A Model of Risk Reduction for Older Adults Vulnerable to Nursing Home Placement

2014 ◽  
Vol 28 (2) ◽  
pp. 162-192 ◽  
Author(s):  
Janice L. Palmer ◽  
Joanne C. Langan ◽  
Jean Krampe ◽  
Mary Krieger ◽  
Rebecca A. Lorenz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Nursing Home ◽  
Health Care Providers ◽  
Functional Disability ◽  
Nursing Home Placement ◽  
Nursing Home Care ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
Home Placement

Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.

The Risk of Nursing Home Placement and Subsequent Death Among Older Adults

1992 ◽  
Vol 47 (4) ◽  
pp. S173-S182 ◽  
Author(s):  
F. D. Wolinsky ◽  
C. M. Callahan ◽  
J. F. Fitzgerald ◽  
R. J. Johnson
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Home Placement ◽  
Home Placement

Risk factors for nursing home placement following major nonemergent surgery

2004 ◽  
Vol 13 (10) ◽  
pp. 12
Author(s):  
V.J. Legner ◽  
D. Doerner ◽  
D.F. Reilly ◽  
W.C. McCormick
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Nursing Home Placement ◽  
Home Placement

scholarly journals Early- versus Late-Onset Alzheimer Disease: Long-Term Functional Outcomes, Nursing Home Placement, and Risk Factors for Rate of Progression

2017 ◽  
Vol 7 (1) ◽  
pp. 172-187 ◽  
Author(s):  
Carina Wattmo ◽  
Åsa K. Wallin
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Nursing Homes ◽  
Alzheimer Disease ◽  
Late Onset ◽  
Age At Onset ◽  
Clinical Importance ◽  
Nursing Home Placement ◽  
Antidepressant Use ◽  
Home Placement

Background/Aims: Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL) and nursing home placement (NHP) in cholinesterase inhibitor (ChEI)-treated patients with early-onset AD (EOAD) versus late-onset AD (LOAD). Methods: This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset <65 years) and 874 LOAD (onset ≥65 years). Possible sociodemographic and clinical factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Results: Younger individuals exhibited longer illness duration before AD diagnosis, whereas 6-month functional response to ChEI therapy, 3-year changes in ADL capacities, time from diagnosis to NHP, and survival time in nursing homes were similar between the groups. In LOAD, a higher ChEI dose, no antidepressant use, and lower education level were protective factors for slower instrumental ADL (IADL) decline. In EOAD, antihypertensives/cardiac therapy implied faster IADL progression but lower risk of NHP. Conclusion: This study highlights the clinical importance of an earlier diagnosis and treatment initiation and the need for functional evaluations in EOAD. Despite the age differences between EOAD and LOAD, a similar need for nursing homes was observed.

scholarly journals Effect of Patients’ Life Stories in Bringing Meaning to Nursing Home Care

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Jane Qu ◽  
Laura N. Goldman ◽  
Joanne E. Wilkinson
Keyword(s):  
Nursing Home ◽  
Family Medicine ◽  
Home Care ◽  
Health Care Providers ◽  
Life Stories ◽  
Nursing Home Care ◽  
Semistructured Interview ◽  
Care Providers ◽  
Nursing Home Patients ◽  
Family Medicine Residents

Introduction: Although there is an increasing need for geriatricians, fewer physicians are entering the field. Family medicine residents find geriatrics, especially nursing home care, unsatisfying. Life stories of older adult patients may help providers cope with the challenges of nursing home care and increase provider satisfaction by offering a way to connect with patients. Methods: We conducted a qualitative study on life stories’ effects on attitudes towards nursing home care. Fourteen patient stories were created. Seven Boston University family medicine residents and one nurse practitioner participated in a semistructured interview both before and at least 2 months after learning about their patients’ stories. Data were analyzed using qualitative techniques from grounded theory. Results: Participants found nursing home care challenging, particularly for patients who were nonverbal due to advanced dementia, because they had difficulties forming meaningful relationships or discussing medical decisions with their patients. Life stories increased empathy, deepened relationships with patients, and led participants to feel more satisfied in their role as providers. The stories were considered useful for end-of-life discussions. Conclusion: Life stories incorporated into physician practice may help health care providers feel more connected to their patients and ultimately more satisfied in the care of nursing home patients.

Encounters With Health-Care Providers and Advance Directive Completion by Older Adults

2018 ◽  
Vol 33 (3) ◽  
pp. 178-181 ◽  
Author(s):  
Catheryn Koss
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Home ◽  
Advance Directives ◽  
Health Care Providers ◽  
Advance Directive ◽  
Hospice Care ◽  
Outpatient Surgery ◽  
Home Health ◽  
Care Providers

Background: The Patient Self-Determination Act (PSDA) requires hospitals, home health agencies, nursing homes, and hospice providers to offer new patients information about advance directives. There is little evidence regarding whether encounters with these health-care providers prompt advance directive completion by patients. Objective: To examine whether encounters with various types of health-care providers were associated with higher odds of completing advance directives by older patients. Method: Logistic regression using longitudinal data from the 2012 and 2014 waves of the Health and Retirement Study. Participants were 3752 US adults aged 65 and older who reported not possessing advance directives in 2012. Advance directive was defined as a living will and/or durable power of attorney for health care. Four binary variables measured whether participants had spent at least 1 night in a hospital, underwent outpatient surgery, received home health or hospice care, or spent at least one night in a nursing home between 2012 and 2014. Results: Older adults who received hospital, nursing home, or home health/hospice care were more likely to complete advance directives. Outpatient surgery was not associated with advance directive completion. Conclusions: Older adults with no advance directive in 2012 who encountered health-care providers covered by the PSDA were more likely to have advance directives by 2014. The exception was outpatient surgery which is frequently provided in freestanding surgery centers not subject to PSDA mandates. It may be time to consider amending the PSDA to cover freestanding surgery centers.

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