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Webster L, Costafreda SG, Powell K, Livingston G. How do care home staff use non-pharmacological strategies to manage sleep disturbances in residents with dementia: The SIESTA qualitative study. PLoS One 2022; 17:e0272814. [PMID: 35944055 PMCID: PMC9362920 DOI: 10.1371/journal.pone.0272814] [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: 09/20/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Sleep disturbances affect 38% of care home residents living with dementia. They are often treated with medication, but non-pharmacological interventions may be safer and effective yet more difficult to implement. In the SIESTA study (Sleep problems In dEmentia: interviews with care home STAff) we explored care home staffs’ experience of managing sleep disturbances in their residents living with dementia. Methods We conducted one-to-one semi-structured interviews in four UK care homes, and purposively recruited a maximum variation sample of 18 nurses and care assistants, who were each interviewed once. We used a topic guide and audio-recorded the interviews. Two researchers independently analysed themes from transcribed interviews. Results Staff used a range of techniques that often worked in improving or preventing residents’ sleep disturbance. During the daytime, staff encouraged residents to eat well, and be physically active and stimulated to limit daytime sleep. In the evening, staff settled residents into dark, quiet, comfortable bedrooms often after a snack. When residents woke at night, they gave them caffeinated tea or food, considered possible pain and discomfort, and reassured residents they were safe. If residents remained unsettled, staff would engage them in activities. They used telecare to monitor night-time risk. Staff found minimising daytime napping difficult, described insufficient staffing at night to attend to reorient and guide awake residents and said residents frequently did not know it was night-time. Conclusions Some common techniques, such as caffeinated drinks, may be counterproductive. Future non-pharmacological interventions should consider practical difficulties staff face in managing sleep disturbances, including struggling to limit daytime napping, identifying residents’ night-time needs, day-night disorientation, and insufficient night-time staffing.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, UCL, London, United Kingdom
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Sergi G. Costafreda
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | | | - Gill Livingston
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
- * E-mail:
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Hollinghurst J, Hollinghurst R, North L, Mizen A, Akbari A, Long S, Lyons RA, Fry R. COVID-19 risk factors amongst 14,786 care home residents: an observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays and vaccination status in Wales (UK) between 1 September 2020 and 1 May 2021. Age Ageing 2022; 51:6577098. [PMID: 35511729 PMCID: PMC9070807 DOI: 10.1093/ageing/afac084] [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: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND COVID-19 vaccinations have been prioritised for high risk individuals. AIM Determine individual-level risk factors for care home residents testing positive for SARS-CoV-2. STUDY DESIGN Longitudinal observational cohort study using individual-level linked data from the Secure Anonymised Information Linkage (SAIL) databank. SETTING Fourteen thousand seven hundred and eighty-six older care home residents (aged 65+) living in Wales between 1 September 2020 and 1 May 2021. Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes. METHODS We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 PCR test. We included time-dependent covariates for the estimated community positive test rate of COVID-19, hospital inpatient status, vaccination status and frailty. Additional covariates were included for age, sex and specialist care home services. RESULTS The multivariable regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year), community positive test rate (OR 1.13 [1.12,1.13] per percent increase), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09], respectively) were associated with a decreased odds. CONCLUSIONS Care providers need to remain vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Minimising potential COVID-19 infection for care home residents when admitted to hospital should be prioritised.
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Affiliation(s)
| | | | | | | | | | | | - Ronan A Lyons
- Population Data Science, Swansea University, Wales, UK
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Hollinghurst J, North L, Emmerson C, Akbari A, Torabi F, Williams C, Lyons RA, Hawkes AG, Bennett E, Gravenor MB, Fry R. Intensity of COVID-19 in care homes following hospital discharge in the early stages of the UK epidemic. Age Ageing 2022; 51:afac072. [PMID: 35291009 PMCID: PMC8992303 DOI: 10.1093/ageing/afac072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND defining features of the COVID-19 pandemic in many countries were the tragic extent to which care home residents were affected and the difficulty in preventing the introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most important transmission pathways. One hypothesised route at the start of the pandemic, prior to widespread testing, was the transfer of patients from hospitals that were experiencing high levels of nosocomial events. METHODS we tested the hypothesis that hospital discharge events increased the intensity of care home cases using a national individually linked health record cohort in Wales, UK. We monitored 186,772 hospital discharge events over the period from March to July 2020, tracking individuals to 923 care homes and recording the daily case rate in the homes populated by 15,772 residents. We estimated the risk of an increase in case rates following exposure to a hospital discharge using multi-level hierarchical logistic regression and a novel stochastic Hawkes process outbreak model. FINDINGS in regression analysis, after adjusting for care home size, we found no significant association between hospital discharge and subsequent increases in care home case numbers (odds ratio: 0.99, 95% CI: 0.82, 1.90). Risk factors for increased cases included care home size, care home resident density and provision of nursing care. Using our outbreak model, we found a significant effect of hospital discharge on the subsequent intensity of cases. However, the effect was small and considerably less than the effect of care home size, suggesting the highest risk of introduction came from interaction with the community. We estimated that approximately 1.8% of hospital discharged patients may have been infected. INTERPRETATION there is growing evidence in the UK that the risk of transfer of COVID-19 from the high-risk hospital setting to the high-risk care home setting during the early stages of the pandemic was relatively small. Although access to testing was limited to initial symptomatic cases in each care home at this time, our results suggest that reduced numbers of discharges, selection of patients and action taken within care homes following transfer all may have contributed to the mitigation. The precise key transmission routes from the community remain to be quantified.
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Affiliation(s)
- Joe Hollinghurst
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | - Laura North
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | | | - Ashley Akbari
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | - Fatemeh Torabi
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | | | - Ronan A Lyons
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
| | - Alan G Hawkes
- Hawkes Centre for Empirical Finance, Swansea University, Swansea SA2 8PP, UK
| | - Ed Bennett
- Computer Science, Swansea University, Swansea SA2 8PP, UK
| | - Mike B Gravenor
- Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK
| | - Richard Fry
- Population Data Science and Health Data Research UK, Swansea University, Swansea SA2 8PP, UK
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Hollinghurst J, North L, Perry M, Akbari A, Gravenor MB, Lyons RA, Fry R. COVID-19 infection risk amongst 14,104 vaccinated care home residents: a national observational longitudinal cohort study in Wales, UK, December 2020-March 2021. Age Ageing 2022; 51:6430099. [PMID: 34850818 PMCID: PMC8690013 DOI: 10.1093/ageing/afab223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/14/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND vaccinations for COVID-19 have been prioritised for older people living in care homes. However, vaccination trials included limited numbers of older people. AIM we aimed to study infection rates of SARS-CoV-2 for older care home residents following vaccination and identify factors associated with increased risk of infection. STUDY DESIGN AND SETTING we conducted an observational data-linkage study including 14,104 vaccinated older care home residents in Wales (UK) using anonymised electronic health records and administrative data. METHODS we used Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of testing positive for SARS-CoV-2 infection following vaccination, after landmark times of either 7 or 21 days post-vaccination. We adjusted HRs for age, sex, frailty, prior SARS-CoV-2 infections and vaccination type. RESULTS we observed a small proportion of care home residents with positive polymerase chain reaction (tests following vaccination 1.05% (N = 148), with 90% of infections occurring within 28 days. For the 7-day landmark analysis we found a reduced risk of SARS-CoV-2 infection for vaccinated individuals who had a previous infection; HR (95% confidence interval) 0.54 (0.30, 0.95). For the 21-day landmark analysis, we observed high HRs for individuals with low and intermediate frailty compared with those without; 4.59 (1.23, 17.12) and 4.85 (1.68, 14.04), respectively. CONCLUSIONS increased risk of infection after 21 days was associated with frailty. We found most infections occurred within 28 days of vaccination, suggesting extra precautions to reduce transmission risk should be taken in this time frame.
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Affiliation(s)
- Joe Hollinghurst
- Address correspondence to: Joe Hollinghurst, Data Science Building, Singleton Campus, Swansea University, Swansea, Wales SA2 8PP, UK. Tel: +44 (0)1792 606522.
| | - Laura North
- Population Data Science and Health Data Research UK, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Malorie Perry
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK
| | - Ashley Akbari
- Population Data Science and Health Data Research UK, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Mike B Gravenor
- Health Data Science, Swansea University Medical School, Swansea University, Swansea,Wales SA2 8PP, UK
| | - Ronan A Lyons
- Population Data Science and Health Data Research UK, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Richard Fry
- Population Data Science and Health Data Research UK, Swansea University, Swansea, Wales SA2 8PP, UK
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Williams O, Williams C, Turner D, Bull M, Watkins J, Hurt L. An epidemiological investigation of COVID-19 outbreaks in a group of care homes in Wales, UK: a retrospective cohort study. J Public Health (Oxf) 2021; 44:606-613. [PMID: 33993283 PMCID: PMC8194567 DOI: 10.1093/pubmed/fdab150] [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: 04/22/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study describes the epidemiology of COVID-19 outbreaks in four care homes in terms of spread, severity, presentation and interventions. Methods Participants were 100 residents and 102 staff from four co-located care homes in Wales. Data were collected from the homes and Public Health Wales, including demographics, presentations, test status and results, hospital admissions and deaths. Genomic sequencing of confirmed case samples was completed, where possible. Epi-curves, crude attack rates, a Kaplan-Meier survival curve and adjusted hazard ratios were calculated using R. Results About 14 confirmed and 43 possible resident cases, 23 confirmed and 47 possible staff cases occurred. Crude attack rates of possible and confirmed cases were 57% (residents) and 69% (staff). Genomic sequencing for 10 confirmed case PCR samples identified at least 5 different UK lineages of COVID-19.42 (42%) residents died, 23 (55%) with COVID-19 or suspected COVID-19 recorded on the death certificate. The hazard ratio for death amongst resident possible and confirmed cases compared to null cases, adjusting for age and sex, was 13.26 (95% CI 5.61–31.34). Conclusions There were extensive outbreaks of COVID-19 in these homes with high crude attack rates and deaths. Universal testing and early isolation of residents are recommended.
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Affiliation(s)
- O Williams
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - C Williams
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - D Turner
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - M Bull
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - J Watkins
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - L Hurt
- Cardiff University, Cardiff CF14 4YS, UK
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Hollinghurst J, Lyons J, Fry R, Akbari A, Gravenor M, Watkins A, Verity F, Lyons RA. The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016-2020. Age Ageing 2021; 50:25-31. [PMID: 32951042 PMCID: PMC7546151 DOI: 10.1093/ageing/afaa207] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020. Methods we calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions. Results survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.
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Affiliation(s)
- Joe Hollinghurst
- Address correspondence to Joe Hollinghurst, Data Science Building, Swansea University (Singleton Campus), Swansea, UK.
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Ferreira AR, Simões MR, Moreira E, Guedes J, Fernandes L. Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs. Arch Gerontol Geriatr 2020; 86:103919. [DOI: 10.1016/j.archger.2019.103919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/01/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023]
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Robertson S, Cooper C, Hoe J, Lord K, Rapaport P, Marston L, Cousins S, Lyketsos CG, Livingston G. Comparing proxy rated quality of life of people living with dementia in care homes. Psychol Med 2020; 50:86-95. [PMID: 30691541 PMCID: PMC6945323 DOI: 10.1017/s0033291718003987] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/31/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. METHODS We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. RESULTS Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as 'Poor' (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents' QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. CONCLUSION Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.
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Affiliation(s)
- S. Robertson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - C. Cooper
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - J. Hoe
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - K. Lord
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - P. Rapaport
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - L. Marston
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - S. Cousins
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - C. G. Lyketsos
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - G. Livingston
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Rahman MM, Byles JE. Trajectories of Long-Term Residential Care Needs Among Older Australian Women: A Cohort Study Using Linked Data. J Am Med Dir Assoc 2019; 21:786-792.e2. [PMID: 31668738 DOI: 10.1016/j.jamda.2019.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/08/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Older women are more likely than men to enter residential aged care (RAC) and generally stay longer. We aimed to identify and examine their trajectories of care needs over time in RAC across 3 fundamental care needs domains, including activities of daily living (ADL), behavior, and complex health care. DESIGN Population-based longitudinal cohort study. SETTING RAC facilities in Australia. PARTICIPANTS A total of 3519 participants from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), who used permanent RAC between 2008 and 2014. METHODS We used data from the Aged Care Funding Instrument, National Death Index, and linked ALSWH survey. Participants' care needs in the 3 domains were followed every 6 months up to 60 months from the date of admission to RAC. Trajectories of care needs over time were identified using group-based multitrajectory modeling. RESULTS Five distinct trajectory groups were identified, with large variation in the combinations of levels of care needs over time. Approximately 28% of residents belonged to the "high dependent-behavioral and complex need" group, which had high care needs in all 3 domains over time, whereas around one-third of residents (31%) were included in 2 trajectory groups ("less dependent-low need" and "less dependent-increasing need"), which had low or low to medium care needs over time. More than two-fifths of residents (41%) comprised 2 trajectory groups ("high dependent-complex need" and "high dependent-behavioral need"), which had medium to high care needs in 2 domains. Higher age at admission to RAC and multiple morbidities were associated with increased odds of being a member of the high dependent-complex need group than the less dependent-increasing need group. CONCLUSIONS AND IMPLICATIONS Identification of the differential trajectories of care needs among older women in RAC will help to better understand the circumstances of their changing care needs over time. This will facilitate appropriate care planning and service delivery for RAC residents, who are mostly older women.
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Affiliation(s)
- Md Mijanur Rahman
- Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Australia; Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, Australia; Department of Statistics, Comilla University, Bangladesh.
| | - Julie E Byles
- Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Australia; Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, Australia
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Lloyd T, Conti S, Santos F, Steventon A. Effect on secondary care of providing enhanced support to residential and nursing home residents: a subgroup analysis of a retrospective matched cohort study. BMJ Qual Saf 2019; 28:534-546. [PMID: 30956202 PMCID: PMC6593648 DOI: 10.1136/bmjqs-2018-009130] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/05/2019] [Accepted: 03/01/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thirteen residential care homes and 10 nursing homes specialising in older people in Rushcliffe, England, participated in an improvement programme. The enhanced support provided included regular visits from named general practitioners and additional training for care home staff. We assessed and compared the effect on hospital use for residents in residential and nursing homes, respectively. METHODS Using linked care home and administrative hospital data, we examined people aged 65 years or over who moved to a participating care home between 2014 and 2016 (n=568). We selected matched control residents who had similar characteristics to the residents receiving enhanced support and moved to similar care homes not participating in the enhanced support (n=568). Differences in hospital use were assessed for residents of each type of care home using multivariable regression. RESULTS Residents of participating residential care homes showed lower rates of potentially avoidable emergency admissions (rate ratio 0.50, 95% CI 0.30 to 0.82), emergency admissions (rate ratio 0.60, 95% CI 0.42 to 0.86) and Accident & Emergency attendances (0.57, 95% CI 0.40 to 0.81) than matched controls. Hospital bed days, outpatient attendances and the proportion of deaths that occurred out of hospital were not statistically different. For nursing home residents, there were no significant differences for any outcome. CONCLUSIONS The enhanced support was associated with lower emergency hospital use for older people living in residential care homes but not for people living in nursing homes. This might be because there was more potential to reduce emergency care for people in residential care homes. In nursing homes, improvement programmes may need to be more tailored to residents' needs or the context of providing care in that setting.
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Affiliation(s)
- Therese Lloyd
- Improvement Analytics Unit, The Health Foundation, London, UK
| | - Stefano Conti
- Improvement Analytics Unit and Data, Analysis and Intelligence Services, NHS England, London, UK
| | - Filipe Santos
- Improvement Analytics Unit and Data, Analysis and Intelligence Services, NHS England, London, UK
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Mikelyte R, Milne A. The role and influence of micro-cultures in long-term care on the mental health and wellbeing of older people: a scoping review of evidence. QUALITY IN AGEING AND OLDER ADULTS 2016. [DOI: 10.1108/qaoa-09-2015-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Iliffe S, Wilcock J, Drennan V, Goodman C, Griffin M, Knapp M, Lowery D, Manthorpe J, Rait G, Warner J. Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM). PROGRAMME GRANTS FOR APPLIED RESEARCH 2015. [DOI: 10.3310/pgfar03030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BackgroundThe needs of people with dementia and their carers are inadequately addressed at all key points in the illness trajectory, from diagnosis through to end-of-life care. The EVIDEM (Evidence-based Interventions in Dementia) research and development programme (2007–12) was designed to help change this situation within real-life settings.ObjectivesThe EVIDEM projects were (1) evaluation of an educational package designed to enhance general practitioners’ (GPs’) diagnostic and management skills; (2) evaluation of exercise as therapy for behavioural and psychological symptoms of dementia (BPSD); (3) development of a toolkit for managing incontinence in people with dementia living at home; (4) development of a toolkit for palliative care for people with dementia; and (5) development of practice guidance on the use of the Mental Capacity Act (MCA) 2005.DesignMixed quantitative and qualitative methods from case studies to large database analyses, including longitudinal surveys, randomised controlled trials and research register development, with patient and public involvement built into all projects.SettingGeneral practices, community services, third-sector organisations and care homes in the area of the North Thames Dementia and Neurodegenerative Diseases Research Network local research network.ParticipantsPeople with dementia, their family and professional carers, GPs and community mental health team members, staff in local authority social services and third-sector bodies, and care home staff.Main outcome measuresDementia management reviews and case identification in general practice; changes in behavioural and psychological symptoms measured with the Neuropsychiatric Inventory (NPI); extent and impact of incontinence in community-dwelling people with dementia; mapping of pathways to death of people with dementia in care homes, and testing of a model of collaborative working between primary care and care homes; and understandings of the MCA 2005 among practitioners working with people with dementia.ResultsAn educational intervention in general practice did not alter management or case identification. Exercise as a therapy for BPSD did not reduce NPI scores significantly, but had a significant positive effect on carer burden. Incontinence is twice as common in community-dwelling people with dementia than their peers, and is a hidden taboo within a stigma. Distinct trajectories of dying were identified (anticipated, unexpected and uncertain), and collaboration between NHS primary care and care homes was improved, with cost savings. The MCA 2005 legislation provided a useful working framework for practitioners working with people with dementia.ConclusionsA tailored educational intervention for general practice does not change practice, even when incentives, policy pressure and consumer demand create a favourable environment for change; exercise has potential as a therapy for BPSD and deserves further investigation; incontinence is a common but unrecognised problem for people with dementia in the community; changes in relationships between care homes and general practice can be achieved, with benefits for people with dementia at the end of life and for the UK NHS; application of the MCA 2005 will continue to improve but educational reinforcements will help this. Increased research capacity in dementia in the community was achieved. This study suggests that further work is required to enhance clinical practice around dementia in general practice; investigate the apparent beneficial effect of physical activity on BPSD and carer well-being; develop case-finding methods for incontinence in people with dementia; optimise working relationships between NHS staff and care homes; and reinforce practitioner understanding of the MCA 2005.Trial registrationEVIDEM: ED-NCT00866099; EVIDEM: E-ISRCTN01423159.FundingThis project was funded by the Programme Grants for Applied Research programme of the National Institute for Health Research.
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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, The Faculty of Health, Social Care and Education at Kingston University London & St George’s University of London (previously at University College London), London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Mark Griffin
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit (PSSRU), Department of Social Policy, London School of Economics and Political Science, London, UK
| | - David Lowery
- Older Peoples Mental Health Services, Central and North West London NHS Foundation Trust (previously known as Central & NW London Mental Health NHS Trust), London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, Policy Institute at King’s, King’s College London, London, UK
| | - Greta Rait
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - James Warner
- Older Peoples Mental Health Services, Central and North West London NHS Foundation Trust (previously known as Central & NW London Mental Health NHS Trust), London, UK, Department of Psychiatry, Faculty of Medicine, Imperial College London, London, UK
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Hutson C, Orrell M, Dugmore O, Spector A. Sonas: a pilot study investigating the effectiveness of an intervention for people with moderate to severe dementia. Am J Alzheimers Dis Other Demen 2014; 29:696-703. [PMID: 24833646 PMCID: PMC10852570 DOI: 10.1177/1533317514534756] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVE To investigate the feasibility and effectiveness of Sonas, a group intervention involving multisensory stimulation, reminiscence, and light physical activity. METHODS A total of 39 participants with moderate to severe dementia were randomized to receive either 14 sessions of Sonas or treatment as usual. Measures such as quality of life (QoL), communication, depression, anxiety, and behavioral disturbance were administered at baseline and follow-up. RESULTS No statistically significant results were found. However, participant attendance to sessions was good (mean = 12.4 sessions of 14 offered). CONCLUSIONS Sonas sessions did not lead to improvements in QoL and behavioral and psychological symptoms of dementia.
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Affiliation(s)
- Charlotte Hutson
- Department of Clinical, Educational and Health Psychology, University College London, Torrington, London
| | - Martin Orrell
- Division of Psychiatry, Faculty of Brain Sciences, Unit of Mental Health Sciences, University College London, Torrington, London
| | - Ottilie Dugmore
- Department of Clinical, Educational and Health Psychology, University College London, Torrington, London
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, Torrington, London
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Challis D, Tucker S, Wilberforce M, Brand C, Abendstern M, Stewart K, Jasper R, Harrington V, Verbeek H, Jolley D, Fernandez JL, Dunn G, Knapp M, Bowns I. National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Sue Tucker
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Mark Wilberforce
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Christian Brand
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Michele Abendstern
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Karen Stewart
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Rowan Jasper
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Val Harrington
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - David Jolley
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Jose-Luis Fernandez
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Ian Bowns
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
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15
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Sihapark S, Kuhirunyaratn P, Chen H. Severe Disability Among Elderly Community Dwellers in Rural Thailand: Prevalence and Associated Factors. AGEING INTERNATIONAL 2014. [DOI: 10.1007/s12126-013-9190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Lam SC, Lee DTF, Yu DSF. Establishing CUTOFF values for the Simplified Barthel Index in elderly adults in residential care homes. J Am Geriatr Soc 2014; 62:575-7. [PMID: 24628634 DOI: 10.1111/jgs.12716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Simon C Lam
- Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Fletcher-Smith JC, Walker MF, Cobley CS, Steultjens EMJ, Sackley CM. Occupational therapy for care home residents with stroke. Cochrane Database Syst Rev 2013; 2013:CD010116. [PMID: 23740541 PMCID: PMC6464854 DOI: 10.1002/14651858.cd010116.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is a worldwide problem and is a leading cause of adult disability, resulting in dependency in activities of daily living (ADL) for around half of stroke survivors. It is estimated that up to 25% of all care home residents in the USA and in the UK have had a stroke. Stroke survivors who reside in care homes are likely to be more physically and cognitively impaired and therefore more dependent than those able to remain in their own home. Overall, 75% of care home residents are classified as severely disabled, and those with stroke are likely to have high levels of immobility, incontinence and confusion, as well as additional co-morbidities. It is not known whether this clinically complex population could benefit from occupational therapy in the same way as community-dwelling stroke survivors. The care home population with stroke differs from the general stroke population living at home, and a review was needed to examine the benefits of occupational therapy provided to this specific group. This review therefore focused on occupational therapy interventions for ADL for stroke survivors residing in care homes. OBJECTIVES To measure the effects of occupational therapy interventions (provided directly by an occupational therapist or under the supervision of an occupational therapist) targeted at improving, restoring and maintaining independence in ADL among stroke survivors residing in long-term institutional care, termed collectively as 'care homes'. As a secondary objective, we aimed to evaluate occupational therapy interventions for reducing complications such as depression and low mood. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (August 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, September 2012), MEDLINE (1948 to September 2012), EMBASE (1980 to September 2012), CINAHL (1982 to September 2012) and 10 additional bibliographic databases and six trials registers. We also handsearched seven journals, checked reference lists and obtained further information from individual trialists. SELECTION CRITERIA Randomised controlled trials investigating the impact of an occupational therapy intervention for care home residents with stroke versus standard care. DATA COLLECTION AND ANALYSIS The lead review author performed all searches. Two review authors then independently assessed all titles and abstracts of studies and selected trials for inclusion, with a third review author resolving any discrepancies. The same two review authors independently extracted data from all included published sources to ensure reliability. Primary outcomes were performance in ADL at the end of scheduled follow-up and death or a poor outcome. Secondary outcomes aimed to reflect the domains targeted by an occupational therapy intervention. MAIN RESULTS We included in the review one study involving 118 participants. We found one ongoing study that also met the inclusion criteria for the review, but the data were not yet available. AUTHORS' CONCLUSIONS We found insufficient evidence to support or refute the efficacy of occupational therapy interventions for improving, restoring or maintaining independence in ADL for stroke survivors residing in care homes. The effectiveness of occupational therapy for the population of stroke survivors residing in care homes remains unclear, and further research in this area is warranted.
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Profiling the Multidimensional Needs of New Nursing Home Residents: Evidence to Support Planning. J Am Med Dir Assoc 2012; 13:487.e9-17. [DOI: 10.1016/j.jamda.2012.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 01/13/2012] [Accepted: 02/17/2012] [Indexed: 11/22/2022]
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Kimyagarov S, Klid R, Fleissig Y, Kopel B, Arad M, Adunsky A. Skeletal muscle mass abnormalities are associated with survival rates of institutionalized elderly nursing home residents. J Nutr Health Aging 2012; 16:432-6. [PMID: 22555785 DOI: 10.1007/s12603-012-0005-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Knowledge about the changes in skeletal muscle mass in nursing home residents is very limited. We hypothesized that such patients have different types of skeletal muscle mass abnormalities that may affect mortality rates. Therefore, the objective of this study was to evaluate the prevalence and extent of skeletal muscle mass decline, its different clinical phenotypes (sarcopenia, wasting/atrophy and cachexia) and the mortality rates associated with these abnormalities. METHODS A retrospective chart-review study comprising 109 institutionalized nursing home residents. Body mass index, body fat mass, fat free mass, skeletal muscle mass and survival rates were assessed. RESULTS Skeletal muscle mass abnormalities were found among 73 out of 109 (67.0%) patients and were more prevalent in males compared with females (97.8% and 43.8%, respectively, p<0.001). Most of these patients had muscle wasting/atrophy (51.4%) or sarcopenia (40.3%), and 9.7% suffered from cachexia. One third of the patients with abnorrmal skeletal muscle mass showed a moderate decline of skeletal muscle mass (34.7%) while the remainder (65.3%) had very low levels of skeletal muscle mass. Each group was characterized by typical medical conditions associated with skeletal muscle mass abnormality. A Kaplan-Meier survival plot of mortality showed only lower one-year survival rates in the group with sarcopenia (60%) and muscle atrophy or cachexia (53%), compared with elderly participants with a normal skeletal muscle mass (73%), (p<0.0001). There were no significant differences in 1-year mortality rates between patients with abnormal skeletal muscle mass (whether sarcopenia, cachexia or wasting). CONCLUSION About two thirds of nursing home patients show skeletal muscle mass abnormalities, most within the range of very low skeletal muscle mass rather than moderately low skeletal muscle mass, that are associated with shorter survival rates, compared with normal skeletal muscle mass patients.
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Affiliation(s)
- S Kimyagarov
- The Gilad Geriatric Center, Ramat-Gan, Tel Hashomer, 52621, Israel
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Boyd M, Bowman C, Broad JB, Connolly MJ. International comparison of long-term care resident dependency across four countries (1998-2009): a descriptive study. Australas J Ageing 2012; 31:233-40. [PMID: 23252981 DOI: 10.1111/j.1741-6612.2011.00584.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To describe an international comparison of dependency of long-term care residents. METHODS All Auckland aged care residents were surveyed in 1998 and 2008 using the 'Long-Term Care in Auckland' instrument. A large provider of residential aged care, Bupa-UK, performed a similar but separate functional survey in 2003, again in 2006 (including UK Residential Nursing Home Association facilities), and in 2009 which included Bupa facilities in Spain, New Zealand and Australia. The survey questionnaires were reconciled and functional impairment rates compared. RESULTS Of almost 90,000 residents, prevalence of dependent mobility ranged from 27 to 47%; chronic confusion, 46 to 75%; and double incontinence, 29 to 49%. Continence trends over time were mixed, chronic confusion increased, and challenging behaviour decreased. CONCLUSION Overall functional dependency for residents is high and comparable internationally. Available trends over time indicate increasing resident dependency signifying care required for this population is considerable and possibly increasing.
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Affiliation(s)
- Michal Boyd
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, New Zealand.
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21
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Szczepura A. Residential and nursing homes: how can they meet the challenge of an aging population? ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A rapidly aging society presents important challenges to care homes. Faced with increasingly elderly residents and progressively more complex clinical and social care needs, nursing and residential homes will have to address a number of issues. These include: how to maintain residents’ quality of life as well as quality of care; how to integrate health and social care provision; how best to manage their interface with hospitals in order to prevent avoidable hospitalizations and facilitate early discharges; and how to utilize new technology in a cost-effective manner. This review examines evidence from across the world on how care home placements can evolve to meet these challenges, with discussion largely adopting a UK perspective. The evidence on innovative ways of working to achieve such aims is growing, although slowly. The potential for new technologies to maintain quality and contain costs is significantly under-developed. More research is now needed.
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Affiliation(s)
- Ala Szczepura
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Substitution between formal and informal care: a ‘natural experiment’ in social policy in Britain between 1985 and 2000. AGEING & SOCIETY 2011. [DOI: 10.1017/s0144686x11000833] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThis paper is concerned with the issue of substitution between formal and informal care in Britain between 1985 and 2000. This period provides the conditions for a ‘natural experiment’ in social policy. During the late 1980s/early 1990s, there was an increase in long-stay residential care for older people, which came to an end around the mid-1990s. The paper examines whether this increase in formal services led to a decline in informal care, and whether this was subsequently reversed. The focus is on provision of intense informal care by adult children to their older parents, trends in which are identified using General Household Survey data. The paper shows that there was a decline in provision of intense and very intense co-resident care for older parents between 1985 and 1995, which came to an end in the mid-1990s. These trends in intergenerational care were negatively related to changes in long-stay residential care. In particular, controlling for age and disability, there was evidence of substitution between nursing home/hospital care and very intense co-resident care for older parents. A key policy implication is that an expansion of very intense formal services for older people could bring about a decline in very intense intergenerational care. The paper relates these findings to the current debate on reform of the long-term care system in England.
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Boyd M, Broad JB, Kerse N, Foster S, von Randow M, Lay-Yee R, Chelimo C, Whitehead N, Connolly MJ. Twenty-Year Trends in Dependency in Residential Aged Care in Auckland, New Zealand: A Descriptive Study. J Am Med Dir Assoc 2011; 12:535-40. [DOI: 10.1016/j.jamda.2011.01.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 01/27/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
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Seymour JE, Kumar A, Froggatt K. Do nursing homes for older people have the support they need to provide end-of-life care? A mixed methods enquiry in England. Palliat Med 2011; 25:125-38. [PMID: 21282349 PMCID: PMC3057627 DOI: 10.1177/0269216310387964] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nursing homes are a common site of death, but older residents receive variable quality of end-of-life care. We used a mixed methods design to identify external influences on the quality of end-of-life care in nursing homes. Two qualitative case studies were conducted and a postal survey of 180 nursing homes surrounding the case study sites. In the case studies, qualitative interviews were held with seven members of nursing home staff and 10 external staff. Problems in accessing support for end-of-life care reported in the survey included variable support by general practitioners (GPs), reluctance among GPs to prescribe appropriate medication, lack of support from other agencies, lack of out of hours support, cost of syringe drivers and lack of access to training. Most care homes were implementing a care pathway. Those that were not rated their end-of-life care as in need of improvement or as average. The case studies suggest that critical factors in improving end-of-life care in nursing homes include developing clinical leadership, developing relationships with GPs, the support of 'key' external advocates and leverage of additional resources by adoption of care pathway tools.
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Affiliation(s)
- Jane E Seymour
- The Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, UK.
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Eeles EMP, Hubbard RE, White SV, O'Mahony MS, Savva GM, Bayer AJ. Hospital use, institutionalisation and mortality associated with delirium. Age Ageing 2010; 39:470-5. [PMID: 20554540 DOI: 10.1093/ageing/afq052] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Delirium is a disorder affecting consciousness, which gives rise to core clinical features and associated symptoms. Older patients are particularly prone, owing to higher rates of pre-existing cognitive impairment, frailty, co-morbidity and polypharmacy. OBJECTIVES The aim of this study was to investigate the hypotheses that delirium affects the most vulnerable older adults and is associated with long-term adverse health outcome. METHODS This prospective cohort study evaluated 278 medical patients aged > or = 75 years admitted acutely to a district general hospital in South Wales. Patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Assessments also included illness severity, preadmission cognition, co-morbidity and functional status. Patients were followed for 5 years to determine rates of institutionalisation and mortality. Number of days in hospital in the 4 years prior to and 5 years after index admission were recorded. RESULTS Delirium was detected in 103 patients and excluded in 175. Median time to death was 162 days (interquartile range 21-556) for those with delirium compared with 1,444 days (25% mortality 435 days, 75% mortality>5 years) for those without (P < 0.001). After adjusting for multiple confounders, delirium was associated with an increased risk of death (hazard ratio range 2.0-3.5; P < or = 0.002). Institutionalisation was higher in the first year following delirium (P = 0.03). While those with delirium tended to be older with more preadmission cognitive impairment, greater functional dependency and more co-morbidity, they did not spend more days in hospital in the 4 years prior to index admission. CONCLUSIONS Delirium is associated with high rates of institutionalisation and an increased risk of death up to 5 years after index event. Prior to delirium, individuals seem to compensate for their vulnerability. The impact of delirium itself, directly or indirectly, may convert vulnerability into adverse outcome.
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Pain and Quality of Life Among Residents of Norwegian Nursing Homes. Pain Manag Nurs 2010; 11:35-44. [DOI: 10.1016/j.pmn.2009.01.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 01/19/2009] [Accepted: 01/26/2009] [Indexed: 11/18/2022]
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Torvik K, Kaasa S, Kirkevold Ø, Saltvedt I, Hølen JC, Fayers P, Rustøen T. Validation of Doloplus-2 among nonverbal nursing home patients--an evaluation of Doloplus-2 in a clinical setting. BMC Geriatr 2010; 10:9. [PMID: 20170535 PMCID: PMC2841602 DOI: 10.1186/1471-2318-10-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 02/20/2010] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Pain measurement in nonverbal older adults is best based on behavioural observation, e.g. using an observational measurement tool such as Doloplus-2. The purposes of this study were to examine the use of Doloplus-2 in a nonverbal nursing home population, and to evaluate its reliability and validity by comparing registered nurses' estimation of pain with Doloplus-2 scores. METHOD In this cross-sectional study, Doloplus-2 was used to observe the pain behaviour of patients aged above 65 years who were unable to self-report their pain. Nurses also recorded their perceptions of patient pain (yes, no, don't know) before they used Doloplus-2. Data on demographics, medical diagnoses, and prescribed pain treatment were collected from patient records. Daily life functioning was measured and participants were screened using the Mini Mental State Examination. RESULTS In total, 77 nursing home patients were included, 75% were women and the mean age was 86 years (SD 6.6, range 68-100). Over 50% were dependent on nursing care to a high or a medium degree, and all were severely cognitively impaired. The percentage of zero scores on Doloplus-2 ranged from 17% (somatic reactions) to 40% (psychosocial reactions). Cronbach's alpha was 0.71 for the total scale. In total, 52% of the patients were judged by nurses to be experiencing pain, compared with 68% when using Doloplus-2 (p = 0.01). For 29% of the sample, nurses were unable to report if the patients were in pain. CONCLUSIONS In the present study, more patients were categorized as having pain while using Doloplus-2 compared with nurses' estimation of pain without using any tools. The fact that nurses could not report if the patients were in pain in one third of the patients supports the claim that Doloplus-2 is a useful supplement for estimating pain in this population. However, nurses must use their clinical experience in addition to the use of Doloplus-2, as behaviour can have different meaning for different patients. Further research is still needed about the use of Doloplus-2 in patients not able to self-report their pain.
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Affiliation(s)
- Karin Torvik
- Faculty of Nursing, Oslo University College, Oslo, Norway
- Department of Cancer Research & Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing, Sør Trøndelag University College, Trondheim, Norway
| | - Stein Kaasa
- Department of Cancer Research & Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim, Norway
| | - Øyvind Kirkevold
- Norwegian Centre for Dementia Research, Vestfold Mental Health Care Trust, Tønsberg, Sem, Norway
- Faculty of Health and Sports, University of Agder, Kristiansand, Norway
| | - Ingvild Saltvedt
- Department of Neuroscience, Faculty of Medicine, University of Science and Technology (NTNU), Trondheim, Norway
| | - Jacob C Hølen
- Department of Public Health and General Practice, University of Science and Technology (NTNU), Trondheim, Norway
| | - Peter Fayers
- Department of Cancer Research & Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Tone Rustøen
- Faculty of Nursing, Oslo University College, Oslo, Norway
- Centre for Shared Decision Making and Nursing Research, Oslo University Hospital, Oslo, Norway
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Wikby K, Ek AC, Christensson L. Implementation of a nutritional programme in elderly people admitted to resident homes. Scand J Caring Sci 2009; 23:421-30. [DOI: 10.1111/j.1471-6712.2008.00632.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Canavan PK, Cahalin LP, Lowe S, Fitzpatrick D, Harris M, Plummer-D'Amato P. Managing gait disorders in older persons residing in nursing homes: a review of literature. J Am Med Dir Assoc 2009; 10:230-7. [PMID: 19426938 DOI: 10.1016/j.jamda.2009.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 02/16/2009] [Indexed: 10/20/2022]
Abstract
Managing gait disorders in the nursing home setting is a challenge. Nursing home residents can present with a variety of factors that may contribute to the presentation of gait abnormalities. The development of an individualized intervention program can be effective in improving a resident's ability to ambulate. This article reviews the research pertaining to the management of gait disorders including deconditioning, therapeutic exercise intervention, dementia, and cardiovascular and cardiopulmonary systems. The review provides the reader with strategies to help improve and understand gait performance in older persons residing in nursing homes.
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Affiliation(s)
- Paul K Canavan
- Department of Physical Therapy, Northeastern University, Boston, MA 02113, USA.
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Abstract
BACKGROUND much has been written about the demographic and health characteristics which act as risk factors for care home admission in the UK. However, few studies have examined variation in care home admission rates across areas, whilst controlling for the demographic and health characteristics of the individuals living within these areas. This is surprising given that decisions which affect admission are often taken at the local level. The aim of the study was to determine if there were variations in care home admission rates across trusts in Northern Ireland, once adjustment had been made for the demographic and health characteristics of the individuals residing within these areas. METHODS a retrospective cohort study was undertaken, using data from the Data Retrieval in General Practice (DRGP) project in Northern Ireland, to identify a cohort of individuals aged 65 and over and living in the community at the outset of the study. A total of 28,064 individuals were followed up for 5 years to identify those who subsequently entered a nursing or residential care home. Controlling for the demographic, household composition and health characteristics of individuals, Poisson regression was used to estimate the incidence rate ratios of care home admission for 10 trusts. RESULTS a total of 24,691 of the initial cohort had complete information for all variables and were included in the final analysis; 1,313 (5.3%) had entered a care home at the end of the 5 years of follow-up. Admission increased significantly with age, and diagnoses of dementia and stroke. Controlling for the age, sex and health composition of individuals, some variations in admission rates were found across trusts. CONCLUSIONS the study has highlighted the importance of age and clinical conditions as risk factors for care home admission. In addition, it appears that the area of residence might be important in determining a person's risk of care home admission. Such differences may be attributable to particular characteristics of the trust, such as the level of deprivation or degree of rurality, or to differing policies in relation to services for older people. More work is required to identify the causes of the differences to allow policies to be implemented to ensure equitable access to care homes across Northern Ireland.
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Affiliation(s)
- Sheelah Connolly
- Epidemiology and Public Health, Queen's University Belfast, Royal Victoria Hospital site, Belfast, UK.
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Modernising social care services for older people: scoping the United Kingdom evidence base. AGEING & SOCIETY 2009. [DOI: 10.1017/s0144686x08008301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTIn common with other developed countries at the end of the 20th century, modernising public services was a priority of the United Kingdom (UK) Labour administration after its election in 1997. The modernisation reforms in health and social care exemplified their approach to public policy. The authors were commissioned to examine the evidence base for the modernisation of social care services for older people, and for this purpose conducted a systematic review of the relevant peer-reviewed UK research literature published from 1990 to 2001. Publications that reported descriptive, analytical, evaluative, quantitative and qualitative studies were identified and critically appraised under six key themes of modernisation: integration, independence, consistency, support for carers, meeting individuals' needs, and the workforce. This paper lists the principal features of each study, provides an overview of the literature, and presents substantive findings relating to three of the modernisation themes (integration, independence and individuals' needs). The account provides a systematic portrayal both of the state of social care for older people prior to the modernisation process and of the relative strengths and weaknesses of the evidence base. It suggests that, for evidence-based practice and policy to become a reality in social care for older people, there is a general need for higher quality studies in this area.
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Brittle N, Patel S, Wright C, Baral S, Versfeld P, Sackley C. An exploratory cluster randomized controlled trial of group exercise on mobility and depression in care home residents. Clin Rehabil 2009; 23:146-54. [DOI: 10.1177/0269215508098891] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the feasibility, acceptability and potential efficacy of group exercise for residents in care homes. Design: Exploratory cluster randomized controlled trial. Setting: Five randomly selected care homes in South Birmingham, UK. Participants: Fifty-six care home residents (mean age 84.5, 71% female), 39 (70%) with cognitive impairments. Intervention: Two homes (n = 28) were randomized to group exercise held twice weekly for five weeks. The remaining three homes (n = 28) formed the control group and received usual care, with no person specifically responsible for exercise training. Outcome measures: Assessments were conducted at zero (pre-intervention), three (post-intervention) and six months (follow-up) using the Rivermead Mobility Index and Hospital Anxiety and Depression Scale or Stroke Aphasic Depression Questionnaire (depending on cognitive impairment). Adherence to group exercise and retention to the study were also documented. Results: No statistically significant improvements in mobility or depression were found in favour of group exercise. Retention to the study was high with 46 (82%) participants completing all assessments. Adherence to group exercise was somewhat lower with participants attending a mean of 3.61 out of 8.5 prescribed sessions (42.5%). Conclusions: Group exercise can be delivered to care home residents with reduced mobility but it is not suitable for residents with severe cognitive impairment. An estimated sample size of 240 participants would be required to detect a clinically significant difference in the Rivermead Mobility Index with 90% power.
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Affiliation(s)
- Nicola Brittle
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, ,
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, Division of Medical Sciences, Robert Aitken Institute, Edgbaston
| | - Christine Wright
- Nursing and Physiotherapy, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham
| | - Sabrina Baral
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Pam Versfeld
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Catherine Sackley
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Sackley CM, Rodriguez NA, van den Berg M, Badger F, Wright C, Besemer J, van Reeuwijk KTV, van Wely L. A phase II exploratory cluster randomized controlled trial of a group mobility training and staff education intervention to promote urinary continence in UK care homes. Clin Rehabil 2009; 22:714-21. [PMID: 18678571 DOI: 10.1177/0269215508089058] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess feasibility, acceptability and potential efficacy of group exercise and staff education intervention to promote continence in older people residing in care homes. To establish measures and information to inform a larger trial. DESIGN Phase II pilot exploratory cluster randomized controlled trial. SETTING Six purposely selected care homes in the West Midlands, UK. SUBJECTS Thirty-four care home residents (mean age 86, 29 female), 23 with cognitive impairments. INTERVENTION Physiotherapy-led group exercise and staff continence and mobility facilitation training. MAIN OUTCOME MEASURES Reported continence status, Rivermead Mobility Index. Feasibility was assessed by uptake and compliance, and acceptability by verbal feedback. A staff knowledge questionnaire was used. RESULTS Thirty-three residents, cluster sizes from 3 to 7. The number of residents agreeing with the statement 'Do you ever leak any urine when you don't mean to?' in the intervention group decreased from 12/17 at baseline to 7/17 at six weeks in the intervention group and increased from 9/16 at baseline to 9/15 at six weeks. The Rivermead Mobility Index scores were better in the intervention group (n=17; baseline: 6.1, six weeks: 6.2) compared with controls (n=16; baseline: 5.9, six weeks: 4.75). The intervention was feasible, well received and had good compliance. CONCLUSIONS Group mobility training and staff education to promote continence is feasible and acceptable for use with care home residents, including those with cognitive impairment.
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Affiliation(s)
- Catherine M Sackley
- Department of Primary Care and General Practice, School of Health Sciences, University of Birmingham, Edgbaston, UK.
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Abstract
The aims of this study were to describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain. Inpatients (n = 307) older than 64 years from nursing homes were included. Pain was measured with a 4-point verbal rating scale in the self-reported group (SRG) and Doloplus-2 in the proxy-rated group (PRG). The mean age was 86 years (SD, 7), and more than two-thirds were female. A total of 128 (60%) patients were able to self-report their pain. Approximately 50% of the SRG reported 'pain now', and of these, nearly 50% reported moderate or severe pain intensity. Better cognitive function was associated with higher pain and receiving more potent pain medication in the SRG. The pain prevalence in the PRG was higher than in the SRG (67.5% vs 51%), but no variable was associated with proxy-rated pain. Nearly 30% in the SRG and 40% in the PRG did not receive pain medication in spite of pain. Pain is still a huge problem in the nursing homes, and more research is needed on pain management in nursing home residents.
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Affiliation(s)
- K Torvik
- Department of Nursing, Oslo University College, Oslo.
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Hubbard RE, O'Mahony MS, Woodhouse KW. Characterising frailty in the clinical setting--a comparison of different approaches. Age Ageing 2009; 38:115-9. [PMID: 19008304 DOI: 10.1093/ageing/afn252] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Ruth E Hubbard
- Department of Geriatric Medicine, School of Medicine, Cardiff University, Academic Centre, Llandough Hospital, Penlan Road, PenarthSouth Wales CF64 2XX, UK.
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Szczepura A, Nelson S, Wild D. In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness. BMC Health Serv Res 2008; 8:269. [PMID: 19102743 PMCID: PMC2627849 DOI: 10.1186/1472-6963-8-269] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 12/22/2008] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A joint NHS-Local Authority initiative in England designed to provide a dedicated nursing and physiotherapy in-reach team (IRT) to four residential care homes has been evaluated. The IRT supported 131 residents and maintained 15 'virtual' beds for specialist nursing in these care homes. METHODS Data captured prospectively (July 2005 to June 2007) included: numbers of referrals; reason for referral; outcome (e.g. admission to IRT bed, short-term IRT support); length of stay in IRT; prevented hospital admissions; early hospital discharges; avoided nursing home transfers; and detection of unrecognised illnesses. An economic analysis was undertaken. RESULTS 733 referrals were made during the 2 years (range 0.5 to 13.0 per resident per annum) resulting in a total of 6,528 visits. Two thirds of referrals aimed at maintaining the resident's independence in the care home. According to expert panel assessment, 197 hospital admissions were averted over the period; 20 early discharges facilitated; and 28 resident transfers to a nursing home prevented. Detection of previously unrecognised illnesses accounted for a high number of visits. Investment in IRT equalled 44.38 pounds per resident per week. Savings through reduced hospital admissions, early discharges, delayed transfers to nursing homes, and identification of previously unrecognised illnesses are conservatively estimated to produce a final reduction in care cost of 6.33 pounds per resident per week. A sensitivity analysis indicates this figure might range from a weekly overall saving of 36.90 pounds per resident to a 'worst case' estimate of 2.70 pounds extra expenditure per resident per week.Evaluation early in implementation may underestimate some cost-saving activities and greater savings may emerge over a longer time period. Similarly, IRT costs may reduce over time due to the potential for refinement of team without major loss in effectiveness. CONCLUSION Introduction of a specialist nursing in-reach team for residential homes is at least cost neutral and, in all probability, cost saving. Further benefits include development of new skills in the care home workforce and enhanced quality of care. Residents are enabled to stay in familiar surroundings rather than unnecessarily spending time in hospital or being transferred to a higher dependency nursing home setting.
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Affiliation(s)
- Ala Szczepura
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Sara Nelson
- Faculty of Health and Social Care, University of the West of England, Bristol, UK
| | - Deidre Wild
- Faculty of Health and Social Care, University of the West of England, Bristol, UK
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Worden A, Challis D, Hancock G, Woods R, Orrell M. Identifying need in care homes for people with dementia: the relationship between two standard assessment tools. Aging Ment Health 2008; 12:719-28. [PMID: 19023723 DOI: 10.1080/13607860802154382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Considerable effort has been invested in improving assessment processes for older people, some of the most vulnerable of whom live in care homes. The paper compares two well-known assessment tools used in care homes, the CANE and the Minimum Data Set/Resident Assessment Instrument. There was poor agreement between the tools in terms of domains of need covered. Nineteen pairs of items could be compared, with agreement greater than 60% found on 11 items. Of the 15 items where kappa could be computed, seven significant values were found. High levels of agreement existed in relation to behaviour, psychological wellbeing, mood state, psychotic symptoms, incontinence, mobility and inadvertent self-harm (risk). The study suggests that tools commonly used for assessment are not interchangeable and that the selection of assessment tool should be determined by the setting in which it is used, the needs of the population being assessed, the skills and knowledge of those undertaking the assessment and the purpose of the assessment itself.
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Affiliation(s)
- A Worden
- PSSRU, School of Community Based Medicine, University of Manchester, Manchester, UK.
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Abstract
Purpose: The aim of this study is to determine the cultural adequateness of the Arabic version of the Care Dependency Scale (CDS), an internationally used instrument to measure care needs by either self-reports or external assessment. Method: A Delphi study in two rounds about the Arabic version was performed with 37 panelists in Cairo. Acceptance of CDS items was rated on a 4-point Likert-type scale. Results: Agreement among panelists in the second round was found for 11 CDS items, but 2 items had decreased acceptance after rephrasing and 2 were rejected. Discussion: Rejected items seem to reflect a heterogeneous perception in the target population. Despite some limitations, the CDS is a promising instrument to detect care needs among older Egyptians.
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Boggatz T, Dijkstra A, Lohrmann C, Dassen T. The meaning of care dependency as shared by care givers and care recipients: a concept analysis. J Adv Nurs 2008; 60:561-9. [PMID: 17973720 DOI: 10.1111/j.1365-2648.2007.04456.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper is a report of a concept analysis to identify a meaning of care dependency that can be shared by both care givers and care recipients. BACKGROUND Care dependency can be perceived from the care recipient's and the care giver's perspective. To allow for comparisons, both sides should share the same understanding of the concept. The current research about care dependency has focused on external assessment by nurses and suffers from a tendency to use the concept with different meanings. As a consequence, research on dependency may capture different phenomena. METHOD Walker and Avant's method for concept analysis served as the guideline for this study. The Medline, CINAHL and Cochrane databases were searched for the period 1996-2006 using the terms dependence, dependency, care dependence and care dependency. RESULTS Care dependency can be defined as a subjective, secondary need for support in the domain of care to compensate a self-care deficit. Functional limitations are a necessary antecedent and unmet needs are a possible consequence of care dependency. The conceptual difference between care dependency, functional limitations and unmet needs may be meaningless for study participants. They may better understand these differences if they are asked about all three phenomena in the same investigation. CONCLUSION Care givers and care recipients can agree on the suggested attributes of care dependency but may judge them in different ways. Self-assessed care dependency has the potential to challenge preconceptions of care givers about care dependency.
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Affiliation(s)
- Thomas Boggatz
- Department of the Education for Nurse and Paramedical Teachers and Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Germany.
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DAVIES SUE, GOODMAN CRIPACC CLAIRE. Supporting quality improvement in care homes for older people: the contribution of primary care nurses. J Nurs Manag 2008; 16:115-20. [DOI: 10.1111/j.1365-2834.2007.00838.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wenborn J, Challis D, Pool J, Burgess J, Elliott N, Orrell M. Assessing the validity and reliability of the Pool Activity Level (PAL) Checklist for use with older people with dementia. Aging Ment Health 2008; 12:202-11. [PMID: 18389400 DOI: 10.1080/13607860801984375] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Activity is key to maintaining physical and mental health and well-being. However, as dementia affects the ability to engage in activity, care-givers can find it difficult to provide appropriate activities. The Pool Activity Level (PAL) Checklist guides the selection of appropriate, personally meaningful activities. The aim of this study was to assess the reliability and validity of the PAL Checklist when used with older people with dementia. A postal questionnaire sent to activity providers assessed content validity. Validity and reliability were measured in a sample of 60 older people with dementia. The questionnaire response rate was 83% (102/122). Most respondents felt no important items were missing. Seven of the nine activities were ranked as 'very important' or 'essential' by at least 77% of the sample, indicating very good content validity. Correlation with measures of cognition, severity of dementia and activity performance demonstrated strong concurrent validity. Inter-item correlation indicated strong construct validity. Cronbach's alpha coefficient measured internal consistency as excellent (0.95). All items achieved acceptable test-retest reliability, and the majority demonstrated acceptable inter-rater reliability. We conclude that the PAL Checklist demonstrates adequate validity and reliability when used with older people with dementia and appears a useful tool for a variety of care settings.
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Affiliation(s)
- Jennifer Wenborn
- Department of Mental Health Sciences, University College London, UK.
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Sutcliffe C, Burns A, Challis D, Mozley CG, Cordingley L, Bagley H, Huxley P. Depressed mood, cognitive impairment, and survival in older people admitted to care homes in England. Am J Geriatr Psychiatry 2007; 15:708-15. [PMID: 17504909 DOI: 10.1097/jgp.0b013e3180381537] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate psychiatric morbidity, cognitive impairment, dependency, and survival in residents newly admitted to care homes. METHODS A total of 308 older people were assessed using measures of cognitive impairment and depressive symptomatology, and interviewable residents completed a quality-of-life interview. Dependency levels were assessed by interviews with staff and medication data were collected from home records. Follow-up assessments were carried out at five and nine months. A telephone follow-up approximately 12 months later augmented the survival data. RESULTS Of residents whose outcomes were known, 73% survived throughout the nine-month study period. Residents who died before the five-month follow-up had higher scores on the depression measure than those surviving longer. Reduced survival was predicted by greater dependency at baseline. Of 188 surviving residents, 63 (38%) were classified as depressed at baseline. Twenty-seven (43%) of the latter were still classed as depressed at five and nine months. Just 19% of residents rated as depressed at baseline were prescribed antidepressant medication, increasing to 26% at each follow-up. There was significant coexistence of cognitive impairment and depressive symptomatology. CONCLUSION High levels of mortality, psychiatric morbidity, and chronicity of depressed mood among residents requires care homes to improve access to specialist resources such as geriatric consultation, old-age psychiatry, occupational therapy, and physiotherapy. Findings suggest that future care standards should include external factors, such as the extent of access to relevant specialist services for vulnerable older people.
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Affiliation(s)
- Caroline Sutcliffe
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom.
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Reed J, Watson B, Cook M. Assessing the Registered Nursing Care Contribution for older people in care homes: issues of reliability and validity. HEALTH & SOCIAL CARE IN THE COMMUNITY 2007; 15:136-45. [PMID: 17286675 DOI: 10.1111/j.1365-2524.2006.00668.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The present paper reports on a study designed to investigate the validity and reliability of the Registered Nursing Care Contribution (RNCC) tool for assessing the level of nursing care required by care home residents. Care plan data from 186 residents in participating care homes were assessed by multiple assessors using the RNCC tool (i.e. care home registered nurses, a nurse researcher, an external care home expert and a nurses consultant). The Minimum Data Set (MDS) rating was used as a validated comparison. The findings from the study indicated that there were disparities between the RNCC and MDS bandings, and between different raters, with the external care home expert achieving the closest agreement with the MDS. This suggests that the use of the RNCC tool varies considerably according to the assessor, which also suggests that training of users is needed to ensure consistency and reliability. However, the difference between the outcomes of using the RNCC tool and the MDS suggests that assessment of nursing need may need to be re-examined to ensure validity.
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Affiliation(s)
- Jan Reed
- Centre for Care of Older People, Coach Lane Campus, Northumbria University, Newcastle upon Tyne, UK.
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Abstract
In many countries there is a concern to improve assessment procedures for older people to avoid misplacement in nursing homes and ensure that rehabilitation takes place where possible. The study examined assessment documentation in 126 care homes in North West England. On a set of core domains for assessing need, the level of coverage varied considerably. The use of standardised scales was infrequent apart from those that measured risk of developing pressure sores. Some important key domains were infrequently mentioned on the assessment forms including mental health, pain, oral health and foot care. The most frequently covered items were the activities of daily living. There were clear differences in the assessment approaches employed in different types of home. The lack of inclusion of certain key health areas on some assessment forms suggests that the well-being and quality of life of some residents may be poorly addressed, and that further work is required for the standard of assessment in care homes to match that in community-based care.
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Affiliation(s)
- A Worden
- Personal Social Services Research Unit, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
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Sackley C, Levin S, Cardoso K, Hoppitt T. Observations of activity levels and social interaction in a residential care setting. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2006. [DOI: 10.12968/ijtr.2006.13.8.370] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Karina Cardoso
- Research Psychologist Department of Primary Health Care, University of Oxford, UK
| | - Thomas Hoppitt
- Research Assistant, Department of Health Sciences, University of Birmingham, Birmingham B15 2TT
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Goodman C, Robb N, Drennan V, Woolley R. Partnership working by default: district nurses and care home staff providing care for older people. HEALTH & SOCIAL CARE IN THE COMMUNITY 2005; 13:553-62. [PMID: 16218984 DOI: 10.1111/j.1365-2524.2005.00587.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Older people residents in care homes that only offer residential care rely on primary health care services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary health care team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on-site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community-based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the 171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community-based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.
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Affiliation(s)
- Claire Goodman
- Primary Care Nursing Research Unit, Department of Primary Care and Population Sciences, University College London/King's College London, London, UK.
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O'Malley L, Croucher K. Housing and dementia care - a scoping review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2005; 13:570-7. [PMID: 16218986 DOI: 10.1111/j.1365-2524.2005.00588.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This paper reports the findings of a scoping study designed to describe the evidence base with regard to housing provision for elderly people with dementia with the aim of identifying gaps in existing knowledge. This report from the scoping study findings covers studies of housing and accommodation in relation to dementia that have been published in the UK since the early 1980s, although we draw on limited aspects of overseas research to illuminate issues missing from the UK research agenda. The results reveal a significant number of research gaps in the UK context, most notably in relation to end-of-life care for people with dementia and the effectiveness of integrated and segregated facilities. UK policy regarding the development of extra-care housing also neglects the long-term future of people with dementia. A more robust evidence base will be required, combining a variety of methodological approaches, if UK dementia research is to contribute to future housing policy developments.
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Affiliation(s)
- Lisa O'Malley
- Department for Social Policy and Social Work, University of York, York, UK.
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Nygaard HA, Jarland M. Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment? Int J Geriatr Psychiatry 2005; 20:730-7. [PMID: 16035124 DOI: 10.1002/gps.1350] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mentally impaired and demented nursing home patients are at increased risk of undertreatment for pain. We wanted to examine pain assessment and complaints and pain treatment of nursing home patients according to mental state, and with special regard to treatment of patients with dementia diagnosis and cognitively impaired patients who did not have a dementia diagnosis. METHODS Cross sectional study from three nursing homes in Bergen, Norway including 125 persons (median age 84 years), living permanently in a nursing home. Diagnoses and prescribed and administered analgesic drugs were recorded. An experienced nurse interviewed nurses in charge and patients regarding presence of pain during the last week. Patients who were able to answer whether they had experienced pain during the last week were categorised as communicative. Cognitive function was assessed by means of the Abbreviated Mental Test. RESULTS Seventeen percent of the patients were cognitively intact, 30% cognitively impaired and 54% had a dementia diagnosis. Forty-seven percent of communicative patients complained of pain, nurses reported pain in 67% patients. Twenty-nine percent of the patients had received scheduled analgesics during the last week, cognitively intact patients 38%, cognitively impaired 30%, demented 25% (p = 0.53). Twenty percent were given analgesics PRN: cognitively intact patients 33%, cognitively impaired 27%, demented 12% (p = 0.05). Logistic regression analyses revealed that patients with dementia diagnosis were less likely to receive PRN medication [Adjusted odds ratio (AOR) 0.22 95% confidence interval (CI) 0.06-0.76] compared to mentally impaired patients. Regarding scheduled medication there was no difference between the groups. Nurses' opinion of pain was a significant factor for receiving analgesic drugs, scheduled AOR 3.95 95% CI 1.48-10.5, PRN 3.80-95% CI 1.28-11.3). CONCLUSIONS A label of dementia may bias the interpretation of pain cues of demented patients, while complaints from cognitively impaired patients may be taken for granted. This may contribute to lower use of PRN medication in demented patients compared to cognitively impaired patients.
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Affiliation(s)
- Harald A Nygaard
- Section for Geriatric Medicine, Department of Public Health and Primary Health Care, University of Bergen, Norway.
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Fitzpatrick JM, Roberts JD. Challenges for care homes: education and training of healthcare assistants. ACTA ACUST UNITED AC 2004; 13:1258-61. [PMID: 15580072 DOI: 10.12968/bjon.2004.13.21.17124] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The spotlight is increasingly on all care homes, including those catering specifically for older people, to deliver on quality targets in an attempt to drive up the standards of care provision. These targets include the education, training and supervision of care staff. Representing a major component of the care staff workforce in care homes are healthcare assistants and they play a key role in care provision and will continue so to do. However, pivotal to their effective role performance is preparation and support - the provision of which has been patchy to date. For care homes that provide nursing care the challenges of delivering on these targets by 2005 are significant, particularly as the majority of these homes are run as private enterprises and in the absence of any form of central funding. This article examines key issues to education and training provision. A strategic nationwide approach to education and training for healthcare assistants in care homes is recommended, coupled with robust evaluation of outcomes. Such initiatives will need to be supported by significant financial investment if the Government's targets are to be achieved.
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Affiliation(s)
- Joanne M Fitzpatrick
- Ageing and Health Section, Florence Nightingale School of Nursing and Midwifery, King's College London
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Takata Y, Ansai T, Awano S, Sonoki K, Fukuhara M, Wakisaka M, Takehara T. Activities of daily living and chewing ability in an 80-year-old population. Oral Dis 2004; 10:365-8. [PMID: 15533213 DOI: 10.1111/j.1601-0825.2004.01047.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether chewing ability or number of intact teeth was related to performance of activities of daily living in 80-year olds. DESIGN This was a cross-sectional survey including dental examinations, chewing self-assessment, and everyday function. SUBJECTS AND METHODS A total of 823 people (309 males, 514 females) who were 80 years of age and resident in the Fukuoka Prefecture, Japan participated in this study. RESULTS The mean number of intact teeth was 7.5 +/- 8.7; of the 15 food items offered, the mean number of foods chewed was 11.2 +/- 3.8. Function was independent in 713 subjects, and dependent in 93. After adjustment for gender, we found the number of foods chewed being linked to independent function by the multiple regression analysis (beta = 0.223, P < 0.0001); the number of intact teeth was only weakly related (beta = 0.077, P = 0.03). By logistic regression analysis, functional dependency was 7.5 times more prevalent in individuals capable of chewing four foods or fewer, and 3.3 times more prevalent in those chewing five to nine, than in those chewing all 15 items. No significant functional difference was related to the number of intact teeth. CONCLUSION Chewing ability may be independently related with functional status in 80-year olds.
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Affiliation(s)
- Y Takata
- Department of Internal Medicine, Kyushu Dental College, Kitakyushu, Japan.
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