Very poor prognosis after a conservatively treated hip fracture in the most frail nursing home residents

Purpose: In very frail nursing home residents transport to the hospital for diagnostics in case of a suspected hip fracture might be considered too burdensome or not desirable. We aimed to elucidate the prognosis and disease course for this group. Methods: We performed a retrospective cohort study between 2017 and 2020 in a nursing home in the Netherlands. All patients with a suspected hip fracture were eligible. The main exclusion criteria was transport to the hospital for diagnostics. Our primary outcome is survival after one month. Results: 23 patients fulfilled the inclusion criteria. Median age was 84 years. Almost all patients had severe dementia. After one month 20 patients (87%) had died. Median survival was 5 days (interquartile range 3-8). Conclusion: In the most frail nursing home residents with a suspected hip fracture the prognosis is very poor with a median survival of only 5 days.

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An Outreach Rehabilitation Program for Nursing Home Residents After Hip Fracture May Be Cost-Saving

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa074 ◽

2020 ◽

Vol 75 (10) ◽

pp. e159-e165

Author(s):

Lauren A Beaupre ◽

Doug Lier ◽

Jay S Magaziner ◽

C Allyson Jones ◽

D William C Johnston ◽

...

Keyword(s):

Nursing Home ◽

Hip Fracture ◽

Cost Saving ◽

Incremental Cost ◽

Usual Care ◽

Nursing Home Residents ◽

Rehabilitation Program ◽

Study Entry ◽

Rehabilitation Intervention ◽

The Cost

Abstract Background We compared the cost-effectiveness of 10 weeks of outreach rehabilitation (intervention) versus usual care (control) for ambulatory nursing home residents after hip fracture. Methods Enrollment occurred February 2011 through June 2015 in a Canadian metropolitan region. Seventy-seven participants were allocated in a 2:1 ratio to receive a 10-week rehabilitation program (intervention) or usual care (control) (46 intervention; 31 control). Using a payer perspective, we performed main and sensitivity analyses. Health outcome was measured by quality-adjusted life years (QALYs), using the EQ5D, completed at study entry, 3-, 6-, and 12-months. We obtained patient-specific data for outpatient visits, physician claims, and inpatient readmissions; the trial provided rehabilitation utilization/cost data. We estimated incremental cost and incremental effectiveness. Results Groups were similar at study entry; the mean age was 87.9 ± 6.6 years, 54 (71%) were female and 58 (75%) had severe cognitive impairment. EQ5D QALYs scores were nonsignificantly higher for intervention participants. Inpatient readmissions were two times higher among controls, with a cost difference of −$3,350/patient for intervention participants, offsetting the cost/intervention participant of $2,300 for the outreach rehabilitation. The adjusted incremental QALYs/patient difference was 0.024 favoring the intervention, with an incremental cost/patient of −$621 for intervention participants; these values were not statistically significant. A sensitivity analysis reinforced these findings, suggesting that the intervention was likely dominant. Conclusion A 10-week outreach rehabilitation intervention for nursing home residents who sustain a hip fracture may be cost-saving, through reduced postfracture hospital readmissions. These results support further work to evaluate postfracture rehabilitation for nursing home residents.

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

Innovation in Aging ◽

10.1093/geroni/igaa057.3362 ◽

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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Pain Treatments After Hip Fracture Among Older Nursing Home Residents

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2017.11.008 ◽

2018 ◽

Vol 19 (2) ◽

pp. 174-176 ◽

Cited By ~ 4

Author(s):

Andrew R. Zullo ◽

Tingting Zhang ◽

Francesca L. Beaudoin ◽

Yoojin Lee ◽

Kevin W. McConeghy ◽

...

Keyword(s):

Nursing Home ◽

Hip Fracture ◽

Nursing Home Residents

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Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2017.09.015 ◽

2018 ◽

Vol 19 (4) ◽

pp. 328-332.e2 ◽

Cited By ~ 5

Author(s):

David D. Dore ◽

Andrew R. Zullo ◽

Vincent Mor ◽

Yoojin Lee ◽

Sarah D. Berry

Keyword(s):

Nursing Home ◽

Hip Fracture ◽

Nursing Home Residents ◽

Dose Effects

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LIMITED VALIDITY OF MINIMUM DATA SET ITEMS ON SLEEP AND HYPNOTIC USE IN PREDICTING FALLS AND HIP FRACTURE IN NURSING HOME RESIDENTS

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2006.00777.x ◽

2006 ◽

Vol 54 (7) ◽

pp. 1150-1151 ◽

Cited By ~ 11

Author(s):

Jennifer L. Martin ◽

Cathy A. Alessi

Keyword(s):

Nursing Home ◽

Hip Fracture ◽

Nursing Home Residents ◽

Minimum Data Set ◽

Data Set ◽

Minimum Data

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A Tablet ‐ Based Intervention for Activating Nursing Home Residents with Dementia: Results from a Cluster-Randomised Controlled Trial

10.21203/rs.3.rs-66724/v1 ◽

2020 ◽

Author(s):

Julie Lorraine O'Sullivan ◽

Sonia Lech ◽

Paul Gellert ◽

Ulrike Grittner ◽

Jan-Niklas Voigt-Antons ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Nursing Homes ◽

Primary Outcome ◽

Controlled Trial ◽

Nursing Home Residents ◽

Cluster Randomised Controlled Trial ◽

Post Intervention ◽

Randomised Controlled

Abstract Background: Non-pharmacological interventions (NPI) can improve cognitive and non-cognitive symptoms in nursing home residents living with dementia. However, delivery of suitable NPI can be challenging in everyday nursing home settings. Internet and communication technologies (ICT) may be promising tools for supporting NPI delivery in nursing homes. Methods: A two-arm cluster-randomised controlled trial was conducted to investigate global and momentary effects of a novel ICT-based NPI for nursing home residents with dementia. Ten nursing homes were randomly allocated to the tablet-based intervention (TBI) or conventional activity sessions (CAS) group (each with five nursing homes) between April 2016 and May 2017. A total of N = 162 participants received either regular TBI (n = 80) or CAS (n = 82) over a period of eight weeks. Linear mixed models were used to analyse group differences regarding the primary outcome apathy (AES-I), and secondary outcomes quality of life (QOL-AD, QUALIDEM), neuropsychiatric (NPI-NH, psychotropic medication) and depressive symptoms (GDS). Ecological Momentary Assessments (EMA) of quality of life were also conducted in both groups before and after each activity session.Results: No significant group difference in the change of apathy (AES-I score, primary outcome) was found post intervention (mean group difference: B = .19; 95% CI: -3.90 to 4.28, p = .93). Regarding secondary outcomes, a reduction of psychotropic medication was found for TBI compared to CAS (B = .42; 95% CI: .15 to .69, p < .01). Further analyses revealed a post-intervention improvement of informant-rated quality of life across both groups (B = 3.69; 95% CI: .68 to 6.69, p = .02). Analysis of EMA also rendered short-term post-session improvements of quality of life in the CAS group (B = .43; 95% CI: .30 to .57, p < .001). Conclusions: These findings suggest that NPI involving individually tailored activities have a beneficial impact on quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, ICT have the potential to support NPI delivery and facilitate regular assessments of fluctuating momentary states in nursing home residents with dementia. Trial registration: The trial was retrospectively registered with the ISRCTN registry (Trial registration number: ISRCTN98947160) on 01/09/2016 http://www.isrctn.com/ISRCTN98947160.

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

Innovation in Aging ◽

10.1093/geroni/igz038.2605 ◽

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<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<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.

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