scholarly journals Low Cognitive Performance Increases The Risk Of Hospital-Associated Complications In Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 981-981
Author(s):  
Juliana Souza-Talarico ◽  
Siomara Yamaguti ◽  
Adriana Dutra ◽  
Daniel Apolinario
Keyword(s):  
Cognitive Performance ◽  
Functional Performance ◽  
Point Of Care ◽  
Functional Decline ◽  
Screening Tools ◽  
Word Recall ◽  
Temporal Orientation ◽  
Physical Restraints ◽  
Term Care

Abstract Considering the limited evidence regarding the factors that contribute to long-term consequences after hospitalization of older people, we analysed the relationship between cognitive performance and hospital-associated complications (HAC). One thousand, three hundred Individuals aged 60 and older (mean age 82.3, 53.3% female), not assigned to palliative care and admitted in medical and surgical wards from a private hospital, were followed up from admission to 30 days after discharge. HAS was evaluated using a multicomponent measure that combines 12 hospital-associated complications (delirium, functional decline, falls, pressure injuries, bronchoaspiration, non-planned ICU transfer, physical restraints, hospital stay > 30 days, death, long-term care transfer, and readmission). Cognitive performance was assessed using the "10-point cognitive screener (10-CS)", which combines temporal orientation, category fluency, and word recall evaluation. Results Overall, 464 (35.7%) participants had one or more HAC during their admission. Patients with HAC showed lower 10-CS scores than those with in HAC (p <0.001). Adjusting for sociodemographic data, medication, chronic diseases, delirium screening, functional performance, each 10-CS point decreased the HAC changes by 19.2% (odds ratio = 0.808; 95% CI = 0.660 – 0.990). Conclusion These findings show that low cognitive performance was significantly associated with the risk of developing HAC during hospitalization and within 30 days after discharge. That evidence forms the critical foundation for the next steps towards validating the accuracy of these models in predicting vulnerability to HAC and developing screening tools to be used at the point of care.

scholarly journals Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chan Mi Park ◽  
Wonsock Kim ◽  
Hye Chang Rhim ◽  
Eun Sik Lee ◽  
Jong Hun Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Outcome ◽  
Long Term Care ◽  
Functional Decline ◽  
Tube Feeding ◽  
Term Care ◽  
Pneumonia Severity ◽  
Frailty Assessment ◽  
Nasogastric Tube Feeding

Abstract Background Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty. Methods A prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0–1; robust < 0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0–5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution. Results The population had a median age 79 (interquartile range, 75–84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0–2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3–5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar. Conclusions Older adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.

scholarly journals The Impact of Function Focused Care From Acute Care to Home Care and Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 629-629
Author(s):  
Silke Metzelthin ◽  
Sandra Zwakhalen ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
The Netherlands ◽  
Home Care ◽  
Acute Care ◽  
Long Term Care ◽  
Functional Decline ◽  
Term Care ◽  
The Us ◽  
The Impact

Abstract Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

scholarly journals Financing Long-term Care: Lessons From Japan

2019 ◽  
Vol 8 (8) ◽  
pp. 462-466 ◽  
Author(s):  
Naoki Ikegami
Keyword(s):  
Social Services ◽  
Social Insurance ◽  
Ad Hoc ◽  
Long Term Care ◽  
Early Stage ◽  
Functional Decline ◽  
Eligibility Criteria ◽  
Term Care ◽  
Service Levels

Long-term care (LTC) must be carefully delineated when expenditures are compared across countries because how LTC services are defined and delivered differ in each country. LTC’s objectives are to compensate for functional decline and mitigate the care burden of the family. Governments have tended to focus on the poor but Germany opted to make LTC universally available in 1995/1996. The applicant’s level of dependence is assessed by the medical team of the social insurance plan. Japan basically followed this model but, unlike Germany where those eligible may opt for cash benefits, they are limited to services. Benefits are set more generously in Japan because, prior to its implementation in 2000, health insurance had covered long-stays in hospitals and there had been major expansions of social services. These service levels had to be maintained and be made universally available for all those meeting the eligibility criteria. As a result, efforts to contain costs after the implementation of the LTC Insurance have had only marginal effects. This indicates it would be more efficient and equitable to introduce public LTC Insurance at an early stage before benefits have expanded as a result of ad hoc policy decisions.

Falls

2017 ◽  
pp. 373-382
Author(s):  
Clemens Becker ◽  
Jean Woo ◽  
Chris Todd
Keyword(s):  
Older People ◽  
Best Practice ◽  
Long Term Care ◽  
Acute Hospital ◽  
Screening Tools ◽  
Term Care ◽  
Risk Factors For Falls ◽  
Use Of Health Services

Falls are very common among older people, with 30–40% of people aged 65 or over falling each year. Incidence increases with age, is particularly high in residential care settings, and has a considerable burden in terms of morbidity, mortality, use of health services, and reductions in quality of life. In the first section of this chapter we define falls, then review the epidemiology of falls in the community, and acute hospital, residential, and long-term care. We review and identify the major risk factors for falls and the assessment and screening tools used to detect risk and resources of best practice recommendations for clinical practice. In the second section, we provide overviews of best practice in prevention and clinical management, first for older people living independently in the community, then for acute hospital care, and thirdly for residential and long-term care.

Is an unhealthy work environment in nursing home care for people with dementia associated with the prescription of psychotropic drugs and physical restraints?

2016 ◽  
Vol 28 (6) ◽  
pp. 983-994 ◽  
Author(s):  
Bernadette M. Willemse ◽  
Jan de Jonge ◽  
Dieneke Smit ◽  
Wouter Dasselaar ◽  
Marja F. I. A. Depla ◽  
...  
Keyword(s):  
Work Environment ◽  
Psychotropic Drugs ◽  
Long Term Care ◽  
Longitudinal Research ◽  
Nursing Home Care ◽  
Physical Restraints ◽  
Term Care ◽  
People With Dementia ◽  
Care Facilities

ABSTRACTBackground:Research showed that long-term care facilities differ widely in the use of psychotropic drugs and physical restraints. The aim of this study is to investigate whether characteristics of an unhealthy work environment in facilities for people with dementia are associated with more prescription of psychotropic drugs and physical restraints.Methods:Data were derived from the first wave (2008–2009) of a national monitoring study in the Netherlands. This paper used data on prescription of psychotropic drugs and physical restraints from 111 long-term care facilities, residing 4,796 residents. Survey data of a sample of 996 staff and 1,138 residents were considered. The number of residents with prescribed benzodiazepines and anti-psychotic drugs, and physical restraints were registered. Work environment was assessed using the Leiden Quality of Work Questionnaire (LQWQ).Results:Logistic regression analyses showed that more supervisor support was associated with less prescription of benzodiazepines. Coworker support was found to be related to less prescription of deep chairs. Job demands and decision authority were not found to be predictors of psychotropic drugs and physical restraints.Conclusions:Staff's job characteristics were scarcely related to the prescription of psychotropic drugs and physical restraints. This finding indicates that in facilities with an unhealthy work environment for nursing staff, one is not more likely to prescribe drugs or restraints. Further longitudinal research is needed with special attention for multidisciplinary decision making – especially role of physician, staff's knowledge, philosophy of care and institutional policy to gain further insight into factors influencing the use of psychotropic drugs and restraints.

scholarly journals SCREENING FOR VISION AND HEARING LOSS IN OLDER ADULTS WITH DEMENTIA: A FEASIBILITY STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S120-S121
Author(s):  
Katherine McGilton ◽  
Fiona Höbler ◽  
Marilyn Reed ◽  
Tammy Labreche ◽  
M Kathleen Pichora-Fuller ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Vision Loss ◽  
Hearing Screening ◽  
Screening Tools ◽  
Sensory Loss ◽  
Term Care ◽  
Multi Stage ◽  
Dual Sensory Loss

Abstract Sensory loss accounts for one of the most common chronic conditions among older adults, with hearing loss affecting half of adults aged over 65 years and vision loss almost one fifth of those aged 70 years and over. Together, dual sensory loss is found to be most prevalent in older adults with dementia. The highest prevalence is found in long-term care (LTC) settings. For this reason, we conducted a multi-stage study to identify the most effective vision and hearing screening tools for use with older adults living with dementia and to evaluate their feasibility of use by nurses working in LTC. We first conducted a comprehensive review of the literature, and supplemented this with an environmental scan of healthcare professionals and sensory specialists working with older adults who have dementia. Following this extensive review and consultative decision-making process, a package of vision and hearing screening tools was selected for use by nurses working in LTC. On-site training was provided by two experienced audiologists and optometrists, after which the feasibility of sensory screening by three nurses of 17 residents under their care was evaluated. We report on the six measures of hearing and seven measures of vision that were piloted for screening of older adults with dementia living in LTC, and on the findings for their feasibility of use by nurses working in this setting. Recommendations regarding the feasibility and reliability of screening for vision and hearing loss in older adults with dementia are discussed.

054 Decrease in physical restraints for aged fall prone patients in a long term care setting

2010 ◽  
Vol 19 (Suppl 1) ◽  
pp. A115-A116
Author(s):  
M. Micheline ◽  
M. Olivier ◽  
B.-L. Aude
Keyword(s):  
Care Setting ◽  
Long Term Care ◽  
Physical Restraints ◽  
Term Care

scholarly journals Pilot of a Tailored Dance Intervention to Support Function in People With Cognitive Impairment Residing in Long-Term Care: A Brief Report

2017 ◽  
Vol 3 ◽  
pp. 233372141773467 ◽  
Author(s):  
Hannah M. O’Rourke ◽  
Souraya Sidani ◽  
Charlene H. Chu ◽  
Mary Fox ◽  
Katherine S. McGilton ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Repeated Measures ◽  
Long Term Care ◽  
Functional Decline ◽  
Canadian English ◽  
Term Care ◽  
Repeated Measures Design ◽  
English Speaking ◽  
Dance Intervention

Older adults who live in long-term care settings are at risk for functional decline, which may be mitigated by regular exercise. Using a single-group repeated measures design, this pilot study explored the feasibility, acceptability, and preliminary effects of a Waltz-based dance intervention delivered to 13 Canadian, English-speaking, long-term care residents with mild to moderate cognitive impairment. The findings supported intervention feasibility, based on a high completion rate (93%), level of attendance ( M = 7.15 of 10 sessions) and level of engagement during dance sessions ( M = 1.75 to 1.97 out of 2.00). On average, residents perceived dance sessions positively, and staff and family participants ( N = 26) rated them as somewhat acceptable overall ( M = 2.37, 0 to 4 scale). Additional research is needed to assess intervention efficacy in a larger sample.

scholarly journals Adaptations for TAP in a Long-Term Care Setting

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 631-631
Author(s):  
Katherine Marx ◽  
Lauren Parker ◽  
Laura Gitlin
Keyword(s):  
Behavioral Interventions ◽  
Long Term Care ◽  
Clinical Symptoms ◽  
Functional Decline ◽  
Care Facility ◽  
Direct Care ◽  
Care Staff ◽  
Term Care ◽  
Long Term Care Facility

Abstract One of the most difficult aspects of caring for people living with dementia is managing neuropsychologic symptoms and functional decline. Although there are hundreds of efficacious non-pharmacologic interventions tested in homes, few are adapted for and tested in long-term care. The purpose of this pilot study was to identify the adaptations needed for the Tailored Activity Program (TAP) to make it feasible and acceptable in a long-term care facility. TAP provides tailored activities matched to interests and abilities to address dementia-related clinical symptoms. Two sites, under the umbrella of one company, participated. A total of five persons living with dementia, their family caregivers, two direct care staff and an interventionist participated, and occupational therapist who contracts with the site on a regular basis. Adaptations included shorter sessions and changes to forms to fit with workflows and documentation. Additional considerations challenging implementation of TAP included staff turn-over and training. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.

Sign in / Sign up

Export Citation Format

Share Document