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Montoya A, Park P, Bynum J, Chang CH. Transfer Trauma Among Nursing Home Residents: Development of a Composite Measure. THE GERONTOLOGIST 2024; 64:gnad085. [PMID: 37392460 DOI: 10.1093/geront/gnad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing home (NH)-to-NH transfers place NH residents at risk for developing transfer trauma. We aimed to develop a composite measure of transfer trauma and apply it among those transferring before and during the pandemic. RESEARCH DESIGN AND METHODS Cross-sectional cohort analysis of long-stay NH residents with a NH-to-NH transfer. Minimum Data Set data (2018-2020) were used to create the cohorts. A composite measure of transfer trauma was developed (2018 cohort) and applied to the 2019 and 2020 cohorts. We analyzed resident characteristics and conducted logistic regression analyses to compare rates of transfer trauma between periods. RESULTS In 2018, 794 residents were transferred; 242 (30.5%) met the criteria for transfer trauma. In the 2019 and 2020, 750 residents (2019) and 795 (2020) were transferred. In 2019 cohort, 30.7% met the criteria for transfer trauma, and 21.9% in 2020 cohort. During the pandemic, a higher proportion of transferred residents left the facility before the first quarterly assessment. Among residents who stayed in NH for their quarterly assessment, after adjusting for demographic characteristics, residents in the 2020 cohort were less likely to experience transfer trauma than those in the 2019 cohort (adjusted odds ratio [AOR] = 0.64, 95% confidence interval [CI]: 0.51, 0.81). However, residents in 2020 cohort were two times more likely to die (AOR = 1.94, 95% CI: 1.15, 3.26) and 3 times more likely to discharge within 90 days after transfer (AOR = 2.86, 95% CI: 2.30, 3.56) compared with those in 2019 cohort. DISCUSSION AND IMPLICATIONS These findings highlight how common transfer trauma is after NH-to-NH transfer and the need for further research to mitigate negative outcomes associated with the transfer in this vulnerable population.
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Affiliation(s)
- Ana Montoya
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Pil Park
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Julie Bynum
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Chiang-Hua Chang
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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Chang CH, Park P, Bynum JP, Montoya A. Nursing Home to Nursing Home Transfers during the Early COVID-19 Pandemic. J Am Med Dir Assoc 2023; 24:441-446. [PMID: 36878263 PMCID: PMC9915045 DOI: 10.1016/j.jamda.2023.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To examine the nursing home to nursing home transfer rates before and during the early COVID-19 pandemic and to identify risk factors associated with those transfers in a state with a policy to create COVID-19-care nursing homes. DESIGN Cross-sectional cohorts of nursing home residents in prepandemic (2019) and COVID-19 (2020) periods. SETTING AND PARTICIPANTS Michigan long-term nursing home residents were identified from the Minimum Data Set. METHODS Each year, we identified transfer events as a resident's first nursing home to nursing home transfer between March and December. We included residents' characteristics, health status, and nursing home characteristics to identify risk factors for transfer. Logistic regression models were conducted to determine risk factors for each period and changes in transfer rates between the 2 periods. RESULTS Compared to the prepandemic period, the COVID-19 period had a higher transfer rate per 100 (7.7 vs 5.3, P < .05). Age ≥80 years, female sex, and Medicaid enrollment were associated with a lower likelihood of transfer for both periods. During the COVID-19 period, residents who were Black, with severe cognitive impairment, or had COVID-19 infection were associated with a higher risk of transfer [adjusted odds ratio (AOR) (95% CI): 1.46 (1.01-2.11), 1.88 (1.11-3.16), and 4.70 (3.30-6.68), respectively]. After adjusting for resident characteristics, health status, and nursing home characteristics, residents had 46% higher odds [AOR (95% CI): 1.46 (1.14-1.88)] of being transferred to another nursing home during the COVID-19 period compared to the prepandemic period. CONCLUSIONS AND IMPLICATIONS In the early COVID-19 pandemic, Michigan designated 38 nursing homes to care for residents with COVID-19. We found a higher transfer rate during the pandemic than during the prepandemic period, especially among Black residents, residents with COVID-19 infection, or residents with severe cognitive impairment. Further investigation is warranted to understand the transfer practice better and if any policies would mitigate the transfer risk for these subgroups.
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Affiliation(s)
- Chiang-Hua Chang
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Pil Park
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Julie Pw Bynum
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ana Montoya
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Weaver RH, Roberto KA, Brossoie N. A Scoping Review: Characteristics and Outcomes of Residents Who Experience Involuntary Relocation. THE GERONTOLOGIST 2020; 60:e20-e37. [PMID: 31112600 DOI: 10.1093/geront/gnz035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Relocation to a residential care facility has been described as the most significant relocation affecting older adults, yet subsequent relocations, like in the case of a facility closure, have received minimal attention in the scholarly research literature. This paper reviews the published literature on involuntary relocation, focusing on the experiences of residents, families, and staff and the effects of involuntary relocation on nursing home residents' health. RESEARCH DESIGN AND METHODS We conducted a scoping review to identify peer-reviewed studies reporting on involuntary relocation of nursing home residents. A total of 28 quantitative, qualitative, and mixed-method articles met inclusion criteria. RESULTS Researchers mostly relied on longitudinal designs and quantitative indicators of functional health, cognitive status, psychological and emotional well-being, environment, and relocation context to examine residents' mortality risk and health outcomes associated with involuntary relocation. Inclusion of qualitative and mixed-method approaches was infrequent, as were indicators of social engagement and perceptions of relocation. Residents' awareness of and preparation for involuntary relocation positively influenced their health and well-being. Family involvement was frequently hindered by communication challenges with facilities. Staff expressed concern about residents, experienced increased workload demands, and acknowledged challenges with planning and communication. DISCUSSION AND IMPLICATIONS Based on the collective findings, we propose a conceptual model of critical factors at play during relocation for consideration for guiding future research and developing provisions to current policies guiding relocation processes. Facilities and policymakers need to consider procedures that enhance planning efforts and decision-making among this vulnerable population and their families.
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Affiliation(s)
- Raven H Weaver
- Department of Human Development, Washington State University, Pullman
| | - Karen A Roberto
- Institute for Society, Culture and Environment.,Center for Gerontology, Virginia Tech, Blacksburg
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Costlow K, Parmelee PA. The impact of relocation stress on cognitively impaired and cognitively unimpaired long-term care residents. Aging Ment Health 2020; 24:1589-1595. [PMID: 31468988 PMCID: PMC7048638 DOI: 10.1080/13607863.2019.1660855] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Abstract
Objectives: The current aims were to explore the effects of relocation stress on depression and anxiety in long-term care residents and to investigate the moderating effect of cognitive status.Methods: The study used existing data from nursing home and congregate apartment residents. Self-reported measures of relocation stress, cognitive status, depression, and anxiety were examined. Exploratory analyses examined group differences in depression and anxiety within the full sample (n = 568) and the sample of first-year residents (n = 347). Main analyses were conducted in a subsample of 107 first-year residents who completed the measure of relocation stress.Results: Residents who had moved in the past year reported more anxiety but not depression than longer-term residents. Relocation stress significantly predicted depression but not anxiety in the subsample of first-year residents. There was no significant effect of cognitive status or the interaction of cognitive status and relocation stress on depression and anxiety.Conclusion: Findings suggest that cognitively impaired older adults are no more vulnerable to the negative effects of relocation stress than cognitively unimpaired older adults. Relocation stress should be regarded as a risk factor for depression in long-term care residents, regardless of cognitive status, in the first year after relocation.
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Affiliation(s)
- Kyrsten Costlow
- Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, USA
| | - Patricia A. Parmelee
- Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, USA
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Wu CS, Rong JR. Relocation experiences of the elderly to a long-term care facility in Taiwan: a qualitative study. BMC Geriatr 2020; 20:280. [PMID: 32762717 PMCID: PMC7409483 DOI: 10.1186/s12877-020-01679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relocation to a long-term care (LTC) facility is a major life change for most elderly people. Following relocation, many elderly experience difficulties in adapting to changes in the living environment. Taiwan is increasingly becoming an "aging society" and the numbers of those who relocate from family residences to long-term residential care facilities have increased over years. However, in-depth evidence on the experiences of the elderly of their stay in LTC facilities in Taiwan is relatively sparse. This study aimed to explore the relocation experiences of the elderly to a LTC facility to inform policy and practice to address their needs effectively. METHODS A qualitative study, using semi-structured in-depth interviews, was conducted to explore the experiences of 16 elderly people who have relocated to and lived in a LTC facility in Taiwan for up to a period of 12 months. All interviews were recorded, transcribed, and analyzed using grounded theory approach. RESULTS Participants' accounts reflected four interrelated key themes: wish to minimize the burden, but stay connected with the family; perceived barriers to adaptation; valuing tailored care; and acceptance and engagement. Each theme included interrelated subthemes that influenced one another and represented the different stages in the relocation journey. Most participants viewed relocation as a way of minimizing the burden of their care from family members, but desired to keep a close connection with family and friends. Participants recounted experiences of psychological resistance while making the decision to relocate. Fear of losing autonomy and the ability to perform self-care was a major reason for resistance to adapt. Provision of tailored care was accorded much value by the participants. The decision to accept the relocation and to adapt themselves to the new environment due to their needs for constant care was explicit in some accounts. CONCLUSIONS Relocation to LTC facility is a dynamic process in the first year of moving into the facility, and involves a range of emotions, feelings and experiences. Adaptation of the elderly into the LTC facility can be maximized if the relocation is well planned with provisions for individually tailored care and family involvement.
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Affiliation(s)
- Chia-Shan Wu
- Department of Nursing, National Tainan Junior College of Nursing, 78, Sec.2 Minzu Rd, Tainan City, Taiwan
| | - Jiin-Ru Rong
- School of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
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Bobian M, El-Kashlan N, Hanba CJ, Svider PF, Folbe AJ, Eloy JA, Zuliani GF, Carron M. Traumatic Facial Injuries Among Elderly Nursing Home Residents: Never Event or Frequent Occurrence? JAMA Otolaryngol Head Neck Surg 2017; 143:569-573. [PMID: 28301646 DOI: 10.1001/jamaoto.2016.4275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance As the nursing home population continues to increase, an understanding of preventable injuries becomes exceedingly important. Although other fall-related injuries have been characterized, little attention has been dedicated to facial trauma. Objectives To estimate the incidence of facial trauma among nursing home residents and detail mechanisms of injury, injury characteristics, and patient demographic data. Design, Setting, and Participants The National Electronic Injury Surveillance System was used to calculate a weighted national incidence of facial trauma among individuals older than 60 years from a nationally representative collection of emergency departments from January 1, 2011, through December 31, 2015. Entries were screened for nursing home residents, and diagnosis, anatomical site, demographic data, and mechanism of injury were analyzed. Results There were 109 795 nursing home residents (median age, 84.1 years; interquartile range, 79-89 years; 71 466 women [65.1%]) who required emergency department care for facial trauma. Women sustained a greater proportion of injuries with increasing age. The most common injuries were lacerations (48 679 [44.3%]), other soft-tissue injuries (45 911 [41.8%]; avulsions, contusions, and hematomas), and fractures (13 814 [12.6%]). Nasal (9331 [67.5%]) and orbital (1144 [8.3%]) fractures were the most common sites. The most common injury causes were direct contact with structural housing elements or fixed items (62 604 [57.0%]) and transfer to and from bed (24 870 [22.6%]). Conclusions and Relevance Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, our analysis in the nursing home setting found more than 100 000 facial injuries during 5 years, suggesting these underappreciated injuries contribute substantially to health care expenditures. Although structural elements facilitated the greatest number of falls, transfer to and from bed remains a significant mechanism, suggesting an area for intervention.
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Affiliation(s)
- Michael Bobian
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Nour El-Kashlan
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Curtis J Hanba
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark4Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey5Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey6Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
| | - Giancarlo F Zuliani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan7Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan8Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Michael Carron
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan7Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan8Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan
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Gaudet Hefele J, Li Y, Campbell L, Barooah A, Wang J. Nursing home Facebook reviews: who has them, and how do they relate to other measures of quality and experience? BMJ Qual Saf 2017; 27:130-139. [PMID: 28780533 DOI: 10.1136/bmjqs-2017-006492] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND The growing use of social media creates opportunities for patients and families to provide feedback and rate individual healthcare providers. Whereas previous studies have examined this emerging trend in hospital and physician settings, little is known about user ratings of nursing homes (NHs) and how these ratings relate to other measures of quality. OBJECTIVE To examine the relationship between Facebook user-generated NH ratings and other measures of NH satisfaction/experience and quality. METHODS This study compared Facebook user ratings of NHs in Maryland (n=225) and Minnesota (n=335) to resident/family satisfaction/experience survey ratings and the Centers for Medicare and Medicaid (CMS) 5-star NH report card ratings. RESULTS Overall, 55 NHs in Maryland had an official Facebook page, of which 35 provided the opportunity for users to rate care in the facility. In Minnesota, 126 NHs had a Facebook page, of which 78 allowed for user ratings. NHs with higher aid staffing levels, not affiliated with a chain and located in higher income counties were more likely to have a Facebook page. Facebook ratings were not significantly correlated with the CMS 5-star rating or survey-based resident/family satisfaction ratings. CONCLUSIONS Given the disconnect between Facebook ratings and other, more scientifically grounded measures of quality, concerns about the validity and use of social media ratings are warranted. However, it is likely consumers will increasingly turn to social media ratings of NHs, given the lack of consumer perspective on most state and federal report card sites. Thus, social media ratings may present a unique opportunity for healthcare report cards to capture real-time consumer voice.
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Affiliation(s)
- Jennifer Gaudet Hefele
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Lauren Campbell
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Adrita Barooah
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Joyce Wang
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
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Hoben M, Norton PG, Ginsburg LR, Anderson RA, Cummings GG, Lanham HJ, Squires JE, Taylor D, Wagg AS, Estabrooks CA. Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial. Trials 2017; 18:9. [PMID: 28069045 PMCID: PMC5223357 DOI: 10.1186/s13063-016-1748-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units. METHODS INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides - non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides' quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument - Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention. DISCUSSION INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 2016.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
- Alberta Innovates-Health Solutions (AIHS) post-doctoral fellow, Translating Research in Elder Care (TREC), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Peter G. Norton
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - Liane R. Ginsburg
- Faculty of Health, York University, School of Health Policy and Management, Toronto, Ontario Canada
| | - Ruth A. Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | | | - Holly J. Lanham
- Department of Medicine and Department of Family and Community Medicine, University of Texas, Health Science Center San Antonio, San Antonio, Texas USA
| | | | - Deanne Taylor
- Interior Health Authority, Kelowna, British Columbia Canada
| | - Adrian S. Wagg
- Faculty of Medicine and Dentistry, University of Alberta, Division of Geriatric Medicine, Edmonton, Alberta Canada
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Umegaki H, Asai A, Kanda S, Maeda K, Shimojima T, Nomura H, Kuzuya M. Risk Factors for the Discontinuation of Home Medical Care among Low-functioning Older Patients. J Nutr Health Aging 2016; 20:453-7. [PMID: 26999247 DOI: 10.1007/s12603-015-0606-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Older patients receiving home medical care often have declining functional status and multiple disease conditions. It is important to identify the risk factors for care transition events in this population in order to avoid preventable transitions. In the present study, therefore, we investigated the factors associated with discontinuation of home medical care as a potentially preventable care transition event in older patients. METHODS Baseline data for participants in the Observational study of Nagoya Elderly with HOme MEdical (ONEHOME) study and data on the mortality, institutionalization, or hospitalisation of the study participants during a 2-year follow-up period were used. Discontinuation of home care was defined as admission to a hospital for any reason, institutionalization, or death. Univariate and multivariate Cox hazard models were used to assess the association of each of the factors with the discontinuation of home care during the observational period. The covariates included in the multivariate analysis were those significantly associated with the discontinuation of home care at the level of P<0.05 in the univariate analysis. RESULTS The univariate Cox hazard model revealed that a low hemoglobin level (< 11g/dL), low serum albumin level (< 3g/dL), higher Charlson Comorbidity Index score, and low Mini Nutritional Assessment Short Form score (< 7) were significantly associated with the discontinuation of home care. A multivariate Cox hazard model including these four factors demonstrated that all four were independently associated with home-care discontinuation. CONCLUSIONS The present results demonstrated that anemia, hypoalbuminemia, malnourishment, and the presence of serious comorbidities were associated with the discontinuation of home medical care among low-functioning older patients.
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Affiliation(s)
- H Umegaki
- Hiroyuki Umegaki, Nagoya University Graduate School of Medicine, Department of Community Healthcare and Geriatrics, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan, Phone: +81-52-744-2364; Fax: +81-52-744-2371; Email address:
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Nakanishi M, Hattori K, Nakashima T, Sawamura K. Health Care and Personal Care Needs Among Residents in Nursing Homes, Group Homes, and Congregate Housing in Japan: Why Does Transition Occur, and Where Can the Frail Elderly Establish a Permanent Residence? J Am Med Dir Assoc 2014; 15:76.e1-6. [DOI: 10.1016/j.jamda.2013.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
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Lach HW, Parsons JL. Impact of fear of falling in long term care: an integrative review. J Am Med Dir Assoc 2013; 14:573-7. [PMID: 23602257 DOI: 10.1016/j.jamda.2013.02.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Abstract
Long term care elders with fear of falling may restrict their activity resulting in declines in function and excess disability. To further explore this problem, a review of the literature was conducted. The search yielded 26 studies on the epidemiology of fear of falling in nursing homes and assisted living as well as intervention studies in these settings. Fear of falling is common, affecting more than 50% of long term care elders and is associated with negative outcomes, including falls, functional impairments, depression, and poor quality of life. Longitudinal studies are rare. There were few intervention studies, with most testing exercise programs, including balance training, such as t'ai chi, and little research testing other approaches. Few conclusions can be drawn about interventions, as most sample sizes were small and the interventions and measurement varied widely. Additional research is needed to identify long term care residents most in need of intervention, and the best ways to reduce fear of falling and its consequences.
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Affiliation(s)
- Helen W Lach
- School of Nursing, Saint Louis University, St. Louis, MO 63104, USA.
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Leland NE, Gozalo P, Teno J, Mor V. Falls in newly admitted nursing home residents: a national study. J Am Geriatr Soc 2012; 60:939-45. [PMID: 22587857 DOI: 10.1111/j.1532-5415.2012.03931.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the relationship between nursing home (NH) organizational characteristics and falls in newly admitted NH residents. DESIGN Observational cross-sectional study from January 1, 2006, to December 31, 2006. SETTING NHs in the United States in 2006. PARTICIPANTS Individuals (n = 230,730) admitted to a NH in 2006 without a prior NH stay and with a follow-up Minimum Data Set (MDS) assessment completed 30 days or more after admission. MEASUREMENTS The relationship between experiencing a fall noted on the MDS assessment and NH characteristics (e.g., staffing, profit and chain status, religious affiliation, hospital-based facility status, number of beds, presence of a special care unit, funding) was examined, adjusting for NH resident characteristics. RESULTS Twenty-one percent of this cohort (n = 47,750) had experienced at least one fall in the NH at the time of the MDS assessment, which was completed for newly admitted NH residents who had at least a 30-day stay. NHs with higher certified nursing assistant (CNA) staffing had lower rates of falls (adjusted odds ratio = 0.97, 95% confidence interval = 0.95-0.99). CONCLUSION For newly admitted NH residents, NHs with higher CNA staffing had a lower fall rate. In an effort to maximize fall prevention efforts, further research is needed to understand the relationship between CNA staffing and falls in this NH population.
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Affiliation(s)
- Natalie E Leland
- Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry and Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA.
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Doupe M, Brownell M, St. John P, Strang DG, Chateau D, Dik N. Nursing Home Adverse Events: Further Insight into Highest Risk Periods. J Am Med Dir Assoc 2011; 12:467-74. [DOI: 10.1016/j.jamda.2011.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/03/2011] [Accepted: 02/04/2011] [Indexed: 11/27/2022]
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Abstract
RÉSUMÉCette étude phénoménologique et herméneutique a donné un aperçu des expériences des membres des familles des résidents qui ont été diagnostiqués d’une démence légère à modérée et qui ont été déménagés de leur institution de soins dans une résidence medicalisée unique. Des entrevues semi-dirigées ont été realisées avec 10 membres de la famille, dont six thèmes ont émergé : (a) la communication en cours, (b) de secours et de contentement, (c) des activités significatives, (d) un environnement amélioré, (e) le fonctionnement amélioré, et (f) le personnel engagé. Ces résultats ont des implications importantes pour la prestation des soins et la planification des programmes futurs dans les soins aux résidents ayant des besoins spéciaux. Surtout, nous pouvons conclure que les résultats axés sur le client des soins produit des résultats positifs pour les résidents et les membres des familles.
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Li Y, Harrington C, Spector WD, Mukamel DB. State regulatory enforcement and nursing home termination from the medicare and medicaid programs. Health Serv Res 2010; 45:1796-814. [PMID: 20819106 DOI: 10.1111/j.1475-6773.2010.01164.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Nursing homes certified by the Medicare and/or Medicaid program are subject to federally mandated and state-enforced quality and safety standards. We examined the relationship between state quality enforcement and nursing home terminations from the two programs. STUDY DESIGN Using data from a survey of state licensure and certification agencies and other secondary databases, we performed bivariate and multivariate analyses on the strength of state quality regulation in 2005, and nursing home voluntary terminations (decisions made by the facility) or involuntary terminations (imposed by the state) in 2006-2007. PRINCIPAL FINDINGS Involuntary terminations were rarely imposed by state regulators, while voluntary terminations were relatively more common (2.16 percent in 2006-2007) and varied considerably across states. After controlling for facility, market, and state covariates, nursing homes in states implementing stronger quality enforcement were more likely to voluntarily terminate from the Medicare and Medicaid programs (odds ratio = 1.53, p = .018). CONCLUSIONS Although involuntary nursing home terminations occurred rarely in most states, nursing homes in states with stronger quality regulations tend to voluntarily exit the publicly financed market. Because of the consequences of voluntary terminations on patient care and access, state regulators need to consider the effects of increased enforcement on both enhanced quality and the costs of termination.
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Affiliation(s)
- Yue Li
- Department of Internal Medicine, University of Iowa & Iowa City VA Medical Center, SE610 GH, 200 Hawkins Dr, Iowa City, IA 52242, USA.
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Letts L, Moreland J, Richardson J, Coman L, Edwards M, Ginis KM, Wilkins S, Wishart L. The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies. Aust Occup Ther J 2010; 57:51-64. [DOI: 10.1111/j.1440-1630.2009.00787.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rapp K, Lamb SE, Klenk J, Kleiner A, Heinrich S, König HH, Nikolaus T, Becker C. Fractures after nursing home admission: incidence and potential consequences. Osteoporos Int 2009; 20:1775-83. [PMID: 19238306 DOI: 10.1007/s00198-009-0852-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
Abstract
SUMMARY Fracture rates were examined in residents newly admitted to nursing homes. The risk of a fracture was highest during the first months after admission and declined thereafter. This risk pattern was observed independently of fracture site, gender or degree of care need. INTRODUCTION AND HYPOTHESIS Residents of nursing homes are a high-risk group for fractures. The aim of the study was to analyse fracture rates as a function of time from admission to nursing home. METHODS Fractures of the upper limb, femur, pelvis and lower leg, time to first and subsequent fractures, age, gender and care needs at admission were measured in 93,424 women and men aged 65 years and over and newly admitted to nursing homes in Bavaria between 2001 and 2006. RESULTS Fracture incidence was highest during the first months after admission to nursing homes and declined thereafter. This pattern was observed for all fracture sites, in women and men and in residents with different care needs. For example, fracture rates of the upper limb declined from 30.0 to 13.5/1,000 person-years in the first 9 months after admission and for all fracture sites from 135.3 to 69.4/1,000 person-years in a corresponding time period. CONCLUSION Newly admitted residents have the highest fracture risk. The pattern of risk is similar across all fractures, suggesting a generic causal pathway. Implementation of effective fracture prevention efforts should be a priority at the time of admission to nursing homes.
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Affiliation(s)
- K Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
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Abstract
Falls are common in the elderly, and frequently result in injury and disability. Most falls result from an interaction between individual characteristics that increase an individual's propensity to fall and acute mediating risk factors that provide the opportunity to fall. Predisposing risk factors include age-associated changes in strength and balance, comorbidities such as osteoarthritis, visual impairment and dementia, psychotropic medications, and certain types of footwear. Fewer studies have focused on acute precipitating factors, but environmental and situational factors are clearly important to fall risk. Approximately 30% of falls result in an injury that requires medical attention, with fractures occurring in approximately 10%. In addition to the risk factors for falls, the fall descent, fall impact, and bone strength are all important determinants of whether a fall will result in a fracture. In recent years, numerous studies have been directed toward the development of effective fall and fall-related fracture prevention interventions.
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Affiliation(s)
- Sarah D. Berry
- Hebrew SeniorLife, Institute for Aging Research, 1200 Centre Street, Boston, MA 02131, 617-363-8237,
| | - Ram Miller
- Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, 410-706-2406,
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Abstract
It is assumed that nursing homes are the setting with the highest incidence of hip fractures. This observation is, however, based on very little data. The aim of this study was to analyze hip fracture rates and the associated excess mortality in a large nursing home population. A cohort of >69,000 women and men newly admitted to German nursing homes were used to calculate sex- and age-specific incidence rates of hip fractures. To calculate excess mortality, a retrospective cohort study was conducted. To each patient with a hip fracture (n = 4342), four residents without hip fracture (n = 17,368) were matched by sex, age, and level of care (measure for the need of care). Hazard regression models were applied. During 91,850 person-years, 4342 hip fractures were observed. The crude incidence rates for hip fractures were 50.8/1000 person-years in women and 32.7/1000 person-years in men. The incidence rates increased with increasing age categories and were highest in the first months after admission to the nursing home. Increasing care need reduced the risk of hip fracture. Mortality in patients with a hip fracture was increased (women: hazard rate ratio for the first 3 mo after fracture, 1.72; 95% CI, 1.59-1.86; men: hazard ratio, 2.14; 95% CI, 1.80-2.53), but excess mortality was limited to the first months after injury. Data are presented for hip fracture rates and excess mortality after a hip fracture. Our results have implications on the timing and the allocation of specific measures for hip fracture prevention.
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Kerse N, Butler M, Robinson E, Todd M. Physical Activity: Wearing slippers, falls and injury in residential care. Aust N Z J Public Health 2008; 28:180-7. [PMID: 15233359 DOI: 10.1111/j.1467-842x.2004.tb00933.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Risk factor studies for falls in residential care have not included factors related to the facilities themselves. OBJECTIVE To identify risk factors for falls and injury related to the individual and the facility. METHOD Cohort study with 1 to 17 months of followup. SETTING A random sample of 14 residential care homes in Auckland, New Zealand. SUBJECTS All residents were approached and 606 (97%) participated, mean (SD) age was 83 (11) years. 114 (19%) residents died and 64 (11%) were transferred. MEASURES Rate of falls and injurious falls per resident year were measured. RESULTS The mean rate of falls and injurious falls was 2.75 and 1.75 per resident year respectively. Factors independently associated with increased falls included: increased mobility (IRR 1.25; 95% CI 1.14-1.37), and less problematic behaviours (IRR 1.09, 95% CI 1.02-1.17), while unexpectedly digoxin use (IRR 0.56, 95% CI 0.33-0.97) was associated with decreased falls. Factors associated with increased risk of injury included being born in the UK (IRR 2.89, 95% CI 1.24-7.19) and being more mobile (OR 1.15, 95% CI 1.06-1.25), whereas wearing soft-soled shoes compared with slippers (IRR 0.50, 95% CI 0.28-0.90) and unexpectedly visual impairment (IRR 0.52, 95% CI 0.33-0.80) was associated with decreased injury. No significant factors related to the facility were identified. CONCLUSION Falls are frequent in residential care facilities and risk factors related to footwear are potentially reversible. IMPLICATIONS Residents should be encouraged to wear shoes rather than slippers.
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Affiliation(s)
- Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
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22
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The Controversy Inherent in Managing Frail Nursing Home Residents During Complex Hurricane Emergencies. J Am Med Dir Assoc 2008; 9:599-604. [DOI: 10.1016/j.jamda.2008.05.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 05/22/2008] [Accepted: 05/30/2008] [Indexed: 11/18/2022]
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Intrator O, Schleinitz M, Grabowski DC, Zinn J, Mor V. Maintaining continuity of care for nursing home residents: effect of states' Medicaid bed-hold policies and reimbursement rates. Health Serv Res 2008. [PMID: 18783452 DOI: 10.1111/j.1475‐6773.2008.00898.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Recent public concern in response to states' intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies. DATA SOURCES/STUDY DESIGN Minimum Data Set assessments of long-stay nursing home residents in April-June 2000 linked to Medicare claims enabled tracking residents' hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics. RESULTS Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52-0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer. CONCLUSIONS Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective.
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Affiliation(s)
- Orna Intrator
- Brown University, Box G-S121-6, Providence, RI 02912, USA.
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Intrator O, Schleinitz M, Grabowski DC, Zinn J, Mor V. Maintaining continuity of care for nursing home residents: effect of states' Medicaid bed-hold policies and reimbursement rates. Health Serv Res 2008; 44:33-55. [PMID: 18783452 DOI: 10.1111/j.1475-6773.2008.00898.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Recent public concern in response to states' intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies. DATA SOURCES/STUDY DESIGN Minimum Data Set assessments of long-stay nursing home residents in April-June 2000 linked to Medicare claims enabled tracking residents' hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics. RESULTS Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52-0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer. CONCLUSIONS Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective.
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Affiliation(s)
- Orna Intrator
- Brown University, Box G-S121-6, Providence, RI 02912, USA.
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25
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The relationship of nursing staff to the hospitalization of nursing home residents. Res Nurs Health 2008; 31:238-51. [DOI: 10.1002/nur.20249] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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26
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Decker FH. Dying in a nursing home: the role of local bed supply in nursing home discharges. J Aging Health 2007; 20:66-88. [PMID: 18042962 DOI: 10.1177/0898264307309935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The relationship of nursing home (NH) discharges due to death to NH bed supply and hospital bed supply was examined. METHOD Data on discharges came from the 1999 National Nursing Home Survey (N = 6,335). County-level bed supply, controls for hospice agency supply, and a nursing facility's percentage of area NH beds came from the Area Resource File. Multinomial logistic regression was used to compare deaths with live discharges. Marginal effects were calculated. RESULTS Discharges due to death increased with increasing NH bed supply and decreased in areas with greater hospital bed supply, areas where hospitalizations were more likely. Hospice supply and a facility's share of area NH beds also affected the probability of discharges due to death. DISCUSSION Supply factors appear related to discharge decisions in a manner affecting the probability of discharges due to death, although the magnitude of the relationship may be less than expected.
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Laughlin A, Parsons M, Kosloski KD, Bergman-Evans B. Predictors of Mortality Following Involuntary Interinstitutional Relocation. J Gerontol Nurs 2007; 33:20-6; quiz 28-9. [PMID: 17899997 DOI: 10.3928/00989134-20070901-04] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Relocation is traumatic for older adults. There is a paucity of literature about the characteristics of individuals who are most susceptible to negative effects of relocation. Residents of a nursing home that closed were compared with residents of a control institution to determine whether relocation had a significant effect on mortality and to identify risk factors for death. The difference in mortality was significant. A Cox regression model demonstrated that the only variable to achieve significance in predicting mortality was the relocation itself. Research must evaluate strategies that will reduce the negative effects of involuntary relocation.
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Affiliation(s)
- Ann Laughlin
- School of Nursing, Creighton University, Omaha, NE 68178, USA
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28
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Gillespie SM, Friedman SM. Fear of falling in new long-term care enrollees. J Am Med Dir Assoc 2007; 8:307-13. [PMID: 17570309 PMCID: PMC2043160 DOI: 10.1016/j.jamda.2007.04.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 04/11/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To measure the prevalence of fear of falling in older adults at the time of long- term care (LTC) enrollment and identify potentially treatable risk factors for low fall related self-efficacy. DESIGN Prospective cohort study. SETTING Three LTC programs in Upstate New York. PARTICIPANTS 112 new enrollees in LTC, aged 55 or older, who passed a cognitive screen. MEASUREMENTS Self-reported falls, the falls efficacy scale (FES), medical conditions, the short geriatric depression scale, and physical performance measures (Berg balance scale, hip flexor, knee extensor and grip strength, gait speed and a six-minute walk). RESULTS Of the 54 subjects (48.2%) who reported fear of falling, 41 (75.9%) reported activity modification secondary to fear. Fearful subjects were more likely to be female (P = .003), report low back pain (P = .030) and lower extremity arthritis (P = .037). Fearful subjects were weaker at the hip (P < .001) and knee (P = .001), and had shorter six-minute walk distances. Subjects with better FES scores had better Berg scores (P < .001), had greater hip and knee strength, had faster gait speeds and walked further in six minutes (P < .001, P = .006, P = .001 and P = .001 respectively). Subjects with low FES scores and fearful subjects were more likely to have depressive symptoms (P = .003, P = .044, respectively). CONCLUSION Falls and fear of falling are more common in new LTC enrollees than in previously described community dwelling and SNF cohorts. Attention to associated characteristics like depression, arthritis, low back pain and lower extremity weakness may identify opportunities to reduce fear and improve patient safety during this transitional period.
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Affiliation(s)
- Suzanne M Gillespie
- Division of Geriatrics/Aging, University of Rochester School of Medicine and Dentistry, Monroe Community Hospital, Rochester, NY, USA.
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Horttana BM, Ahlström G, Fahlström G. Patterns of and Reasons for Relocation in Dementia Care. Geriatr Nurs 2007; 28:193-200. [PMID: 17561017 DOI: 10.1016/j.gerinurse.2006.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 11/28/2006] [Accepted: 12/03/2006] [Indexed: 11/29/2022]
Abstract
Because dementia is a progressive disease, the need for care in municipal shelter accommodations might change over time, raising the crucial question whether to relocate an individual. The aim of the study was to investigate the number of relocations between municipal dementia housing units and to examine the patterns and reasons for relocation, together with the various municipal prerequisites for carrying out relocation. Thirty-three managers of 101 dementia care units in 12 municipalities in Sweden were interviewed, and records of persons who had moved into or out of the dementia care units during the year 2002 were reviewed retrospectively. The results showed that turnover occurred in 35% of the 865 rooms during the year. Of those relocations, 78 (9%) were persons who moved to another accommodation-either into (59), between (13), or out of (6) a dementia care unit. This finding indicates that there are situations in which remaining in place was considered less appropriate than relocating a single individual with dementia to other accommodations with or without dementia specialization. The most common reason for relocation within the municipal shelters was an increased need for care.
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Walker CA, Curry LC, Hogstel MO. Relocation stress syndrome in older adults transitioning from home to a long-term care facility: myth or reality? J Psychosoc Nurs Ment Health Serv 2007; 45:38-45. [PMID: 17304985 DOI: 10.3928/02793695-20070101-09] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Relocation stress syndrome is a nursing diagnosis characterized by symptoms such as anxiety, confusion, hopelessness, and loneliness. It usually occurs in older adults shortly after moving from a private residence to a nursing home or assisted-living facility. The primary purpose of this study was to validate the symptoms of relocation stress syndrome. Eight nursing home residents and 8 assisted-living facility residents were interviewed 2 to 10 weeks after admission, when symptoms of relocation stress syndrome are most likely to appear. Results of this study indicate that the incidence of relocation stress syndrome may be overestimated. More accurate diagnosis and treatment of depression in older adults is needed.
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Affiliation(s)
- Charles A Walker
- Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth 76129, USA.
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Affiliation(s)
- J Belmin
- Service Hospitalo-Universitaire de Gériatrie, Hôpital Charles-Foix et Université Paris 6, Ivry-sur-Seine, France
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Nursing Home Involuntary Relocation: Clinical Outcomes and Perceptions of Residents and Families. J Am Med Dir Assoc 2006; 7:486-92. [PMID: 17027625 DOI: 10.1016/j.jamda.2006.02.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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KOBAYASHI N, SUGAI Y. Witnessed and unwitnessed falls among the elderly with dementia in Japanese nursing homes+. Jpn J Nurs Sci 2006. [DOI: 10.1111/j.1742-7924.2006.00053.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
There is now firm evidence to support interventions in the prevention of falls in older people, and emerging data support prevention of falls as a method of fracture prevention. This chapter discusses the epidemiology of falls, risk factors associated with an increased risk of falling, assessment of the older faller, and evidence-based approaches to the prevention of falls in the older person. Several randomized controlled trials have found that hip protectors, if worn, probably prevent hip fractures, but that poor compliance is a major issue limiting the effectiveness of this form of intervention. More data are needed to support the role of prevention of falls in preventing fractures, as well as comparative cost-effectiveness data with other evidence-based approaches to preventing fractures in an older population.
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Affiliation(s)
- Jacqueline C T Close
- Prince of Wales Medical Research Institute, UNSW, Randwick, Sydney, NSW, Australia.
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Abstract
In recent years the evidence base for prevention of falls in older people has increased and associated with this has been an inevitable expansion in clinical services which attempt to localize and implement what is described in the literature. This article reviews the basic physiology implicit in maintenance of the upright posture; highlights the diversity of medical and non-medical risk factors associated with falls; describes the clinical assessment of an older person at risk of falls; reviews the evidence for intervention in the prevention of falls in older people; and acknowledges the need for a clear strategic direction to successfully prevent falls and the requirement for ongoing research as well as much needed service evaluation.
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Hill-Westmoreland EE, Gruber-Baldini AL. Falls Documentation in Nursing Homes: Agreement Between the Minimum Data Set and Chart Abstractions of Medical and Nursing Documentation. J Am Geriatr Soc 2005; 53:268-73. [DOI: 10.1111/j.1532-5415.2005.53113.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boockvar KS, Litke A, Penrod JD, Halm EA, Morrison RS, Silberzweig SB, Magaziner J, Koval K, Siu AL. Patient relocation in the 6 months after hip fracture: risk factors for fragmented care. J Am Geriatr Soc 2004; 52:1826-31. [PMID: 15507058 PMCID: PMC1447596 DOI: 10.1111/j.1532-5415.2004.52512.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the incidence and patterns of patient relocation after hip fracture, identify factors associated with relocation, and examine effect of relocation on outcomes. DESIGN Prospective cohort study. SETTING Four hospitals in the New York metropolitan area. PARTICIPANTS A total of 562 patients hospitalized for hip fracture discharged alive in 1997 to 1998. MEASUREMENTS Patient characteristics and hospital course were ascertained using patient or surrogate interview, research nurse assessment, and medical record review. Patient location was ascertained at five time points using patient or surrogate interview, and hospital readmissions were identified using New York state and hospital admission databases. Mobility was measured using patient or surrogate report using the Functional Independence Measure. RESULTS During 6 months of follow-up, the mean number of relocations per patient+/-standard deviation was 3.5+/-1.5 (range 2-10). Forty-one percent of relocations were between home and hospital, 36% between rehabilitation or nursing facility and hospital, 17% between rehabilitation or nursing facility and home, and 4% between two rehabilitation/nursing facilities. In a Poisson regression model that controlled for patient characteristics, hospital course, and length of follow-up, factors associated with relocation (P<.05) were absence of dementia, in-hospital delirium, one or more new impairments at hospital discharge, hospital discharge other than to home, and not living at home alone prefracture. Relocation was not significantly associated with immobility or mortality at 6 months (odds ratio=1.14, 95% confidence interval=0.97-1.35). CONCLUSION Subgroups of patients with elevated risk of relocation after hip fracture may be target groups for intensive care coordination and care planning interventions.
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Affiliation(s)
- Kenneth S Boockvar
- Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, 130 W. Kingsbridge Road, Bronx, NY 10468, USA.
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Hodgson N, Freedman VA, Granger DA, Erno A. Biobehavioral correlates of relocation in the frail elderly: salivary cortisol, affect, and cognitive function. J Am Geriatr Soc 2004; 52:1856-62. [PMID: 15507062 DOI: 10.1111/j.1532-5415.2004.52505.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine affect and physiological stress in frail older adults in response to a voluntary nursing home relocation. DESIGN Randomized, controlled trial. SETTING Long-term care facility located within the greater Philadelphia, Pennsylvania, community. PARTICIPANTS Seventy-seven nursing home residents, aged 65 and over. INTERVENTION Experimental group residents were relocated to a newly built nursing home facility with a cluster design in the fall of 2001; control group residents were moved after study completion in the spring of 2002. MEASUREMENTS Mini-Mental State Examination scores, Observed Affect Rating Scale scores, salivary cortisol, blood pressure, and pulse obtained 1 week before moving and 1 week and 4 weeks after moving. RESULTS Relocated nursing home residents demonstrated significant differences in salivary cortisol and mood from a randomly selected group of residents that had not yet moved. Relocation resulted in significantly higher cortisol levels 1 week after the move (P=.005), followed by a significant decline in afternoon cortisol at 4 weeks after the move (P=.03). Moreover, relocated residents had significantly lower depression and anxiety symptoms and pulse rates than residents who had not yet moved. CONCLUSION These findings have important implications for planning medical and social services for relocated elderly. Efforts should be made to prepare individuals for the initial stressors associated with relocation, but it also appears that the stress imposed by relocation is time limited and may begin to ease as early as 4 weeks postmove.
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Affiliation(s)
- Nancy Hodgson
- Polisher Research Institute, Madlyn and Leonard Abramson Center for Jewish Life, 1425 Horsham Road, North Wales, PA 19454, USA.
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Kao HFS, Travis SS, Acton GJ. Relocation to a Long-Term Care Facility: Working With Patients and Families Before, During, and After. J Psychosoc Nurs Ment Health Serv 2004; 42:10-6. [PMID: 15068162 DOI: 10.3928/02793695-20040315-04] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Permanent relocation of a dependent older adult to a long-term care facility can occur for a number of reasons, including the need for postacute care or a higher level of care than can be provided in a less-restrictive environment, and/or the inability of family members or others to care for the individual in a noninstitutional setting. Outcomes of institutional placement may be either negative, such as the older adult experiencing relocation stress syndrome, or positive, such as improved management of chronic illnesses and reversal of functional decline. This article offers a review of the factors that predict when and where older adults will relocate for institutional long-term care, an overview of individual transitions to institutional care, and suggestions for seamless transitions during the preinstitutionalization, transitional, and postinstitutionalization phases of relocation, which are guided by a transactionist approach to stress and coping.
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Affiliation(s)
- Hsueh-Fen S Kao
- School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, 28223, USA.
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Mirotznik J. Does cognitive status moderate the health effects of single-person room transfers on nursing home residents? THE GERONTOLOGIST 2002; 42:634-42. [PMID: 12351798 DOI: 10.1093/geront/42.5.634] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study investigated whether cognitively impaired nursing home residents are particularly vulnerable to harmful effects during single-person, intrabuilding room transfers. DESIGN AND METHODS A variation of a pretest-posttest experimental-comparison group design was used. Data on cognitive status, mortality, and seven morbidity outcome measures were abstracted from the Minimum Data Set Plus and were analyzed by means of event history analyses, controlling for covariates as well as baseline status of outcome variables. RESULTS None of the Relocation x Cognitive Status interaction effects were significant at the Bonferroni corrected p value. IMPLICATIONS These findings suggest that cognitive status may not moderate the health effects of single-person room transfers.
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Affiliation(s)
- Jerrold Mirotznik
- Department of Health and Nutrition Sciences, Brooklyn College, NY 11210, USA.
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Abstract
In this article, the author reviews 78 studies addressing the relocation of the elderly. He begins by defining the four major forms of relocation and describing the trends in the current health care marketplace precipitating relocation events. Next, he reviews the major findings of studies assessing the potential negative and positive outcomes of relocation. These outcomes include changes in mortality rates, morbidity, and psychological or social changes. In addition, factors associated with successful relocation are presented. Finally, the primary contribution of this article is that the author assesses the strengths and limitations of this prior literature and combines the research he reviews in an analytic model. This model helps show some opportunities for future research in the relocation of the elderly.
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Mirotznik J, Kamp LL. Cognitive status and relocation stress: a test of the vulnerability hypothesis. THE GERONTOLOGIST 2000; 40:531-9. [PMID: 11037931 DOI: 10.1093/geront/40.5.531] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study investigated whether cognitively impaired nursing home residents are at particular risk of experiencing harmful effects during a mass, intra-institutional, interbuilding relocation. DESIGN AND METHODS A pretest-post-test experimental-comparison group design was used. Data on cognitive status, functional capacity, psychosocial health status, physical health status, and mortality were abstracted from the Minimum Data Set Plus and were analyzed using continuous and discrete survival analyses, controlling for covariates as well as baseline status of outcome variables. RESULTS None of the Relocation x Cognitive Status interaction effects were significant. Relocation main effects indicated that movers in general were more likely than nonmovers to decline in physical health status. Evidence also emerged for a positive long-term effect of moving on psychosocial health status. IMPLICATIONS These findings suggest cognitively impaired residents are not at unusual risk of harmful effects as a consequence of mass, interbuilding transfer. Given the significant relocation main effects, though, caution must be taken in moving cognitively impaired residents, as it should be in moving any residents.
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Affiliation(s)
- J Mirotznik
- Department of Health and Nutrition Sciences, Brooklyn College, New York 11210, USA.
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Abstract
Alzheimer's disease is a disorder which is typified by a deterioration in cognition and a range of behavioural problems which result in a loss of functional ability and often necessitate transfer to residential care. This article looks at a growing body of research which is revealing the presence of changes in vision, particularly contrast sensitivity and acuity. We discuss the possible pathological basis for such deficits, and examine the possibility that such changes in vision may impact on the behavioural and functional outcomes of the demented individual.
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Affiliation(s)
- F K Cormack
- Department of Psychology, University of Newcastle upon Tyne, UK
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