scholarly journals OUTCOMES OF DISCONTINUING CHOLINESTERASE INHIBITORS IN NURSING HOME RESIDENTS WITH SEVERE DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S731-S731
Author(s):  
Joshua D Niznik ◽  
Xinhua Zhao ◽  
Meiqi He ◽  
Sherrie Aspinall ◽  
Joseph Hanlon ◽  
...  
Keyword(s):  
Nursing Home ◽  
Cholinesterase Inhibitors ◽  
Nursing Home Residents ◽  
Depression Severity ◽  
Aggressive Behaviors ◽  
Severe Dementia ◽  
Data Set ◽  
Point Increase ◽  
Patient Health ◽  
The Impact

Abstract Some clinical guidelines advocate for the withdrawal of cholinesterase inhibitors (ChEIs) in patients with severe dementia. However, there have been no studies of the outcomes of deprescribing ChEIs specifically in patients with severe dementia, and concerns about subsequent worsening of behavioral symptoms may serve as a barrier to ChEI discontinuation. Our objective was to evaluate the impact of deprescribing ChEIs on aggressive behaviors and depression severity in older nursing home (NH) residents with severe dementia. We conducted a retrospective cohort study using Medicare claims, Part D prescriptions, Minimum Data Set (MDS) v3.0, Area Health Resource File, and Nursing Home Compare, for non-skilled NH residents aged 65+ with severe dementia receiving AChEIs with ≥2 MDS assessments in 2016 (n=30,788). The Aggressive Behavior Scale (ABS) and the Patient Health Questionnaire (PHQ-9) evaluated aggression and depression, respectively. Marginal structural models with inverse probability of treatment weights evaluated the association of deprescribing with outcomes, accounting for time-dependent confounding. The sample was primarily white (78.7%), female (76.6%), >80 years old (77.6%), and 22.8% were deprescribed ChEIs. In adjusted models, deprescribing was not associated with aggression (0.002 point increase in ABS, p=0.90) or depression (0.04 point increase in PHQ-9, p=0.50). Deprescribing ChEIs in NH residents with severe dementia did not lead to an increase in aggressive behaviors or depression severity. Our findings provide insight into the potential risks and benefits associated with deprescribing ChEIs and help inform decision-making in patients with severe dementia.

scholarly journals MEASURING EFFECT OF PERSONALIZED MUSIC TO REDUCE BEHAVIORS IN NURSING HOME RESIDENTS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S52-S52
Author(s):  
Ellen McCreedy ◽  
Xiaofei Yang ◽  
Rosa Baier ◽  
Kali S Thomas ◽  
James Rudolph ◽  
...  
Keyword(s):  
Nursing Home ◽  
Pragmatic Trial ◽  
Nursing Home Residents ◽  
Program Music ◽  
Aggressive Behaviors ◽  
Severe Dementia ◽  
Data Set ◽  
Music Program ◽  
Direct Observations ◽  
Before And After

Abstract The purpose of this six-month pilot study was to identify an optimal measurement strategy for assessing the effects of a personalized music program, MUSIC & MEMORY, on agitated and aggressive behaviors among 45 nursing home residents with moderate to severe dementia. Dementia-related behaviors were measured before and after the intervention with three methods 1) observationally using the Agitation Behavior Mapping Instrument (ABMI); 2) staff report using the Cohen-Mansfield Agitation Inventory (CMAI); and 3) administratively using Minimum Data Set - Aggressive Behavior Scale (MDS-ABS). ABMI score was 4.4 (standard deviation, SD: 2.3) while not listening to the music and 1.6 (SD: 1.5) while listening to music (p<.01). CMAI score was 61.24 (SD: 16.32) before the music and 51.24 (SD: 16.05) after the music (p<.01). MDS-ABS score was .8 (SD: 1.6) before music and .7 (SD: 1.4) after music (p=.59). Direct observations were most likely to capture behavioral responses, followed by staff interviews. No effect was found using exclusively available administrative data. There is growing interest in identifying and testing non-pharmaceutical alternatives to managing agitated and aggressive behaviors in nursing home residents with dementia. Measurement occurring closest in time to the intervention was most likely to capture responses, but was also most costly, least pragmatic, and most subject to confirmation bias. These findings will inform a large pragmatic trial, beginning Spring 2019.

scholarly journals The Effects of Evacuation on Nursing Home Residents With Dementia

2012 ◽  
Vol 27 (6) ◽  
pp. 406-412 ◽  
Author(s):  
Lisa M. Brown ◽  
David M. Dosa ◽  
Kali Thomas ◽  
Kathryn Hyer ◽  
Zhanlian Feng ◽  
...  
Keyword(s):  
At Risk ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Steady Increase ◽  
Cognitively Impaired ◽  
Severe Dementia ◽  
Data Set ◽  
Percent Increase ◽  
Resident Assessment

Background: In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired. Methods: Nursing homes in counties located in the path of Hurricane Gustav were identified. The Minimum Data Set resident assessment files were merged with the Centers for Medicare enrollment file to determine date of death for residents in identified facilities. Difference-in-differences analyses were conducted adjusting for residents' demographic characteristics and acuity. Results: The dataset included 21,255 residents living in 119 at risk nursing homes over three years of observation. Relative to the two years before the storm, there was a 2.8 percent increase in death at 30 days and a 3.9 percent increase in death at 90 days for residents with severe dementia who evacuated for Hurricane Gustav, controlling for resident demographics and acuity. Conclusions: The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility.

scholarly journals Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident’s Place of Death

2019 ◽  
Author(s):  
Aluem Tark ◽  
Mansi Agarwal ◽  
Andrew Dick ◽  
Jiyoun Song ◽  
Patricia Stone
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Treatment Program ◽  
Nursing Home Residents ◽  
Vital Statistics ◽  
Short Stay ◽  
Data Set ◽  
Significant Difference ◽  
Life Sustaining Treatment ◽  
The Impact

Abstract Background: The Physician Orders for Life-Sustaining Treatment program was developed to enhance quality of care delivered at end-of-life. Although positive impacts of the Physician Orders for Life-Sustaining Treatment Program use have been identified, the association between a state’s program maturity status and nursing home resident’s likelihood of dying in their current care settings, nursing homes, remain unanswered. Objective: Examine the impact of the Physician Orders for Life-Sustaining Program maturity status on nursing home residents’ odds of dying in nursing homes.Methods: Program maturity status data were linked with multiple datasets: Minimum Data Set, Vital Statistics Data, Master Beneficiary Summary File, Certification and Survey Provider Enhanced Reports, and Area Health Resource File. Stratifying residents on long-stay and short-stay, we used descriptive statistics and multivariable logistic regression models for total 595,152 individuals.Results: Controlling for individual and contextual variables, long-stay nursing home residents living in states where the program was mature status had 20% increased odds of dying in nursing homes (OR: 1.20; CI 1.02-1.43) compared to those who resided in states with non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes (OR: 1.12; CI 1.02-1.24) compared to non-conforming status. No significant difference was noted for short-stay nursing home residents.Conclusion: Mature and developing maturity status were associated with greater likelihood of dying in nursing homes among long-stay residents. Our findings inform that a well-structured advance care planning program such as Physician Orders for Life-Sustaining Program enhances care outcomes among older adults living in nursing homes.

scholarly journals Impact of the Sonas Programme on Communication over a Period of 24 Weeks in People with Moderate-to-Severe Dementia

2018 ◽  
Vol 8 (2) ◽  
pp. 238-247
Author(s):  
Benedicte Sørensen Strøm ◽  
Jūratė Šaltytė Benth ◽  
Knut Engedal
Keyword(s):  
Nursing Home ◽  
Cognitive Abilities ◽  
Linear Trend ◽  
Nursing Home Residents ◽  
Descriptive Study ◽  
Verbal Communication ◽  
Communication Tool ◽  
Severe Dementia ◽  
The Impact ◽  
Over Time

Objectives: The primary aim was to examine how communication abilities changed over time among nursing home residents with moderate-to-severe dementia who were attending the Sonas programme and to explore whether changes in communication abilities were related to cognitive ability. Method: A longitudinal secondary descriptive study method was employed, where 56 people with moderate-to-severe dementia attended a 45-min Sonas group session twice a week for 24 weeks. The Threadgold Communication Tool (TCT) was completed every 4 weeks. Results: The impact of the Sonas programme on communication showed a significant non-linear trend in the TCT, with an increase in communication abilities during the first 16 weeks, regardless of the level of the residents’ cognitive abilities. Thereafter it levelled out. No interaction was found between time and the frequency of attendances at Sonas sessions. Both verbal and non-verbal communication increased from the baseline, with non-verbal communication increasing quickly and verbal communication increasing marginally. Conclusion: Communication abilities increased with the time of the intervention, but the peak was achieved after 16 weeks, after which the effect levelled out. This suggest that the Sonas programme should be used for a period of at least 16 weeks before evaluating its effect.

Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD) in adults: Design and pilot study in nursing home residents

2018 ◽  
Vol 27 (4) ◽  
pp. 191-198
Author(s):  
Karen Van den Bussche ◽  
Sofie Verhaeghe ◽  
Ann Van Hecke ◽  
Dimitri Beeckman
Keyword(s):  
Nursing Home ◽  
Pilot Study ◽  
Nursing Home Residents ◽  
Minimum Data Set ◽  
Data Set ◽  
Minimum Data

scholarly journals Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER)

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042941
Author(s):  
Vanja Milosevic ◽  
Aimee Linkens ◽  
Bjorn Winkens ◽  
Kim P G M Hurkens ◽  
Dennis Wong ◽  
...  
Keyword(s):  
Nursing Home ◽  
Fall Risk ◽  
Nursing Home Residents ◽  
High Sensitivity ◽  
Secondary Outcome ◽  
Operating Characteristics ◽  
Retrospective Case ◽  
Data Set ◽  
Fall Incident ◽  
Clinical Rule

ObjectivesTo develop (part I) and validate (part II) an electronic fall risk clinical rule (CR) to identify nursing home residents (NH-residents) at risk for a fall incident.DesignObservational, retrospective case–control study.SettingNursing homes.ParticipantsA total of 1668 (824 in part I, 844 in part II) NH-residents from the Netherlands were included. Data of participants from part I were excluded in part II.Primary and secondary outcome measuresDevelopment and validation of a fall risk CR in NH-residents. Logistic regression analysis was conducted to identify the fall risk-variables in part I. With these, three CRs were developed (ie, at the day of the fall incident and 3 days and 5 days prior to the fall incident). The overall prediction quality of the CRs were assessed using the area under the receiver operating characteristics (AUROC), and a cut-off value was determined for the predicted risk ensuring a sensitivity ≥0.85. Finally, one CR was chosen and validated in part II using a new retrospective data set.ResultsEleven fall risk-variables were identified in part I. The AUROCs of the three CRs form part I were similar: the AUROC for models I, II and III were 0.714 (95% CI: 0.679 to 0.748), 0.715 (95% CI: 0.680 to 0.750) and 0.709 (95% CI: 0.674 to 0.744), respectively. Model III (ie, 5 days prior to the fall incident) was chosen for validation in part II. The validated AUROC of the CR, obtained in part II, was 0.603 (95% CI: 0.565 to 0.641) with a sensitivity of 83.41% (95% CI: 79.44% to 86.76%) and a specificity of 27.25% (95% CI 23.11% to 31.81%).ConclusionMedication data and resident characteristics alone are not sufficient enough to develop a successful CR with a high sensitivity and specificity to predict fall risk in NH-residents.Trial registration numberNot available.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

scholarly journals Sequential Dependencies in Solid and Fluid Intake in Nursing Home Residents with Dementia: A Multistate Model

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 915-915
Author(s):  
Wen Liu ◽  
Kristine Williams ◽  
Yong Chen
Keyword(s):  
Nursing Home ◽  
Fluid Intake ◽  
Nursing Home Residents ◽  
Temporal Association ◽  
Negative Consequences ◽  
Severe Dementia ◽  
Assistance Programs ◽  
Sequential Dependencies ◽  
Dementia Severity ◽  
Multinomial Logit Models

Abstract Nursing home (NH) residents with dementia commonly experience low food intake leading to negative consequences. While multilevel factors influence intake, evidence is lacking on how intake is sequentially associated. This study examined the temporal association between previous and current solid and fluid intake in NH residents with dementia. We analyzed 160 mealtime videos involving 27 residents and 36 staff (53 dyads) in 9 NHs. The dependent variable was the current intake state (fluid, solid, no-intake). Independent variables included the prior intake state, technique of current intake state (resident-initiated, staff-facilitated), duration between previous and current intakes. Covariates included resident and staff characteristics. Two-way interactions of duration and technique with the prior intake state, and resident comorbidity and dementia severity were examined using Multinomial Logit Models. Interactions were significant for technique by comorbidity, technique by dementia severity, technique by prior fluid and solid intake, and duration by prior fluid intake. Successful previous intake increased odds of current solid and fluid intake. Staff-facilitation (vs. resident-initiation) reduced odds of solid and fluid intake for residents with moderately severe (vs. severe) dementia. Higher morbidity decreased odds of solid intake (vs. no-intake) for staff-facilitated intake. Resident with severe dementia had smaller odds of solid and fluid intake for resident-initiated intake. Longer duration increased odds of transition from liquid to solid intake. Findings supported strong sequential dependencies in intake, indicating the promise of intervening behaviorally to modify transitions to successful intake during mealtime. Findings inform the development and implementation of innovative mealtime assistance programs to promote intake.

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