551 EASING THE STRAIN OF CONSTIPATION IN CARE HOMES

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
F Kirkpatrick ◽  
P Crawford
Keyword(s):  
Quality Of Life ◽  
Educational Intervention ◽  
Medication Review ◽  
Care Home ◽  
Care Homes ◽  
Staff Education ◽  
Care Home Staff ◽  
Laxative Use ◽  
Key Aspects

Abstract Introduction Older individuals are particularly prone to constipation with a reported prevalence of up 50% for those living in community with the prevalence rising to 70% within nursing homes (De Giorgio et al, 2015 1). Objectives To assess impact of staff education & pharmacist intervention on appropriateness of laxative use: Staff education: Examine the baseline knowledge of care home staff on constipation and laxative use: Formulate an education package to deliver to care home staff on key aspects of laxative use: Evaluate the staff knowledge, post the educational intervention.: Impact of pharmacist medication review on laxative use: Evaluate impact of pharmacist review on appropriateness of laxative use in care Homes. Method Three BHSCT Care Homes being case managed by the Medicines Optimisation Pharmacist were included in the study. Staff Education: The baseline knowledge of care home staff was examined by questionnaire, pre- and post-educational intervention on key aspects of laxative use. Staff directly administering medication or directly impacting on patients’ care in were included. An education package on key aspects of laxative use for delivery in nursing homes was designed and implemented. Impact of Pharmacist medication review on laxative use: We retrospectively examined if 30 patients were prescribed multiple laxatives from the same group as an indicator of inappropriate laxative use, pre and post pharmacist intervention. Results Staff education: Thirty-three staff completed the questionnaires. The educational package developed on laxative use had a positive impact on the knowledge of the staff on constipation and laxative use with statistically significant improvements in staff knowledge post education, with p-value <0.05. Healthcare assistants’ mean percentage increase in knowledge following education mirrored that of nursing staff at almost 50%. Impact of Pharmacist medication review on laxative use: There was a statistically significant improvement in appropriateness of laxative prescribing following the pharmacist led medication review of 30 residents. Fewer patients were prescribed laxatives from the same class following medication reviews with a p value of < 0.00001, the result is significant at p < 0.05. Discussion The positive impact of this study supports the conclusion by Chen et al 2 (2014) that patient and carer education should be first line treatment for non-severe constipation. Shen Q et al 3 (2018) suggested that educational intervention for patients can effectively improve constipation symptoms, treatment and result in improved health habits however this study provides further evidence that the education of care home staff plays a significant role in improving the appropriate management of constipation for care home residents. Pharmacist-led review of laxatives has the potential to improve a Care Home resident’s quality of life, as previously suggested by Dennison et al 4 (2005), with the potential to reduce the risk of complications or hospital admissions from ineffective treatment of chronic constipation. Conclusion The development & delivery of a bespoke laxative educational package along with pharmacist medication review of residents’ current laxatives regimes resulted in a statistically improved appropriateness in laxative use. The education package developed will be shared with Medicines Optimisation for Older People (MOOP) Care Home Pharmacists for delivery in NI trusts. References 1. De Giorgio et al. 2015. Chronic constipation in the elderly: a primer for gastroenterologist. BMC Gastroenterology, 14:130. 2. Dennison, C et al. 2005. the health-related quality of life and economic burden of constipation. Pharmaceoconmics 23 (5), 461–476. 3. Chen I. C. et al. (2014). Prevalence and effectiveness of laxative use among elderly residents in a regional hospital affiliated nursing home in Hsinchu County. Nursing and Midwifery Studies, 3(1), e13962. 4. Shen Q et al. (2018) Nurse-Led Self-Management Educational Intervention Improves Symptoms of Patients With Functional Constipation. West J Nurs Res. 2018 Jun;40(6):874–888. 5. Dennison et al. (2005) The Health-Related Quality of Life and Economic Burden of Constipation. Pharmacoeconomics, 23 (5), 461–476.

scholarly journals Measuring health-related quality of life of care home residents, comparison of self-report with staff proxy responses for EQ-5D-5L and HowRu: protocol for assessing proxy reliability in care home outcome testing

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e022127 ◽  
Author(s):  
Adeela Usman ◽  
Sarah Lewis ◽  
Kathryn Hinsliff-Smith ◽  
Annabelle Long ◽  
Gemma Housley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Care Home ◽  
Care Homes ◽  
Health Related Quality ◽  
Care Home Staff ◽  
Related Quality ◽  
Health Related ◽  
Proxy Responses

IntroductionResearch into interventions to improve health and well-being for older people living in care homes is increasingly common. Health-related quality of life (HRQoL) is frequently used as an outcome measure, but collecting both self-reported and proxy HRQoL measures is challenging in this setting. This study will investigate the reliability of UK care home staff as proxy respondents for the EQ-5D-5L and HowRu measures.Methods and analysisThis is a prospective cohort study of a subpopulation of care home residents recruited to the larger Proactive Healthcare for Older People in Care Homes (PEACH) study. It will recruit residents ≥60 years across 24 care homes and not receiving short stay or respite care. The sample size is 160 participants. Resident and care home staff proxy EQ-5D-5L and HowRu responses will be collected monthly for 3 months. Weighted kappa statistics and intraclass correlation adjusted for clustering at the care home level will be used to measure agreement between resident and proxy responses. The extent to which staff variables (gender, age group, length of time caring, role, how well they know the resident, length of time working in care homes and in specialist gerontological practice) influence the level of agreement between self-reported and proxy responses will be considered using a multilevel mixed-effect regression model.Ethics and disseminationThe PEACH study protocol was reviewed by the UK Health Research Authority and University of Nottingham Research Ethics Committee and was determined to be a service development project. We will publish this study in a peer-reviewed journal with international readership and disseminate it through relevant national stakeholder networks and specialist societies.

scholarly journals Psychometric properties and feasibility of use of dementia specific quality of life instruments for use in care settings: a systematic review

2019 ◽  
pp. 1-15 ◽  
Author(s):  
Laura J. Hughes ◽  
Nicolas Farina ◽  
Thomas E. Page ◽  
Naji Tabet ◽  
Sube Banerjee
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Psychometric Properties ◽  
Care Home ◽  
Care Homes ◽  
Cosmin Checklist ◽  
Many Instruments ◽  
The Uk ◽  
Quality Instruments

ABSTRACTBackground:Over 400,000 people live in care home settings in the UK. One way of understanding and improving the quality of care provided is by measuring and understanding the quality of life (QoL) of those living in care homes. This review aimed to identify and examine the psychometric properties including feasibility of use of dementia-specific QoL measures developed or validated for use in care settings.Design:Systematic review.Methods:Instruments were identified using four electronic databases (PubMed, PsycINFO, Web of Science, and CINAHL) and lateral search techniques. Searches were conducted in January 2017. Studies which reported on the development and/or validation of dementia specific QoL instruments for use in care settings written in English were eligible for inclusion. The methodological quality of the studies was assessed using the COSMIN checklist. Feasibility was assessed using a checklist developed specifically for the review.Results:Six hundred and sixteen articles were identified in the initial search. After de-duplication, screening and further lateral searches were performed, 25 studies reporting on 9 dementia-specific QoL instruments for use in care home settings were included in the review. Limited evidence was available on the psychometric properties of many instruments identified. Higher-quality instruments were not easily accessible or had low feasibility of use.Conclusions:Few high-quality instruments of QoL validated for use in care home settings are readily or freely available. This review highlights the need to develop a well-validated measure of QoL for use within care homes that is also feasible and accessible.

scholarly journals Comparing proxy rated quality of life of people living with dementia in care homes

2019 ◽  
Vol 50 (1) ◽  
pp. 86-95 ◽  
Author(s):  
S. Robertson ◽  
C. Cooper ◽  
J. Hoe ◽  
K. Lord ◽  
P. Rapaport ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Neuropsychiatric Symptoms ◽  
Care Home ◽  
Multilevel Modelling ◽  
Native English Speakers ◽  
Care Homes ◽  
English Speakers ◽  
People With Dementia ◽  
Home Placement

AbstractBackgroundImproving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes.MethodsWe compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews.ResultsStaff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia.ConclusionProxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.

scholarly journals Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study

BJPsych Open ◽  
2017 ◽  
Vol 3 (4) ◽  
pp. 171-178 ◽  
Author(s):  
Gill Livingston ◽  
Julie Barber ◽  
Louise Marston ◽  
Penny Rapaport ◽  
Deborah Livingston ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Care Home ◽  
Cross Sectional Study ◽  
Care Homes ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Random Effects Models ◽  
Dementia Severity ◽  
Clinically Significant

BackgroundAgitation is reportedly the most common neuropsychiatric symptom in care home residents with dementia.AimsTo report, in a large care home survey, prevalence and determinants of agitation in residents with dementia.MethodWe interviewed staff from 86 care homes between 13 January 2014 and 12 November 2015 about residents with dementia with respect to agitation (Cohen-Mansfield Agitation Inventory (CMAI)), quality of life (DEMQOL-proxy) and dementia severity (Clinical Dementia Rating). We also interviewed residents and their relatives. We used random effects models adjusted for resident age, gender, dementia severity and care home type with CMAI as a continuous score.ResultsOut of 3053 (86.2%) residents who had dementia, 1489 (52.7%) eligible residents participated. Fifteen per cent of residents with very mild dementia had clinically significant agitation compared with 33% with mild (odds ratios (ORs)=4.49 95% confidence interval (CI)=2.30) and 45% with moderate or severe dementia (OR=6.95 95% CI=3.63, 13.31 and OR=6.23 95% CI=3.25, 11.94, respectively). More agitation was associated with lower quality of life (regression coefficient (rc)=-0.53; 95% CI=-0.61, -0.46) but not with staffing or resident ratio (rc=0.03; 95% CI=-0.04, 0.11), level of residents' engagement in home activities (rc=3.21; 95% CI=-0.82, 7.21) or family visit numbers (rc=-0.03; 95% CI=-0.15, 0.08). It was correlated with antipsychotic use (rc=6.45; 95% CI=3.98, 8.91).ConclusionsCare home residents with dementia and agitation have lower quality of life. More staffing time and activities as currently provided are not associated with lower agitation levels. New approaches to develop staff skills in understanding and responding to the underlying reasons for individual resident's agitation require development and testing.

scholarly journals An evaluation of group reminiscence arts sessions for people with dementia living in care homes

Dementia ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 805-821 ◽  
Author(s):  
Frank Keating ◽  
Laura Cole ◽  
Robert Grant
Keyword(s):  
Quality Of Life ◽  
Social Inclusion ◽  
Care Home ◽  
Well Being ◽  
Care Homes ◽  
Primary Data ◽  
Evaluation Team ◽  
People With Dementia ◽  
Group Reminiscence

Dementia has been identified as one of the major challenges in the 21st Century. The detrimental effects of dementia can jeopardise personhood, thus person-centred interventions including reminiscence and arts practice have been recommended as tools to promote social inclusion and improve the quality of life. This study aimed to evaluate the effectiveness of group reminiscence arts sessions for people living with dementia in care homes (residential and nursing homes) using a comparative and time series design to collect data on quality of life. The intervention was conducted in six care homes in London over a period of 24 weeks and compared with six care homes not receiving the intervention (control). Dementia Care Mapping was used as the primary data collection instrument to measure positive behaviours and rate quality of life before, during and after group reminiscence arts sessions. The evaluation team observed the sessions at three-weekly intervals. Statistical modelling found that positive behaviours and quality of life of care home residents participating in group reminiscence arts sessions increased over the 24-week period. Well-being increased sharply during each session and plateaued at 50 minutes with a sustained positive effect after the sessions. On a longer timescale, well-being and quality of life increased slowly and steadily from one session to the next. The findings were statistically significant ( p < 0.001). The study concludes that group reminiscence arts sessions can have a positive and sustained impact on the quality of life of people with dementia. However, the evidence on the sustainability of the effect over time remains unknown. More research is needed to assess in much greater depth the association between quality of life and group reminiscence arts sessions.

Care homes lay assessor project – using volunteers to improve the quality of life of older people living in care homes

2016 ◽  
Vol 20 (2) ◽  
pp. 94-100
Author(s):  
Kenneth Walter Dolbear
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Care Home ◽  
Care Homes ◽  
Meaningful Change ◽  
Content Type ◽  
Local Council ◽  
Practical Implications

Purpose – The purpose of this paper is to outline the learning from an innovative approach to using volunteers as lay assessors in order to secure improvements in the quality of life of older people in care homes. Design/methodology/approach – The paper describes the implementation of pilot lay assessor scheme in Bristol and systematically explores the learning from this case study. Findings – The paper concludes that despite a number of important challenges and limitations, a lay assessor approach, particularly when conducted in close co-operation with a local council, can indeed provide demonstrable quality of life benefits for older people in closed institutions such as care homes. Practical implications – The case study highlights a number of key implications for practice including: it is possible to recruit, motivate and train volunteers to provide a lay assessor scheme; working with a local council and providers of care homes can produce real improvements in quality of life; lay assessor schemes are an important way of “shining a light” into closed institutions; defining quality of life and balancing this with institutional attitudes towards risk can be extremely challenging; and working with care home managers, providing them with ideas and support can be effective in bringing about meaningful change. Originality/value – This case study reports on one of the first volunteer lay assessor initiatives in the country. There has been very little if any reporting or analysis of such schemes. This paper therefore adds significantly to this important are of public policy and provision.

scholarly journals Being occupied: supporting ‘meaningful activity’ in care homes for older people in England

2017 ◽  
Vol 38 (11) ◽  
pp. 2218-2240 ◽  
Author(s):  
NICK SMITH ◽  
ANN-MARIE TOWERS ◽  
SINEAD PALMER ◽  
JENNIFER BEECHAM ◽  
ELIZABETH WELCH
Keyword(s):  
Quality Of Life ◽  
Care Home ◽  
Later Life ◽  
Care Homes ◽  
Physical And Mental Health ◽  
Quality Of Life Research ◽  
Meaningful Activity ◽  
Care Outcomes ◽  
Low Levels

ABSTRACTThe benefits of meaningful activity in later life are well documented. Studies show that being occupied contributes to both physical and mental health as well as quality of life. Research also suggests that activity may be beneficial to people residing in care homes, including people living with dementia. This paper presents findings from a study which used the Adult Social Care Outcomes Toolkit (ASCOT) to measure quality of life in six care homes located in the south-east of England. The study found, like previous ones, that care home residents’ days were characterised by a lack of activity. Drawing on observations, interviews and focus groups with residents and staff from these homes, this paper attempts to understand why care home residents do not engage in meaningful activities. We reject the idea that these low levels of activity are a natural part of the ageing process or that they can be explained by notions of resident choice. Instead, the findings point to both insufficient funding and working practices within care homes as more substantive explanations. These explanations inform a discussion of how the low levels of engagement in meaningful activity could be addressed and residents’ quality of life improved.

scholarly journals Dementia Care Mapping™ to reduce agitation in care home residents with dementia: the EPIC cluster RCT

2020 ◽  
Vol 24 (16) ◽  
pp. 1-172 ◽  
Author(s):  
Claire A Surr ◽  
Ivana Holloway ◽  
Rebecca EA Walwyn ◽  
Alys W Griffiths ◽  
David Meads ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Care Home ◽  
Health Technology ◽  
Care Homes ◽  
Care Home Staff ◽  
Care Outcomes ◽  
Secondary Outcomes ◽  
Care Mapping ◽  
Dementia Care Mapping

Background The quality of care for people with dementia in care homes is of concern. Interventions that can improve care outcomes are required. Objective To investigate the clinical effectiveness and cost-effectiveness of Dementia Care Mapping™ (DCM) for reducing agitation and improving care outcomes for people living with dementia in care homes, versus usual care. Design A pragmatic, cluster randomised controlled trial with an open-cohort design, follow-up at 6 and 16 months, integrated cost-effectiveness analysis and process evaluation. Clusters were not blinded to allocation. The primary end point was completed by staff proxy and independent assessors. Setting Stratified randomisation of 50 care homes to the intervention and control groups on a 3 : 2 ratio by type, size, staff exposure to dementia training and recruiting hub. Participants Fifty care homes were randomised (intervention, n = 31; control, n = 19), with 726 residents recruited at baseline and a further 261 recruited after 16 months. Care homes were eligible if they recruited a minimum of 10 residents, were not subject to improvement notices, had not used DCM in the previous 18 months and were not participating in conflicting research. Residents were eligible if they lived there permanently, had a formal diagnosis of dementia or a score of 4+ on the Functional Assessment Staging Test of Alzheimer’s Disease, were proficient in English and were not terminally ill or permanently cared for in bed. All homes were audited on the delivery of dementia and person-centred care awareness training. Those not reaching a minimum standard were provided training ahead of randomisation. Eighteen homes took part in the process evaluation. Intervention Two staff members from each intervention home were trained to use DCM and were asked to carry out three DCM cycles; the first was supported by an external expert. Main outcome measures The primary outcome was agitation (Cohen-Mansfield Agitation Inventory), measured at 16 months. Secondary outcomes included resident behaviours and quality of life. Results There were 675 residents in the final analysis (intervention, n = 388; control, n = 287). There was no evidence of a difference in agitation levels between the treatment arms. The adjusted mean difference in Cohen-Mansfield Agitation Inventory score was –2.11 points, being lower in the intervention group than in the control (95% confidence interval –4.66 to 0.44; p = 0.104; adjusted intracluster correlation coefficient: control = 0, intervention = 0.001). The sensitivity analyses results supported the primary analysis. No differences were detected in any of the secondary outcomes. The health economic analyses indicated that DCM was not cost-effective. Intervention adherence was problematic; only 26% of homes completed more than their first DCM cycle. Impacts, barriers to and facilitators of DCM implementation were identified. Limitations The primary completion of resident outcomes was by staff proxy, owing to self-report difficulties for residents with advanced dementia. Clusters were not blinded to allocation, although supportive analyses suggested that any reporting bias was not clinically important. Conclusions There was no benefit of DCM over control for any outcomes. The implementation of DCM by care home staff was suboptimal compared with the protocol in the majority of homes. Future work Alternative models of DCM implementation should be considered that do not rely solely on leadership by care home staff. Trial registration Current Controlled Trials ISRCTN82288852. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 16. See the NIHR Journals Library website for further project information.

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