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Nath B, Patel P, Oremus M. The association between religious participation and memory among middle-aged and older adults: A systematic review. PLoS One 2023; 18:e0290279. [PMID: 37594926 PMCID: PMC10437981 DOI: 10.1371/journal.pone.0290279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVES Mounting evidence suggests religion plays an important role in maintaining cognition. No prior systematic review has focused on the specific association between religion and the memory domain of cognition in middle-aged and older adults. We carried out a systematic review to explore this association in depth. METHODS We searched the PsycINFO, Scopus, and PubMed databases to identify articles assessing any means of measuring religion as the exposure and memory as the outcome. Articles had to report on studies with comparison groups to be eligible for inclusion in the review. We followed the PRISMA checklist to conduct the review (PROSPERO registration # CRD42022330389). RESULTS Nine out of the 1648 citations retrieved in the literature search were included in the review. The majority of included articles had a moderate risk of bias. Most results showed positive associations between religion and memory. DISCUSSION Despite consistency in the direction of association between religion and memory, the literature contained some important research gaps: the studies were cross-sectional; a lack of information existed regarding whether different faiths, sex/gender and depression affected the association; and underpowered studies prevented us from drawing firm conclusions about the direction or magnitude of effect. Longitudinal studies avoiding these issues are needed in this field.
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Affiliation(s)
- Bonita Nath
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Priya Patel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Hoogendijk EO, Onder G, Smalbil L, Vetrano DL, Hirdes JP, Howard EP, Morris JN, Fialová D, Szczerbińska K, Kooijmans EC, Hoogendoorn M, Declercq A, De Almeida Mello J, Leskelä RL, Häsä J, Edgren J, Ruppe G, Liperoti R, Joling KJ, van Hout HP. Optimising the care for older persons with complex chronic conditions in home care and nursing homes: design and protocol of I-CARE4OLD, an observational study using real-world data. BMJ Open 2023; 13:e072399. [PMID: 37385750 PMCID: PMC10314651 DOI: 10.1136/bmjopen-2023-072399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION In ageing societies, the number of older adults with complex chronic conditions (CCCs) is rapidly increasing. Care for older persons with CCCs is challenging, due to interactions between multiple conditions and their treatments. In home care and nursing homes, where most older persons with CCCs receive care, professionals often lack appropriate decision support suitable and sufficient to address the medical and functional complexity of persons with CCCs. This EU-funded project aims to develop decision support systems using high-quality, internationally standardised, routine care data to support better prognostication of health trajectories and treatment impact among older persons with CCCs. METHODS AND ANALYSIS Real-world data from older persons aged ≥60 years in home care and nursing homes, based on routinely performed comprehensive geriatric assessments using interRAI systems collected in the past 20 years, will be linked with administrative repositories on mortality and care use. These include potentially up to 51 million care recipients from eight countries: Italy, the Netherlands, Finland, Belgium, Canada, USA, Hong Kong and New Zealand. Prognostic algorithms will be developed and validated to better predict various health outcomes. In addition, the modifying impact of pharmacological and non-pharmacological interventions will be examined. A variety of analytical methods will be used, including techniques from the field of artificial intelligence such as machine learning. Based on the results, decision support tools will be developed and pilot tested among health professionals working in home care and nursing homes. ETHICS AND DISSEMINATION The study was approved by authorised medical ethical committees in each of the participating countries, and will comply with both local and EU legislation. Study findings will be shared with relevant stakeholders, including publications in peer-reviewed journals and presentations at national and international meetings.
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Affiliation(s)
- Emiel O Hoogendijk
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Louk Smalbil
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Elizabeth P Howard
- Connell School of Nursing, Boston College, Chestnut Hill, Boston, MA, USA
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - John N Morris
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Kraków, Poland
| | - Eline Cm Kooijmans
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anja Declercq
- LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | | | - Jokke Häsä
- Data and Analytics Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Edgren
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Georg Ruppe
- European Geriatric Medicine Society (EUGMS), Vienna, Austria
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Karlijn J Joling
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Medicine for Older People, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hein Pj van Hout
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Ageing and later life research program, Amsterdam, The Netherlands
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Hogeveen S, Donaghy-Hughes M, Nova A, Saari M, Sinn CLJ, Northwood M, Heckman G, Geffen L, Hirdes JP. The interRAI COVID-19 vulnerability screener: Results of a health surveillance initiative for vulnerable adults in the community during the COVID-19 pandemic. Arch Gerontol Geriatr 2023; 113:105056. [PMID: 37207541 PMCID: PMC10159666 DOI: 10.1016/j.archger.2023.105056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
During the pandemic, the interRAI COVID-19 Vulnerability Screener (CVS) was used to identify community-dwelling older adults or adults with disabilities at risk of negative outcomes and facilitate triage for follow-up with health/social services. The interRAI CVS, a standardized self-report instrument administered virtually by a lay-person, includes COVID-19-related items and psychosocial and physical vulnerability. Our objective was to describe those assessed and identify sub-groups at highest risk of adverse outcomes. Seven community-based organizations in Ontario, Canada, implemented the interRAI CVS. We used descriptive statistics to report results and created a priority indicator for monitoring and/or intervention based on possible COVID-19 symptoms and psychosocial/physical vulnerabilities. We used logistic regression to examine the association between priority level and risk of poor outcomes using fair/poor self-rated health as a proxy measure. The sample included 942 adults assessed (April-November 2020; mean age=79). About 10% of individuals reported potential COVID-19 symptoms and <1% had a positive COVID-19 test/diagnosis. Of those with psychosocial/physical vulnerabilities (73.1%), most common were depressed mood (20.9%), loneliness (21.6%), and limited access to food/medications (7.5%). Overall, 45.7% had a recent doctor or nurse practitioner visit. Odds of fair/poor self-reported health were highest among those who reported both possible symptoms of COVID-19 and psychosocial/physical vulnerabilities (OR 10.9, 95% CI 5.96-20.12) compared to those with neither symptoms nor psychosocial/physical vulnerabilities. The sample represents a population largely unaffected by COVID-19 itself but with identified vulnerabilities. The interRAI CVS allows community providers to stay connected and obtain a better understanding of vulnerable individuals' needs during the pandemic.
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Affiliation(s)
- Sophie Hogeveen
- McMaster Institute for Research on Aging, McMaster University, MIP Suite 109A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Megan Donaghy-Hughes
- Canadian College of Naturopathic Medicine, 1255 Sheppard Ave East, North York, ON M2K1E2, Canada.
| | - Amanda Nova
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada.
| | - Margaret Saari
- SE Research Centre, 90 Allstate Parkway, Suite 300, Markham, Ontario L3R 6H3, Canada.
| | - Chi-Ling Joanna Sinn
- McMaster Institute for Research on Aging, McMaster University, MIP Suite 109A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Melissa Northwood
- Faculty of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada.
| | - Leon Geffen
- Samson Institute for Ageing Research, 9 Gorge Road, Vredehoek 8001, South Africa.
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada.
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Robitaille A, Garcia L, Terrera GM. Differences in the longitudinal change of behaviours related to dementia in long-term care: a growth mixture modelling approach. BMC Geriatr 2023; 23:254. [PMID: 37106334 PMCID: PMC10141941 DOI: 10.1186/s12877-023-03933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/25/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND There is still a need for more information about the different trajectories of responsive behaviours that people living with dementia present in long-term care homes (LTC). OBJECTIVE This study identified subgroups of individuals with similar trajectories of responsive behaviours related to dementia in LTC and evaluated the role of demographic variables, depressive symptomatology, social engagement, cognitive functioning, and activities of daily living (ADL) on class membership. METHODS Growth mixture models were run using data from the Continuing Care Reporting System. RESULTS Results suggest that change in responsive behaviours is best represented by seven classes of trajectories. The largest class was composed of individuals who presented the lowest frequency of behaviours upon entry in LTC that increased at a slow linear rate. The other classes were composed of individuals who presented different frequencies of behaviours upon entry in LTC and varying rates of change (e.g., individuals who presented a low frequency of behaviours upon entry in LTC that increased at a linear rate followed by a decrease in the later months, individuals who presented a high frequency of responsive behaviours upon entry in LTC and that remained stable). Cognitive functioning, social engagement, depressive symptomatology, and ADL were markers of class membership. CONCLUSIONS These findings can help identify individuals at increased risk of presenting a high frequency of responsive behaviours and highlight interventions that could decrease behaviours in LTC.
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Affiliation(s)
- Annie Robitaille
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
- Centre of Excellence, Perley Health, Ottawa, ON, Canada.
| | - Linda Garcia
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Graciela Muniz Terrera
- Ohio University Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
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Eltaybani S, Kitamura S, Fukui C, Igarashi A, Sakka M, Noguchi‐Watanabe M, Takaoka M, Inagaki A, Yasaka T, Kobayashi H, Yamamoto‐Mitani N. Toward developing care outcome quality indicators for home care for older people: A prospective cohort study in Japan. Geriatr Gerontol Int 2023; 23:383-394. [PMID: 37132041 DOI: 10.1111/ggi.14578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Care quality in Japan's long-term care (LTC) agencies, including home care, is the responsibility primarily of individual agencies, and the evaluation of service processes and outcomes is minimal. OBJECTIVES To describe the development of quality indicators for LTC (QIs-LTC) in Japan. METHODS QIs-LTC were developed through literature review and expert panel discussions and then were piloted and used in a 2-year longitudinal survey. The survey (launched in September 2019) targeted older people receiving home care (n = 1450), their family members (n = 880), their professional home care providers (n = 577), and managers of home care agencies (n = 122). RESULTS Across eight domains (maintaining dignity, minimizing symptoms and disease deterioration, maintaining nutritional status, maintaining bladder/bowel control, encouraging physical activities, experiencing sound sleep, maintaining serenity and contentedness, and maintaining family's well-being), 24 care quality objectives were set with 24 outcome QIs-LTC and 144 process QIs-LTC. In the survey, 84.8% of clients were using home care nursing, 26.3% were living alone, and 39.5% had dementia. In the month preceding the data collection, 13.9% of clients had a new disease or worsening of an existing disease, 8.8% were hospitalized at least once, and 47.9% did not participate in activities of interest. About 20% of clients' families were unable to spend time peacefully, and 52.8% were exhausted from the client's care. CONCLUSIONS The QIs-LTC developed in the current study are generic and client- and family-centered. They encompass objective and subjective information and would facilitate standardized monitoring if adopted and comparison between LTC settings, including home care. In addition, future research directives are outlined. Geriatr Gerontol Int 2023; 23: 383-394.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
- Global Nursing Research Center (GNRC), The University of Tokyo Tokyo Japan
| | - Satomi Kitamura
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
- Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare Tokyo Japan
| | - Chie Fukui
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
| | - Mariko Sakka
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
- The Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Maiko Noguchi‐Watanabe
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
- Department of Home Care Nursing Tokyo Medical and Dental University Tokyo Japan
| | - Manami Takaoka
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
| | - Asa Inagaki
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
| | - Taisuke Yasaka
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
| | - Hiromi Kobayashi
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
| | - Noriko Yamamoto‐Mitani
- Department of Gerontological Home Care and Long‐term Care Nursing The University of Tokyo Tokyo Japan
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Northwood M, Turcotte LA, McArthur C, Egbujie BA, Berg K, Boscart VM, Heckman GA, Hirdes JP, Wagg AS. Changes in Urinary Continence After Admission to a Complex Care Setting: A Multistate Transition Model. J Am Med Dir Assoc 2022; 23:1683-1690.e2. [PMID: 35870485 DOI: 10.1016/j.jamda.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services. DESIGN Retrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected with interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care. SETTING AND PARTICIPANTS Adults aged 18 years and older, admitted to Complex Continuing Care hospitals in Ontario, Canada, between 2009 and 2015 (n = 78,913). METHODS A multistate transition model was used to characterize the association between patient characteristics measured at admission and changes in urinary continence state transitions (continent, sometimes continent, and incontinent) between admission and follow-up. RESULTS The cohort included 27,896 patients. At admission, 9583 (34.3%) patients belonged to the continent state, 6441 (23.09%) patients belonged to the sometimes incontinent state, and the remaining 11,872 (42.6%) patients belonged to the incontinent state. For patients who were continent at admission, the majority (62.7%) remained continent at follow-up. However, nearly a quarter (23.9%) transitioned to the sometimes continent state, and an additional 13.4% became incontinent at follow-up. Several factors were associated with continence state transitions, including cognitive impairment, rehabilitation potential, stroke, Parkinson's disease, Alzheimer's disease and related dementias, and hip fracture. CONCLUSIONS AND IMPLICATIONS This study suggests that urinary incontinence is a prevalent problem for Complex Continuing Care hospital patients and multiple factors are associated with continence state transitions. Standardized assessment of urinary incontinence is helpful in this setting to identify patients in need of further assessment and patient-centered intervention and as a quality improvement metric to examine changes in continence from admission to discharge.
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Affiliation(s)
| | - Luke A Turcotte
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Katherine Berg
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Adrian S Wagg
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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Outcomes of advance care directives after admission to a long-term care home: DNR the DNH? BMC Geriatr 2022; 22:22. [PMID: 34979935 PMCID: PMC8725447 DOI: 10.1186/s12877-021-02699-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Residents of long-term care homes (LTCH) often experience unnecessary and non-beneficial hospitalizations and interventions near the end-of-life. Advance care directives aim to ensure that end-of-life care respects resident needs and wishes. Methods In this retrospective cohort study, we used multistate models to examine the health trajectories associated with Do-Not-Resuscitate (DNR) and Do-Not-Hospitalize (DNH) directives of residents admitted to LTCH in Ontario, Alberta, and British Columbia, Canada. We adjusted for baseline frailty-related health instability. We considered three possible end states: change in health, hospitalization, or death. For measurements, we used standardized RAI-MDS 2.0 LTCH assessments linked to hospital records from 2010 to 2015. Results We report on 123,003 LTCH residents. The prevalence of DNR and DNH directives was 71 and 26% respectively. Both directives were associated with increased odds of transitioning to a state of greater health instability and death, and decreased odds of hospitalization. The odds of hospitalization in the presence of a DNH directive were lowered, but not eliminated, with odds of 0.67 (95% confidence interval 0.65–0.69), 0.63 (0.61–0.65), and 0.47 (0.43–0.52) for residents with low, moderate and high health instability, respectively. Conclusion Even though both DNR and DNH orders are associated with serious health outcomes, DNH directives were not frequently used and often overturned. We suggest that policies recommending DNH directives be re-evaluated, with greater emphasis on advance care planning that better reflects resident values and wishes.
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Hirdes JP, Morris JN, Perlman CM, Saari M, Betini GS, Franco-Martin MA, van Hout H, Stewart SL, Ferris J. Mood Disturbances Across the Continuum of Care Based on Self-Report and Clinician Rated Measures in the interRAI Suite of Assessment Instruments. Front Psychiatry 2022; 13:787463. [PMID: 35586405 PMCID: PMC9108209 DOI: 10.3389/fpsyt.2022.787463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/25/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mood disturbance is a pervasive problem affecting persons of all ages in the general population and the subset of those receiving services from different health care providers. interRAI assessment instruments comprise an integrated health information system providing a common approach to comprehensive assessment of the strengths, preferences and needs of persons with complex needs across the continuum of care. OBJECTIVE Our objective was to create new mood scales for use with the full suite of interRAI assessments including a composite version with both clinician-rated and self-reported items as well as a self-report only version. METHODS We completed a cross-sectional analysis of 511,641 interRAI assessments of Canadian adults aged 18+ in community mental health, home care, community support services, nursing homes, palliative care, acute hospital, and general population surveys to develop, test, and refine new measures of mood disturbance that combined clinician and self-rated items. We examined validity and internal consistency across diverse care settings and populations. RESULTS The composite scale combining both clinician and self-report ratings and the self-report only variant showed different distributions across populations and settings with most severe signs of disturbed mood in community mental health settings and lowest severity in the general population prior to the COVID-19 pandemic. The self-report and composite measures were strongly correlated with each other but differed most in populations with high rates of missing values for self-report due to cognitive impairment (e.g., nursing homes). Evidence of reliability was strong across care settings, as was convergent validity with respect to depression/mood disorder diagnoses, sleep disturbance, and self-harm indicators. In a general population survey, the correlation of the self-reported mood scale with Kessler-10 was 0.73. CONCLUSIONS The new interRAI mood scales provide reliable and valid mental health measures that can be applied across diverse populations and care settings. Incorporating a person-centered approach to assessment, the composite scale considers the person's perspective and clinician views to provide a sensitive and robust measure that considers mood disturbances related to dysphoria, anxiety, and anhedonia.
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Affiliation(s)
- John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Margaret Saari
- SE Research Centre, SE Health and Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gustavo S Betini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Hein van Hout
- Department of General Practice and Medicine for Older Persons, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shannon L Stewart
- Faculty of Education, Western University (Canada), London, ON, Canada
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Iheme L, Hirdes JP, Geffen L, Heckman G, Hogeveen S. Psychometric Properties, Feasibility, and Acceptability of the Self-Reported interRAI Check-Up Assessment. J Am Med Dir Assoc 2021; 23:117-121. [PMID: 34197792 DOI: 10.1016/j.jamda.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the feasibility, acceptability, and psychometric properties of the self-report version of the interRAI Check-Up (CUSR). DESIGN Cross-sectional study of participant ratings of item content and difficulty completing the CUSR. Participants were also randomly assigned to complete the assessment by themselves or with help from a lay interviewer. SETTINGS AND PARTICIPANTS A total of 184 older adults from diverse backgrounds, served by 6 Canadian organizations in Ontario and Nova Scotia were recruited. Settings ranged from retirement communities for healthy older adults to assisted living facilities. MEASURES/METHODS Time to complete the interRAI CUSR was tracked automatically. Participants self-reported on what items they wanted to have modified, added, or deleted. The also rated whether items were embarrassing or difficult to complete. Psychometric properties were examined between the 2 approaches to completion and were benchmarked against existing reports on psychometric properties of clinician-led home care assessments. RESULTS The interRAI CUSR takes about 28 minutes to complete with both self-administered and lay interviewer approaches. The convergent validity and reliability of CUSR is comparable to those of clinician-based assessments like the Resident Assessment Instrument-Home Care. Most participants had no difficulty completing the assessment, and none rated the task as very difficult. Poor self-rated health and difficulty with phone use were predictive of any difficult in completing the assessment in a multivariate logistic regression. Most participants reported that CUSR adequately described their health needs, but arthritis, hypertension, and mental health issues were identified as items to be added by participants. CONCLUSIONS AND IMPLICATIONS The CUSR is an appropriate, feasible assessment system with good psychometric properties for use with general populations, including primary care, community services, and patient-reported outcome measurement studies. Interoperability with other interRAI assessments makes it an ideal system to use to obtain a longitudinal view of the person's needs over time.
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Affiliation(s)
- Linda Iheme
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
| | - Leon Geffen
- Samson Institute for Ageing Research, Cape Town, South Africa
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada; Schlegel Research Institute for Aging, Waterloo, Canada
| | - Sophie Hogeveen
- Women's College Hospital, Institute for Health System Solutions and Virtual Care, Toronto, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
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Hanson HM, Léveillé T, Cole M, Soril LJ, Clement F, Wagg A, Silvius J. Effect of a multimethod quality improvement intervention on antipsychotic medication use among residents of long-term care. BMJ Open Qual 2021; 10:bmjoq-2020-001211. [PMID: 33846124 PMCID: PMC8051411 DOI: 10.1136/bmjoq-2020-001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/16/2021] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Antipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted to address inappropriate antipsychotic medication use in long-term care (LTC) in the province of Alberta. METHODS We conducted a multimethod evaluation of the provincial implementation of the project in 170 LTC sites over a 3-year project period incorporating a quasi-experimental before-after design. Using a three-component intervention of education and audit and feedback delivered in a learning workshop innovation collaborative format, local LTC teams were supported to reduce the number of residents receiving antipsychotic medications in the absence of a documented indication. Project resources were preferentially allocated to supporting sites with the highest baseline antipsychotic medication use. Changes in antipsychotic medication use, associated clinical and economic outcomes, and the effects of the project on LTC staff, physicians, leaders and administrators, and family members of LTC residents were assessed at the conclusion of the implementation phase. RESULTS The province-wide initiative was delivered with a 75% implementation fidelity. Inappropriate antipsychotic medication use declined from 26.8% to 21.1%. The decrease was achieved without unintended consequences in other outcomes including physical restraint use or aggressive behaviours. The project was more expensive but resulted in less inappropriate use of antipsychotics than the pre-project period (incremental cost per inappropriate antipsychotic avoided of $5 678.71). Accounts from family, organisational leaders, and LTC staff were supportive of the project activities and outcomes. CONCLUSION This quality improvement initiative was successfully delivered across an entire delivery arm of the continuing care sector. Quality of care in LTC was improved.
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Affiliation(s)
- Heather M Hanson
- Seniors Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada .,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tova Léveillé
- Data & Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Mollie Cole
- Seniors Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lesley Jj Soril
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Health Technology Assessment Unit, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Health Technology Assessment Unit, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Wagg
- Seniors Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - James Silvius
- Seniors Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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11
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Frailty inclusive care in acute and community-based settings: a systematic review protocol. Syst Rev 2021; 10:83. [PMID: 33771224 PMCID: PMC8004471 DOI: 10.1186/s13643-021-01638-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/12/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Frailty is a known risk factor for an array of adverse outcomes including more frequent and prolonged health services use and high health care costs. Aging of the population has implications for care provision across the care continuum, particularly for people living with frailty. Despite known risks associated with frailty, there has been limited research on care pathways that address the needs of persons living with frailty. Our study aims to review and examine, in a rigorous way, the quality of evidence for multi-component interventions and care pathways focused on frailty. METHODS A comprehensive electronic search strategy will be used to identify studies that evaluate multi-component interventions or care pathways for persons living with frailty. The search strategy will include terms for frailty, multi-component interventions, effectiveness, and cost effectiveness applied to the following databases: MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews. An adapted search for Google Scholar and gray literature databases will also be used. References of included studies will be hand-searched for additional citations of frailty-inclusive care. Known experts and corresponding authors of identified articles will be contacted by email to identify further eligible studies. Risk of bias will be assessed using the Effective Public Health Practice Project Quality Assessment tool. Data will be extracted from eligible studies and it is anticipated that narrative analysis will be used. If studies with sufficient homogeneity are found, then pooled effects will be reported using meta-analysis. DISCUSSION This review will appraise the evidence currently available on multi-component frailty interventions. Results will inform on clinical pathway development for people living with frailty across the care continuum and will guide future research to address gaps in the literature and areas in need of further development. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020166733.
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12
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LeBlanc K, Woo KY, VanDenKerkhof E, Woodbury MG. Risk Factors Associated with Skin Tear Development in the Canadian Long-term Care Population. Adv Skin Wound Care 2021; 34:87-95. [PMID: 33021599 DOI: 10.1097/01.asw.0000717232.03041.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Skin tears (STs) are prevalent wounds found in aging populations and in particular among those living in long-term care (LTC) settings. They are often misunderstood as expected outcomes of aging and as a result are frequently underrecognized and undertreated. Although many factors have been associated with ST development, there is little evidence to corroborate their roles as ST risks. OBJECTIVE To examine the risk factors associated with ST development in the Ontario LTC population. METHODS A prospective study design was used to explore the risk factors associated with ST development. A total of 380 individuals 65 years or older from four LTC facilities in Ontario were examined for STs at the beginning of the study and at week 4 to determine if STs had occurred. RESULTS The study found an ST prevalence of 20.8% and an incidence of 18.9%. History of an ST at baseline (relative ratio [RR], 1.84; 95% confidence interval [CI], 1.25-2.70; P = .002); the presence of skin changes associated with aging, ecchymosis, and hematomas (RR, 1.60; 95% CI, 1.43-1.79; P < .001); chronic disease (RR, 1.17; 95% CI, 1.03-1.32; P = .018); requiring assistance with activities of daily living (RR, 1.13; 95% CI, 1.08-1.18; P < .001); and displaying aggressive behavior (RR, 1.06; 95% CI, 1.02-1.10; P = .001) were key risk factors associated with ST development. CONCLUSIONS These results provide much needed Ontario data on the risk factors associated with ST development and can be used to support prevention programs mitigating ST risk.
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Affiliation(s)
- Kimberly LeBlanc
- Kimberly LeBlanc, PhD, RN, NSWOC, is Chair, Wound, Ostomy and Continence Institute; Adjunct Professor, MClSc Program, School of Physical Therapy, Faculty of Health Sciences, Western University; and Affiliate Faculty, Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Kevin Y. Woo, PhD, RN, NSWOC, FAPWCA, is Associate Professor, School of Nursing, Queen's University; and Adjunct Professor, MClSc Program, School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario. Elizabeth VanDenKerkhof, DrPH, RN, is Professor and Sally Smith Chair in Nursing, School of Nursing, Queen's University, Toronto. M. Gail Woodbury, PhD, is Adjunct Assistant Professor, School of Rehabilitation Therapy, Queen's University. The authors have disclosed no financial relationships related to this article. Submitted October 20, 2019; accepted in revised form December 10, 2019; published ahead of print October 6, 2020
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13
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Stewart SL, Celebre A, Head MJ, James ML, Martin L, Fries BE. A Case-Mix System for Children and Youth With Developmental Disabilities. Health Serv Insights 2020; 13:1178632920977899. [PMID: 33414639 PMCID: PMC7750751 DOI: 10.1177/1178632920977899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022] Open
Abstract
Limited funding across health and social service programs presents a challenge
regarding how to best match resources to the needs of the population. There is
increasing consensus that differences in individual characteristics and care
needs should be reflected in variations in service costs, which has led to the
development of case-mix systems. The present study sought to develop a new
approach to allocate resources among children and youth with intellectual and
developmental disabilities (IDD) as part of a system-wide Medicaid payment
reform initiative in Arkansas. To develop the system, assessment data collected
using the interRAI Child and Youth Mental Health-Developmental Disability
instrument was matched to paid service claims. The sample consisted of 346
children and youth with developmental disabilities in the home setting. Using
automatic interactions detection, individuals were sorted into unique,
clinically relevant groups (ie, based on similar resource use) and a
standardized relative measure of the cost of services provided to each group was
calculated. The resulting case-mix system has 8 distinct, final groups and
explains 30% of the variance in per diem costs. Our analyses indicate that this
case-mix classification system could provide the foundation for a future
prospective payment system that is centered around stability and equitability in
the allocation of limited resources within this vulnerable population.
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Affiliation(s)
| | - Angela Celebre
- Faculty of Education, Western University, London, ON, Canada
| | | | - Mary L James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Brant E Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
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14
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Factors That Predict 1-Year Incident Hip and Non-Hip Fractures for Home Care Recipients: A Linked-Data Retrospective Cohort Study. J Am Med Dir Assoc 2020; 22:1035-1042. [PMID: 33008757 DOI: 10.1016/j.jamda.2020.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of our study was to identify factors that predict 1-year incident hip and major osteoporotic non-hip fractures (ie, wrist, spine, pelvis, humerus) for home care recipients while accounting for the competing risk of death. DESIGN We conducted a retrospective cohort study with linked population data. SETTING AND PARTICIPANTS All home care recipients in Ontario, Canada, receiving services for more than 6 months with an admission assessment between April 1, 2011, and March 31, 2015, were included. METHODS Clinical data from the Resident Assessment Instrument Home Care were linked to fracture data from the Discharge Abstract Database and the National Acute Care Reporting System. Competing risk proportional hazard regressions using the Fine and Grey method were performed to model the association between potential risk factors and fracture. RESULTS Previous fall, previous fracture, cognitive impairment, unsteady gait, alcohol use, tobacco use, and Parkinson disease were consistently associated with all fracture types. Cognitive impairment (hazard ratio 2.09; 95% confidence interval 1.86-2.36) and wandering [1.66 (1.06-1.27)] were most predictive of hip fractures and being female [1.86 (1.76-1.98)] and experiencing a previous fracture [1.86 (1.76-1.98)] were most predictive of non-hip fractures. Risk factors unique to non-hip fractures as compared with hip fractures were locomotion ability outdoors and psychotropic medication use. CONCLUSIONS AND IMPLICATIONS Our results indicate that, in addition to typical fracture risk factors, home care recipients have unique characteristics that increase their risk. Fracture risk assessment tools and subsequent prevention strategies should be modified to accurately identify home care recipients at risk for imminent 1-year fracture.
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15
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The Post-Acute Delayed Discharge Risk Scale: Derivation and Validation With Ontario Alternate Level of Care Patients in Ontario Complex Continuing Care Hospitals. J Am Med Dir Assoc 2020; 21:538-544.e1. [DOI: 10.1016/j.jamda.2019.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 11/20/2022]
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16
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Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL, Van Audenhove C. The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front Psychiatry 2020; 10:926. [PMID: 32076412 PMCID: PMC6978285 DOI: 10.3389/fpsyt.2019.00926] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
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Affiliation(s)
- John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Coline van Everdingen
- Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Brant E. Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Jyrki Heikkilä
- Division of Psychiatry, Turku University Hospital, Turku, Finland
| | - Alice Hirdes
- Graduate Program in Health Promotion, Human Development and Society, Lutheran University of Brazil, Canoas, Brazil
| | - Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Mary L. James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Lynn Martin
- Department of Health Sciences for Lynn Martin, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher M. Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Shannon L. Stewart
- Faculty of Education, Althouse College, Western University, London, ON, Canada
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy & Academic Center for General Practice in the Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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17
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Igarashi A, Eltaybani S, Takaoka M, Noguchi-Watanabe M, Yamamoto-Mitani N. Quality Assurance in Long-Term Care and Development of Quality Indicators in Japan. Gerontol Geriatr Med 2020; 6:2333721420975320. [PMID: 35047653 PMCID: PMC8762483 DOI: 10.1177/2333721420975320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/13/2020] [Accepted: 10/27/2020] [Indexed: 11/15/2022] Open
Abstract
Dealing with an aging society is a global challenge, and more countries than ever before are now mobilizing their healthcare systems to provide high-quality long-term care (LTC) to older adults. This paper reviews the current situation pertaining to aging and the issues for measuring the LTC quality in Japan. It also introduces current efforts to develop quality indicators for measuring LTC quality. Assuring the quality of LTC and developing indicators to measure its quality is a challenge worldwide. Detailed systems for LTC quality measurement have been developed and managed, primarily in the US. In Japan, on the other hand, such systems do not exist; the public LTC system mostly depends on the evaluation of structural aspects, such as facility structure and staffing. Our research group has been developing quality indicators to measure LTC quality. In the future, we aim to evaluate care quality in various LTC settings using the proposed quality indicators, aiming to improve care quality across LTC settings in the community-based integrated care system.
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18
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Kadu M, Heckman GA, Stolee P, Perlman C. Risk of Hospitalization in Long-Term Care Residents Living with Heart Failure: a Retrospective Cohort Study. Can Geriatr J 2019; 22:171-181. [PMID: 31885757 PMCID: PMC6887138 DOI: 10.5770/cgj.22.366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Older adults living with heart failure (HF) in long-term care (LTC) experience frequent hospitalization. Using routinely available clinical information, we examined resident-level factors that precipitate hospitalization within 90 days of admission to LTC. METHODS This was a retrospective cohort study of older adults diagnosed with HF, who were admitted to LTC in Ontario, Canada, between 2011 and 2013. Multivariate logistic regression models using generalized estimating equations were developed to determine predictors of hospitalization in residents with HF. RESULTS Entry to LTC from a hospital was the strongest predictor of future hospitalization (OR: 8.1, 95% CI: 7.1-9.3), followed by a score of three or greater on the Changes in Health, End-stage Signs and Symptoms scale, a measure of moderate to severe medical instability (O.R 4.2, 95% CI: 3.1-5.9). Other variables that increased the likelihood of hospitalization included being flagged as a high risk for falls, two or more physician visits, and increased monitoring for acute medical illness within 14 days of admission. CONCLUSION Our findings highlight that health instability and transitions from acute to LTC will increase the likelihood of transitioning back into the hospital setting. The identified predisposing factors suggest the need for targeted prevention strategies for those in high-risk groups.
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Affiliation(s)
- Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - George A. Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Schlegel-University of Waterloo Research Institute on Aging, Waterloo, ON, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Christopher Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Malley J, D'Amico F, Fernandez JL. What is the relationship between the quality of care experience and quality of life outcomes? Some evidence from long-term home care in England. Soc Sci Med 2019; 243:112635. [DOI: 10.1016/j.socscimed.2019.112635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022]
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Groot Kormelinck CM, van Teunenbroek CF, Kollen BJ, Reitsma M, Gerritsen DL, Smalbrugge M, Zuidema SU. Reducing inappropriate psychotropic drug use in nursing home residents with dementia: protocol for participatory action research in a stepped-wedge cluster randomized trial. BMC Psychiatry 2019; 19:298. [PMID: 31606036 PMCID: PMC6790012 DOI: 10.1186/s12888-019-2291-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Psychotropic drugs are often prescribed to treat neuropsychiatric symptoms in nursing home residents with dementia, despite having limited efficacy and considerable side effects. To reduce the inappropriate prescribing of these psychotropic drugs, various non-pharmacological, psychosocial, person-centered, or multidisciplinary interventions are advocated. However, existing multidisciplinary interventions have shown variable effects, with limited effectiveness often resulting from suboptimal implementation. We hypothesize that an effective intervention needs to fit the local situation of a nursing home and that support should be offered during implementation. METHODS We will embed participatory action research within a stepped-wedge cluster randomized controlled trial to study the effects of a tailored intervention and implementation plan to reduce inappropriate psychotropic drug prescribing. Nursing homes will be provided with tailored information about the perceived problems of managing neuropsychiatric symptoms and we will offer coaching support throughout. Alongside the participatory action research, we will perform a process evaluation to examine the quality of the study, the intervention, and the implementation. Our aim is to recruit 600 residents from 16 nursing homes throughout the Netherlands, with measurements taken at baseline, 8 months, and 16 months. Nursing homes will be randomly allocated to an intervention or a deferred intervention group. During each intervention stage, we will provide information about inappropriate psychotropic drug prescribing, neuropsychiatric symptoms, and difficulties in managing neuropsychiatric symptoms through collaboration with each nursing home. After this, a tailored intervention and implementation plan will be written and implemented, guided by a coach. The primary outcome will be the reduction of inappropriate prescribing, as measured by the Appropriate Psychotropic drug use In Dementia index. Secondary outcomes will be the frequency of psychotropic drug use and neuropsychiatric symptoms, plus quality of life. A mixed methods design will be used for the process evaluation. Effects will be assessed using multilevel analyses. The project leader of the nursing home and the coach will complete questionnaires and in-depth interviews. DISCUSSION We anticipate that the proposed tailored intervention with coaching will reduce inappropriate psychotropic drug prescribing for nursing home residents with neuropsychiatric symptoms. This study should also provide insights into the barriers to, and facilitators of, implementation. TRIAL REGISTRATION NTR5872 , registered on July 2, 2016.
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Affiliation(s)
- Claudia M. Groot Kormelinck
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Charlotte F. van Teunenbroek
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Boudewijn J. Kollen
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Margreet Reitsma
- grid.438099.fVilans, (Center of Expertise for Long-term Care), PO Box 8228, 3503 RE Utrecht, The Netherlands
| | - Debby L. Gerritsen
- 0000 0004 0444 9382grid.10417.33Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, location VUmc/Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Sytse U. Zuidema
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
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Dalby DM, Hirdes JP, Stolee P, Strong JG, Poss J, Tjam EY, Bowman L, Ashworth M. Development and Psychometric Properties of a Standardized Assessment for Adults who are Deaf-Blind. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x0910300103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The internal consistency and validity of the interRAI Community Health Assessment and Deafblind Supplement were tested with 182 persons with deaf-blindness. All subscales demonstrated good to excellent internal consistency, and expected associations provided evidence of convergent validity. This instrument can facilitate standardized service planning for persons with deaf-blindness.
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Affiliation(s)
- Dawn M. Dalby
- Department of Kinesiology and Physical Education, BA 521, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, Canada, N2L 3C5
| | - John P. Hirdes
- Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada, N2L 3G1, and director, Homewood Research Institute, Guelph, ON, Canada
| | - Paul Stolee
- Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada N2L 3G1
| | - J. Graham Strong
- Centre for Sight Enhancement and School of Optometry, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Jeff Poss
- Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada, N2L 3G1
| | - Erin Y. Tjam
- St. Mary's General Hospital, 911 Queen's Boulevard, Kitchener, ON, N2M 1B2, Canada
| | - Lindsay Bowman
- Public health planner, Family and Community Resources, Region of Waterloo Public Health, 99 Regina Street South, Waterloo, Ontario, N2J 4V3, Canada
| | - Melody Ashworth
- Ontario Institute for Studies in Education, Department of Human Development and Applied Psychology, University of Toronto, 252 Bloor Street West, Toronto, ON, Canada, M5S 1V6
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Gill C, Hillier LM, Crandall JM, Johnston J. Nursing Guidelines for End-Of-Life Care in Long-Term Care Settings: Sustainable Improvements to Care. J Palliat Care 2018. [DOI: 10.1177/082585971102700308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carole Gill
- LM Hillier (corresponding author) Specialized Geriatric Services, St. Joseph's Health Care London, and Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, 801 Commissioners Road East, London, Ontario, Canada, N6C 5J1
| | - Loretta M. Hillier
- Palliative Pain and Symptom Management Consultation Program—Southwestern Ontario, Windsor, Ontario, Canada
| | - Jacqueline M. Crandall
- London Health Sciences Centre; Faculty of Nursing, University of Western Ontario; and Department of Interdisciplinary Studies, King's University College, London, Ontario, Canada
| | - Julie Johnston
- Palliative Pain and Symptom Management Consultation Program— Southwestern Ontario, London, Ontario, Canada
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Heckman GA, Hirdes JP, Hébert PC, Morinville A, Amaral ACKB, Costa A, McKelvie RS. Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure. J Am Med Dir Assoc 2018; 20:438-443. [PMID: 30573437 DOI: 10.1016/j.jamda.2018.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/25/2018] [Accepted: 10/30/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To understand how a heart failure diagnosis and admission health instability predict health transitions and outcomes among newly admitted nursing home residents. DESIGN Retrospective cohort study of linked administrative data, including the Continuing Care Report System MDS 2.0 for nursing homes, the Discharge Abstract Database for hospitalized patients, and National Ambulatory Care Reporting System to track emergency department visits. SETTING AND PARTICIPANTS Older adults, aged 65 years and above, admitted to nursing homes in Ontario, Alberta, and British Columbia, Canada, from 2010 to 2016. MEASURES Mortality and hospitalization were plotted over 1 year. Multistate Markov models were used to estimate adjusted odds ratios (ORs) for transitions to different states of health in stability, hospitalization, and death, stratified by heart failure diagnosis and by interRAI Changes in Health and End-stage disease Signs and Symptoms (CHESS) score, at 90 days following admission to a nursing home. RESULTS The final sample included 143,067 residents. Adverse events were most common in the first 90 days. A diagnosis of heart failure predicted worsening health instability, hospitalizations, and mortality. The effect of heart failure on hospitalizations and death was strongest for low baseline health instability (CHESS = 0; OR 1.63, 95% confidence interval (CI) 1.58-1.68, and OR 1.71, 95% CI 1.57-1.86, respectively), versus moderate instability (CHESS = 1-2; OR 1.36, 95% CI 1.32-1.39, and OR 1.48, 95% CI 1.41-1.55), versus high instability (CHESS = 3; OR 1.12, 95% CI 1.03-1.23, and OR 1.21, 95% CI 1.11-1.32). The magnitude of the impact of a heart failure diagnosis was greatest for lower baseline health instability. Residents with the highest degree of health instability were also most likely to die in hospital. CONCLUSIONS AND IMPLICATIONS A diagnosis of heart failure and health instability provide complementary information to predict transfers, deaths, and adverse outcomes. Clearly identifying these at-risk patients may be useful in targeting interventions in nursing homes.
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Affiliation(s)
- George A Heckman
- Research Institute for Ageing, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
| | - John P Hirdes
- Research Institute for Ageing, Waterloo, Ontario, Canada
| | - Paul C Hébert
- Département de Médecine, Université de Montréal et Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Anne Morinville
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Andre C K B Amaral
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Costa
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Woo K, LeBlanc K. Prevalence of skin tears among frail older adults living in Canadian long-term care facilities. Int J Palliat Nurs 2018; 24:288-294. [DOI: 10.12968/ijpn.2018.24.6.288] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Woo
- Associate Professor, School of Nursing and School of Rehabilitation, Queen's University, Kingston, Canada
| | - Kim LeBlanc
- Academy Chair, Canadian Association for Enterostomal Therapists
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Psychometric Evaluation of the interRAI Child and Youth Mental Health Disruptive/Aggression Behaviour Scale (DABS) and Hyperactive/Distraction Scale (HDS). Child Psychiatry Hum Dev 2018; 49:279-289. [PMID: 28791517 DOI: 10.1007/s10578-017-0751-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The present study aims to validate the interRAI Child and Youth Mental Health (interRAI ChYMH), Disruptive/Aggression Behaviour Scale (DABS) and Hyperactive/Distraction Scale (HDS). Data were collected from children/youth aged 4-18 (N = 3464) across 39 mental health agencies in Ontario, Canada. Unrestricted factor analysis using polychoric correlation matrices and Samejima's graded item response theory (IRT) parameterizations were conducted for both measures. Scores on the HDS and DABS were also compared amongst children/youth diagnosed with attention-deficit hyperactivity disorder (ADHD) and disruptive behaviour disorder (DBD) respectively using DSM-IV criteria. Results from the factor analysis and IRT analysis demonstrated good measurement properties. Using a receiver operating characteristics curve, the area under the curve (AUC) for the HDS and DABS is 0.79 and 0.75 for a diagnosis of ADHD and DBD respectively. Overall, converging results suggest that the interRAI HDS and DABS may serve as effective measures that detect externalizing mental health indicators.
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Abtan R, Rotondi NK, Macpherson A, Rotondi MA. The effect of informal caregiver support on utilization of acute health services among home care clients: a prospective observational study. BMC Health Serv Res 2018; 18:73. [PMID: 29386027 PMCID: PMC5793410 DOI: 10.1186/s12913-018-2880-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency department visits and hospitalizations (EDVH) place a large burden on patients and the health care system. The presence of informal caregivers may be beneficial for reducing EDVH among patients with specific diagnoses. Our objective was to determine whether the presence of an informal caregiver was associated with the occurrence of an EDVH among clients 50 years of age or older. METHODS Using a database accessed through the Toronto Central Community Care Access Centre (CCAC), we identified 479 adults over 50 years of age who received home care in Toronto, Canada. Exposure variables were extracted from the interRAI health assessment form completed at the time of admission to the CCAC. EDVH data were linked to provincial records through the CCAC database. Data on emergency room visits were included for up to 6 months after time of admission to home care. Multiple logistic regression analysis was used to identify factors associated with the occurrence of an EDVH. RESULTS Approximately half of all clients had an EDVH within 180 days of admission to CCAC home care. No significant association was found between the presence of an informal caregiver and the occurrence of an EDVH. Significant factors associated with an EDVH included: Participants having a poor perception of their health (adjusted OR = 1.68, 95% CI: 1.11-2.56), severe cardiac disorders (adjusted OR = 1.54, 95% CI: 1.04-2.29), and pulmonary diseases (adjusted OR = 1.99, 95% CI: 1.16-3.47). CONCLUSIONS The presence of an informal caregiver was not significantly associated with the occurrence of an EDVH. Future research should examine the potential associations between length of hospital stay or quality of life and the presence of an informal caregiver. In general, our work contributes to a growing body of literature that is increasingly concerned with the health of our aging population, and more specifically, health service use by elderly patients, which may have implications for health care providers.
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Affiliation(s)
- Robert Abtan
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON Canada
| | - Nooshin Khobzi Rotondi
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Alison Macpherson
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON Canada
| | - Michael Anthony Rotondi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON Canada
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The Rest of the Story: A Qualitative Study of Complementing Standardized Assessment Data with Informal Interviews with Older Patients and Families. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:215-224. [PMID: 27596366 DOI: 10.1007/s40271-016-0193-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND While standardized health assessments capture valuable information on patients' demographic and diagnostic characteristics, health conditions, and physical and mental functioning, they may not capture information of most relevance to individual patients and their families. Given that patients and their informal caregivers are the experts on that patient's unique context, it is important to ensure they are able to convey all relevant personal information to formal healthcare providers so that high-quality, patient-centered care may be delivered. This study aims to identify information that older patients and families consider important but that might not be included in standardized assessments. METHODS Transcripts were analyzed from 29 interviews relating to eight patients with hip fractures from three sites (large urban, smaller urban, rural) in two provinces in Canada. These interviews were conducted as part of a larger ethnographic study. Each transcript was analyzed by two researchers using content analysis. Results were reviewed in two focus group interviews with older adults and family caregivers. Identified themes were compared with items from two standardized assessments used in healthcare settings. RESULTS Three broad themes emerged from the qualitative analysis that were not covered in the standardized assessments: informal caregiver and family considerations, insider healthcare knowledge, and patients' healthcare attitudes and experiences. The importance of these themes was confirmed through focus group interviews. Focus group participants also emphasized the importance of conducting assessments in a patient-centered way and the importance of open-ended questions. CONCLUSIONS A less structured interview approach may yield information that would otherwise be missed in standardized assessments. Combining both sources could yield better-informed healthcare planning and quality-improvement efforts.
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Heckman GA, Crizzle AM, Chen J, Pringsheim T, Jette N, Kergoat MJ, Eckel L, Hirdes JP. Clinical Complexity and Use of Antipsychotics and Restraints in Long-Term Care Residents with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 7:103-115. [PMID: 27689617 DOI: 10.3233/jpd-160931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) and/or Parkinsonism are affected by a complex burden of comorbidity. Many ultimately require institutional care, where they may be subject to the application of physical restraints or the prescription of antipsychotic medications, making them more vulnerable to adverse outcomes. OBJECTIVES The objectives of this paper are to: 1) describe the clinical complexity of older institutionalized persons with PD; and 2) examine patterns and predictors of restraint use and prescription of antipsychotics in this population. METHODS Population-based cross-sectional cohort study. Residents with PD and/or Parkinsonism living in long-term care (LTC) facilities in 6 Canadian provinces and 1 Northern Territory and Complex Continuing Care (CCC) facilities in Manitoba and Ontario, Canada. The RAI MDS 2.0 instrument was used to assess all LTC residents and CCC residents. Clinical characteristics and the prevalence of major comorbidities were examined. Multivariate modeling was used to identify the characteristics of PD residents most associated with the prescription of antipsychotics and the use of restraints in LTC and CCC facilities. RESULTS Residents with PD in LTC and CCC exhibit a high prevalence of dementia, major psychiatric disorders, stroke, heart failure, chronic obstructive pulmonary disease and diabetes mellitus. More than 90% of LTC and CCC residents with PD had cognitive impairment; with more than half having moderate to severe impairment. Residents with PD were more likely to receive antipsychotics than those without PD. Antipsychotic use was associated with psychosis and aggressive behaviours, but also with unsteady gait and higher comorbidity and medication count. Similarly, although more common in CCC than LTC facilities, both psychosis and aggressive behaviours were associated with restraint use, as was greater cognitive and functional impairment, and urinary incontinence. Younger age, male gender, and lower physician access were all associated with greater antipsychotic and restraint use. CONCLUSIONS LTC and CCC residents with PD are very complex medically. Use of antipsychotics and restraints is common, and their use is often associated with factors other than psychosis or aggression.
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Affiliation(s)
- George A Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Alexander M Crizzle
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jonathen Chen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences and Hotchkiss Brain Institute and Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences and Hotchkiss Brain Institute and Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | | | - Leslie Eckel
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Daneman N, Campitelli MA, Giannakeas V, Morris AM, Bell CM, Maxwell CJ, Jeffs L, Austin PC, Bronskill SE. Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities. CMAJ 2017; 189:E851-E860. [PMID: 28652480 DOI: 10.1503/cmaj.161437] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Understanding the extent to which current antibiotic prescribing behaviour is influenced by clinicians' historical patterns of practice will help target interventions to optimize antibiotic use in long-term care. Our objective was to evaluate whether clinicians' historical prescribing behaviours influence the start, prolongation and class selection for treatment with antibiotics in residents of long-term care facilities. METHODS We conducted a retrospective cohort study of all physicians who prescribed to residents in long-term care facilities in Ontario between Jan. 1 and Dec. 31, 2014. We examined variability in antibiotic prescribing among physicians for 3 measures: start of treatment with antibiotics, use of prolonged durations exceeding 7 days and selection of fluoroquinolones. Funnel plots with control limits were used to determine the extent of variation and characterize physicians as extreme low, low, average, high and extreme high prescribers for each tendency. Multivariable logistic regression was used to assess whether a clinician's prescribing tendency in the previous year predicted current prescribing patterns, after accounting for residents' demographics, comorbidity, functional status and indwelling devices. RESULTS Among 1695 long-term care physicians, who prescribed for 93 132 residents, there was wide variability in the start of antibiotic treatment (median 45% of patients, interquartile range [IQR] 32%-55%), use of prolonged treatment durations (median 30% of antibiotic prescriptions, IQR 19%-46%) and selection of fluoroquinolones (median 27% of antibiotic prescriptions, IQR 18%-37%). Prescribing tendencies for antibiotics by physicians in 2014 correlated strongly with tendencies in the previous year. After controlling for individual resident characteristics, prior prescribing tendency was a significant predictor of current practice. INTERPRETATION Physicians prescribing antibiotics exhibited individual, measurable and historical tendencies toward start of antibiotic treatment, use of prolonged treatment duration and class selection. Prescriber audit and feedback may be a promising tool to optimize antibiotic use in long-term care facilities.
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Affiliation(s)
- Nick Daneman
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont.
| | - Michael A Campitelli
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont
| | - Vasily Giannakeas
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont
| | - Andrew M Morris
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont
| | - Lianne Jeffs
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont
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St-Maurice J, Burns C. An Exploratory Case Study to Understand Primary Care Users and Their Data Quality Tradeoffs. ACM JOURNAL OF DATA AND INFORMATION QUALITY 2017. [DOI: 10.1145/3058750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Primary care data is an important part of the evolving healthcare ecosystem. Generally, users in primary care are expected to provide excellent patient care and record high-quality data. In practice, users must balance sets of priorities regarding care and data. The goal of this study was to understand data quality tradeoffs between timeliness, validity, completeness, and use among primary care users. As a case study, data quality measures and metrics are developed through a focus group session with managers. After calculating and extracting measurements of data quality from six years of historic data, each measure was modeled with logit binomial regression to show correlations, characterize tradeoffs, and investigate data quality interactions. Measures and correlations for completeness, use, and timeliness were calculated for 196,967 patient encounters. Based on the analysis, there was a positive relationship between validity and completeness, and a negative relationship between timeliness and use. Use of data and reductions in entry delay were positively associated with completeness and validity. Our results suggest that if users are not provided with sufficient time to record data as part of their regular workflow, they will prioritize spending available time with patients. As a measurement of a primary care system's effectiveness, the negative correlation between use and timeliness points to a self-reinforcing relationship that provides users with little external value. In the future, additional data can be generated from comparable organizations to test several new hypotheses about primary care users.
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Hopper T, Slaughter SE, Hodgetts B, Ostevik A, Ickert C. Hearing Loss and Cognitive-Communication Test Performance of Long-Term Care Residents With Dementia: Effects of Amplification. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:1533-1542. [PMID: 27973661 DOI: 10.1044/2016_jslhr-h-15-0135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The study aims were (a) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and (b) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were (a) What is the effect of amplification on cognitive-communication test performance of LTC residents with early- to middle-stage dementia and mild-to-moderate hearing loss? and (b) What is the relationship between measured hearing ability and hearing ability recorded by staff using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS; Hirdes et al., 1999)? METHOD Thirty-one residents from 5 long-term care facilities participated in this quasiexperimental crossover study. Residents participated in cognitive-communication testing with and without amplification. RAI-MDS ratings of participants' hearing were compared to audiological assessment results. RESULTS Participants' speech intelligibility index scores significantly improved with amplification; however, participants did not demonstrate significant improvement in cognitive-communication test scores with amplification. A significant correlation was found between participants' average pure-tone thresholds and RAI-MDS ratings of hearing, yet misclassification of hearing loss occurred for 44% of participants. CONCLUSIONS Measuring short-term improvement of performance-based cognitive communication may not be the most effective means of assessing amplification for individuals with dementia. Hearing screenings and staff education remain necessary to promote hearing health for LTC residents.
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Affiliation(s)
- Tammy Hopper
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Bill Hodgetts
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, CanadaInstitute for Reconstructive Sciences in Medicine, Edmonton, Alberta, Canada
| | - Amberley Ostevik
- Institute for Reconstructive Sciences in Medicine, Edmonton, Alberta, Canada
| | - Carla Ickert
- Faculty of Nursing, University of Alberta, Edmonton, Canada
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Kuluski K, Gandhi S, Diong C, Steele Gray C, Bronskill SE. Patterns of community follow-up, subsequent health service use and survival among young and mid-life adults discharged from chronic care hospitals: a retrospective cohort study. BMC Health Serv Res 2016; 16:382. [PMID: 27522347 PMCID: PMC4983410 DOI: 10.1186/s12913-016-1631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/04/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the demand for rehabilitation and chronic care services across the life course, policy and care strategies tend to focus on older adults and overlook medically complex younger adult populations. This study examined young and mid-life adults discharged from tertiary chronic care hospitals in order to describe their health service use and to examine the association between patterns of timely community follow-up, and subsequent health outcomes. METHODS This population-based retrospective cohort study used linked administrative data to identify 1,906 individuals aged 18-64 years and discharged alive from tertiary chronic care hospitals in Ontario, Canada between April 1, 2005 and March 31, 2006. Multivariate Cox proportional hazard models were used to examine the effect of community follow-up within 7 days of discharge (home care and/or a primary care physician visit or neither) on time to first hospitalization and emergency department (ED) visit. Five-year survival was examined using Kaplan-Meier survival curves. RESULTS The cohort had a high prevalence of multi-morbidity and use of hospital, emergency services and physician services was high in the year following discharge. Most individuals received follow-up care from a primary care physician and/or home care within 7 days of discharge while 30 % received neither. Within 1 year of discharge, 18 % of individuals died. Among those who survived, time to acute care hospitalization in the year following discharge was significantly longer among those who received both a home care and a physician follow-up visit compared to those who received neither. No significant associations were found between community follow-up and ED visits within 1 year. CONCLUSIONS Immediate community follow-up may reduce subsequent use of acute care services. Future research should determine why some individuals, who would likely benefit from services, are not receiving them including barriers to access.
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Affiliation(s)
- Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital Site), 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
| | - Sima Gandhi
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
| | - Christina Diong
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital Site), 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
| | - Susan E. Bronskill
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
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Sutorius FL, Hoogendijk EO, Prins BAH, van Hout HPJ. Comparison of 10 single and stepped methods to identify frail older persons in primary care: diagnostic and prognostic accuracy. BMC FAMILY PRACTICE 2016; 17:102. [PMID: 27488562 PMCID: PMC4973108 DOI: 10.1186/s12875-016-0487-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 07/13/2016] [Indexed: 11/23/2022]
Abstract
Background Many instruments have been developed to identify frail older adults in primary care. A direct comparison of the accuracy and prevalence of identification methods is rare and most studies ignore the stepped selection typically employed in routine care practice. Also it is unclear whether the various methods select persons with different characteristics. We aimed to estimate the accuracy of 10 single and stepped methods to identify frailty in older adults and to predict adverse health outcomes. In addition, the methods were compared on their prevalence of the identified frail persons and on the characteristics of persons identified. Methods The Groningen Frailty Indicator (GFI), the PRISMA-7, polypharmacy, the clinical judgment of the general practitioner (GP), the self-rated health of the older adult, the Edmonton Frail Scale (EFS), the Identification Seniors At Risk Primary Care (ISAR PC), the Frailty Index (FI), the InterRAI screener and gait speed were compared to three measures: two reference standards (the clinical judgment of a multidisciplinary expert panel and Fried’s frailty criteria) and 6-years mortality or long term care admission. Data were used from the Dutch Identification of Frail Elderly Study, consisting of 102 people aged 65 and over from a primary care practice in Amsterdam. Frail older adults were oversampled. The accuracy of each instrument and several stepped strategies was estimated by calculating the area under the ROC-curve. Results Prevalence rates of frailty ranged from 14.8 to 52.9 %. The accuracy for recommended cut off values ranged from poor (AUC = 0.556 ISAR-PC) to good (AUC = 0.865 gait speed). PRISMA-7 performed best over two reference standards, GP predicted adversities best. Stepped strategies resulted in lower prevalence rates and accuracy. Persons selected by the different instruments varied greatly in age, IADL dependency, receiving homecare and mood. Conclusion We found huge differences between methods to identify frail persons in prevalence, accuracy and in characteristics of persons they select. A necessary next step is to find out which frail persons can benefit from intervention before case finding programs are implemented. Further evidence is needed to guide this emerging clinical field. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0487-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fleur L Sutorius
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081, BT, The Netherlands
| | - Emiel O Hoogendijk
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081, BT, The Netherlands.,Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard A H Prins
- Associated General Practitioners Amsterdam Groot-Zuid, Amsterdam, Netherlands
| | - Hein P J van Hout
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081, BT, The Netherlands.
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Muntinga ME, Jansen APD, Schellevis FG, Nijpels G. Expanding access to pain care for frail, older people in primary care: a cross-sectional study. BMC Nurs 2016; 15:26. [PMID: 27110220 PMCID: PMC4842300 DOI: 10.1186/s12912-016-0147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/16/2016] [Indexed: 12/15/2022] Open
Abstract
Background Although untreated pain has a negative impact on quality of life and health outcomes, research has shown that older people do not always have access to adequate pain care. Practice nurse-led, comprehensive geriatric assessments (CGAs) may increase access to tailored pain care for frail, older people who live at home. To explore this, we investigated whether new pain cases were identified by practice nurses during CGAs administered as part of an intervention with the Geriatric Care Model, a comprehensive care model based on the Chronic Care Model, and whether the intervention led to tailored pain action plans in care plans of frail, older people. Methods We used cross-sectional data from the older Adults: Care in Transition (ACT) study, a 2-year clinical trial carried out in two regions of the Netherlands. Practice nurses proactively visited older people at home and administered an in-home CGA that included an assessment of pain. Pain care-related agreements and actions (pain action plans) based on CGA results were described in a tailored care plan. We analyzed care plans of 781 older people who received a first-time CGA by a practice nurse for the presence of pain, pain location and cause, new pain cases, and pain action plans. We used descriptive statistics to analyze our data. Results We found that 315 (40.3 %) older people experienced any type of pain. Practice nurses identified 20 (10.6 %) new pain cases, and 188 (59.7 %) older people with pain formulated at least one therapeutic or non-therapeutic pain action plan together with a practice nurse. More than half of the older people whose pain had already been identified by a primary care physician wanted a pain action plan. Most pain action plans consisted of actions or agreements related to continuity of care. Discussion and conclusion Practice nurses in primary care can contribute to expanding older people's access to tailored pain care. Future researchers should continue to direct their focus at ways to overcome the barriers that restrict older people’s access to pain care.
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Affiliation(s)
- M E Muntinga
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - A P D Jansen
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F G Schellevis
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands ; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - G Nijpels
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients. Qual Life Res 2016; 25:2619-2632. [PMID: 27052421 DOI: 10.1007/s11136-016-1281-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine the relative impact of 16 common chronic conditions and increasing morbidity on health-related quality of life (HRQL) in a population-based sample of home care clients in Ontario, Canada. METHODS Participants were adult clients assessed with the Resident Assessment Instrument for Home Care (RAI-HC) between January and June 2009 and diagnosed with one (or more) of 16 common chronic conditions. HRQL was evaluated using the Minimum Data Set-Health Status Index (MDS-HSI), a preference-based measure derived from items captured in the RAI-HC. Multivariable linear regression models assessed the relative impact of each condition, and increasing number of diagnoses, on MDS-HSI scores. RESULTS Mean (SD) MDS-HSI score in the study population (n = 106,159) was 0.524 (0.213). Multivariable analysis revealed a statistically significant (p < 0.05) and clinically important (difference ≥ 0.03) decrease in MDS-HSI scores associated with stroke (-0.056), osteoarthritis (-0.036), rheumatoid arthritis (-0.033) and congestive heart failure (CHF, -0.030). Differences by age and sex were observed; most notably, the negative impact associated with dementia was greater among men (-0.043) than among women (-0.019). Further, HRQL decreased incrementally with additional diagnoses. In all models, chronic conditions and number of diagnoses accounted for a relatively small proportion of the variance observed in MDS-HSI. CONCLUSION Clinically important negative effects on HRQL were observed for clients with a previous diagnosis of stroke, osteo- and rheumatoid arthritis, or CHF, as well as with increasing levels of multimorbidity. Findings provide baseline preference-based HRQL scores for home care clients with different diagnoses and may be useful for identifying, targeting and evaluating care strategies toward populations with significant HRQL impairments.
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Comparing the care needs of people living with and without HIV in Canadian home and long-term care settings. ACTA ACUST UNITED AC 2016; 42:52-56. [PMID: 29770004 DOI: 10.14745/ccdr.v42i03a01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background With the advent of highly active antiretroviral therapy (HAART), HIV has become a manageable chronic infection and individuals with it are living longer. Older individuals with HIV will begin to seek services across the continuum of health care. Whether their care needs differ from those who are HIV negative has not been well-characterized. Objectives To compare the demographic characteristics, chronic conditions, presence of infections, and mental health issues among HIV-positive versus HIV-negative individuals in home care, long-term care and complex continuing care settings across Canada. Methods This cross-sectional study used interRAI data to compare characteristics of HIV-positive and HIV-negative individuals in long-term care, complex continuing care and home care settings. Chi-square analyses explored differences between groups on co-infections, chronic disease and mental health issues. Results Data from 1,200,073 people were analyzed of whom 1,608 (0.13%) had HIV. Overall, HIV-positive individuals had more co-infections but fewer chronic diseases than their HIV-negative counterparts. Depression, social isolation and the use of psychotropic medications were generally more prevalent in the HIV-positive cohort. Conclusion People living with HIV make up a small cohort of people with complex needs in home care and institutional settings and their care needs differ from those who are HIV negative. As HIV-positive people age, a better understanding of the context in which these issues are experienced will support appropriate interventions.
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Hoogendijk EO, van der Horst HE, van de Ven PM, Twisk JWR, Deeg DJH, Frijters DHM, van Leeuwen KM, van Campen JPCM, Nijpels G, Jansen APD, van Hout HPJ. Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial. Eur J Intern Med 2016; 28:43-51. [PMID: 26597341 DOI: 10.1016/j.ejim.2015.10.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of community-dwelling frail older adults. METHODS A 24-month stepped wedge cluster randomized controlled trial was conducted between May 2010 and March 2013 in 35 primary care practices in the Netherlands, and included 1147 frail older adults. The intervention consisted of a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Reassessment occurred every six months. Nurses worked together with primary care physicians and were supervised and trained by geriatric expert teams. Complex patients were reviewed in multidisciplinary consultations. The primary outcome was quality of life (SF-12). Secondary outcomes were health-related quality of life, functional limitations, self-rated health, psychological wellbeing, social functioning and hospitalizations. RESULTS Intention-to-treat analyses based on multilevel modeling showed no significant differences between the intervention group and usual care regarding SF-12 and most secondary outcomes. Only for IADL limitations we found a small intervention effect in patients who received the intervention for 18months (B=-0.25, 95%CI=-0.43 to -0.06, p=0.007), but this effect was not statistically significant after correction for multiple comparisons. CONCLUSION The GCM did not show beneficial effects on quality of life in frail older adults in primary care, compared to usual care. This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population. TRIAL REGISTRATION The Netherlands National Trial Register NTR2160.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, France; Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Henriëtte E van der Horst
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Peter M van de Ven
- Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Dorly J H Deeg
- Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Dinnus H M Frijters
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Karen M van Leeuwen
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Health Sciences, EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University, Amsterdam, The Netherlands.
| | - Jos P C M van Campen
- Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
| | - Giel Nijpels
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Aaltje P D Jansen
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Hein P J van Hout
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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van Leeuwen KM, Bosmans JE, Jansen APD, Hoogendijk EO, Muntinga ME, van Hout HPJ, Nijpels G, van der Horst HE, van Tulder MW. Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial. J Am Geriatr Soc 2015; 63:2494-2504. [PMID: 26663424 DOI: 10.1111/jgs.13834] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of the Geriatric Care Model (GCM), an integrated care model for frail older adults based on the Chronic Care Model, with that of usual care. DESIGN Economic evaluation alongside a 24-month stepped-wedge cluster-randomized controlled trial. SETTING Primary care (35 practices) in two regions in the Netherlands. PARTICIPANTS Community-dwelling older adults who were frail according to their primary care physicians and the Program on Research for Integrating Services for the Maintenance of Autonomy case-finding tool questionnaire (N = 1,147). INTERVENTION The GCM consisted of the following components: a regularly scheduled in-home comprehensive geriatric assessment by a practice nurse followed by a customized care plan, management and training of practice nurses by a geriatric expert team, and coordination of care through community network meetings and multidisciplinary team consultations of individuals with complex care needs. MEASUREMENTS Outcomes were measured every 6 months and included costs from a societal perspective, health-related quality of life (Medical Outcomes Study 12-item Short-Form Survey (SF-12) physical (PCS) and mental component summary (MCS) scales), functional limitations (Katz activities of daily living and instrumental activities of daily living), and quality-adjusted life years based on the EQ-5D. RESULTS Multilevel regression models adjusted for time and baseline confounders showed no significant differences in costs ($356, 95% confidence interval = -$488-1,134) and outcomes between intervention and usual care phases. Cost-effectiveness acceptability curves showed that, for the SF-12 PCS and MCS, the probability of the intervention being cost-effective was 0.76 if decision-makers are willing to pay $30,000 per point improvement on the SF-12 scales (range 0-100). For all other outcomes the probability of the intervention being cost-effective was low. CONCLUSION Because the GCM was not cost-effective compared to usual care after 24 months of follow-up, widespread implementation in its current form is not recommended.
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Affiliation(s)
- Karen M van Leeuwen
- Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Health Sciences, Faculty of Earth & Life Sciences, Emgo+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Earth & Life Sciences, Emgo+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Aaltje P D Jansen
- Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Gérôntopole, Toulouse University Hospital, Toulouse, France
| | - Maaike E Muntinga
- Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Medical Humanities, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Hein P J van Hout
- Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Henriette E van der Horst
- Department of General Practice and Elderly Care Medicine, Emgo+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth & Life Sciences, Emgo+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
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Cheng L, Zhu M, Poss JW, Hirdes JP, Glenny C, Stolee P. Opinion versus practice regarding the use of rehabilitation services in home care: an investigation using machine learning algorithms. BMC Med Inform Decis Mak 2015; 15:80. [PMID: 26453354 PMCID: PMC4600209 DOI: 10.1186/s12911-015-0203-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Resources for home care rehabilitation are limited, and many home care clients who could benefit do not receive rehabilitation therapy. The interRAI Contact Assessment (CA) is a new screening instrument comprised of a subset of interRAI Home Care (HC) items, designed to be used as a preliminary assessment to identify which potential home care clients should be referred for a full assessment, or for services such as rehabilitation. We investigated which client characteristics are most relevant in predicting rehabilitation use in the full interRAI HC assessment. METHODS We applied two algorithms from machine learning and data mining - the LASSO and the random forest - to frequency matched interRAI HC and service utilization data for home care clients in Ontario, Canada. RESULTS Analyses confirmed the importance of functional decline and mobility variables in targeting rehabilitation services, but suggested that other items in use as potential predictors may be less relevant. Six of the most highly ranked items related to ambulation. Diagnosis of cancer was highly associated with decreased rehabilitation use; however, cognitive status was not. CONCLUSIONS Inconsistencies between variables considered important for classifying clients who need rehabilitation and those identified in this study based on use may indicate a discrepancy in the client characteristics considered relevant in theory versus actual practice.
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Affiliation(s)
- Lu Cheng
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Mathematics Building No. 3, Waterloo, ON N2L 3G1 Canada
| | - Mu Zhu
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Mathematics Building No. 3, Waterloo, ON N2L 3G1 Canada
| | - Jeffrey W. Poss
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Christine Glenny
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
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Phillips CD, Hawes C. The interRAI Pediatric Home Care (PEDS HC) Assessment: Evaluating the Long-term Community-Based Service and Support Needs of Children Facing Special Healthcare Challenges. Health Serv Insights 2015; 8:17-24. [PMID: 26401100 PMCID: PMC4567103 DOI: 10.4137/hsi.s30775] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/05/2022] Open
Abstract
The vast majority of assessment instruments developed to assess children facing special healthcare challenges were constructed to assess children within a limited age range or children who face specific conditions or impairments. In contrast, the interRAI Pediatric Home Care (PEDS HC) Assessment Form was specifically designed to assess the long-term community-based service and support needs of children and youth aged from four to 20 years who face a wide range of chronic physical or behavioral health challenges. Initial research indicates that PEDS HC items exhibit good predictive validity—explaining significant proportions of the variance in parents’ perceptions of needs, case managers’ service authorizations, and Medicaid program expenditures for long-term community-based services and supports. In addition, PEDS HC items have been used to construct scales that summarize the strengths and needs of children facing special healthcare challenges. Versions of the PEDS HC are now being used in Medicaid programs in three states in the United States.
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Affiliation(s)
- Charles D Phillips
- Department of Health Policy and Management, School of Public Health, Health Science Center, Texas A&M University, College Station, TX, USA
| | - Catherine Hawes
- Department of Health Policy and Management, School of Public Health, Health Science Center, Texas A&M University, College Station, TX, USA
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Luo H, Tang JYM, Wong GHY, Chen CCH, Lum TYS, Chi I, Lou VWQ. The Effect of Depressive Symptoms and Antidepressant Use on Subsequent Physical Decline and Number of Hospitalizations in Nursing Home Residents: A 9-Year Longitudinal Study. J Am Med Dir Assoc 2015; 16:1048-54. [PMID: 26234654 DOI: 10.1016/j.jamda.2015.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate whether depressive symptoms and antidepressant use at baseline predict the subsequent decline in physical functioning and number of hospitalizations in nursing home residents. DESIGN Observational study based on Minimum Data Set (MDS) 2.0. SETTING Six nursing homes in Hong Kong. PARTICIPANTS All nursing home residents (n = 1076) assessed with the MDS 2.0 in 2005 followed until 2013. MEASUREMENTS Outcome variables included annual performance in activities of daily living (ADLs) and number of hospitalizations within 90 days before each assessment. The presence of depressive symptoms at baseline was measured by the Resident Assessment Protocol triggered from the MDS 2.0 assessment. Records of antidepressant use and other control variables were exacted directly from the MDS 2.0 assessment. RESULTS The presence of baseline depressive symptoms did not have significant association with baseline ADLs and number of hospitalizations according to the multilevel mixed-effect model. However, it was associated with a faster deterioration of physical functioning (coefficient 0.03; 95% confidence interval [CI] 0.00-0.07) and an increase in the number of hospitalizations (coefficient 0.05; 95% CI 0.03-0.07). No significant difference between elders using antidepressants and elders who were free from depressive symptoms was observed. If depressive symptoms were presented but antidepressants were not used, a much sharper decline was evident (coefficient 0.06; 95% CI 0.02-0.09). CONCLUSIONS This study provided evidence that the presence of depressive symptoms is associated with more utilization of health care services. However, the use of antidepressants may play a significant role in altering the trajectory. The presence of depressive symptoms is a worrisome but treatable condition. Effective intervention/treatment should be called on.
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Affiliation(s)
- Hao Luo
- Department of Sociology, Tsinghua University, Beijing, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong.
| | | | - Gloria H Y Wong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Coco C H Chen
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Terry Y S Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Iris Chi
- School of Social Work, University of Southern California, Los Angeles, CA
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.
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Sources of Discomfort in Persons with Dementia: Scale and Initial Results. Behav Neurol 2015; 2015:732832. [PMID: 26180375 PMCID: PMC4491380 DOI: 10.1155/2015/732832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/20/2015] [Accepted: 06/07/2015] [Indexed: 12/03/2022] Open
Abstract
The Sources of Discomfort Scale (SODS) assesses discomfort manifestations based on source of discomfort, thus making it both distinct from and complementary to pain assessments for persons with dementia. Sources were categorized as pertaining to physical discomfort, to body position, and to environmental sources. Body position sources of discomfort were related to poor functional status and to pain. The SODS scores were not related to cognitive functioning, and sources of discomfort other than those pertaining to body position were not correlated with pain. This paper demonstrates a direct and enhanced method to detect the manifestations of discomfort separately from pain indicators in a population with advanced dementia. The determination of the source of discomfort has direct implications for intervention.
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Stewart SL, Hirdes JP. Identifying mental health symptoms in children and youth in residential and in-patient care settings. Healthc Manage Forum 2015; 28:150-156. [PMID: 26015486 DOI: 10.1177/0840470415581240] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study demonstrates the use of the interRAI assessment instruments to examine mental health symptoms in children and adults within residential and in-patient care settings. Regardless of service setting, children exhibited more harm to self and others than adults. Children in adult in-patient beds were more likely to exhibit suicide and self-harm and less likely to exhibit harm to others compared to children in child-specific service settings. Implications related to service system improvements are discussed.
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Affiliation(s)
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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44
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McArthur C, Hirdes J, Berg K, Giangregorio L. Who receives rehabilitation in canadian long-term care facilities? A cross-sectional study. Physiother Can 2015; 67:113-21. [PMID: 25931661 DOI: 10.3138/ptc.2014-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the proportion of residents receiving occupational therapy (OT) and physical therapy (PT) and the factors associated with receiving PT in long-term care (LTC) facilities across five provinces and one territory in Canada. METHODS Using a population-based, retrospective analysis of cross-sectional data, the proportion of LTC facility residents in each province or territory receiving three different amounts (time and frequency) of PT, OT, or both before July 1, 2013, was calculated according to the Resource Utilization Groups-III rehabilitation classifications. Twenty-three variables from the Resident Assessment Instrument 2.0, such as age and cognition, were examined as correlates; those significant at p<0.01 were included in a multivariate logistic regression. RESULTS Between 63.7% and 88.6% of residents did not receive any PT or OT; 0.8%-12.6% received both PT and OT; 5.8%-29.5% received an unspecified amount of PT; 1.9%-7.0% received 45 minutes or more of PT 3 days or more per week; and fewer than 1% received 150 minutes or more of PT on 5 or more days per week. Province, age, cognitive status, depression, clinical status, fracture, multiple sclerosis, and self-rated potential for improvement were associated with PT irrespective of time intensity. CONCLUSIONS The proportion of LTC residents receiving rehabilitation services varies across Canada and appears to be associated with physical impairments and the potential for improvement; older residents with cognitive impairment or mood disorders are less likely to receive rehabilitation services. Future recommendations should consider what is driving the patterns of service use, determine whether the resources available are appropriate, and address the most appropriate goals for residents in LTC.
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Affiliation(s)
| | - John Hirdes
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo
| | - Katherine Berg
- Department of Physical Therapy, University of Toronto, Ont
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From concept to content: assessing the implementation fidelity of a chronic care model for frail, older people who live at home. BMC Health Serv Res 2015; 15:18. [PMID: 25608876 PMCID: PMC4312437 DOI: 10.1186/s12913-014-0662-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/15/2014] [Indexed: 11/25/2022] Open
Abstract
Background Implementation fidelity, the degree to which a care program is implemented as intended, can influence program impact. Since results of trials that aim to implement comprehensive care programs for frail, older people have been conflicting, assessing implementation fidelity alongside these trials is essential to differentiate between flaws inherent to the program and implementation issues. This study demonstrates how a theory-based assessment of fidelity can increase insight in the implementation process of a complex intervention in primary elderly care. Methods The Geriatric Care Model was implemented among 35 primary care practices in the Netherlands. During home visits, practice nurses conducted a comprehensive geriatric assessment and wrote a tailored care plan. Multidisciplinary team consultations were organized with the aim to enhance the coordination between professionals caring for a single patient with complex needs. To assess fidelity, we identified 5 key intervention components and formulated corresponding research questions using Carroll’s framework for fidelity. Adherence (coverage, frequency, duration, content) was assessed per intervention component during and at the end of the intervention period. Two moderating factors (participant responsiveness and facilitation strategies) were assessed at the end of the intervention. Results Adherence to the geriatric assessments and care plans was high, but decreased over time. Adherence to multidisciplinary consultations was initially poor, but increased over time. We found that individual differences in adherence between practice nurses and primary care physicians were moderate, while differences in participant responsiveness (satisfaction, involvement) were more distinct. Nurses deviated from protocol due to contextual factors and personal work routines. Conclusions Adherence to the Geriatric Care Model was high for most of the essential intervention components. Study limitations include the limited number of assessed moderating factors. We argue that a longitudinal investigation of adherence per intervention component is essential for a complete understanding of the implementation process, but that such investigations may be complicated by practical and methodological challenges. Trial registration The Netherlands National Trial Register (NTR). Trial number: 2160.
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Freeman S, Hirdes JP, Stolee P, Garcia J, Smith TF, Steel K, Morris JN. Care planning needs of palliative home care clients: Development of the interRAI palliative care assessment clinical assessment protocols (CAPs). BMC Palliat Care 2014; 13:58. [PMID: 25550682 PMCID: PMC4279598 DOI: 10.1186/1472-684x-13-58] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The interRAI Palliative Care (interRAI PC) assessment instrument provides a standardized, comprehensive means to identify person-specific need and supports clinicians to address important factors such as aspects of function, health, and social support. The interRAI Clinical Assessment Protocols (CAPs) inform clinicians of priority issues requiring further investigation where specific intervention may be warranted and equip clinicians with evidence to better inform development of a person-specific plan of care. This is the first study to describe the interRAI PC CAP development process and provide an overview of distributional properties of the eight interRAI PC CAPs among community dwelling adults receiving palliative home care services. METHODS Secondary data analysis used interRAI PC assessments (N = 6,769) collected as part of regular clinical practice at baseline (N = 6,769) and follow-up (N = 1,000). Clients across six regional jurisdictions in Ontario, Canada, assessed to receive palliative homecare services between 2006 and 2011 were included (mean age 70.0 years; ±13.4 years). Descriptive analyses focused on the eight interRAI PC CAPs: Fatigue, Sleep Disturbance, Nutrition, Pressure Ulcers, Pain, Dyspnea, Mood Disturbance and Delirium. RESULTS The majority of clients triggered at least one CAP while two thirds triggered two or more. Triggering rates ranged from 74% for the Fatigue CAP to less than 15% for the Delirium and Pressure Ulcers CAPs. The hierarchical CAP triggering structure suggested Fatigue and Dyspnea CAPs were persistent issues prevalent among the majority of clients while Delirium and Pressure Ulcers CAPs rarely trigger in isolation and most often trigger later in the illness trajectory. CONCLUSION When any of the eight interRAI PC CAPs are triggered, clinicians should take notice. CAPs triggered at high rates such as fatigue, dyspnea, and pain warrant increased attention for the majority of clients. Consideration of triggered CAPs provide evidence to inform a collaborative decision making process on whether or not issues raised by the CAPs should be addressed in the plan of care. Integrating evidence from the interRAI PC CAPs into the clinical decision making process support care planning to address client strengths, preferences and needs with greater acuity.
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Affiliation(s)
- Shannon Freeman
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia V2N 4Z9 Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 6P4 Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 6P4 Canada
| | - John Garcia
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 6P4 Canada
| | - Trevor Frise Smith
- Department of Sociology, Nipissing University, North Bay, Ontario Canada
| | - Knight Steel
- Retired Chief Emeritus of Geriatrics, Hackensack University Medical Center, 20 Prospect Ave, Hackensack, NJ 07601 USA
| | - John N Morris
- Hebrew Senior Life, 1200 Centre Street, Boston, MA 02131 USA
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Ismail Z, Arenovich T, Granger R, Grieve C, Willett P, Patten S, Mulsant BH. Associations of medical comorbidity, psychosis, pain, and capacity with psychiatric hospital length of stay in geriatric inpatients with and without dementia. Int Psychogeriatr 2014; 27:1-9. [PMID: 25330847 DOI: 10.1017/s1041610214002002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Background: Geriatric psychiatry hospital beds are a limited resource. Our aim was to determine predictors of hospital length of stay (LOS) for geriatric patients with dementia admitted to inpatient psychiatric beds. Methods: Admission and discharge data from a large urban mental health center, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the resident assessment instrument - mental health (RAI-MH), an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 169 geriatric patients with dementia were compared with 308 geriatric patients without dementia. Predictors of hospital LOS were determined using a series of general linear models. Results: A diagnosis of dementia did not predict a longer LOS in this geriatric psychiatry inpatient population. The presence of multiple medical co-morbidities had an inverse relationship to length of hospital LOS - a greater number of co-morbidities predicted a shorter hospital LOS in the group of geriatric patients who had dementia compared to the without dementia study group. The presence of incapacity and positive psychotic symptoms predicted longer hospital LOS, irrespective of admission group (patients with dementia compared with those without). Conversely, pain on admission predicted shorter hospital LOS. Conclusions: Specific clinical characteristics generally determined at the time of admission are predictive of hospital LOS in geriatric psychiatry inpatients. Addressing these factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.
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Affiliation(s)
- Zahinoor Ismail
- Hotchkiss Brain Institute,University of Calgary,Calgary,Alberta,Canada
| | - Tamara Arenovich
- Clinical Research Department,Centre for Addiction and Mental Health,Division of Biostatistics,Dalla Lana School of Public Health,University of Toronto,Toronto,Ontario,Canada
| | - Robert Granger
- Department of Psychiatry,University of Alberta,Edmonton,Alberta,Canada
| | | | - Peggie Willett
- Centre for Addiction and Mental Health,Toronto,Ontario,Canada
| | - Scott Patten
- Departments of Psychiatry and Community Health Sciences,University of Calgary,Calgary,Alberta,Canada
| | - Benoit H Mulsant
- Department of Psychiatry,University of Toronto,Centre for Addiction and Mental Health,Toronto,Ontario,Canada
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Education and employment needs and receipt of services in community and inpatient mental health settings. Community Ment Health J 2014; 50:637-45. [PMID: 24468798 DOI: 10.1007/s10597-014-9694-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
The interRAI Education and Employment Clinical Assessment Protocol (EdEmp CAP) identifies three groups of individuals in community and inpatient mental health settings: those who are at risk of losing their employment or disrupting their education; those who require support in employment or educational participation; or those for whom interventions related to education and employment are not triggered. The EdEmp CAP was effective in identifying subpopulations who were at risk, but who did not receive any vocational rehabilitation or counseling. The EdEmp CAP can be used in clinical practice to identify individuals who might benefit from specific interventions in these areas.
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Brazil K, Maitland J, Walker M, Curtis A. The character of behavioural symptoms on admission to three Canadian long-term care homes. Aging Ment Health 2014; 17:1059-66. [PMID: 23777187 DOI: 10.1080/13607863.2013.807423] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We determined the prevalence and nature of behavioural symptoms at the time of admission to a long-term care home (LTCH) and occurrence of resident-to-resident aggressive behaviour associated with behavioural symptoms within three months following admission. METHOD The Cohen-Mansfield Agitation Inventory and Aggressive Behaviour Scale were completed at the time residents were admitted into the LTCH. A chart review, conducted three months after admission into the LTCH, abstracted documented resident-to-resident aggression. Three LTCHs located in Ontario, Canada participated in the study. RESULTS During a 16-month period, 339 individuals admitted to the LTCHs comprised the study sample. A comparison was made between residents with and without dementia. At admission, residents with dementia had a greater number of behavioural symptoms than those without dementia (mean = 3.79, SD = 3.32 versus mean = 2.56, SD = 2.24, respectively; t(200) = 1.91; p = 0.059). Residents with and without dementia exhibited similar behaviours but differed on the prevalence of these behaviours. The most frequently reported behavioural symptoms for residents in both groups were verbal agitation and non-aggressive physical behaviours. The most frequently recorded aggressive behaviour for all residents was 'resisting care'. In the three months post admission, 79 (23%) residents were involved in a documented incident that involved aggressive behaviour to another resident. CONCLUSION A standardized comprehensive assessment for admission to a LTCH is an important strategy that can be used to identify behavioural symptoms and plan appropriate care management.
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Affiliation(s)
- Kevin Brazil
- a School of Nursing and Midwifery , Queen's University Belfast , Belfast , United Kingdom
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Armstrong JJ, Zhu M, Hirdes JP, Stolee P. Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision. Disabil Rehabil 2014; 37:625-31. [PMID: 24981016 DOI: 10.3109/09638288.2014.935494] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System. METHODS Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n = 299 262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment. RESULTS Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision. CONCLUSIONS Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population. Implications for Rehabilitation For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community. Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it. This article used clinical assessment data to identify the predictors of and barriers to rehabilitation services for older adults in the Ontario Home Care System. Barriers of PT included dementia diagnosis and French as a first language. Barriers to OT included dementia diagnosis. Policies and practices related to service provision for older adults should be reconsidered if we are going to meet the demands of aging populations and increasing rates of functional and cognitive impairments.
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Affiliation(s)
- Joshua J Armstrong
- Geriatric Medicine Research, Dalhousie University , Halifax, Nova Scotia , Canada
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