The Alchoholic Patient in the Nursing Home

1972 ◽  
Vol 3 (3) ◽  
pp. 273-277 ◽  
Author(s):  
Margaret W. Linn ◽  
Bernard S. Linn ◽  
Shayna R. Greenwald
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Social Workers ◽  
Diagnostic Data ◽  
Nursing Home Patients ◽  
Diabetes Outcome ◽  
Specific Illness

There are indications that more alcoholics are being placed in nursing homes than ever before. To determine in what ways these patients differ from others going to nursing homes, all alcoholics (72) placed from hospital to nursing homes were studied prior to placement and followed 6 months in 35 homes. Seventy-one nonalco-holics placed during the same period were randomly selected for comparison. Hospital disability ratings from physicians, evaluations from social workers, and diagnostic data from records indicated no significant differences in levels of disability or impairment. Alcoholics were less likely to be currently married and had less income. Although they were younger, they had a significantly higher number of diagnoses than other nursing home patients (P< .01); however, with the exception of cirrhosis and brain syndrome, they had fewer serious illnesses such as cancer and diabetes. Outcome after 6 months showed 28 percent left the nursing home, 45 percent were still in the home, 10 percent were hospitalized, and 16 percent had expired. These outcomes were not significantly different from other nursing home patients. Results indicate alcoholics are as much in need of nursing home services as other patients, even though they differ along social and specific illness patterns *

Ethics and quality care in nursing homes: Relatives’ experiences

2017 ◽  
Vol 26 (3) ◽  
pp. 767-777 ◽  
Author(s):  
Rita Jakobsen ◽  
Gerd Sylvi Sellevold ◽  
Veslemøy Egede-Nissen ◽  
Venke Sørlie
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Staff ◽  
Quality Care ◽  
Science Data ◽  
Data Services ◽  
Nursing Home Patients ◽  
Positive Experiences ◽  
Close Relatives

Background: A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients’ relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. Aim: The aim of the study is to investigate relatives of persons with dementia’s experiences with quality care in nursing homes. Method: The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological–hermeneutical method for the study of lived experiences. Participants and research context: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. Ethical considerations: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. Findings: Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives’ experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives experienced powerlessness, distrust and guilt. Discussion: The results are discussed considering the concepts of trust, power and asymmetry. Conclusion: When asked about experiences with quality care, the relatives spoke both of expectations met and of expectations not met. Results in this study are important knowledge for developing units where performing quality care is the overall aim.

Physical Health and Cognitive Ability Among Married Long-Term-Care Patients and Among Their Spouses—A Comparison Between Home Care and Nursing Home Care

1993 ◽  
Vol 5 (2) ◽  
pp. 157-168 ◽  
Author(s):  
Ann-Christine Löfgren ◽  
Gösta Bucht ◽  
Sture Eriksson ◽  
Tage Lundström
Keyword(s):  
Nursing Home ◽  
Cognitive Function ◽  
Nursing Homes ◽  
Home Care ◽  
Physical Health ◽  
Long Term Care ◽  
Nursing Home Care ◽  
Term Care ◽  
Nursing Home Patients

The purpose of this study was to establish whether physical health and cognitive function in married long-term patients or in their spouses determines why some patients are cared for in home care while others reside in nursing homes. Out of 38 married couples with a sick spouse cared for in a nursing home, 23 couples were studied; out of 34 couples with a sick spouse cared for in home care, 22 patients and 25 spouses were studied. The results showed no significant differences in physical health score either between the two groups of patients, or between the two groups of spouses. Both home-care patients and nursing home patients had low cognitive function scores, but nursing home patients had significantly lower scores. A multivariate analysis showed that physical health and cognitive function explained only 20% of patients' residence. Between the two groups of spouses there was no difference in cognitive function score. The conclusion is that physical health status and cognitive function explain only to a small extent why married long-term care patients are cared for in nursing homes or in home care.

The Prevalence and Management of Dementia and Other Psychiatric Disorders in Nursing Homes

1990 ◽  
Vol 2 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Barry W. Rovner ◽  
Pearl S. German ◽  
Jeremy Broadhead ◽  
Richard K. Morriss ◽  
Larry J. Brant ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Mental Disorders ◽  
Psychiatric Disorders ◽  
Nursing Home Residents ◽  
Nursing Time ◽  
Distinct Subgroup ◽  
Diagnostic And Statistical Manual ◽  
Frequent Use ◽  
Nursing Home Patients

The prevalence of psychiatric disorders among new admissions to nursing homes is unknown. Such data are needed to estimate the psychiatric needs of this population. We report the prevalence of specific psychiatric disorders in 454 consecutive new nursing home admissions who were evaluated by psychiatrists and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised. Eighty percent had a psychiatric disorder. The commonest were dementia syndromes (67.4%) and affective disorders (10%). Also, 40% of demented patients had additional psychiatric syndromes such as delusions or depression, and these patients constituted a distinct subgroup that predicted frequent use of restraints and neuroleptics, and the greatest consumption of nursing time. These data demonstrate that the majority of nursing home residents have psychiatric disorders on admission, and that their management is often quite restrictive. Research is now needed to determine the best methods of treatment for nursing home patients with mental disorders.

Coercion in nursing homes

2015 ◽  
Vol 23 (3) ◽  
pp. 253-264 ◽  
Author(s):  
Elisabeth Gjerberg ◽  
Lillian Lillemoen ◽  
Reidar Pedersen ◽  
Reidun Førde
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Next Of Kin ◽  
Best Interest ◽  
Focus Group Interviews ◽  
Ethical Considerations ◽  
Individual Interviews ◽  
Nursing Home Patients ◽  
Legal Challenges ◽  
Group Interviews

Background: Studies have demonstrated the extensive use of coercion in Norwegian nursing homes, which represents ethical, professional as well as legal challenges to the staff. We have, however, limited knowledge of the experiences and views of nursing home patients and their relatives. Objectives: The aim of this study is to explore the perspectives of nursing home patients and next of kin on the use of coercion; are there situations where the use of coercion can be defended, and if so, under which circumstances? Methods: The data are based on individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 60 relatives. Ethical considerations: Participation was based on written informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics. Results: More than half of the patients and the majority of the relatives accepted the use of coercion, trusting the staff to act in the patient’s best interest. However, the acceptance of coercion is strongly related to the patients’ lack of understanding, to prevent health risks and to preserve the patient’s dignity. Conclusion: The majority of nursing home patients and relatives accepted the use of coercion in specific situations, while at the same time they emphasised the need to try alternative strategies first. There is still a need for good qualitative research on the use of coercion in nursing homes, especially with a closer focus on the perspectives and experiences of nursing home patients.

Dementia Syndromes in Nursing Home Patients

1992 ◽  
Vol 4 (2) ◽  
pp. 241-252 ◽  
Author(s):  
M. Andersson ◽  
C. G. Gottfries
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Depressed Mood ◽  
Long Term Care ◽  
Psychiatric Symptoms ◽  
The Elderly ◽  
Minor Importance ◽  
Term Care ◽  
Nursing Home Patients

Patients (n = 191) living in four comparable somaic nursing homes (NH) (nursing homes for physical illness) were studied in order to evaluate dementia syndromes. Dementia and symptoms of depressed mood occurred frequently (72% and 63%, respectively). Dementia was often undiagnosed at admittance. Neither the length of time spent in institutions, nor marital status, age, or sex seemed to be of more than minor importance to the prevalence of dementia syndromes. Concerning functional impairment, convergence of findings across the societies studied indicates that psychiatric symptoms and psychopathology are intrinsic parts of long-term care of the elderly.

scholarly journals Evaluation of prescribing quality in nursing homes based on drug-specific indicators: The Bergen district nursing home (BEDNURS) study

2009 ◽  
Vol 18 (2) ◽  
Author(s):  
Sabine Ruths
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Cross Sectional Study ◽  
Anticholinergic Drugs ◽  
Cross Sectional ◽  
National Board ◽  
Prescribing Quality ◽  
Nursing Home Patients ◽  
Potentially Inappropriate Prescription ◽  
Long Acting

To examine prescribing quality among nursing home patients. Methods: A cross sectional study in 23 nursing homes, based on drug charts. The evaluation of prescribing quality was based on selected drug-specific indicators established by the Swedish National Board of Health and Welfare. Logistic regression analysis was used to examine associations between prescribing indicators and predictors related to patient (age, gender, drug number) and institution (nurse and physician staff time) characteristics. Results: A total of 1513 nursing home patients (76% women, mean age 85 years) were included in the study. On average, the patients used 5.1 (SD 2.5) standing medications. Laxatives were most commonly used (58%), followed by loop-diuretics (35%), antidepressants (31%), and anti-thrombotic agents (27%). Altogether 850 (56%) patients used at least one potentially inappropriate prescription (PIP), including long-term use of contact laxatives without proper indication (25%), long-acting benzodiazepines (17%), and anticholinergic drugs (16%). The number of drugs used was the most important determinant for any PIP as well as for all individual indicators (p<0.001). Relatively younger patients were more likely to receive any PIP, and in particular anticholinergic drugs, multiple psychotropic drugs, and interacting drugs (p<0.05). Conclusion: Prescribing quality assessment by use of drug-specific indicators revealed great potentials for improving drug therapy in Norwegian nursing homes.

Predictors of survival in nursing home patients with severe dementia in whom artificial nutrition and hydration forgone

2006 ◽  
Vol 18 (2) ◽  
pp. 227-240 ◽  
Author(s):  
H. Roeline W. Pasman ◽  
Bregje D. Onwuteaka-Philipsen ◽  
Didi M. W. Kriegsman ◽  
Marcel E. Ooms ◽  
Gerrit van der Wal ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Clinical Judgment ◽  
Strong Predictor ◽  
Artificial Nutrition ◽  
Severe Dementia ◽  
Artificial Nutrition And Hydration ◽  
Nursing Home Patients ◽  
Nutrition And Hydration

Background: To investigate the characteristics of patients in whom artificial nutrition and hydration (ANH) is forgone, duration of survival after the decision and factors that are associated with duration of survival.Methods: Observational study based on written questionnaires in 32 Dutch nursing homes. Of 178 nursing home patients with dementia, their treating nursing home physician (NHP) filled in a questionnaire directly after the decision was made to forgo ANH. The maximum follow-up was 6 weeks. Cox proportional hazards analysis was used to determine predictors of survival.Results: Decisions to forgo ANH in Dutch nursing homes were made most often in patients with severe dementia who also had an acute illness. More than half the patients (59%) died within 1 week after the decision. Patients with dyspnea and/or apathy were more likely to die during follow-up than patients without these symptoms. Patients who were considered more severely ill by the NHP were more likely to die than those who were considered less severely ill. The presence of restlessness indicated a higher chance of survival.Conclusions: The clinical judgment of the NHP of the severity of illness appeared to be a strong predictor of patient survival. NHPs should not rely solely on their clinical judgment concerning survival, but they should also consider the presence or absence of dyspnea, apathy and restlessness.

Change in psychotropic drug use in Norwegian nursing homes between 2004 and 2011

2017 ◽  
Vol 30 (3) ◽  
pp. 385-394 ◽  
Author(s):  
G. Selbæk ◽  
S. I.M. Janus ◽  
S. Bergh ◽  
K. Engedal ◽  
S. Ruths ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Nursing Homes ◽  
Psychotropic Drug ◽  
Psychotropic Drugs ◽  
Antipsychotic Drugs ◽  
Secondary Analysis ◽  
Multivariate Models ◽  
Nursing Home Patients ◽  
Affective Symptoms

ABSTRACTBackground:We aimed to assess whether there were any changes in the use of psychotropic drugs in Norwegian nursing homes between 2004 and 2011. Also, we investigated whether the predictors of use of specific psychotropic drug groups have changed.Methods:We conducted a secondary analysis of two cohort studies of two Norwegian nursing home samples (2004/05 and 2010/11). Multivariate models were applied.Results:We found a significant decrease in the prescription of antipsychotic drugs between 2004 and 2011 (0.63 OR, 95%CI = 0.49–0.82, p < 0.001) even after adjusting for relevant demographic and clinical variables. There are only minor changes for the other psychotropic drugs. We found that (1) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with more affective symptoms and (2) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with lower scores on the Physical Self-Maintenance scale.Conclusion:This is the first study to show a robust decrease in antipsychotic drug use in nursing home patients with dementia unrelated to possible changes in case mix. The change might be explained by treatment recommendations against its use except in the most severe conditions of aggression or psychosis. Our findings indicate that it takes several years to implement scientific knowledge in clinical practice in nursing homes.

scholarly journals Prevalence of Different Combinations of Antiepileptic Drugs and CNS Drugs in Elderly Home Care Service and Nursing Home Patients in Norway

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Kjell H. Halvorsen ◽  
Cecilie Johannessen Landmark ◽  
Anne Gerd Granas
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Antiepileptic Drugs ◽  
Care Service ◽  
Home Care Services ◽  
Home Care Service ◽  
Elderly Home ◽  
Care Services ◽  
Nursing Home Patients

Introduction. Antiepileptic drugs (AEDs) are used to treat different conditions in elderly patients and are among the drug classes most susceptible to be involved in drug-drug interactions (DDI). The aim of the study was to describe and compare use of AEDs between home care service and nursing home patients, as these patients are not included in nationwide databases of drug utilization. In the combined population, we investigate DDI of AEDs with other central nervous system- (CNS-) active drugs and DDIs involving AEDs in general. Materials and Methods. Point-prevalence study of Norwegian patients in home care services and nursing homes in 2009. At the patient level, we screened for different DDIs involving AEDs. Results. In total, 882 patients (7.8%) of 11,254 patients used AEDs and number of users did not differ between home care services and nursing homes (8.2% versus 7.7%). In the combined population, we identified 436 potential DDIs in 45% of the patients. Conclusions. In a large population of elderly, home care service and nursing home patients do not differ with respect to exposure of AEDs but use more AEDs as compared to the general population of similar age. The risk of DDIs with AEDs and other CNS-active drugs should be taken into consideration and individual clinical evaluations are assessed in this population.

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