scholarly journals Health Effects of Power Loss After Hurricane Irma on Nursing Home Residents in Florida

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 286-286
Author(s):  
Lily Gordon ◽  
Julianne Skarha ◽  
Nazmus Sakib ◽  
Joseph June ◽  
Dylan Jester ◽  
...  
Keyword(s):  
Nursing Home ◽  
Power Loss ◽  
Linear Models ◽  
Nursing Home Residents ◽  
Future Research ◽  
Power Outage ◽  
Specific Effects ◽  
Causal Pathways ◽  
Time Specific ◽  
Hurricane Irma

Abstract Previous research establishes that hurricanes adversely affect nursing home (NH) resident health but specific causal pathways are still unclear. We combined power outage data with Medicare claims to determine the effects of power loss from Hurricane Irma(2017) among NH residents in Florida. Out of 580 facilities, 289 reported power loss. These facilities had higher star ratings; higher beds counts, and were preferentially in the Southeast region of Florida compared to facilities without outages. There were 27,767 residents living in a NH without power. They were comparable in characteristics to residents that did not lose power (N=26,383). We ran adjusted generalized linear models with robust standard errors, clustering for NH. We found power loss was associated with a trend towards increased odds of mortality within 7-days (OR:1.12, 95% CI:0.96, 1.30) and 30-days (OR:1.10, 95% CI:1.00, 1.21) post-storm, but not with hospitalization. Future research should investigate the time-specific effects of power outages.

scholarly journals Association between environmental stimulation and apathy in nursing home residents with dementia

2019 ◽  
Vol 31 (08) ◽  
pp. 1109-1120 ◽  
Author(s):  
Ying-Ling Jao ◽  
Wen Liu ◽  
Kristine Williams ◽  
Habib Chaudhury ◽  
Jyotsana Parajuli
Keyword(s):  
Nursing Home ◽  
Linear Models ◽  
Rating Scale ◽  
Nursing Home Residents ◽  
Repeated Measure ◽  
Future Research ◽  
Video Observations ◽  
Environmental Stimulation ◽  
Multilevel Linear Models ◽  
Environmental Feedback

ABSTRACTObjectives:Prior research and theories established the link between care environments and apathy. Yet, empirical evidence on how environmental stimulation impacts apathy is lacking. This study examined the association between environmental stimulation and apathy in nursing home residents with dementia.Design:This repeated-measure study analyzed 104 video observations of staff caregiver–resident interactions.Setting:12 nursing homes.Participants:63 unique staff caregiver–resident dyads that involved 42 caregivers and 44 residents with moderate to severe dementia.Measurements:Second-by-second behavioral coding using Noldus Observer software was conducted to assess apathy and environmental stimulation, using the Person-Environment Apathy Rating scale. The environment subscale includes six items: stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback. The apathy subscale includes six items: facial expression, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression. Multilevel linear models were used for analysis.Results:Results showed that apathy was not associated with the overall quality of environmental stimulation but was significantly associated with stimulation specificity (coefficient = −2.23,p= 0.049). However, the association was not significant after controlling for resident characteristics (p= 0.082). In addition, higher levels of environmental feedback were associated with lower apathy levels (coefficient = −2.14,p= 0.001). The association remained significant after controlling for resident characteristics (coefficient = −1.65,p= 0.014).Conclusion:Findings reveal that when environmental stimulation is individually tailored and prompts engagement, residents are less apathetic. This study highlights the effect of environmental stimulation on apathy. Future research should explore interventions that modify environmental stimulation to reduce apathy and improve dementia care.

scholarly journals Association of Power Outage With Mortality and Hospitalizations Among Florida Nursing Home Residents After Hurricane Irma

2021 ◽  
Vol 2 (11) ◽  
pp. e213900
Author(s):  
Julianne Skarha ◽  
Lily Gordon ◽  
Nazmus Sakib ◽  
Joseph June ◽  
Dylan J. Jester ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Home Residents ◽  
Power Outage ◽  
Hurricane Irma

scholarly journals Association Between Exposure to Hurricane Irma and Mortality and Hospitalization in Florida Nursing Home Residents

2020 ◽  
Vol 3 (10) ◽  
pp. e2019460
Author(s):  
David M. Dosa ◽  
Julianne Skarha ◽  
Lindsay J. Peterson ◽  
Dylan J. Jester ◽  
Nazmus Sakib ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Home Residents ◽  
Hurricane Irma

An Observational Study of Agitation in Agitated Nursing Home Residents

1989 ◽  
Vol 1 (2) ◽  
pp. 153-165 ◽  
Author(s):  
Jiska Cohen-Mansfield ◽  
Perla Werner ◽  
Marcia S. Marx
Keyword(s):  
Nursing Home ◽  
Observational Study ◽  
Nursing Home Residents ◽  
Future Research ◽  
Cognitively Impaired ◽  
High Frequencies ◽  
Direct Observations ◽  
Very High Frequencies ◽  
Very High

Direct observations of 24 highly agitated, cognitively impaired nursing home residents were performed during each hour of the 24-hour day for 2–3 months. Results showed that agitated behaviors (in particular, strange noises, requests for attention, repetitious mannerisms, picking at things, strange movements, and pacing) were manifested at very high frequencies. The data also showed that daytime agitation was positively related to nighttime agitation. Patterns of agitation were specific to each resident, an important finding for future research and intervention.

scholarly journals Blood Pressure Variability and Complexity in Nursing Home Residents Before Death

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 138-138
Author(s):  
Laura A Graham ◽  
Sei Lee ◽  
Michael Steinman ◽  
Carmen Peralta ◽  
Anna Rubinsky ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Nursing Home ◽  
Healthy Aging ◽  
Clinical Decision Making ◽  
Linear Models ◽  
Nursing Home Residents ◽  
Data System ◽  
Veterans Health ◽  
Dynamic Data ◽  
Factors Associated

Abstract Blood pressure (BP) is a complex dynamic system in the human body and an important determinant of healthy aging. Exploring BP as a dynamic data system may provide important insights into how BP patterns can provide complementary information to the static, one-time BP measurements that are more commonly used for clinical decision making. Thus, we sought to describe BP as a dynamic data system in older adults nearing death. Using a prospective cohort study design, we assessed BP measures 6 months before death in Veterans Health Administrative nursing home residents between 10/1/2006 and 9/30/2017. Variability was characterized using standard deviation and mean square error after adjusting for diurnal variations. Complexity (i.e., amount of novel information vs. redundancy) was examined using Shannon’s entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability. We identified 17,953 patients (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mmHg). In the last 6 months of life, systolic BP decreased slightly (⃞-7.2mmHg). Variability was stable until the last month of life, at which point variability increased by as much as 30%. In contrast, complexity did not change in the 6 months before death (⃞0.02 bits). Factors associated with BP variability before death include hospitalizations, hospice care, and medication changes. Systolic BP decreases in the last 6 months before death, and BP variability increases in the last month of life. Further, the increase in BP variability may be driven by increasingly complex care patterns as one approaches death.

Exploring the Dynamics of Week-to-Week Blood Pressure in Nursing Home Residents Before Death

2021 ◽  
Author(s):  
Laura A Graham ◽  
Sei J Lee ◽  
Michael A Steinman ◽  
Carmen A Peralta ◽  
Anna D Rubinsky ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Nursing Home ◽  
Linear Models ◽  
Mean Squared Error ◽  
Nursing Home Residents ◽  
Antihypertensive Medications ◽  
Study Objective ◽  
Factors Associated ◽  
Care Patterns ◽  
Pattern Variability

Abstract BACKGROUND Aging is accompanied by an overall dysregulation of many dynamic physiologic processes including those related to blood pressure (BP). While year-to-year BP variability is associated with cardiovascular events and mortality, no studies have examined this trend with more frequent BP assessments. Our study objective is to take the next step to examine week-to-week BP dynamics—pattern, variability, and complexity—before death. METHODS Using a retrospective study design, we assessed BP dynamics in the 6 months before death in long-term nursing home residents between 1 October 2006 and 30 September 2017. Variability was characterized using SD and mean squared error after adjusting for diurnal variations. Complexity (i.e., amount of novel information in a trend) was examined using Shannon’s entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability. RESULTS We identified 17,953 nursing home residents (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mm Hg). Despite a slight trend of decreasing systolic week-to-week BP over time (delta = 7.2 mm Hg), week-to-week complexity did not change in the 6 months before death (delta = 0.02 bits). Average weekly BP variability was stable until the last 3–4 weeks of life, at which point variability increased by 30% for both systolic and diastolic BP. Factors associated with BP variability include average weekly systolic/diastolic BP, days in the nursing home, days in the hospital, and changes to antihypertensive medications. CONCLUSIONS Week-to-week BP variability increases substantially in the last month of life, but complexity does not change. Changes in care patterns may drive the increase in BP variability as one approaches death.

Communicating With Nursing Home Residents About End of Life

2021 ◽  
pp. 104990912110648
Author(s):  
Janet Sopcheck ◽  
Ruth M. Tappen
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Family Members ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Future Research ◽  
Life Care ◽  
Older Individuals ◽  
Past Experiences

Approximately 33% of the 1.2 million older individuals residing in nursing homes have the capacity to discuss their preferences for end-of-life care, and 35% will die within their first year in the nursing home. These conversations necessary to promote care consistent with the resident’s preferences are often limited and most often occur when the resident is actively dying. The purpose of this secondary analysis was to understand the resident’s perspectives on end-of-life communication in the nursing home and suggest approaches to facilitate this communication. We interviewed 46 participants (16 residents, 10 family members, and 20 staff) in a Southeast Florida nursing home from January to May 2019. The data were analyzed using descriptive and pattern coding and matrices to decipher preliminary categories and thematic interpretation within and across each participant group. Two themes emerged from this secondary analysis that residents assume others know their end-of-life preferences, and past experiences may predict future end-of-life choices. Residents and family members were willing to discuss end-of-life care. Study findings also suggested that past experiences with the end-of-life and critical illness of another could impact residents’ and family members’ end-of-life care decisions, and that nurses’ recognition of subtle signs of a resident’s decline may trigger provider-initiated end-of-life conversations. Future research should focus on strategies to promote earlier end-of-life discussions to support independent decision-making about end-of-life care in this relatively dependent population of older adults.

scholarly journals Mortality and Morbidity Among Nursing Home Residents Exposed to Hurricane Irma

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 734-734
Author(s):  
David Dosa ◽  
Julianne Skarha ◽  
Lindsay Peterson ◽  
Dylan Jester ◽  
Nazmus Sakib ◽  
...  
Keyword(s):  
Nursing Home ◽  
Administrative Data ◽  
Nursing Home Residents ◽  
Minimum Data Set ◽  
Control Group ◽  
Short Stay ◽  
Data Set ◽  
Mortality And Morbidity ◽  
Minimum Data ◽  
Hurricane Irma

Abstract We combined Medicare claims and nursing home (NH) administrative data to determine the mortality and morbidity effect of Hurricane Irma on nursing home residents. We utilized the Centers for Medicare and Medicaid Services (CMS) Standard Analytical Files (SAFs) combined with the Minimum Data Set (MDS) to create an exposure cohort of NH residents residing in Florida facilities immediately prior to Hurricane Irma’s landfall on September 10, 2017. We created a control group of residents who resided in the same NHs over the same dates in 2015, a year when there were no hurricanes. Outcome variables included 30/90-day mortality and first hospitalizations post storm. Compared to the control, an additional 260 more NH deaths were identified at 30 days and 429 more deaths at 90 days. Long stay residents (≥100 days) were at particular risk for mortality compared to short stay residents (<100 days). Hospitalization was also markedly increased.

scholarly journals Facility Characteristics and Quality Deficiencies of Florida Nursing Homes With COVID-19 Cases and Deaths

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 945-945
Author(s):  
Xiaochuan Wang ◽  
Courtney Wilson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Infection Control ◽  
Nursing Home Residents ◽  
The United States ◽  
Future Research ◽  
Staffing Level ◽  
Policy And Practice ◽  
Staff Shortage ◽  
Facility Size

Abstract The Coronavirus disease 2019 (COVID-19) has been disproportionately affecting nursing homes throughout the United States, resulting elevated risk for COVID-19 morbidity and mortality to nursing home residents. Given the high percentage of aging population, large number of nursing homes, and staggering surge of COVID-19 cases in Florida, it’s critical to understand factors that may affect Florida nursing homes’ vulnerability to the COVID-19 pandemic. Using Nursing Home COVID-19 Dataset as of July 26, 2020 obtained through Centers for Medicare and Medicaid Services (CMS), and Provider Info Dataset and Health Deficiencies Dataset available through CMS Nursing Home Compare data, we constructed a database of Florida nursing facilities with confirmed COVID-19 cases and deaths, with corresponding facility characteristics and quality deficiencies. We examined the facility characteristics (e.g. facility size, ownership state, chain affiliation, staffing level) and quality deficiencies (e.g. infection control deficiencies) of Florida nursing homes with and without publicly reported COVID-19 cases and deaths. Results indicated that, as of July 26, 2020, 73.3% and 40.8% of Florida nursing homes had resident COVID-19 cases and death, respectively (N=701). Findings also suggested that Florida nursing homes of large facility size, chain affiliated, and for profit, were significantly more likely to have documented resident COVID-19 cases (p<.05). Larger facility size (120 beds or more), staff shortage, and having prior infection control deficiency citation, were significantly related to the odds of having resident COVID-19 deaths (p<.05). Policy and practice implications and future research directions will be addressed to better protect the at-risk nursing home residents.

A Systematic Review of Tools Assessing the Perspective of Caregivers of Residents With Dementia

2021 ◽  
pp. 073346482110286
Author(s):  
Alexandra E. Harper ◽  
Stephanie Rouch ◽  
Natalie E. Leland ◽  
Rose L. Turner ◽  
William E. Mansbach ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nursing Home ◽  
Psychological Symptoms ◽  
Medication Use ◽  
Nursing Home Residents ◽  
Self Report ◽  
Future Research ◽  
Specific Knowledge ◽  
Meta Analyses ◽  
Knowledge Communication

In collaboration with stakeholders, we conducted a systematic review of psychometric evidence for self-report tools measuring the perspective of family caregivers of nursing home residents with dementia. Our rationale for this review was based on evidence that nonpharmacological interventions can ameliorate dementia symptoms in nursing home residents. Such interventions require caregiver participation, which is influenced by perspectives. Yet, no existing tool measures the multidomain caregiver perspective. Our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The final sample included 42 articles describing 33 tools measuring domains of nursing home dementia care such as behavioral and psychological symptoms of dementia, resident quality of life, dementia-specific knowledge, communication, and medication use. We uncovered evidence gaps for tools measuring dementia-specific knowledge, communication, and medication use, all of which were important to our stakeholders. Future research should focus on development of psychometrically sound tools in alignment with the multidomain caregiver perspective.

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