scholarly journals Characteristics, Hospital Referrals and 60-Day Mortality of Older Patients Living In Nursing Homes With Covid-19 Assessed by a Liaison Geriatric Team During The First Wave: A Research Article.

2021 ◽  
Author(s):  
Lorena García-Cabrera ◽  
Noelia Pérez-Abascal ◽  
Beatriz Montero-Errasquín ◽  
Lourdes Rexach Cano ◽  
Jesús Mateos-Nozal ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Nursing Home ◽  
Nursing Homes ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Hospital System ◽  
Factors Associated ◽  
Hospital Referral ◽  
Geriatric Hospital ◽  
Geriatric Team

Abstract Background: The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19.Methods: A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. Results: 419 patients were included in the study (median age 89 years old, 71.6% women, 63.7% with moderate-severe dependence, and 43.8% with advanced dementia). 31.1% were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home.Conclusions and implications: 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.

scholarly journals Characteristics, hospital referrals and 60-day mortality of older patients living in nursing homes with COVID-19 assessed by a liaison geriatric team during the first wave: a research article

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lorena García-Cabrera ◽  
Noelia Pérez-Abascal ◽  
Beatriz Montero-Errasquín ◽  
Lourdes Rexach Cano ◽  
Jesús Mateos-Nozal ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Nursing Home ◽  
Nursing Homes ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Hospital System ◽  
Factors Associated ◽  
Hospital Referral ◽  
Geriatric Hospital ◽  
Geriatric Team

Abstract Background The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19. Methods A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. Results 419 patients were included in the study (median age 89 years old, 71.6 % women, 63.7 % with moderate-severe dependence, and 43.8 % with advanced dementia). 31.1 % were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home. Conclusions and implications 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.

scholarly journals Care Deficiencies and Super-Organization of American Nursing Homes in Hospital Referral Region

2021 ◽  
Vol 8 ◽  
Author(s):  
Tyler Pittman
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Ownership ◽  
Open Data ◽  
Nursing Home Residents ◽  
The United States ◽  
Care Quality ◽  
Hospital Referral Region ◽  
Hospital Referral ◽  
Open Datasets

Super-organization has been associated with worse care quality in nursing homes. Previous research on the chain ownership of American nursing homes excluded government facilities in public-private partnerships, and focused on corporate entities. This longitudinal study proposes a novel method of demarcating the latent ownership networks of for-profit, government and non-profit nursing homes in the United States through use of open data and social network analysis. Facility characteristics and care quality measures were analyzed from an ecological cohort of 9,001 American nursing homes that had a registered organization for owner, and were reimbursed through Medicare or Medicaid. Information was obtained from the Nursing Home Compare open datasets at five semi-annual processing dates from March 2016 to March 2018. Ownership networks of American nursing homes were constructed using the exact legal name of registered organizations. As hospital discharge is a routine admission source of nursing home residents, hospital referral region was actualized to demarcate focal area. Utilizing Bayesian hierarchical models, the association between nursing home super-organization in hospital referral region (inferred by degree-based centrality and Herfindahl-Hirschman Index) to scope of cited care deficiencies (denoted by Total Weighted Health Survey Score) was explored. The percentage of nursing homes having super-organization increased from 56.8 to 56.9% over the 2-year period. During this interval, the mean size of nursing home ownership group in hospital referral region increased from 3.11 to 3.23 facilities. Overall, super-organization in hospital referral region was not associated with care deficiencies in American nursing homes. However, being part of an ownership group with more facilities was beneficial for care quality among nursing homes with super-organization.

scholarly journals Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
F. Javier Afonso-Argilés ◽  
◽  
Gabriele Meyer ◽  
Astrid Stephan ◽  
Mercè Comas ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Hospital Admission ◽  
Caregiver Burden ◽  
Care Setting ◽  
Hospital Admissions ◽  
Factors Associated ◽  
People With Dementia

Abstract Background Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it. Methods The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019. Results The study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care. Conclusion Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.

scholarly journals Factors associated with do-not-resuscitate document completion among patients hospitalized in geriatric ward

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chien-Yi Wu ◽  
Chun-Hao Jen ◽  
Yun-Shiuan Chuang ◽  
Tzu-Jung Fang ◽  
Yu-Hsuan Wu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Older Patients ◽  
Clinical Information ◽  
Tertiary Hospital ◽  
Albumin Level ◽  
Do Not Resuscitate ◽  
Geriatric Ward ◽  
Chi Square ◽  
Nutrition Screening ◽  
Factors Associated

Abstract Background With a rapidly aging population, there is an increasing need for do-not-resuscitate (DNR) and advance care planning (ACP) discussions. This study investigated the factors associated with signing DNR documents of older patients in the geriatric ward. Methods We conducted a retrospective cohort study at a geriatric ward in a tertiary hospital in Southern Taiwan. Three hundred and thirty-seven hospitalized older patients aged ≥65 years in the geriatric ward from 2018 to 2019. The Hospital Information System and electronic medical records were accessed to obtain details regarding patients’ demographics, daily living activities, serum albumin level, nutrition screening score, intensive care unit transferal, resuscitation procedure, days of hospital stay, and survival status on discharge, and DNR status was recorded retrospectively. Patients were classified into DNR and non-DNR groups, with t-tests and Chi-square tests applied to compare the differences between groups. Logistic regression was performed to predict factors related to the DNR documents. Results A total of 337 patients were included, 66 of whom had signed a DNR during hospitalization. After multivariate logistic regression, age 85 or more compared to age 65–74 (adjusted odds ratio, aOR 5.94), poor nutrition with screening score two or more (aOR 2.71), albumin level less than 3 (aOR 3.24), Charlson Comorbidity Index higher than 2 (aOR 2.46) and once transferred to ICU (aOR 5.11) were independently associated with DNR documentation during hospitalization. Conclusions Several factors related to DNR documents for geriatric patients were identified which could provide clinical information for physicians, patients, and their families to discuss DNR and ACP.

scholarly journals Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs

2020 ◽  
Author(s):  
F. Javier Afonso-Argilés ◽  
Gabriele Meyer ◽  
Astrid Stephan ◽  
Mercè Comas ◽  
Ansgar Wübker ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Hospital Admission ◽  
Caregiver Burden ◽  
Care Setting ◽  
Hospital Admissions ◽  
Factors Associated ◽  
People With Dementia

Abstract Background: Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it.Methods: The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last three months, as well as from their caregivers. Data on hospital admissions at three months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019.Results: The study sample comprised 1,700 people with dementia living in the community and nursing homes. Within three months, 13.8% and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care.Conclusion: Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.

Factors associated with quality of life in dementia patients in long-term care

2012 ◽  
Vol 25 (4) ◽  
pp. 577-585 ◽  
Author(s):  
María Crespo ◽  
Carlos Hornillos ◽  
Mónica Bernaldo de Quirós
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Functional Capacity ◽  
Daily Living ◽  
Close Relative ◽  
Term Care ◽  
Factors Associated ◽  
Staff Members

ABSTRACTBackground: The aim of this study is to describe and determine the factors associated with the quality of life (QoL) of patients with dementia living in nursing homes as perceived by themselves and by proxies (both family and staff).Method: Data on residents with dementia were collected in 11 nursing homes. The Quality of Life-Alzheimer's Disease Scale (QoL-AD) residential version was directly applied to residents with dementia diagnosis and Mini-Mental State Examination score of less than 27, randomly selected in each center. Residents’ QoL was further assessed from the perspective of some close relative and staff member. Altogether, 102 data sets from residents, 184 from relatives, and 197 from staff members were collected.Results: Stepwise multiple linear regression analysis showed that depression and cognitive function were the best predictors of self-rated QoL. Predictors of family-rated QoL were resident's functional capacity to carry out activities of daily living (ADL), the family member paying for the nursing home fees, and use of feeding tubes as part of the resident's care. Predictors of staff-rated QoL were resident's functional capacity to carry out ADL, cognitive impairment and depression, staff-member's work pattern of shifts (rotating vs. permanent) and type of center administration (public vs. private). Explained variance for the three models was 42%, 25% and 41% respectively.Conclusions: The QoL perception by persons with dementia living in a nursing home is mainly affected by their emotional state (depression level), while proxies’ perceptions (both family and staff) are mainly associated with patients’ functional autonomy in daily living. Therefore, perspectives of persons with dementia and their informants are not congruent. Moreover, facility features and family and staff members’ personal features do not affect QoL ratings.

scholarly journals Care deficiencies and super-organization of American nursing homes in hospital referral region: an ecological cohort study

2020 ◽  
Author(s):  
Tyler Pittman
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Ownership ◽  
Nursing Home Residents ◽  
Care Quality ◽  
Bayesian Hierarchical ◽  
Non Profit ◽  
Hospital Referral Region ◽  
Hospital Referral ◽  
Open Datasets

Abstract Background Super-organization has been associated with worse care quality in nursing homes. Previous research on the chain ownership of American nursing homes excluded government facilities in public-private partnerships, and focused on corporate entities. This longitudinal study proposes a novel method of demarcating the latent ownership networks of for-profit, government and non-profit nursing homes in hospital referral region. Methods Facility characteristics and care quality measures were analyzed from an ecological cohort of 9,001 American nursing homes that had a registered organization for owner and were reimbursed through Medicare and Medicaid. Information was obtained from the Nursing Home Compare open datasets at five semi-annual processing dates from March 2016 to March 2018. Ownership networks of American nursing homes were constructed through application of social network analysis, using the exact legal name of registered organizations. As hospital discharge is a routine admission source of nursing home residents, hospital referral region was actualized to demarcate focal area. Utilizing Bayesian hierarchical models, the association between nursing home super-organization in hospital referral region (inferred by degree-based centrality and Herfindahl-Hirschman Index) to scope of cited care deficiencies (denoted by Total Weighted Health Survey Score) was explored. Results The percentage of nursing homes having super-organization increased from 56.8–56.9% over the two-year period. During this interval, the mean size of nursing home ownership group in hospital referral region increased from 3.11 to 3.23 facilities. Conclusions Overall, super-organization in hospital referral region was not associated with care deficiencies in American nursing homes. However, among nursing home with super-organization, being part of an ownership group with more facilities was beneficial for care quality. Evidence suggests that super-organization is detrimental for government nursing homes.

scholarly journals Regional Variation in Healthcare Use Among Medicare Beneficiaries With Alzheimer’s Disease and Related Dementias

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 21-22
Author(s):  
Elizabeth White ◽  
Momotazur Rahman
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Nursing Homes ◽  
Regional Variation ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Term Care ◽  
Regional Patterns ◽  
Hospital Referral

Abstract In this national prospective study we describe regional variation in healthcare utilization among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) in the six years after diagnosis. We use 2008-2015 Medicare claims and other administrative data to map nursing home, home health, hospital, and hospice use across hospital referral regions; and examine the relationship of state and county supply-side factors to time beneficiaries spend in different settings. The sample includes 1,158,655 Medicare fee-for-service beneficiaries diagnosed with ADRD in 2008 and 2009. Nationally, beneficiaries spent a mean of 70.6% of survived days in the community, 23.9% of days in nursing home, and 5.4% of days in hospital. 37.2% of beneficiaries who died within six years had received hospice. Distinct regional patterns emerged. Adjusting for beneficiary and local characteristics, beneficiaries in Midwestern states spent the most time in nursing homes, while beneficiaries in Western states spent the most time in community. The probability of receiving hospice was generally highest in Western and Southern states, and lowest in the Midwest and Northeast. Controlling for beneficiary, local, and state characteristics, we found the following factors to be associated with beneficiaries spending less time in nursing homes: fewer nursing home beds in the county, higher state Medicaid long-term care spending for home and community-based services (HCBS), and state use of Certificate of Need laws. These findings illustrate that state investment in HCBS, and state and local regulation of provider supply are important factors influencing where individuals with ADRD receive care.

Use of Psychotropics in Sydney Nursing Homes: Associations With Depression, Psychosis, and Behavioral Disturbances

2001 ◽  
Vol 13 (1) ◽  
pp. 107-120 ◽  
Author(s):  
Brian Draper ◽  
Henry Brodaty ◽  
Lee-Fay Low ◽  
Dania Saab ◽  
David Lie ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Nursing Home ◽  
Depressive Symptoms ◽  
Nursing Homes ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Psychological Symptoms ◽  
Nursing Home Residents ◽  
Behavioral Disturbances ◽  
Affective Disturbances

The purpose of this study was to determine the prevalence of psychotropic use in nursing home residents, the extent to which psychotropic dosage is consistent with published guidelines, and the relationships between psychotropic class and psychiatric and behavioral disturbances. Six hundred forty-seven subjects, mean age 82.3 years, residing in 11 nursing homes in the eastern suburbs of Sydney, Australia, were assessed using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), the Abbreviated Mental Test Scale, and the Even Briefer Assessment Scale for Depression (EBAS-DEP). Details of psychotropic prescription and diagnoses of depression, dementia, and psychosis were obtained from nursing home charts. Psychotropics were prescribed for 333 (51.5%) residents, 381 (58.9%) if “as required” (PRN) use is included. Prescription of multiple psychotropics was present in 148 (22.7%) residents. Antidepressants were prescribed for 19.8% of residents, with subtherapeutic doses less likely in residents on selective serotonin reuptake inhibitors. On logistic regression, the use of antidepressants was predicted by the affective disturbances subscale on the BEHAVE-AD. Only 30.4% of residents with significant depressive symptoms on the EBAS-DEP were prescribed antidepressants. Antipsychotics were prescribed for 21.3% residents at a mean dosage of 73 mg chlorpromazine equivalence. Residents on antipsychotics had significantly higher scores on the delusions, hallucinations, activity disturbance, and aggressiveness subscales of the BEHAVE-AD. On logistic regression, only the activity disturbance subscale and chart diagnoses of dementia and psychosis were significant predictors. Psychosis (58.8%) and behavioral disturbances (91.9%) were more prevalent in residents prescribed antipsychotics than in residents not prescribed antipsychotics (42.5% and 76.6%, respectively). High rates of behavioral and psychological symptoms of dementia remained in residents prescribed antipsychotics and high rates of depressive symptoms in residents prescribed antidepressants, suggesting a role for nonpharmacological strategies.

Prognostic Models Associated with 6-Month Survival of Patients Admitted to Nursing Homes

Gerontology ◽  
2018 ◽  
Vol 65 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Ana A. Esteban-Burgos ◽  
Jamal El Mansouri-Yachou ◽  
Rafael Muñoz-Ramirez ◽  
Cesar Hueso-Montoro ◽  
Maria P. Garcia-Caro ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Nursing Home ◽  
Nursing Homes ◽  
Logistic Regression Analysis ◽  
Multiple Logistic Regression Analysis ◽  
Prognostic Index ◽  
Prognostic Models ◽  
Persistent Symptoms

Background: Health status and the needs presented by people admitted to nursing homes make it necessary to contemplate aspects such as prognosis to offer quality palliative care. Objective: To compare the prognostic utility in nursing homes of two prognostic models of 6-month survival based on the Palliative Prognostic Index (PPI) or Palliative Performance Status (PPS) instruments and palliative needs indicators. Methods: A longitudinal prospective observational and analytical cohort study of survival and prognostic models in 88 patients with palliative needs (assessed by the NECPAL-ICO-CCOMS©) from an Andalusian (Spain) nursing home was performed. Sociodemographic and clinical variables were assessed, and 6 months later, in September 2017, survival was checked. Multiple logistic regression analysis was performed using the R-Commander program (version 3.2.2). Results: Two models of the logistic regression analysis met the fit criteria. The two models combined the Surprise Question, the presence of persistent symptoms, and the clinical indicators of severity from the NECPAL tool, in addition to the Charlson Comorbidity Index, and varied only in terms of the latter variable, including the PPI in the first model and the PPS in the second. In the first model, significant associations were identified between 6-month survival and the persistent symptoms variable (OR = 7.78, p = 0.025, 95% CI = 1.45–60.92) and PPI (OR = 1.94, p < 0.001, 95% CI = 1.21). In the second model, 6-month survival was also significantly associated with the persistent symptoms variable (OR = 4.57, p = 0.045, 95% CI = 1.07–22.41) and the PPS (OR = 0.93, p = 0.001, 95% CI = 0.88–0.96). Conclusions: Prognostic models such as ours that include variables commonly included in clinical assessments can help nursing home professionals prioritize and ensure adequate mobilization of palliative care resources, which are very limited in these institutions.

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