scholarly journals 299 A Retrospective Review of Unscheduled Hospital Admissions of Nursing Home Residents Over a Two Year Period

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Aoife McFeely ◽  
Cliona Small ◽  
Susie Hyland ◽  
Jonathan O'Keeffe ◽  
Graham Hughes ◽  
...  
Keyword(s):  
Nursing Home ◽  
Older People ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Integrated Approach ◽  
Care Team ◽  
Similar Data ◽  
Readmission Rates ◽  
Increased Risk ◽  
One Year

Abstract Background Older people living in Nursing Homes (NHs) represent a frail and vulnerable group. With multiple co-morbidities they are at increased risk of acute health deterioration prompting urgent hospital transfer. Our aim was to examine the outcomes for nursing home residents following unscheduled hospital attendances. Methods A prospective database was collected between 1 January 2016 and 31 December 2017. This recorded all emergency admissions of older people from NHs. The data was retrospectively analysed. Outcomes assessed included: length of stay (LOS), 30-day readmission rates, number of readmissions within one year and mortality. We compared these results to similar data collected in 2012-13. Results Over a two-year period, there were 1435 hospital admissions; a 7% increase from 1015 in 2012. 60% were female and 40% male with a mean age of 84.7 years. The average LOS was 9.58 days (vs 11.2 days in 2012-13). The 30-day readmission rate was 9.8% (vs 14% in 2012-13). 30.45% of all patients went on to have 2 or more readmissions within one year, an increase from 21.1% in 2012-13. The total in-hospital mortality was 14%. Conclusion An increase in the number of NH residents presenting to an acute hospital over the past 5 years was observed. Despite this, we have seen reductions in average LOS and 30 day readmission rates. There is, however, an increasing number of recurrent admissions (≥ 2) to the hospital within one year. These results highlight the importance of an integrated approach to patient care; from the primary care team, hospital team, palliative and community care services. We believe the continued development of Nursing Home Outreach Programmes and community liaison services, combined with the evolving role of the in-hospital Geriatric ANP and liaison palliative care team, will help reduce inappropriate ED referrals and encourage advanced care planning.

scholarly journals Physical performance trajectories and mortality among nursing home residents: results of the SENIOR cohort

2020 ◽  
Vol 49 (5) ◽  
pp. 800-806 ◽  
Author(s):  
Alexia Charles ◽  
Johann Detilleux ◽  
Fanny Buckinx ◽  
Jean-Yves Reginster ◽  
Bastien Gruslin ◽  
...  
Keyword(s):  
Nursing Home ◽  
Older People ◽  
Physical Performance ◽  
Nursing Home Residents ◽  
Value Added ◽  
Growth Curve Analysis ◽  
Risk Of Mortality ◽  
Slow Decline ◽  
Increased Risk ◽  
Fast Decline

Abstract Background Previous studies have shown that older people can experience a considerable change in their physical performance (PP) over time. Objectives To identify PP trajectories and their association with mortality among nursing home residents who were followed up for 3 years. Design Three-year longitudinal observational study. Setting Subjects of the SENIOR cohort. Subjects Six hundred and four nursing home residents with a mean age of 82.9 ± 9.1 years. Methods Baseline characteristics and the date of death were collected from the medical records. PP was assessed annually by the short physical performance battery (SPPB) test. Multiple imputations were performed to manage the missing data. PP trajectory groups were estimated using latent growth curve analysis. Cox proportional hazard regression models were applied to examine the risk of mortality according to the PP trajectory groups. Results Three PP trajectory groups were identified: slow decline (N = 96), moderate decline (N = 234) and fast decline (N = 274). After adjustments for potential confounding variables and the baseline SPPB scores, the residents in the fast decline and moderate decline trajectory groups had an increased risk of mortality compared to those in the slow decline trajectory group, with hazard ratio values of 1.78 (95% confidence interval [CI] = 1.34–2.26) and 1.37 (95% CI = 1.10–1.66), respectively. Conclusions PP trajectories provide value-added information to baseline geriatric assessments and could be used for predicting 3-year mortality among nursing home residents. It may be important to regularly monitor the SPPB score and signal an alert when a fast decline in PP is detected in older people.

scholarly journals Antibiotic Prescribing Choices and Their Comparative C. Difficile Infection Risks: A Longitudinal Case-Cohort Study

2020 ◽  
Author(s):  
Kevin Antoine Brown ◽  
Bradley Langford ◽  
Kevin L Schwartz ◽  
Christina Diong ◽  
Gary Garber ◽  
...  
Keyword(s):  
Nursing Home ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Nursing Home Residents ◽  
Quantitative Information ◽  
Antibiotic Prescribing ◽  
Adjusted Relative Risk ◽  
Increased Risk ◽  
Antibiotic Duration ◽  
Antibiotic Courses

Abstract Background Antibiotic use is the strongest modifiable risk factor for the development of Clostridioides difficile infection, but prescribers lack quantitative information on comparative risks of specific antibiotic courses. Our objective was to estimate risks of C. difficile infection associated with receipt of specific antibiotic courses. Methods We conducted a longitudinal case-cohort analysis representing over 90% of Ontario nursing home residents, between 2012 and 2017. Our primary exposure was days of antibiotic receipt in the prior 90 days. Adjustment covariates included: age, sex, prior emergency department or acute care stay, Charlson comorbidity index, prior C. difficile infection, acid suppressant use, device use, and functional status. We examined incident C. difficile infection, including cases identified within the nursing home, and those identified during subsequent hospital admissions. Adjusted and unadjusted regression models were used to measure risk associated with 5- to 14-day courses of 18 different antibiotics. Results We identified 1708 cases of C. difficile infection (1.27 per 100 000 resident-days). Longer antibiotic duration was associated with increased risk: 10- and 14-day courses incurred 12% (adjusted relative risk [ARR] = 1.12, 95% confidence interval [CI]: 1.09, 1.14) and 27% (ARR = 1.27, 95% CI: 1.21,1.30) more risk compared to 7-day courses. Among 7-day courses with similar indications: moxifloxacin resulted in 121% more risk than amoxicillin (ARR = 2.21, 95% CI: 1.67, 3.08), ciprofloxacin engendered 89% more risk than nitrofurantoin (ARR = 1.89, 95% CI: 1.45, 2.68), and clindamycin resulted in 112% (ARR = 2.12, 95% CI: 1.32, 3.78) more risk than cloxacillin. Conclusions C. difficile infection risk increases with antibiotic duration, and there are wide disparities in risks associated with antibiotic courses used for similar indications.

The Role of Nursing Homes Architectural Design in Mitigating the Risk of COVID-19 Pandemics: The Case of Slovenia

2022 ◽  
Vol 8 (1) ◽  
pp. 51-66
Author(s):  
Vesna Žegarac Leskovar ◽  
Vanja Skalicky Klemenčič
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Older People ◽  
Architectural Design ◽  
Nursing Home Residents ◽  
The Elderly ◽  
Evaluation Tool ◽  
Negative Effect ◽  
Disproportionate Number ◽  
Role Of Nursing

Currently, many older people live in institutions for various social and health reasons. In Slovenia, this proportion is almost 5% of the population aged 65 and over. In the COVID-19 pandemic, the elderly proved to be the most vulnerable social group, as they are exposed to a number of comorbidities that increase the risk of mortality. At that time, nursing homes represented one of the most critical types of housing, as seen from a disproportionate number of infections and deaths among nursing home residents worldwide, including Slovenia. During the emergency, a number of safety protocols had to be followed to prevent the spread of infection. Unfortunately, it turned out that while the safety measures protected the nursing home residents, they also had a negative effect on their mental health, mainly due to isolation and social distancing. It follows that especially in times of epidemics of infectious respiratory diseases, the quality of life in nursing homes requires special attention. In this context, it is also necessary to consider whether and how an appropriate architectural design can help mitigating the spread of infections, while at the same time enable older people to live in dignity and with a minimum of social exclusion. To this end, the present study examined 97 nursing homes in Slovenia, analysing the number of infections in nursing homes and their correlation with the degree of infection in the corresponding region in Slovenia. Additionally, 2 nursing homes were studied in more detail with the use of newly developed “Safe and Connected” evaluation tool, analysing the architectural features of each building. The advantages identified so far include living in smaller units, single rooms with balconies, the possibility of using green open spaces and the use of an adequate ventilation. Conclusions of this study are useful for further consideration of design of new nursing homes and the refurbishment of existing ones.

scholarly journals Paramedics’ Perspectives on the Hospital Transfers of Nursing Home Residents—A Qualitative Focus Group Study

2020 ◽  
Vol 17 (11) ◽  
pp. 3778
Author(s):  
Alexandra Pulst ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann ◽  
Guido Schmiemann
Keyword(s):  
Nursing Home ◽  
Nursing Staff ◽  
Hospital Admissions ◽  
Urinary Catheter ◽  
Nursing Home Residents ◽  
Point Of View ◽  
Focus Group Study ◽  
Professional Groups ◽  
Catheter Complications ◽  
Ed Visits

Emergency department (ED) visits and hospital admissions are common among nursing home residents (NHRs). Little is known about the perspectives of emergency medical services (EMS) which are responsible for hospital transports. The aim of this study was to explore paramedics’ experiences with transfers from nursing homes (NHs) and their ideas for possible interventions that can reduce transfers. We conducted three focus groups following a semi-structured question guide. The data were analyzed by content analysis using the software MAXQDA. In total, 18 paramedics (mean age: 33 years, male n = 14) participated in the study. Paramedics are faced with complex issues when transporting NHRs to hospital. They mainly reported on structural reasons (e.g., understaffing or lacking availability of physicians), which led to the initiation of an emergency call. Handovers were perceived as poorly organized because required transfer information (e.g., medication lists, advance directives (ADs)) were incomplete or nursing staff was insufficiently prepared. Hospital transfers were considered as (potentially) avoidable in case of urinary catheter complications, exsiccosis/infections and falls. Legal uncertainties among all involved professional groups (nurses, physicians, dispatchers, and paramedics) seemed to be a relevant trigger for hospital transfers. In paramedics’ point of view, emergency standards in NHs, trainings for nursing staff, the improvement of working conditions and legal conditions can reduce potentially avoidable hospital transfers from NHs.

PP038 NUTRIENT STATUS IN NURSING HOME RESIDENTS - A ONE-YEAR FOLLOW-UP STUDY

2010 ◽  
Vol 5 (2) ◽  
pp. 37-38
Author(s):  
R. Kaiser ◽  
K. Winning ◽  
D. Volkert ◽  
T. Bertsch ◽  
S. Lesser ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Home Residents ◽  
Nutrient Status ◽  
Follow Up Study ◽  
One Year

Choosing to live in a nursing home: a culturally and linguistically diverse perspective

2015 ◽  
Vol 21 (2) ◽  
pp. 239
Author(s):  
Cecilia A. Yeboah
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Older People ◽  
Cultural History ◽  
Nursing Home Residents ◽  
Linguistically Diverse ◽  
Culturally And Linguistically Diverse ◽  
Individual Interviews ◽  
Cultural Origins ◽  
Diverse Perspective

As part of the findings of a study on culturally and linguistically diverse older people relocating to a nursing home, this paper contributes to our understanding of how older people draw on their cultural history to explain their decisions to relocate. Family reciprocity was identified by most participants as central to their decisions, regardless of their specific cultural origins. Using the grounded theory methodology, data were collected through progressive, semi-structured, repeated, in-person, individual interviews with 20 residents of four nursing homes in the northern suburbs of Melbourne, Australia. Culturally and linguistically diverse (CALD) older people, regardless of specific cultural origin, make relocation decisions based on the importance and meaning of reciprocity within families. Understanding their decisions as reflecting a culturally valued reciprocity offered a sense of cultural continuity to the relocation and was comforting to the older adults involved in the study. This study also suggests that culturally and linguistically diverse older people are much more active participants in the decision to relocate to a nursing home than is commonly recognised. The four nursing homes in the northern suburbs of Melbourne and the 20 participants studied constitute only a small proportion of all culturally and linguistically diverse older nursing home residents in Australia. Therefore, the findings may not be pertinent to other culturally and linguistically diverse elderly. Nonetheless, this study makes an important contribution to future discussions regarding cultural diversity in the nursing home relocation of culturally and linguistically diverse older Australians. The study findings provide some insight into the conditions and contexts that impact nursing home relocation.

Odds of Venous Thromboembolims (VTE) Associated with Hospitalization, Surgery, and Cancer Among Nursing Home Residents: A Population-Based Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2984-2984
Author(s):  
Cynthia L. Leibson ◽  
John A. Heit ◽  
Kent R. Bailey ◽  
Tanya M. Petterson ◽  
Aneel Ashrani
Keyword(s):  
Nursing Home ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Conflicts Of Interest ◽  
Conditional Logistic Regression ◽  
Nursing Home Residents ◽  
Population Based ◽  
Olmsted County ◽  
Increased Risk ◽  
Active Cancer

Abstract Abstract 2984 Poster Board II-960 In previous studies of venous thromboembolism (VTE) among all residents of Olmsted County, MN, the odds of VTE associated with surgery, medical hospitalization, or active cancer were extremely high (Univariate odds ratio [OR] =14.6; 4.6, and 8.4 respectively). We also showed that nursing home (NH) residency was an independent risk factor for VTE (OR =5.6). From a clinical practice perspective, it is important to identify which NH residents are at risk of VTE. While it might be assumed that, similar to estimates for the population generally, surgery, medical hospitalization, and cancer are associated with increased risk of VTE within the NH population, the answer remains unclear. We took advantage of the previous identification of all Olmsted County, MN residents who met research criteria for incident VTE 1998-2005 (N=1168). We then determined which individuals were resident of a local NH at time of symptom onset, regardless of location of symptom onset (i.e., for purposes of this study, individuals whose VTE occurred in-hospital having been admitted from a NH were considered NH residents). For each such NH VTE case (N=96), we identified 2 same sex Olmsted County residents of similar age and duration-of-medical-history who were resident of a local NH at the time of the case's VTE event (i.e., index date) (N=192). The detailed provider-linked medical records of NH VTE cases and NH non-VTE controls were reviewed for 3 months before index for surgery or medical hospitalization and for 6 months surrounding index for active cancer. Using conditional logistic regression, we tested and estimated the odds ratio associated with each of these potential risk factors. The proportions of NH VTE cases and NH non-VTE controls with surgery (33%, 28%), medical hospitalization (44%, 46%), and active cancer (12%, 9%) were similar. Univariate odds ratios (95% confidence intervals) and p values for surgery, medical hospitalization, and active cancer were 1.5 (0.7-3.1), p=0.30; 1.1 (0.6-2.1), p=0.74; and 1.4 (0.6-3.2), p=0.46 respectively. Compared to the entire Olmsted County population, the odds of VTE associated with surgery, hospitalization, and cancer are surprisingly much lower for NH residents. Additional investigation is needed to characterize the subset of NH residents at increased risk of VTE. Disclosures: No relevant conflicts of interest to declare.

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