Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities

Background: Falls are leading cause of injury among older people, especially for those living in long-term care facilities (LTCFs). Very few studies have assessed the effect of sleep quality and hypnotics use on falls, especially in Chinese LTCFs. The study aimed to examine the association between sleep quality, hypnotics use, and falls in institutionalized older people. Methods: We recruited 605 residents from 25 LTCFs in central Shanghai and conducted a baseline survey for sleep quality and hypnotics use, as well as a one-year follow-up survey for falls and injurious falls. Logistic regression models were applied in univariate and multivariate analysis. Results: Among the 605 participants (70.41% women, mean age 84.33 ± 6.90 years), the one-year incidence of falls and injurious falls was 21.82% and 15.21%, respectively. Insomnia (19.83%) and hypnotics use (14.21%) were prevalent. After adjusting for potential confounders, we found that insomnia was significantly associated with an increased risk of falls (adjusted risk ratio (RR): 1.787, 95% CI, 1.106–2.877) and the use of benzodiazepines significantly increased the risk of injurious falls (RR: 3.128, 95% CI, 1.541–6.350). Conclusion: In elderly LTCF residents, both insomnia and benzodiazepine use are associated with an increased risk of falls and injuries. Adopting non-pharmacological approaches to improve sleep quality, taking safer hypnotics, or strengthening supervision on benzodiazepine users may be useful in fall prevention.

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Variation and appropriateness of antipsychotic use in long-term care facilities across Newfoundland and Labrador

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/17151635211005161 ◽

2021 ◽

pp. 171516352110051

Author(s):

Zachary E. M. Giovannini-Green ◽

John-Michael Gamble ◽

Brendan Barrett ◽

Zhiwei Gao ◽

Susan Stuckless ◽

...

Keyword(s):

Newfoundland And Labrador ◽

Long Term Care ◽

Assessment Instrument ◽

Linear Regression Models ◽

Term Care ◽

Data Set ◽

Increased Risk ◽

Care Facilities ◽

Risk Of Falls

Objective: The use of antipsychotics to treat seniors in long-term care facilities (LTCFs) has raised concern because of health consequences (i.e., increased risk of falls, stroke, death) in this vulnerable population. This study measured geographic patterns of antipsychotic utilization among seniors living in LTCFs in Newfoundland and Labrador (NL) and assessed potential inappropriateness. Method: We analyzed prescription records among adults 66 years and older with provincial prescription drug coverage admitted to LTCFs in NL between April 1, 2011, and March 31, 2014. Patterns of use were analyzed across the 4 regional health authorities (RHAs) in NL and LTCFs. Logistic, Poisson and linear regression models were used to test variations in prevalence, rate and volume of antipsychotic utilization. To assess potential inappropriateness of antipsychotic use, we analyzed data from Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0 forms from NL LTCFs between January 1, 2016, and December 31, 2018. Pearson chi-squared analysis was performed at the RHA and LTCF levels to determine changes in percentage of total prescriptions or antipsychotic prescriptions without psychosis. Results: Between 2011 and 2014, 2843 seniors were admitted to LTCFs across NL; of these, 1323 residents were prescribed 1 or more antipsychotics. Within the 3-year period, the percentage of antipsychotic use across facilities ranged from 35% to 78%. Using data from 27,260 RAI-MDS 2.0 assessments between 2016 and 2018, 71% (6995/9851) of antipsychotic prescriptions were potentially inappropriate. Discussion: There is substantial variation across NL regions concerning the utilization of antipsychotics for senior in LTCFs. Facility size and management styles may be reasons for this. Conclusion: With nearly three-quarters of antipsychotic prescriptions shown to be potentially inappropriate, systematic interventions to assess indications for antipsychotic use are warranted. Can Pharm J (Ott) 2021;154:xx-xx.

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Risk of Hospitalization and Death Associated With Pimavanserin Use in Older Adults With Parkinson Disease

Neurology ◽

10.1212/wnl.0000000000012601 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012601

Author(s):

Y. Joseph Hwang ◽

G. Caleb Alexander ◽

Huijun An ◽

Thomas J Moore ◽

Hemalkumar B Mehta

Keyword(s):

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Long Term Care ◽

Term Care ◽

Risk Of Death ◽

Increased Risk ◽

Care Facilities ◽

One Year

Objective:To determine the risk of hospitalization and death associated with pimavanserin use.Methods:We conducted a retrospective cohort study of adults 65 years and older with Parkinson’s disease between November 1, 2015 and December 31, 2018 using an administrative dataset on residents of Medicare-certified long-term care facilities and linked Medicare claims data. Propensity score-based inverse probability of treatment weighting (IPTW) was used to balance pimavanserin users and nonusers on 24 baseline characteristics. Fine-Gray competing risk and Cox proportional hazards regression models were used to estimate the risk of hospitalization and death up to one year, respectively.Results:The study cohort included 2,186 pimavanserin users and 18,212 nonusers. There was a higher risk of 30-day hospitalization with pimavanserin use vs. nonuse (IPTW adjusted hazard ratio [aHR] 1.24, 95% confidence intervals [CI] 1.06–1.43). There was no association of pimavanserin use with 90-day hospitalization (aHR 1.10, CI 0.99–1.24) nor with 30-day mortality (aHR 0.76, CI 0.56–1.03). Pimavanserin use vs. nonuse was associated with an increased 90-day mortality (aHR 1.20, CI 1.02–1.41) that persisted after 180 days (aHR 1.28, CI 1.13–1.45) and 1 year (aHR 1.56, CI 1.42–1.72).Conclusions:Pimavanserin use vs. nonuse in older adults was associated with an increased risk of hospitalization at one month of initiation and a higher risk of death for up to one year following initiation. These findings, in a large real-world cohort within long-term care facilities, may help to inform decisions regarding its risk-benefit balance among patients with Parkinson’s disease.Classification of Evidence:This study provides Class II evidence that in patients with Parkinson’s disease who are 65 or older and residing in Medicare-certified long-term care facilities, pimavanserin prescribing is associated with an increased risk of 30-day hospitalization and higher 90-, 180-, and, 365-day mortality.

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Case–control study to estimate odds of death within 28 days of positive test for SARS-CoV-2 prior to vaccination for residents of long-term care facilities in England, 2020–2021

Journal of Epidemiology & Community Health ◽

10.1136/jech-2021-218135 ◽

2021 ◽

pp. jech-2021-218135

Author(s):

Karthik Paranthaman ◽

Hester Allen ◽

Dimple Chudasama ◽

Neville Q Verlander ◽

James Sedgwick

Keyword(s):

Long Term Care ◽

Multivariable Analysis ◽

Adverse Outcomes ◽

Positive Test ◽

Mortality Data ◽

Multivariable Logistic Regression Analysis ◽

Term Care ◽

Increased Risk ◽

Care Facilities

BackgroundPersons living in long-term care facilities (LTCFs) are presumed to be at higher risk of adverse outcomes from SARS-CoV-2 infection due to increasing age and frailty, but the magnitude of increased risk is not well quantified.MethodsAfter linking demographic and mortality data for cases with confirmed SARS-CoV-2 infection between March 2020 and January 2021 in England, a random sample of 6000 persons who died and 36 000 who did not die within 28 days of a positive test was obtained from the dataset of 3 020 800 patients. Based on an address-matching process, the residence type of each case was categorised into one of private home and residential or nursing LTCF. Univariable and multivariable logistic regression analysis was conducted.ResultsMultivariable analysis showed that an interaction effect between age and residence type determined the outcome. Compared with a 60-year-old person not living in LTCF, the adjusted OR (aOR) for same-aged persons living in residential and nursing LTCFs was 1.77 (95% CI 1.21 to 2.6, p=0.0017) and 3.95 (95% CI 2.77 to 5.64, p<0.0001), respectively. At 90 years of age, aORs were 0.87 (95% CI 0.72 to 1.06, p=0.21) and 0.74 (95% CI 0.61 to 0.9, p=0.001), respectively. The model had an overall accuracy of 94.2% (94.2%) when applied to the full dataset of 2 978 800 patients.ConclusionThis study found that residents of LTCFs in England had higher odds of death up to 80 years of age. Beyond 80 years, there was no difference in the odds of death for LTCF residents compared with those in the wider community.

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Is treated hypertension associated with a lower one-year mortality among older residents of long-term care facilities with multimorbidity?

Polish Archives of Internal Medicine ◽

10.20452/pamw.15944 ◽

2021 ◽

Author(s):

Anna Kańtoch ◽

Agnieszka Pac ◽

Barbara Wizner ◽

Jadwiga Wójkowska-Mach ◽

Piotr Heczko ◽

...

Keyword(s):

Long Term Care ◽

Term Care ◽

Care Facilities ◽

One Year

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Iron deficiency is associated with increased risk for cardiovascular disease and all-cause mortality in the elderly living in long-term care facilities

Nutrition ◽

10.1016/j.nut.2012.10.015 ◽

2013 ◽

Vol 29 (5) ◽

pp. 737-743 ◽

Cited By ~ 16

Author(s):

Hua-Shui Hsu ◽

Chia-Ing Li ◽

Chiu-Shong Liu ◽

Cheng-Chieh Lin ◽

Kuo-Chin Huang ◽

...

Keyword(s):

Cardiovascular Disease ◽

Iron Deficiency ◽

Long Term Care ◽

The Elderly ◽

Term Care ◽

Increased Risk ◽

Care Facilities ◽

All Cause Mortality ◽

Elderly Living

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Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Antibiotics ◽

10.3390/antibiotics10060680 ◽

2021 ◽

Vol 10 (6) ◽

pp. 680

Author(s):

Ángel Rodríguez-Villodres ◽

Cecilia Martín-Gandul ◽

Germán Peñalva ◽

Ana Belén Guisado-Gil ◽

Juan Carlos Crespo-Rivas ◽

...

Keyword(s):

Risk Factors ◽

Long Term Care ◽

Multidrug Resistant ◽

Term Care ◽

Extended Spectrum ◽

Increased Risk ◽

Modifiable Factors ◽

Care Facilities ◽

Multidrug Resistant Organisms

Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.

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Among elderly residents of long term care facilities, a visit to the emergency department is associated with an increased risk of acquiring a new respiratory or gastrointestinal infection

Evidence-Based Nursing ◽

10.1136/eb-2012-100771 ◽

2012 ◽

Vol 16 (1) ◽

pp. 33-34

Author(s):

Gail Lusardi

Keyword(s):

Emergency Department ◽

Long Term Care ◽

Gastrointestinal Infection ◽

Term Care ◽

Increased Risk ◽

Care Facilities

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One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins

Canadian Medical Association Journal ◽

10.1503/cmaj.180853 ◽

2019 ◽

Vol 191 (2) ◽

pp. E32-E39 ◽

Cited By ~ 5

Author(s):

Michael A. Campitelli ◽

Colleen J. Maxwell ◽

Laura C. Maclagan ◽

Dennis T. Ko ◽

Chaim M. Bell ◽

...

Keyword(s):

Cardiovascular Events ◽

Long Term Care ◽

Moderate Dose ◽

Term Care ◽

Care Facilities ◽

One Year

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Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.288 ◽

2018 ◽

Vol 40 (1) ◽

pp. 18-23 ◽

Cited By ~ 7

Author(s):

Bo R. Weber ◽

Brie N. Noble ◽

David T. Bearden ◽

Christopher J. Crnich ◽

Katherine D. Ellingson ◽

...

Keyword(s):

Hospital Readmission ◽

Long Term Care ◽

Antibiotic Prescription ◽

Antibiotic Prescribing ◽

Day Hospital ◽

Post Discharge ◽

Term Care ◽

Increased Risk ◽

Care Facilities

AbstractObjectiveTo quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).DesignRetrospective cohort study.SettingA 576-bed, academic hospital in Portland, Oregon.PatientsAdult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.MethodsOur primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge.ResultsAmong 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02–1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02–2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9–1.2).ConclusionsAntibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.

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