scholarly journals Social Connectedness, Meals on Wheels Services and Healthcare Utilization Among High-Need Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 961-961
Author(s):  
Jennifer Chubinski ◽  
Sarah Walsh ◽  
France Weaver
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Healthcare Utilization ◽  
Social Cohesion ◽  
Panel Study ◽  
Nursing Home Residents ◽  
Social Health ◽  
Multivariate Techniques ◽  
Meals On Wheels ◽  
Increased Risk

Abstract Homebound vulnerable adults 65+ are at an increased risk for social isolation and loneliness. The adverse consequences of loneliness are profound – including increased health care utilization, burden of dementia, chronic diseases, and mortality. Meals on Wheels (MOW) is a familiar source of nutritional support for homebound individuals who wish to stay in their homes and has additional important benefits. A growing body of evidence demonstrates that MOW provides mental and social health benefits beyond nutrition, but less is known about the interplay between MOW, social cohesion, and health services use. This project will address this gap in the literature using data from the 2013-2020 National Health and Aging Trends Study (NHATS), a nationally-representative panel study of 65+ Medicare enrollees. Using matching and longitudinal multivariate techniques, the risks of hospitalization and permanent nursing home entry are compared between MOW users and non-users. Our longitudinal dataset includes 11,266 observations. Of those, 12.8% rely on MOW or other food assistance (N= 1,488) and 16.6% experience low social cohesion (N= 1,936). Some 6.6% of participants are nursing home residents (N= 748) and the 39.1% report an overnight hospital stay in the prior year (N= 4,560). MOW is a comparatively low-cost intervention to help homebound older adults retain their independence and limit costlier healthcare utilization. This work extends our understanding of MOW services beyond simple nutrition benefits to its potential impact on social health.

Retrospective Review of Selective Serotonin Reuptake Inhibitors and Falling in Older Nursing Home Residents

2001 ◽  
Vol 13 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Cynthia L. Arfken ◽  
Jacquelyn Gardner Wilson ◽  
Stephen M. Aronson
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Nursing Home Residents ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Pharmacy Records ◽  
Increased Risk ◽  
Injurious Fall

We compared the rate of falling in older nursing home residents who had been prescribed selective serotonin reuptake inhibitors (SSRIs), other classes of antidepressants, and no antidepressants. Data were obtained from pharmacy records, medical records, fall logs, and incidence reports for one nursing home (1995 data). Older adults on SSRIs were more likely to fall than older adults not on antidepressants (p = .003) and were more likely to have an injurious fall (p = .03). The association with falling remained significant even when including potential confounders (p = .007). Older nursing home residents should be treated for depression. However, SSRIs may also carry an increased risk for falling.

Deficits in Selective Attention Alter Gait in Frail Older Adults

GeroPsych ◽  
2016 ◽  
Vol 29 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Véronique Cornu ◽  
Jean-Paul Steinmetz ◽  
Carine Federspiel
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Selective Attention ◽  
Dual Task ◽  
Nursing Home Residents ◽  
Gait Rehabilitation ◽  
Rehabilitation Programs ◽  
Gait Parameters ◽  
Growing Body ◽  
Task Conditions

Abstract. A growing body of research demonstrates an association between gait disorders, falls, and attentional capacities in older adults. The present work empirically analyzes differences in gait parameters in frail institutionalized older adults as a function of selective attention. Gait analysis under single- and dual-task conditions as well as selective attention measures were collected from a total of 33 nursing-home residents. We found that differences in selective attention performances were related to the investigated gait parameters. Poorer selective attention performances were associated with higher stride-to-stride variabilities and a slowing of gait speed under dual-task conditions. The present findings suggest a contribution of selective attention to a safe gait. Implications for gait rehabilitation programs are discussed.

scholarly journals A bio-psycho-social approach for frailty amongst Singaporean Chinese community-dwelling older adults – evidence from the Singapore Longitudinal Aging Study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nigel Teo ◽  
Pei Shi Yeo ◽  
Qi Gao ◽  
Ma Shwe Zin Nyunt ◽  
Jie Jing Foo ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Functional Disability ◽  
Empirical Studies ◽  
Social Contact ◽  
Population Based ◽  
Community Dwelling ◽  
Severe Disability ◽  
Cross Sectional ◽  
Increased Risk

Abstract Background Few empirical studies support a bio-psycho-social conceptualization of frailty. In addition to physical frailty (PF), we explored mental (MF) and social (SF) frailty and studied the associations between multidimensional frailty and various adverse health outcomes. Methods Cross-sectional and longitudinal analyses were conducted using data from a population-based cohort (SLAS-1) of 2387 community-dwelling Singaporean Chinese older adults. Outcomes examined were functional and severe disability, nursing home referral and mortality. PF was defined by shrinking, weakness, slowness, exhaustion and physical inactivity, 1–2 = pre-frail, 3–5 = frail; MF was defined by ≥1 of cognitive impairment, low mood and poor self-reported health; SF was defined by ≥2 of living alone, no education, no confidant, infrequent social contact or help, infrequent social activities, financial difficulty and living in low-end public housing. Results The prevalence of any frailty dimension was 63.0%, dominated by PF (26.2%) and multidimensional frailty (24.2%); 7.0% had all three frailty dimensions. With a few exceptions, frailty dimensions share similar associations with many socio-demographic, lifestyle, health and behavioral factors. Each frailty dimension varied in showing independent associations with functional (Odds Ratios [ORs] = 1.3–1.8) and severe disability prevalence at baseline (ORs = 2.2–7.3), incident functional disability (ORs = 1.1–1.5), nursing home referral (ORs = 1.5–3.4) and mortality (Hazard Ratios = 1.3–1.5) after adjusting for age, gender, medical comorbidity and the two other frailty dimensions. The addition of MF and SF to PF incrementally increased risk estimates by more than 2 folds. Conclusions This study highlights the relevance and utility of PF, MF and SF individually and together. Multidimensional frailty can better inform policies and promote the use of targeted multi-domain interventions tailored to older adults’ frailty statuses.

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 No Other Safe Care Option: Nursing Home Admission as a Last Resort Strategy

2020 ◽  
Vol 60 (8) ◽  
pp. 1504-1514
Author(s):  
Heather J Campbell-Enns ◽  
Megan Campbell ◽  
Kendra L Rieger ◽  
Genevieve N Thompson ◽  
Malcolm B Doupe
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Community Setting ◽  
Nursing Home Admission ◽  
Care Needs ◽  
Community Based ◽  
Field Notes ◽  
Care Nursing

Abstract Background and Objectives Nursing homes are intended for older adults with the highest care needs. However, approximately 12% of all nursing home residents have similar care needs as older adults who live in the community and the reasons they are admitted to nursing homes is largely unstudied. The purpose of this study was to explore the reasons why lower-care nursing home residents are living in nursing homes. Research Design and Methods A qualitative interpretive description methodology was used to gather and analyze data describing lower-care nursing home resident and family member perspectives regarding factors influencing nursing home admission, including the facilitators and barriers to living in a community setting. Data were collected via semistructured interviews and field notes. Data were coded and sorted, and patterns were identified. This resulted in themes describing this experience. Results The main problem experienced by lower-care residents was living alone in the community. Residents and family members used many strategies to avoid safety crises in the community but experienced multiple care breakdowns in both community and health care settings. Nursing home admission was a strategy used to avoid a crisis when residents did not receive the needed support to remain in the community. Discussion and Implications To successfully remain in the community, older adults require specialized supports targeting mental health and substance use needs, as well as enhanced hospital discharge plans and improved information about community-based care options. Implications involve reforming policies and practices in both hospital and community-based care settings.

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.

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.

scholarly journals Comparison of the Microbiota of Older Adults Living in Nursing Homes and the Community

mSphere ◽  
2017 ◽  
Vol 2 (5) ◽  
Author(s):  
Mary-Claire Roghmann ◽  
Alison D. Lydecker ◽  
Lauren Hittle ◽  
Robert T. DeBoy ◽  
Rebecca G. Nowak ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Relative Abundance ◽  
Bacterial Communities ◽  
Nursing Home Residents ◽  
The Body ◽  
Health Care Environment ◽  
The Past

ABSTRACT The nose, throat, and skin over the subclavian and femoral veins are the body sites which harbor the bacteria which most commonly cause health care-associated infection. We assessed the effect of nursing home residence on the microbiota of these body sites in older adults. We found that the microbiota composition of the different body sites was similar between nursing home and community participants, but we identified differences in relative abundance levels. We found remarkable similarities in the bacterial communities of different body sites in older adults who lived in nursing homes compared to those in the community among people who had not been on antibiotics for the past 3 months. We also found that the femoral skin microbiota had evidence of stool contamination in the nursing home residents, providing a rationale for improved skin hygiene. Taken together, it appears that the health care environment does not alter the microbiota to the extent that antibiotics do. Our objective for this study was to characterize the microbial communities of the anterior nares (nose), posterior pharynx (throat), and skin of the femoral and subclavian areas in older adults from nursing homes and the community. Older adults (≥65 years) without antibiotic use for the past 3 months were recruited from nursing homes (NH; n = 16) and from the community (CB; n = 51). Specimens were taken from nose, throat, and skin sites for culture and bacterial profiling using 16S rRNA gene sequencing. We found that pathogenic Gram-negative rod (GNR) colonization on the femoral skin was higher in NH participants than CB participants; otherwise, there were no differences in GNR colonization at other body sites or in Staphylococcus aureus colonization at any body site. Bacterial community profiling demonstrated that the operational taxonomic unit compositions of the different body sites were similar between NH and CB participants, but the analysis identified differences in relative abundance levels. Streptococcus spp. were more abundant and Prevotella spp. were less abundant in the throats of NH participants than in throats of CB participants. Proteus, Escherichia coli, and Enterococcus were more abundant in NH participants on the femoral skin. We found a pattern of decreased abundance of specific Proteobacteria in NH participants at the anterior nares and at both skin sites. We concluded that bacterial communities were largely similar in diversity and composition within body sites between older adults without recent antibiotic use from NH compared to those from the community. Our findings support the rationale for improved hygiene in NH residents to reduce the transmission risk of antibiotic-resistant bacteria, such as Enterococcus spp. or Enterobacteriaceae. IMPORTANCE The nose, throat, and skin over the subclavian and femoral veins are the body sites which harbor the bacteria which most commonly cause health care-associated infection. We assessed the effect of nursing home residence on the microbiota of these body sites in older adults. We found that the microbiota composition of the different body sites was similar between nursing home and community participants, but we identified differences in relative abundance levels. We found remarkable similarities in the bacterial communities of different body sites in older adults who lived in nursing homes compared to those in the community among people who had not been on antibiotics for the past 3 months. We also found that the femoral skin microbiota had evidence of stool contamination in the nursing home residents, providing a rationale for improved skin hygiene. Taken together, it appears that the health care environment does not alter the microbiota to the extent that antibiotics do.

scholarly journals Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study (Preprint)

2020 ◽  
Author(s):  
Guillaume Sacco ◽  
Sébastien Lléonart ◽  
Romain Simon ◽  
Frédéric Noublanche ◽  
Cédric Annweiler ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Older People ◽  
Acute Care ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Term Care ◽  
Telephone Calls ◽  
Acute Care Unit

BACKGROUND Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. OBJECTIVE Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. METHODS The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. RESULTS A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (<i>P</i>=.03) and were more satisfied with their communication experiences (<i>P</i>=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (<i>P</i>=.1), with no effect of age (<i>P</i>=.97) or gender (<i>P</i>=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (<i>P</i>=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; <i>P</i>=.02). CONCLUSIONS Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. CLINICALTRIAL ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849.

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