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https://www.readbyqxmd.com/read/30503588/threshold-for-a-reduction-in-anticholinergic-burden-to-decrease-behavioral-and-psychological-symptoms-of-dementia
#1
Yacine Jaïdi, Adrien Guilloteau, Vignon Nonnonhou, Laurie-Anne Bertholon, Sarah Badr, Isabella Morrone, Jean-Luc Novella, Rachid Mahmoudi
BACKGROUND: A high anticholinergic burden (AB) is associated with the occurrence of behavioral and psychological symptoms (BPSDs), which are frequent in dementia. OBJECTIVES: Our aim was to determine the threshold for a reduction in AB that would lead to a clinically significant improvement in BPSDs (in terms of frequency, severity, and disruptiveness). DESIGN: A single-center prospective study. SETTINGS: Dedicated geriatric care unit specializing in the management of patients with dementia...
November 28, 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/30501484/is-there-a-woodwork-effect-addressing-a-200-year-debate-on-the-impacts-of-expanding-community-based-services
#2
Diane Berish, Ian Nelson, Shahla Mehdizadeh, Robert Applebaum
In U.S. social welfare history, many have suggested that if benefits were too attractive, consumers would come out of the woodwork to take advantage of the opportunity. Clinical trials have provided evidence of the woodwork effect's existence, suggesting caution when expanding home- and community-based services (HCBS). However, it is unclear whether these studies are best suited to assess whether a system-level effect occurs. Using state and federal data tracking Ohio's long-term services and support (LTSS) system from 1995 to 2015, this paper examines changes in the utilization rates and expenditures of Medicaid LTSS to explore whether a woodwork effect occurred as Ohio moved to improve its LTSS system balance (80% Nursing Home [NH], 20% HCBS) to (49% Nursing Home [NH], 51% HCBS)...
December 1, 2018: Journal of Aging & Social Policy
https://www.readbyqxmd.com/read/30471802/effect-of-an-educational-and-organizational-intervention-on-pain-in-nursing-home-residents-a-nonrandomized-controlled-trial
#3
Vincent Guion, Philipe De Souto Barreto, Sandrine Sourdet, Yves Rolland
OBJECTIVES: To determine whether an intervention based on education and professional support to nursing home (NH) staff would decrease the number of residents with a pain complaint, and to determine whether the intervention would improve pain management. DESIGN: Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong intervention group consisting in audit, feedback, and collaborative work on quality indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting in audit and feedback only...
December 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/30471800/improving-nursing-home-residents-oral-hygiene-results-of-a-cluster-randomized-intervention-trial
#4
Jane A Weintraub, Sheryl Zimmerman, Kimberly Ward, Christopher J Wretman, Philip D Sloane, Sally C Stearns, Patricia Poole, John S Preisser
OBJECTIVE: A 2-year cluster randomized trial of Mouth Care Without a Battle (MCWB) was conducted in nursing homes (NHs) to determine if recommended mouth care practices provided by NH staff could improve residents' oral hygiene and denture outcomes. DESIGN: Cluster randomized trial of NHs. SETTING AND PARTICIPANTS: Seven MCWB NHs and 6 control NHs. A total of 219 NH residents completed baseline and 24-month oral examinations and, if applicable, denture assessments (control = 98, intervention = 121)...
December 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/30470575/association-between-end-of-life-conversations-in-nursing-homes-and-end-of-life-care-outcomes-a-systematic-review-and-meta-analysis
#5
REVIEW
Silvia Gonella, Ines Basso, Valerio Dimonte, Barbara Martin, Paola Berchialla, Sara Campagna, Paola Di Giulio
OBJECTIVE: Less aggressive end-of-life (EOL) care has been observed when health care professionals discuss approaching EOL and preferences about life-sustaining treatments with nursing home (NH) residents or their families. We performed a comprehensive systematic review to evaluate the association between health care professionals-residents and health care professionals-family EOL conversations and EOL care outcomes. DESIGN: Systematic review with meta-analysis...
November 20, 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/30464423/factors-influencing-the-quality-of-life-perceptions-of-cognitively-impaired-older-adults-in-a-nursing-home-and-their-informal-and-professional-caregivers-a-mixed-methods-study
#6
Henk Verloo, Alexandre Salina, Assunta Fiorentino, Christine Cohen
Background: Identifying the objective and subjective aspects of the quality of life (QoL) of institutionalized cognitively impaired older adults (CIOAs) is a challenge. However, it can reveal which aspects of their care require improvement. Aim: The aim of this study was to identify the core aspects of the QoL of CIOAs living in a nursing home (NH) by involving informal and professional caregivers (PCs). Methods: Our sequential, mixed methods study exploring the QoL of CIOAs was based on Lodgson et al's (2002) quantitative quality of life-Alzheimer's disease (QoL-AD) questionnaire...
2018: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/30449141/natural-course-of-neuropsychiatric-symptoms-in-nursing-home-patients-with-mental-physical-multimorbidity-in-the-first-eight-months-after-admission
#7
Anne van den Brink, Debby L Gerritsen, Miranda M H de Valk, Richard Oude Voshaar, Raymond Koopmans
OBJECTIVE: Aging societies will bring an increase in the number of long-term care patients with mental-physical multimorbidity (MPM). This paper aimed to describe the natural course of neuropsychiatric symptoms (NPS) in patients with MPM in the first 8 months after admission to a geronto-psychiatric nursing home (GP-NH) unit. METHODS: Longitudinal cohort study among 63 patients with MPM no dementia living in 17 GP-NH units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, and brief neuropsychological testing, among which our primary outcome measure the Neuropsychiatric Inventory (NPI)...
November 18, 2018: Aging & Mental Health
https://www.readbyqxmd.com/read/30445937/the-impact-of-attending-day-care-designed-for-home-dwelling-people-with-dementia-on-nursing-home-admission-a-24-month-controlled-study
#8
Anne Marie Mork Rokstad, Knut Engedal, Øyvind Kirkevold, Jūratė Šaltytė Benth, Geir Selbæk
BACKGROUND: Day care services offer meaningful activities, a safe environment for attendees and respite for family caregivers while being expected to delay the need for nursing home (NH) admission. However, previous research has shown inconsistent results regarding postponement of NH admission. The objective of the study was to explore the influence of a day care programme designed for home-dwelling people with dementia on NH admission. METHOD: A quasi-experimental trial explored the proportion of patients permanently admitted to nursing homes after 24 months as the main outcome by comparing a group of day care attendees (DG) and a group of participants without day care (CG)...
November 16, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/30430646/the-use-of-direct-care-in-nursing-home-residents-a-longitudinal-cohort-study-over-three-years
#9
C Vossius, G Selbaek, J Šaltytė Benth, A Wimo, S Bergh
OBJECTIVES: To evaluate the trend in the use of direct care in a cohort of Nursing home (NH) residents and explore its association with resident characteristics and organizational factors. METHODS/DESIGN: A total of 696 NH residents from 47 Norwegian NHs were included at admissions at NH. In 537 residents the use of direct care was assessed every 6 months over a course of three years. A multiple model was estimated to identify demographic, clinical and organizational characteristics associated with the use of direct care time...
November 14, 2018: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/30428053/multitasking-in-nursing-homes-differences-between-for-profit-and-nonprofit-quality-outcomes
#10
Jennifer Gaudet Hefele, Xiao Joyce Wang, Christine E Bishop, Adrita Barooah
Background and Objectives: Nursing homes (NHs) in the United States face increasing pressures to admit Medicare postacute patients, given higher payments relative to Medicaid. Changes in the proportion of residents who are postacute may initiate shifts in care practices, resource allocations, and priorities. Our study sought to determine whether increases in Medicare short-stay census have an impact on quality of care for long-stay residents. Research Design and Methods: This study used panel data (2005-2010) from publicly-available sources (Nursing Home Compare, Area Health Resource File, LTCFocus...
November 14, 2018: Gerontologist
https://www.readbyqxmd.com/read/30409493/aggressive-behaviors-among-nursing-home-residents-association-with-dementia-and-behavioral-health-disorders
#11
Xi Cen, Yue Li, Michael Hasselberg, Thomas Caprio, Yeates Conwell, Helena Temkin-Greener
OBJECTIVES: We measured the prevalence and severity of aggressive behaviors (ABs) among nursing home (NH) residents and examined whether individuals with behavioral health disorders were more likely to exhibit aggressive behaviors than others. SETTING AND PARTICIPANTS: The analytical sample included 3,270,713 first Minimum Data Set (MDS) assessments for residents in 15,706 NHs in 2015. MEASURES: Individuals were identified as having (1) behavioral health disorders only (hierarchically categorized as schizophrenia/psychosis, bipolar disorder, personality disorder, substance abuse, depression/anxiety); (2) dementia only; (3) behavioral health disorders and dementia; or (4) neither...
December 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/30406574/apathy-and-health-related-quality-of-life-in-nursing-home-residents
#12
Johanna M H Nijsten, Ruslan Leontjevas, Martin Smalbrugge, Raymond T C M Koopmans, Debby L Gerritsen
PURPOSE: To explore the association between apathy and health-related quality of life (HRQoL) from resident and proxy perspectives and whether cognition and depression moderate this relationship. METHODS: Secondary analyses with baseline data from a cluster randomized trial on the effects of a care program for depression in Nursing Homes (NHs) were conducted. For HRQoL, the Visual Analogue Scale (VAS) and the Dutch version of the European Quality of Life (EQ-5D) were administered to 521 NH residents, and to professional caregivers reporting from the perspective of the NH resident (Resident-Proxy) and from their own perspective (Proxy-Proxy)...
November 7, 2018: Quality of Life Research
https://www.readbyqxmd.com/read/30390429/associations-of-potentially-inappropriate-medication-use-with-four-year-survival-of-an-inception-cohort-of-nursing-home-residents
#13
Kristel Paque, Monique Elseviers, Robert Vander Stichele, Tinne Dilles, Koen Pardon, Luc Deliens, Thierry Christiaens
BACKGROUND: Survival in older adults has a high variability. The possible association of length of survival with potentially inappropriate medication (PIM) use remains unclear. AIM: To examine the four-year survival rate, the prevalence of polypharmacy and PIM use at admission, and the association between the two, in an inception cohort of newly admitted nursing home residents METHODS: Data were used from ageing@NH, a prospective observational cohort study in nursing homes...
October 26, 2018: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/30386370/the-impact-of-using-measurements-of-electrodermal-activity-in-the-assessment-of-problematic-behaviour-in-dementia
#14
Catharina A Melander, Basel Kikhia, Malin Olsson, Britt-Marie Wälivaara, Stefan Sävenstedt
Background: A major and complex challenge when trying to support individuals with dementia is meeting the needs of those who experience changes in behaviour and mood. Aim: To explore how a sensor measuring electrodermal activity (EDA) impacts assistant nurses' structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions. Methods: Fourteen individuals with dementia wore a sensor that measured EDA...
September 2018: Dementia and Geriatric Cognitive Disorders Extra
https://www.readbyqxmd.com/read/30385229/the-impact-of-incomplete-nursing-home-transfer-documentation-on-emergency-department-care
#15
Cameron J Gettel, Roland C Merchant, Yanan Li, Sara Long, Austin Tam, Sarah J Marks, Elizabeth M Goldberg
OBJECTIVES: Emergency department (ED) clinicians rely on the accuracy of written communication when assessing needs of nursing home (NH) residents. This study aimed to review the completeness of NH transfer documentation according to expected core components, as guided by the INTERACT 4.0 quality improvement tool. We also describe the association between patient or facility characteristics and transfer documentation completeness, as well as establish whether information gaps in NH-ED transfer documentation were associated with hospital admission...
October 29, 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/30370946/prevalence-of-cancer-and-management-in-elderly-nursing-home-residents-a-descriptive-study-in-45-french-nursing-homes
#16
Evelyne Liuu, Nicolas Guyot, Simon Valero, Amelie Jamet, Houria El Ouazzani, Patrick Bouchaert, Jean-Marc Tourani, Virginie Migeot, Marc Paccalin
This study aimed to determine cancer prevalence occurring after the age of 75 in 45 French nursing homes (NH), as well as residents' characteristics and parameters associated with cancer-specific management. Descriptive retrospective study including 214 residents (mean age, 89.7 years) with cancer diagnosed after age 75. The studied parameters were sociodemographic, functional, nutritional and cognitive data; comorbidity assessment; date of tumoral diagnosis; cancer type; tumoral stage; treatment plan; multidisciplinary staff decision and oncologic follow-up...
October 29, 2018: European Journal of Cancer Care
https://www.readbyqxmd.com/read/30366510/shall-i-stay-or-shall-i-go-the-choice-to-remain-in-the-nursing-home-among-residents-with-high-potential-for-discharge
#17
Kathleen Abrahamson, Zachary Hass, Greg Arling
Minnesota's Return to Community Initiative (RTCI) assists private-pay nursing home (NH) residents to return to the community. Using data from a 1-year admission cohort of RTCI-targeted NH residents, we examined why residents who at admission expressed a desire for discharge, were paying privately, and had relatively low-care needs chose to remain in the NH. Characteristics of those who remained were compared with those who discharged using logistic regression, and barriers to discharge were summarized. Residents who were older, more cognitively impaired (OR = 1...
October 26, 2018: Journal of Applied Gerontology: the Official Journal of the Southern Gerontological Society
https://www.readbyqxmd.com/read/30361189/impact-of-an-awareness-of-the-doctors-treating-on-the-decrease-of-the-prescriptions-of-antipsychotics-in-the-demented-residents-in-ehpad
#18
Anne-Sophie Philippe, David Braunstein, Priscilla Clot-Faybesse, Sylvie Teissier, Bénédicte Roch, Joëlle Micallef, Sylvie Bonin-Guillaume
BACKGROUND: Despite the context of several national warnings, antipsychotics drugs are commonly used to treat behavioural and psychological symptoms in dementia (BPSD). AIM: To observe a decrease of antipsychotic drug prescription, in old NH (nursing homes) residents with dementia, after an awareness of their general practitioner. METHODS: Observational, prospective, multicenter study. The study population corresponds to NH residents with dementia, and antipsychotic drug consumption, in nursing homes volunteered to participate...
October 25, 2018: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
https://www.readbyqxmd.com/read/30357589/private-equity-ownership-and-nursing-home-quality-an-instrumental-variables-approach
#19
Sean Shenghsiu Huang, John R Bowblis
Since the 2000s, private equity (PE) firms have been actively acquiring nursing homes (NH). This has sparked concerns that with stronger profit motive and aggressive use of debt financing, PE ownership may tradeoff quality for higher profits. To empirically address this policy concern, we construct a panel dataset of all for-profit NHs in Ohio from 2005 to 2010 and link it with detailed resident-level data. We compare the quality of care provided to long-stay residents at PE NHs and other for-profit (non-PE) NHs...
October 24, 2018: International Journal of Health Economics and Management
https://www.readbyqxmd.com/read/30353536/antihypertensive-drug-deintensification-and-recurrent-falls-in-long-term-care
#20
Wei Song, Orna Intrator, Sei Lee, Kenneth Boockvar
OBJECTIVE: To examine the relationship between antihypertensive drug deintensification and recurrent falls in long-term care. DATA SOURCES/SETTINGS: Department of Veterans Affairs (VA) inpatient, outpatient, and purchased care data, Minimum Data Set assessments from VA nursing homes (NHs), and Medicare claims from fiscal years 2010 - 2015. STUDY DESIGN: We identified NH residents with evidence of overaggressive antihypertensive treatment, defined as systolic blood pressure (SBP) 80-120 and an index fall...
December 2018: Health Services Research
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