532
Author(s):  
Stephanie A. Chamberlain ◽  
Wendy Duggleby ◽  
Pamela B. Teaster ◽  
Carole A. Estabrooks
Keyword(s):  
Cohort Study ◽  
Functional Status ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Socially Isolated

Objectives: To identify socially isolated long-term care residents and to compare their demographic characteristics, functional status, and health conditions to residents who are not isolated. Methods: We conducted a retrospective cohort study using the Resident Assessment Instrument, Minimum Data Set, 2.0 (RAI-MDS) data, from residents in 34 long-term care homes in Alberta, Canada (2008–2018). Using logistic regression, we compared the characteristics, conditions, and functional status of residents who were socially isolated (no contact with family/friends) and non-socially isolated residents. Results: Socially isolated residents were male, younger, and had a longer length of stay in the home, than non-socially isolated residents. Socially isolated residents lacked social engagement and exhibited signs of depression. Discussion: Socially isolated residents had unique care concerns, including psychiatric disorders, and co-morbid conditions. Our approach, using a single item in an existing data source, has the potential to assist clinicians in screening for socially isolated long-term care residents.

scholarly journals Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Nicole Williams ◽  
Natalie A Phillips ◽  
Walter Wittich ◽  
Jennifer L Campos ◽  
Paul Mick ◽  
...  
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Assessment Instrument ◽  
Term Care ◽  
Data Set ◽  
Individual Level ◽  
The Individual

Abstract Background and Objectives The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions. Research Design and Methods This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants’ most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan–Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC. Results In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer’s dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11). Discussion and Implications Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.

scholarly journals DEVELOPING A RAI-MDS 2.0 BEHAVIOR-BASED PAIN ASSESSMENT SCALE FOR LONG-TERM CARE RESIDENTS WITH ADVANCED DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S622-S623
Author(s):  
Jennifer A Knopp-Sihota
Keyword(s):  
Pain Assessment ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Assessment Scale ◽  
Self Report ◽  
Factor Analyses ◽  
Factor Solution ◽  
Term Care ◽  
Data Set

Abstract In Canadian and many international long-term care (LTC) facilities, pain assessment frequently relies on data from the Resident Assessment Instrument – Minimum Data Set 2.0 (RAI-MDS). The RAI-MDS produces a two-item scale, measuring both pain frequency and pain intensity. This scale correlates well with self-reported pain in cognitively intact LTC residents, but despite repeated testing, is less valid for use in residents with more advanced cognitive impairment who are unable to self-report their pain. In this study we aimed to develop and validate a behaviour-based pain assessment scale for long-term care residents using data available in the RAI-MDS. To construct our initial scale, we reviewed the literature and compiled a list of observable indicators of pain (e.g., grimacing) and linked these with 28 similar items available in the RAI-MDS. Using Delphi techniques, we further refined this to 20 items. We then evaluated the psychometric properties of our scale using two independent, representative samples, of urban LTC residents in Western Canada. Exploratory factor analyses were conducted in sample one (n=16,282) and confirmatory factor analyses (CFA) were then conducted in sample two (n=15,785) in order to test, and confirm, our model. A two-factor solution was identified grouping RAI-MDS items into subscales 1) change in status (e.g., new onset restlessness) and 2) behaviours (e.g., crying). Commonly recognized model fit indices were acceptable suggesting the adequacy of the two-factor solution. Results provide preliminary support for the use of behavioural-based pain assessment scale using RAI-MDS data. Further evaluation and validation of our scale is warranted.

scholarly journals Developing an RAI-MDS Behavior-Based Pain Scale for Long-Term Care Residents With Advanced Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 203-204
Author(s):  
Jennifer Knopp-Sihota ◽  
Matthias Hoben ◽  
Jeff Poss ◽  
Carole Estabrooks
Keyword(s):  
Pain Assessment ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Assessment Scale ◽  
Self Report ◽  
Factor Analyses ◽  
Factor Solution ◽  
Term Care ◽  
Data Set

Abstract In Canadian and many international long-term care (LTC) facilities, pain assessment frequently relies on data from the Resident Assessment Instrument – Minimum Data Set 2.0 (RAI-MDS). The RAI-MDS produces a two-item scale, measuring both pain frequency and pain intensity. This scale correlates well with self-reported pain in cognitively intact LTC residents, but despite repeated testing, is less valid for use in residents with more advanced cognitive impairment who are unable to self-report their pain. In this study we aimed to develop and validate a behaviour-based pain assessment scale for long-term care residents using data available in the RAI-MDS. To construct our initial scale, we reviewed the literature and compiled a list of observable indicators of pain (e.g., grimacing) and linked these with 28 similar items available in the RAI-MDS. Using Delphi techniques, we further refined this to 20 items. We then evaluated the psychometric properties of our scale using two independent, representative samples, of urban LTC residents in Western Canada. Exploratory factor analyses were conducted in sample one (n=16,282) and confirmatory factor analyses (CFA) were then conducted in sample two (n=15,785) in order to test, and confirm, our model. A two-factor solution was identified grouping RAI-MDS items into subscales 1) change in status (e.g., new onset restlessness) and 2) behaviours (e.g., crying). Commonly recognized model fit indices were acceptable suggesting the adequacy of the two-factor solution. Results provide preliminary support for the use of behavioural-based pain assessment scale using RAI-MDS data. Further evaluation and validation of our scale is warranted.

scholarly journals Relationship between environmental factors and responsive behaviours in long-term care homes: a secondary data analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047364
Author(s):  
Kelsey Holt ◽  
Matthias Hoben ◽  
Lori Weeks ◽  
Carole Estabrooks
Keyword(s):  
Environmental Quality ◽  
Long Term Care ◽  
Care Delivery ◽  
Research Programme ◽  
Assessment Instrument ◽  
Cross Sectional ◽  
Term Care ◽  
Data Set

ObjectiveResponsive behaviours (eg, wandering, resisting care and verbal abuse) are a continuing issue for staff and individuals living in long-term care (LTC) homes. The LTC environment can influence responsive behaviours and is a factor in determining the quality of life for those living there. The ways in which the quality of the environment might influence responsive behaviours has not been investigated yet. We hypothesised that better quality environments would be associated with reduced rates of responsive behaviours. We used a tool that simultaneously encompasses human and structural elements of the environment, a novel approach in this field of research.DesignCross-sectional study, using data collected from September 2014 to May 2015 as part of the Translating Research in Elder Care research programme.SettingA representative, stratified (size, owner-operator model and health region) random sample of 76 LTC homes in British Columbia, Alberta, Manitoba.Participants13 224 individuals (67.3% females) living in participating LTC homes.Outcome measuresQuality of care unit work environment was assessed using the observable indicators of quality (OIQ) tool. Responsive behaviours were assessed using routinely collected Resident Assessment Instrument-Minimum Data Set V.2.0 data.ResultsAdjusted regression coefficients of overall Aggressive Behaviour Scale score and interpersonal communication were 0.02 (95% CI −0.011 to 0.045), grooming 0.06 (95% CI −0.032 to 0.157), environment-basics 0.067 (95% CI 0.024 to 0.110), odour −0.066 (95% CI −0.137 to −0.004), care delivery −0.007 (95% CI −0.033 to 0.019), environment-access −0.027 (95% CI −0.062 to 0.007), environment-homelike −0.034 (95% CI −0.065 to −0.002) and total OIQ score 0.003 (95% CI −0.004 to 0.010).ConclusionsWe found small associations between the environmental quality and responsive behaviours in Western Canadian LTC homes. Higher scores on homelikeness were associated with decreased responsive behaviours. Higher scores on basic environmental quality were associated with increased responsive behaviours.

scholarly journals Variation and appropriateness of antipsychotic use in long-term care facilities across Newfoundland and Labrador

2021 ◽  
pp. 171516352110051
Author(s):  
Zachary E. M. Giovannini-Green ◽  
John-Michael Gamble ◽  
Brendan Barrett ◽  
Zhiwei Gao ◽  
Susan Stuckless ◽  
...  
Keyword(s):  
Newfoundland And Labrador ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Linear Regression Models ◽  
Term Care ◽  
Data Set ◽  
Increased Risk ◽  
Care Facilities ◽  
Risk Of Falls

Objective: The use of antipsychotics to treat seniors in long-term care facilities (LTCFs) has raised concern because of health consequences (i.e., increased risk of falls, stroke, death) in this vulnerable population. This study measured geographic patterns of antipsychotic utilization among seniors living in LTCFs in Newfoundland and Labrador (NL) and assessed potential inappropriateness. Method: We analyzed prescription records among adults 66 years and older with provincial prescription drug coverage admitted to LTCFs in NL between April 1, 2011, and March 31, 2014. Patterns of use were analyzed across the 4 regional health authorities (RHAs) in NL and LTCFs. Logistic, Poisson and linear regression models were used to test variations in prevalence, rate and volume of antipsychotic utilization. To assess potential inappropriateness of antipsychotic use, we analyzed data from Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0 forms from NL LTCFs between January 1, 2016, and December 31, 2018. Pearson chi-squared analysis was performed at the RHA and LTCF levels to determine changes in percentage of total prescriptions or antipsychotic prescriptions without psychosis. Results: Between 2011 and 2014, 2843 seniors were admitted to LTCFs across NL; of these, 1323 residents were prescribed 1 or more antipsychotics. Within the 3-year period, the percentage of antipsychotic use across facilities ranged from 35% to 78%. Using data from 27,260 RAI-MDS 2.0 assessments between 2016 and 2018, 71% (6995/9851) of antipsychotic prescriptions were potentially inappropriate. Discussion: There is substantial variation across NL regions concerning the utilization of antipsychotics for senior in LTCFs. Facility size and management styles may be reasons for this. Conclusion: With nearly three-quarters of antipsychotic prescriptions shown to be potentially inappropriate, systematic interventions to assess indications for antipsychotic use are warranted. Can Pharm J (Ott) 2021;154:xx-xx.

An evaluation of a person-centred care programme for long-term care facilities

2013 ◽  
Vol 35 (3) ◽  
pp. 457-488 ◽  
Author(s):  
JAIME WILLIAMS ◽  
THOMAS HADJISTAVROPOULOS ◽  
OMEED O. GHANDEHARI ◽  
XUE YAO ◽  
LISA LIX
Keyword(s):  
Focus Group ◽  
Long Term Care ◽  
Empirical Studies ◽  
Assessment Instrument ◽  
Programme Implementation ◽  
Term Care ◽  
Data Set ◽  
Care Programme ◽  
Care Facilities

ABSTRACTPerson-centred approaches in long-term care focus on providing holistic care to residents in order to improve quality of life, enhance resident wellbeing and autonomy, and mitigate behavioural and/or other symptoms. The results of research on person-centred approaches to care are mixed, with very few high-quality empirical studies examining resident outcomes specifically. The purpose of this investigation was to examine a person-centred care programme implemented in three Canadian long-term care facilities to determine its effect on resident outcomes, approach to care and maintenance of the programme three years after implementation. Using the Resident Assessment Instrument Minimum Data Set (RAI-MDS) scale scores and quality indicators, we retrospectively examined resident outcomes before, after and six months following the initiation of the programme using three additional facilities as control. We did not find any effects on resident outcomes. Focus group interviews with facility staff revealed no systematic differences between the programme and control facilities in their approach to care. All facilities supported aspects of a person-centred philosophy. Focus group interview data from the programme facilities indicated partial maintenance in two facilities and more complete maintenance in one facility. Although staff members supported the programme, implementation and maintenance proved difficult and effectiveness on resident outcomes was not indicated in this research. Additional controlled studies are needed.

scholarly journals MEASURING THE EFFECTS OF A CYCLING PROGRAM ON QUALITY OF LIFE OF OLDER ADULTS LIVING IN LONG TERM CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S848-S849
Author(s):  
Victoria Cotnam ◽  
Aleksandra Zecevic
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Social Engagement ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Time Data ◽  
Term Care ◽  
Data Set

Abstract Cycling Without Age (CWA) is a program offered in long-term care (LTC) homes around the world that allows older adults who are unable to ride a bicycle the pleasure of a bike ride again. Two residents sit in the front bench seat of a trishaw, and a volunteer bike pilot pedals the bike. A variety of anecdotal benefits have been reported and no study has rigorously measured the effects of this program. The purpose of this research is to measure the effects of the CWA program on happiness and quality of life of LTC home residents, through observation of an existing program in a Canadian LTC home. A total of 24 residents were purposefully recruited in a biking group (n=23) who were biked twice a week for 12 weeks, and a strolls group (n=16) who went for outdoors walks or wheelchair rides for the same period of time. Data on pain, cognition, social engagement, and aggressive behaviour was harvested from the Resident-Assessment Instrument – Minimum Data Set (RAI-MDS). Happiness was measured pre and post all bike rides and strolls using a visual analogue scale, and the LTC QoL assessment was used to assess QOL. Findings show that biking group scored higher on happiness after bike rides compared to before, as well as compared to strolls. Bike group QOL scores are higher at the end of the 12 weeks than were strolls group. In summary, CWA shows potential to increase QOL and happiness of residents living in LTC.

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