scholarly journals DNR Linked to Reduced Depressive Symptoms in Nursing Home Residents During COVID-19 Illness

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 720-721
Author(s):  
Wingyun Mak ◽  
Orah Burack ◽  
Joann Reinhardt ◽  
Himali Weerahandi ◽  
Benjamin Canter ◽  
...  
Keyword(s):  
Nursing Home ◽  
Depressive Symptoms ◽  
Functional Status ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Do Not Resuscitate ◽  
Term Care ◽  
Data Set ◽  
Care Plans

Abstract Prior work shows that older adults who establish future care plans have a lower risk of depression. Residents in long-term care may benefit from establishing a do-not-resuscitate (DNR) order when cardiopulmonary resuscitation is unlikely to provide medical benefit. The current study examines whether having a DNR order in place prior to COVID-19 diagnosis was associated with fewer depressive symptoms during the illness course. Residents at a NYC skilled nursing facility with a positive COVID-19 PCR test between 3/1/2020 – 6/1/2020 were included (N=338). The Minimum Data Set (3.0) was used to examine residents’ Patient Health Questionnaire-9 (PHQ-9) scores 1-30 days after diagnosis, functional status, cognition, age, and sex. A retrospective chart review was conducted to determine whether participants had an established DNR, DNI, and/or DNH order before developing COVID-19. Forty-eight percent, 46%, and 12% of participants had a DNR, DNI, or DNH order prior to COVID-19 illness, respectively. Average PHQ-9 score was 1.65 (SD=2.37). A hierarchical regression showed that after controlling for age (β=-.13, p=.06), sex (β=-.08, p=.28), cognition (β=.14, p=.04), and functional status (β=.23, p=.001; R2=.10, p=.001), having a DNR (β=-.22, p=.006) order in place prior to COVID illness was associated with lower endorsement of depressive symptoms during illness (ΔR2=.04, p=.01). Results suggest that establishing a DNR in long-term care residents when appropriate may potentially buffer depressive symptoms during illness in nursing home residents regardless of their age, sex, cognitive abilities, and functional status. Future examination of the underlying mechanism is warranted.

Caring About Residents’ Experiences and Symptoms (CARES) Program: A Model of Palliative Care Consultation in the Nursing Home

2016 ◽  
Vol 34 (5) ◽  
pp. 466-469 ◽  
Author(s):  
Deborah A. Morris ◽  
Marissa Galicia-Castillo
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Long Term Care ◽  
Descriptive Analysis ◽  
Nursing Home Residents ◽  
Term Care ◽  
Code Status ◽  
Care Plans ◽  
Palliative Care Consultation

Objectives: To describe the CARES program, a model of palliative care for nursing home residents. Design: Descriptive analysis of the Caring About Residents’ Experiences and Symptoms (CARES) Program that provides palliative care services to nursing home residents. Program evaluation: The CARES Program serves as an example of collaborative efforts to meet community needs. To evaluate the program, we document the services provided as well as process outcomes (changes to care plans, hospitalizations, location of death, and hospice utilization) for residents referred. Results: 170 nursing home residents were seen by CARES Program between February 2013 to December 2015, 48% for skilled services, and 52% for long term care. Majority of referrals were for goals of care and concurrent symptom management. Following consultation, 67% of residents had a change in code status. Of residents desiring a palliative course 90% were never hospitalized. Overall, 53% of residents died; and those in long term care dying more often with hospice. Conclusion: The CARES program of palliative consultation addresses the needs of nursing home residents. The model has potential to be reproducible in in other communities.

scholarly journals The Interplay Between Infection Risk Factors of SARS-CoV-2 and Prognosis: A Cross-Sectional Study from a Cohort of Long-Term Care Nursing Home Residents

2021 ◽  
Author(s):  
Laura Soldevila ◽  
Núria Prat ◽  
Miquel À. Mas ◽  
Mireia Massot ◽  
Ramon Miralles ◽  
...  
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Risk Of Infection ◽  
Cross Sectional ◽  
Term Care ◽  
Facility Size ◽  
Care Nursing ◽  
Pcr Test

Abstract Background: Covid-19 pandemic has particularly affected older people living in Long-term Care settings. Methods: We carried out a cross-sectional analysis of a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at last one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered.Results: A total of 8021 participants were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = 0.03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < .001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). Conclusions: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

The vulnerability of nursing home residents to the Covid-19 pandemic

2020 ◽  
Vol 23 (2-3) ◽  
pp. 57-60 ◽  
Author(s):  
Edward H Wagner
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Nursing Assistants ◽  
Nursing Home Care ◽  
Term Care ◽  
Staff Members ◽  
Care Facilities

Residents in nursing homes and other long-term care facilities comprise a large percentage of the deaths from Covid 19. Is this inevitable or are there problems with NHs and their care that increase the susceptibility of their residents. The first U.S. cluster of cases involved the residents, staff, and visitors of a Seattle-area nursing home. Study of this cluster suggested that infected staff members were transmitting the disease to residents. The quality of nursing home care has long been a concern and attributed to chronic underfunding and resulting understaffing. Most NH care is delivered by minimally trained nursing assistants whose low pay and limited benefits compel them to work in multiple long-term care settings, increasing their risk of infection, and work while ill. More comparative studies of highly infected long-term care facilities with those organizations that were able to better protect their residents are urgently needed. Early evidence suggests that understaffing of registered nurses may increase the risk of larger outbreaks.

scholarly journals TRENDS IN OPIOID USE IN LONG-TERM CARE NURSING HOME RESIDENTS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S709-S709
Author(s):  
Hemalkumar B Mehta ◽  
Yong-Fang Kuo ◽  
Jordan Westra ◽  
Mukaila Raji ◽  
James S Goodwin
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Opioid Use ◽  
Severe Dementia ◽  
Term Care ◽  
Dementia Patients ◽  
Moderate Dementia ◽  
Long Acting

Abstract We examined opioid use in long-term care nursing home residents with dementia. This retrospective cohort study used Minimum Data Set linked Medicare data, 2011-2016, and included long-term care episodes for residents 65+ years who survived 100+ days each year (592,211 episodes for 256,207 residents). Cognitive status at first annual assessment was classified as none/mild, moderate and severe impairment. Overall opioid use, prolonged opioid use (prescription supply 90+ days) and long-acting opioid use were identified from Medicare part D. Descriptive statistics were used to describe opioid use by cognitive impairment. Cochrane Armitage trends test was used to determine trends in opioid use. 114,622 (19%) patients had severe and 129,257 (22%) had moderate dementia. Overall opioid (none/mild=15.4%, moderate=13.9%, severe=9%), prolonged opioid (none/mild=5.2%, moderate=4.5%, severe=3.2%) and long-acting opioid use (none/mild=1.1%, moderate=0.9%, severe=0.3% ) were lower in patients with advanced dementia. Opioid use was significantly higher in females and Whites and varied by states. Substantial increase was found in overall opioid and prolonged opioid use from 2011 to 2016, with greater increase in none/mild and moderate dementia patients. For example, prolonged opioid use increased by 69% in none/mild and 71% in moderate dementia patients compared to 52% in severe dementia patients (p&lt;0.0001). Long-acting opioid use decreased, with a greater decline in none/mild (69%) and moderate (71%) dementia patients compared to severe dementia patients (58%) (p&lt;0.0001). Contrary to decreasing opioid use in community setting, overall and prolonged opioid use increased in nursing home residents. Future studies should identify the reasons behind increased use.

scholarly journals P4-634: ASSOCIATION OF DEMENTIA SEVERITY AND OPIOID USE IN LONG-TERM CARE NURSING HOME RESIDENTS WITH DEMENTIA

2019 ◽  
Vol 15 ◽  
pp. P1571-P1571
Author(s):  
Hemalkumar B. Mehta ◽  
Yong-Fang Kuo ◽  
Jordan Westra ◽  
James S. Goodwin ◽  
Mukaila Raji
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Opioid Use ◽  
Term Care ◽  
Dementia Severity ◽  
Care Nursing
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