1
|
Sengupta M, Agree EM. Metro-Nonmetro Differences in Adverse Events in Residential Care Communities: Results From the National Post-Acute and Long-Term Care Study. J Appl Gerontol 2024; 43:413-422. [PMID: 37916406 DOI: 10.1177/07334648231206323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
More than 1 in 5 older Americans live in rural areas (10.6 million of the 46.2 million aged 65 and older). Long-term care for aging rural populations is a growing challenge in the United States. Research on long-term care services in nonmetro areas has focused almost exclusively on nursing home care, despite growth of residential care alternatives. This paper uses unique facility-level data from the 2020 National Post-acute and Long-term Care Study (NPALS) to examine the relationship of residential care community (RCC) features in metro and nonmetro settings with adverse outcomes (emergency department visits, overnight hospital stays, and falls). Nationally, in 2020, about 13.5% of RCC residents made visits to the emergency department, 8.6% had overnight hospital stays, and 21.3% had falls. Controlling for facility characteristics, RCCs in metro areas had higher risks of overnight hospital stays (p < .001) but lower risks of falls (p = .06).
Collapse
|
2
|
Hosseini H. Optimizing Falls-related Planning and Intervention for Nursing Facilities by Ownership Type. Hosp Top 2022:1-6. [PMID: 36066933 DOI: 10.1080/00185868.2022.2118094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Falls among older adults are a major public health concern: They result in $30 billion in direct US healthcare costs annually and take an immense psychological and physical toll on older adults. Particularly concerning are falls in nursing home settings, which account for three times as many falls in adults over 65 than in any other setting. Objectives: We hypothesized that tailoring falls prevention and response plans to nursing home profit model (for- or nonprofit) and ownership type (public, private, franchise) would greatly improve effectiveness of general plans. Methods: To this end, we extracted data from existing government databases, collected qualitative data through structured interviews with home employees, and collected novel quantitative data through web surveys from a representative sample of 40 Pennsylvania nursing homes about prevention and mitigation protocols, population, and facility characteristics, and falls outcome metrics. We analyzed fall-related risk factors that we scored and used to build multivariate logistic regression models to predict falls rates, and subsequently used to build multilevel logistic regression multivariate models to pinpoint the influence of facility type. Results: We found a significant correlation between facility ownership and profit type and falls rates and outcomes. Conclusions: Armed with these analytical insights, we formulated improved falls prevention plans targeted to home types to achieve better falls outcomes as predicted by the models. Finally, we quantify the predicted impact of implementing these targeted plans on fall rates and outcomes in the homes in our study.
Collapse
Affiliation(s)
- Hengameh Hosseini
- Department of Health Administration and Human Resources, The University of Scranton, Scranton, PA, USA
| |
Collapse
|
3
|
Trevisan C, Noale M, Imoscopi A, Bigolaro C, Derni C, Agio E, Dal Ben S, Ceccato M, Tono F, Maggi S, Welmer AK, Sergi G. Trajectories of cognitive and physical performance after accidental falls in nursing home residents: A prospective study. Geriatr Nurs 2022; 47:100-106. [PMID: 35901577 DOI: 10.1016/j.gerinurse.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/04/2022]
Abstract
This prospective study evaluated cognitive and physical trajectories of nursing home (NH) residents after fall occurrence and their predictors. In 167 residents aged ≥60, we considered the closest pre-fall assessment and up to the first three post-fall assessments of cognitive and physical functions performed through Mini-Mental State Examination (MMSE) and Tinetti tests. Mixture models identified three post-fall cognitive and physical trajectories: stability, slow decline, and rapid decline. At logistic regression, older age, fewer informal visits, and falls within one month from institutionalization increased the probability of experiencing a decline in MMSE and Tinetti scores. Worse pre-fall cognitive function increased the likelihood of cognitive and physical decline, while worse pre-fall Tinetti score negatively impacted only physical decline. In conclusion, the impact of falls on the cognitive and physical health of NH residents may be modulated by their pre-fall cognitive function and some modifiable factors, such as social interactions and physical function.
Collapse
Affiliation(s)
- Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy; Department of Medical Sciences, University of Ferrara, Ferrara, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padua, Italy
| | | | - Chiara Bigolaro
- Psychological Service, Istituto AltaVita - IRA, Padua, Italy
| | - Cosetta Derni
- Psychological Service, Istituto AltaVita - IRA, Padua, Italy
| | - Elena Agio
- Psychological Service, Istituto AltaVita - IRA, Padua, Italy
| | - Sara Dal Ben
- Physical Therapy Service, Istituto AltaVita - IRA, Padua, Italy
| | - Marco Ceccato
- Physical Therapy Service, Istituto AltaVita - IRA, Padua, Italy
| | - Federica Tono
- Physical Therapy Service, Istituto AltaVita - IRA, Padua, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
| |
Collapse
|
4
|
Leland NE, Lekovitch C, Martínez J, Rouch S, Harding P, Wong C. Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults. J Appl Gerontol 2022; 41:2187-2196. [PMID: 35618304 DOI: 10.1177/07334648221104375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Of the 33 included studies, common PAC intervention domains included implementing facility-based strategies (e.g., staff education), evaluating patient-specific fall risk factors (e.g., function), and developing an individualized risk profile and treatment plan that targets the patient's constellation of fall risk factors. However, there was variability across studies in how and to what extent the domains were addressed. While further research is warranted, health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach that fosters a culture of safety, addresses individuals' fall risk, and champions a multidisciplinary team.
Collapse
Affiliation(s)
- Natalie E Leland
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Cara Lekovitch
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Jenny Martínez
- Department of Occupational Therapy, 6559Jefferson College of Rehabilitation Sciences, Philadelphia, PA, USA
| | - Stephanie Rouch
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Harding
- Chan Division of Occupational Science and Occupational Therapy, 5116University of Southern California, Los Angeles, CA, USA
| | - Carin Wong
- Department of Sociology, 14669California State University Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
5
|
Tzeng HM, Downer B, Haas A, Ottenbacher KJ. Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay. J Am Med Dir Assoc 2022; 23:128-132.e2. [PMID: 34237256 PMCID: PMC8712356 DOI: 10.1016/j.jamda.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine the relationship between cognitive status and falls with and without injury among older adults during the first 18 days of a skilled nursing facility (SNF) and determine if this association is mediated by limitations in activities of daily living (ADL) and impaired balance. DESIGN Cohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017. SETTINGS AND PARTICIPANTS 815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge. METHODS Cognitive status at SNF admission was classified as intact, mild, moderate, or severe impairment. Residents were classified as having no falls, a fall without injury, and a fall with a minor or major injury. We used ordinal logistic regression to model the association between cognitive status and falls adjusting for resident and facility characteristics. A causal mediation analysis was used to test for the mediating effects of ADL limitations and impaired balance on the association between cognitive status and falls with an injury. RESULTS Mild, moderate, and severe cognitive impairment were associated with 1.72 (95% CI: 1.68-1.75), 2.72 (95% CI: 2.66-2.78), and 2.61 (95% CI: 2.48-2.75) higher odds of being in a higher fall severity category, respectively, compared to being cognitively unimpaired. Greater ADL limitations and impaired balance were significantly associated with falls, but each mediated the association between cognitive status and falls by less than 2%. CONCLUSIONS AND IMPLICATIONS Older adults with cognitive impairment are more likely to experience a fall during an SNF stay. ADL limitations and impaired balance are risk factors for falls but may not contribute to the increased fall risk for SNF residents with cognitive impairment. Continued research is needed to better understand the risk factors for falls among SNF residents with cognitive impairment.
Collapse
Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - Allen Haas
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
6
|
Thomas KS, Cornell PY, Zhang W, Smith L, Hua C, Kaskie B, Carder P. The Relationship Between States' Staffing Regulations And Hospitalizations Of Assisted Living Residents. Health Aff (Millwood) 2021; 40:1377-1385. [PMID: 34495716 DOI: 10.1377/hlthaff.2021.00598] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Assisted living provides housing and long-term care services to more than 811,000 older adults in the United States daily and is regulated by the states. This article describes changes in the specificity of state regulations governing the staffing in assisted living settings (that is, requirements for sufficient staffing or staffing ratios or levels) between 2007 and 2018 and the association between these changes and rates of hospitalization among a national sample of assisted living residents, including a subgroup with dementia. We found that increased regulatory specificity for direct care workers (for example, a change from requiring "sufficient" direct care worker staffing to requiring a specific staffing ratio or level) was associated with a 4 percent reduction in the monthly risk for hospitalization among residents in our sample and a 6 percent reduction among the subgroup with dementia. However, an increase in regulatory specificity for licensed practical nurses was associated with a 2.5 percent increase in the monthly risk for hospitalization and a 5 percent increase among the subgroup with dementia. Given that no federal requirements exist for the number of staff members or composition of staff in assisted living, these findings can inform states' policy decisions about staffing requirements for assisted living settings.
Collapse
Affiliation(s)
- Kali S Thomas
- Kali S. Thomas is an associate professor in the Department of Health Services, Policy, and Practice in the Brown University School of Public Health and a research health scientist in the Center of Innovation in Long-Term Services and Supports at the Providence Veterans Affairs (VA) Medical Center, all in Providence, Rhode Island
| | - Portia Y Cornell
- Portia Y. Cornell is a health science specialist in the Center of Innovation for Long-Term Services and Supports, Providence VA Medical Center, and an investigator in the Center for Gerontology and Healthcare Research, Brown University School of Public Health
| | - Wenhan Zhang
- Wenhan Zhang is an analyst in the Center for Gerontology and Healthcare Research, Brown University School of Public Health
| | - Lindsey Smith
- Lindsey Smith is a PhD student in the Institute on Aging, Portland State University, in Portland, Oregon
| | - Cassandra Hua
- Cassandra Hua is an investigator in the Center for Gerontology and Healthcare Research, Brown University School of Public Health
| | - Brian Kaskie
- Brian Kaskie is an associate professor in the Department of Health Management and Policy, University of Iowa, in Iowa City, Iowa
| | - Paula Carder
- Paula Carder is a professor in the Institute on Aging, Portland State University
| |
Collapse
|
7
|
Trevisan C, Noale M, Mazzochin M, Greco GI, Imoscopi A, Maggi S, Spinella P, Manzato E, Welmer AK, Sergi G. Falls may trigger body weight decline in nursing home residents. Nutrition 2021; 90:111429. [PMID: 34481268 DOI: 10.1016/j.nut.2021.111429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The effect of falls on changes in body weight is still unknown. This study investigated the extent to which falls can modify the course of body weight in nursing home residents, and aimed to identify the factors that might modulate this effect. METHODS The sample included 132 residents aged ≥60 y who had experienced at least one fall after nursing home admission. Body weight was measured monthly in the 6 mo after the fall in the entire sample, and also in the 6 mo prefall in a subsample (n = 111). Sociodemographic and health data were obtained from medical records. Linear mixed models were used to estimate the average monthly changes in body weight after the fall in the total sample, and as a function of the sociodemographic and medical factors. RESULTS Falls modified the course of body weight in the total sample (β = -0.28, 95% confidence interval, -0.44 to -0.12, for the change in slope before and after fall) in all age classes and especially in individuals with severe cognitive impairment who received less-frequent informal visits (β = -0.55, 95% confidence interval, -0.87 to -0.22). Individuals aged ≥90 y and those with severe cognitive impairment had a steeper monthly weight decline in the 6 mo postfall, of 0.23 and 0.35 kg greater, respectively, than their younger and cognitively healthier counterparts. CONCLUSIONS Falls may trigger a body weight loss in nursing home residents, especially in the oldest old people and those with severe cognitive impairment who receive little support from informal caregivers. These findings highlight the importance of monitoring nutritional status of people who live in institutions after falls.
Collapse
Affiliation(s)
- Caterina Trevisan
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Mattia Mazzochin
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| | - Giada Ida Greco
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Paolo Spinella
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| | - Enzo Manzato
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy; National Research Council, Neuroscience Institute, Padua, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Giuseppe Sergi
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| |
Collapse
|
8
|
Alqenae FA, Steinke D, Keers RN. Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review. Drug Saf 2021; 43:517-537. [PMID: 32125666 PMCID: PMC7235049 DOI: 10.1007/s40264-020-00918-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Little is known about the epidemiology of medication errors and medication-related harm following transition from secondary to primary care. This systematic review aims to identify and critically evaluate the available evidence on the prevalence and nature of medication errors and medication-related harm following hospital discharge. Methods Studies published between January 1990 and March 2019 were searched across ten electronic databases and the grey literature. No restrictions were applied with publication language or patient population studied. Studies were included if they contained data concerning the rate of medication errors, unintentional medication discrepancies, or adverse drug events. Two authors independently extracted study data. Results Fifty-four studies were included, most of which were rated as moderate (39/54) or high (7/54) quality. For adult patients, the median rate of medication errors and unintentional medication discrepancies following discharge was 53% [interquartile range 33–60.5] (n = 5 studies) and 50% [interquartile range 39–76] (n = 11), respectively. Five studies reported adverse drug reaction rates with a median of 27% [interquartile range 18–40.5] and seven studies reported adverse drug event rates with a median of 19% [interquartile range 16–24]. For paediatric patients, one study reported a medication error rate of 66.3% and another an adverse drug event rate of 9%. Almost a quarter of studies (13/54, 24%) utilised a follow-up period post-discharge of 1 month (range 2–180 days). Drug classes most commonly implicated with adverse drug events were antibiotics, antidiabetics, analgesics and cardiovascular drugs. Conclusions This is the first systematic review to explore the prevalence and nature of medication errors and adverse drug events following hospital discharge. Targets for future work have been identified. Electronic supplementary material The online version of this article (10.1007/s40264-020-00918-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Fatema A Alqenae
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Douglas Steinke
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Richard N Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
9
|
Suh M, Cho I. Effectiveness of nursing care provided for fall prevention: Survival analysis of nursing records in a tertiary hospital. Jpn J Nurs Sci 2021; 18:e12403. [PMID: 33448157 DOI: 10.1111/jjns.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
AIM This study was carried out to analyze nursing care provided to patients on high and low fall-risk days and to evaluate the effectiveness of nursing care in terms of preventing falls. METHODS A retrospective review of medical records was conducted for patients admitted to a tertiary hospital in Korea. General and clinical information, fall occurrences, Hendrich II Fall Risk Model (HFRM II) fall-risk assessment scores, nursing care related to fall prevention, and medications administered were extracted. RESULTS Data from 43,267 days of records for 11,718 patients were analyzed. Nursing assessment, intervention, and administration of medication were provided more frequently on high fall-risk days than on low fall-risk days. Analysis performed on the entire cohort days showed fall occurrence was significantly associated with infrequent mobility assessment and greater usage of anti-anxiety agents. On high fall-risk days, fall occurrence was related to less restraint assessment and greater usage of vessel dilatators. CONCLUSIONS The implementation of risk-targeted interventions for fall prevention based on fall-risk assessment is needed. For general fall prevention, assessment of patients' mobility should be strengthened. For high fall-risk patients, it may be more effective for nurses to focus on assessing restraints, evaluating medication records, and withdrawing medications related to falls.
Collapse
Affiliation(s)
- Minhee Suh
- Department of Nursing, Inha University, Incheon, South Korea
| | - Insook Cho
- Department of Nursing, Inha University, Incheon, South Korea
| |
Collapse
|
10
|
Baixinho CRSL, Dixe MDACR. EVALUATION OF FALL RISK FACTORS PRESENT DURING INSTITUTIONALIZATION OF ELDERLY PEOPLE. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
ABSTRACT Objectives: to describe the development and validation of the Scale of Practices of Evaluation of Fall Risk Factors during Institutionalization of Elderly People and to describe the practices of evaluation of communication of fall risks to institutionalized elderly people. Methods: methodological study, which allowed construction and determination of the psychometric properties of the Scale of Practices of Evaluation of Fall Risk Factors during Institutionalization of Elderly People, which was carried out in six long-term care institutions for elderly people, in 2018. Results: the scale showed satisfactory internal consistency, with a Cronbach’s alpha of 0.949. It was designed to have three dimensions: practices of evaluation of biophysiological risk factors; practices of communication and training; and practices of evaluation of risks related to elderly people’s putting on clothing and footwear. Conclusions: the risk factors that had their value recognized were related to mobility. There is not proper recognition of the importance of information about fall risk factors and communication between elderly people and health teams during institutionalization.
Collapse
|
11
|
Baughman RA, Stanley B, Smith KE. Second Job Holding Among Direct Care Workers and Nurses: Implications for COVID-19 Transmission in Long-Term Care. Med Care Res Rev 2020; 79:151-160. [PMID: 33213282 DOI: 10.1177/1077558720974129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One reason that nursing homes are a primary source of COVID-19 infections and deaths in the United States may be that workers hold multiple jobs. We use 2010-2019 Current Population Survey data to document the rate of second jobholding among nursing and long-term care workers. On average, 6.41% of personal care and nursing aides and 6.23% of licensed practical nurses and registered nurses hold second jobs; second job holding rates are 35% and 32% higher than those of other workers, respectively. Both wages and hours in the primary job are negatively associated with the probability of holding a second job for personal care and nursing aides, while lower hours are more strongly correlated with a second job for registered nurses and licensed practical nurses. Many of these workers move across health settings from their first to second jobs, and 15% of second jobs for personal care and nursing aides are in other "essential" occupations.
Collapse
|
12
|
Berry SD, Daiello LA, Lee Y, Zullo AR, Wright NC, Curtis JR, Kiel DP. Secular Trends in the Incidence of Hip Fracture Among Nursing Home Residents. J Bone Miner Res 2020; 35:1668-1675. [PMID: 32302028 PMCID: PMC7486242 DOI: 10.1002/jbmr.4032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/28/2020] [Accepted: 04/13/2020] [Indexed: 12/30/2022]
Abstract
A recent study suggested a decline in the incidence of hip fracture among US women between 2002 and 2012, followed by a leveling in the incidence rate from 2013 to 2015. Newly admitted nursing home residents are particularly vulnerable to hip fracture, and it is unclear whether that trend is observed in this high risk group. The purpose of our study was to describe trends in hip fracture rates and postfracture mortality among 2.6 million newly admitted US nursing home residents from 2007 to 2015, and to examine whether these trends could be explained by differences in resident characteristics. Medicare claims data were linked with the Minimum Data Set (MDS), a clinical assessment performed quarterly on all nursing home residents. In each year (2007-2015), we identified newly admitted long-stay (ie, 100 days in the same facility) nursing home residents. Hip fracture was defined using Medicare Part A diagnostic codes. Follow-up time was calculated from the index date until the first event of hospitalized hip fracture, Medicare disenrollment, death, or until 1 year. Poisson regression was used to adjust rates of hip fracture for age and sex. The number of newly admitted nursing home residents ranged from 324,508 in 2007 to 257,350 in 2015. Although mean age remained similar (83 years), residents were more functionally dependent over time. There was a small absolute decrease in the incidence rate of hip fracture between 2007 (3.32/100 person-years) and 2013 (2.82/100 person-years), with an increase again in 2015 (3.03/100 person-years). Adjusting for patient characteristics somewhat attenuated these trends. One-year mortality was high following fracture in all years (42.6% in 2007, 42.1% in 2014). In summary, we observed a recent slight rise in the incidence rates of hip fracture among nursing home residents that was at least partially explained by differences in resident characteristics over time. © 2020 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Lori A Daiello
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey R Curtis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| |
Collapse
|
13
|
Lee SK, Ahn J, Shin JH, Lee JY. Application of Machine Learning Methods in Nursing Home Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6234. [PMID: 32867250 PMCID: PMC7503291 DOI: 10.3390/ijerph17176234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Abstract
Background: A machine learning (ML) system is able to construct algorithms to continue improving predictions and generate automated knowledge through data-driven predictors or decisions. Objective: The purpose of this study was to compare six ML methods (random forest (RF), logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM) of predicting falls in nursing homes (NHs). Methods: We applied three representative six-ML algorithms to the preprocessed dataset to develop a prediction model (N = 60). We used an accuracy measure to evaluate prediction models. Results: RF was the most accurate model (0.883), followed by the logistic regression model, SVM linear, and polynomial SVM (0.867). Conclusions: RF was a powerful algorithm to discern predictors of falls in NHs. For effective fall management, researchers should consider organizational characteristics as well as personal factors. Recommendations for Future Research: To confirm the superiority of ML in NH research, future studies are required to discern additional potential factors using newly introduced ML methods.
Collapse
Affiliation(s)
- Soo-Kyoung Lee
- College of Nursing, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea;
| | - Jinhyun Ahn
- Department of Management Information Systems, Jeju National University, Jeju-do 63243, Korea;
| | - Juh Hyun Shin
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
| | - Ji Yeon Lee
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
| |
Collapse
|
14
|
Baixinho CL, Dixe MDA. Practices and behaviors of professionals after falls in institutionalized elderly with and without cognitive decline. Dement Neuropsychol 2020; 14:62-68. [PMID: 32206200 PMCID: PMC7077869 DOI: 10.1590/1980-57642020dn14-010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/21/2019] [Indexed: 02/07/2023] Open
Abstract
Falls are a major problem in nursing homes due to their high prevalence and impact on the functioning of elderly. OBJECTIVE This study aims to: a) construct and validate a scale for assessing the practices and behaviors of professionals from nursing homes after falls in elderly; b) describe practices and behaviors after falls; and c) associate practices and behaviors with professionals' length of experience, training and age. METHODS This is a correlational study, conducted in a sample of 152 professionals from six nursing homes. The study adhered to all of the Declaration of Helsinki principles. RESULTS The scale constructed has a Cronbach's alpha of 0.938. The 12 items of the scale are grouped into two factors. The most expressive indicators are the communication of fall episodes that result in severe injuries (4.64 ± 0.812) and the communication of falls that result in injuries and need intervention from health technicians (4.61 ± 0.832). We found no significant statistical difference between length of professional experience, training and age when associated with professional practices and behaviors after falls in elderly (p > 0.05). CONCLUSION Future studies should investigate the association of post-fall professional practices and behaviors with fear of another fall, fall recurrence, and changes in functioning of the elderly following a fall.
Collapse
Affiliation(s)
- Cristina Lavareda Baixinho
- School of Health Sciences, Centre for Innovative Care and Health
Technology (ciTechCare), Polytechnic Institute of Leiria (IPLeiria), Leiria,
Portugal
- The Health Sciences Research Unit: Nursing, Nursing School of
Coimbra, Coimbra, Portugal
| | - Maria dos Anjos Dixe
- The Health Sciences Research Unit: Nursing, Nursing School of
Coimbra, Coimbra, Portugal
- Escola Superior de Saúde, Instituto Politécnico de Leiria,
Portugal
| |
Collapse
|
15
|
Hanratty B, Craig D, Brittain K, Spilsbury K, Vines J, Wilson P. Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - John Vines
- Northumbria School of Design, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
| |
Collapse
|
16
|
Plaku-Alakbarova B, Punnett L, Gore RJ. Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes. Saf Health Work 2018; 9:408-415. [PMID: 30559988 PMCID: PMC6284169 DOI: 10.1016/j.shaw.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2017] [Accepted: 12/09/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. METHODS Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. RESULTS A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0-100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. CONCLUSION Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.
Collapse
Affiliation(s)
- Bora Plaku-Alakbarova
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPHNEW), University of Massachusetts Lowell, Lowell, MA, USA
| | | | | | | |
Collapse
|
17
|
Wong C, Martinez J, Fagan B, Leland NE. Understanding Communication Between Rehabilitation Practitioners and Nurses: Implications for Post-Acute Care Quality. J Appl Gerontol 2018; 39:795-802. [PMID: 30141715 DOI: 10.1177/0733464818794148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study examined post-acute care (PAC) rehabilitation practitioner's perspectives on communication. Method: This is a secondary data analysis of a larger qualitative study, which included PAC rehabilitation provider (n = 99) focus groups that were held in a purposive sample of 13 skilled nursing facilities (SNFs). Results: Participants emphasized the importance of bidirectional communication between rehabilitation and nursing. Three themes were identified: (a) communication between rehabilitation practitioners and registered nurses or licensed practical nurses, (b) communication between rehabilitation practitioners and certified nursing assistants, and (c) communication between rehabilitation practitioners and nursing leaders. Two subthemes within each of the three themes were further characterized to understand how information was exchanged: (a) static communication and (b) action-oriented communication. Conclusion: Our findings highlight opportunities for better communication in PAC between rehabilitation practitioners and nursing and thus lay a foundation for future efforts to improve care coordination through enhancing interdisciplinary communication.
Collapse
Affiliation(s)
- Carin Wong
- University of Southern California, Los Angeles, USA
| | | | - Brenda Fagan
- University of Southern California, Los Angeles, USA
| | | |
Collapse
|
18
|
Zullo AR, Zhang T, Banerjee G, Lee Y, McConeghy KW, Kiel DP, Daiello LA, Mor V, Berry SD. Facility and State Variation in Hip Fracture in U.S. Nursing Home Residents. J Am Geriatr Soc 2018; 66:539-545. [PMID: 29336024 PMCID: PMC5849498 DOI: 10.1111/jgs.15264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To quantify the variation in hip fracture incidence across U.S. nursing home (NH) facilities and states and examine how hip fracture incidence varies according to facility- and state-level characteristics. DESIGN Retrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting records; and Medicare claims. SETTING U.S. NHs with 100 or more beds. PARTICIPANTS Long-stay NH residents between May 1, 2007, and April 30, 2008, from 1,481 facilities and 46 U.S. states (N = 201,892). MEASUREMENTS Incident hip fractures were ascertained using Medicare Part A diagnostic codes. Each resident was followed for up to 2 years. RESULTS The mean adjusted incidence rate of hip fractures for all facilities was 3.13 (95% confidence interval (CI) = 3.01-3.26) per 100 person-years (range 1.20, 95% CI = 1.15-1.26 to 6.40, 95% CI = 6.07-6.77). Facilities with the highest rates of hip fracture had greater percentages of residents taking psychoactive medications (top tertile 27.2%, bottom tertile 24.8%), and fewer nursing (top tertile 3.43, bottom tertile 3.53) and direct care (top tertile 3.22, bottom tertile 3.29) hours per day per resident. The combination of state and facility characteristics explained 6.7% of the variation in hip fracture, and resident characteristics explained 7.6%. CONCLUSION Much of the variation in hip fracture incidence remained unexplained, although these findings indicate that potentially modifiable state and facility characteristics such as psychoactive drug prescribing and minimum staffing requirements could be addressed to help reduce the rate of hip fracture in U.S. NHs.
Collapse
Affiliation(s)
- Andrew R. Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI
| | - Tingting Zhang
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | - Geetanjoli Banerjee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | - Kevin W. McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI
| | - Douglas P. Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Lori A. Daiello
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | - Sarah D. Berry
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| |
Collapse
|
19
|
Leland NE, Lepore M, Chang SH, Wong C, Freeman L, Crum K, Gillies H, Nash P. Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners. Disabil Rehabil 2018; 40:646-654. [PMID: 28110561 PMCID: PMC5522785 DOI: 10.1080/09638288.2016.1273973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 01/17/2023]
Abstract
AIM The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners' perspectives on the practices that constitute high quality hip fracture rehabilitation. METHODS Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners' perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach. RESULTS Seven themes emerged: objectives of care; first 72 h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration. CONCLUSIONS Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners' perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes. Implications for Rehabilitation This study highlights occupational and physiotherapy therapy practitioners' perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation. While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers. Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.
Collapse
Affiliation(s)
- Natalie E. Leland
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
- Davis School of Gerontology at University of Southern California, Los Angeles, California, USA
- Aging, Disability, and Long-Term Care program at RTI International, Washington, DC, USA
| | - Michael Lepore
- Aging, Disability, and Long-Term Care program at RTI International, Washington, DC, USA
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA
| | - Sun Hwa Chang
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Carin Wong
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Lynn Freeman
- Aegis Therapies, Plano, Texas USA
- Post-Acute Therapeutics and Health Clinical Research Institute, Seattle, Washington USA
| | - Karen Crum
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | | | - Paul Nash
- Center for Innovative Aging at Swansea University, Swansea, Wales, UK
| |
Collapse
|
20
|
Zhang N, Lu SF, Zhou Y, Zhang B, Copeland L, Gurwitz JH. Body Mass Index, Falls, and Hip Fractures Among Nursing Home Residents. J Gerontol A Biol Sci Med Sci 2018; 73:1403-1409. [DOI: 10.1093/gerona/gly039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ning Zhang
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Susan F Lu
- Kranner School of Management, Purdue University, West Lafayette, Indiana
| | - Yanhua Zhou
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Bo Zhang
- Department of Quantitative health Sciences, University of Massachusetts Medical School, Worcester
| | | | - Jerry H Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| |
Collapse
|
21
|
Management Team Perceptions of Risks and Strategies for Preventing Falls Among Short-Stay Patients in Nursing Homes. Health Care Manag (Frederick) 2017; 37:76-85. [PMID: 29266090 DOI: 10.1097/hcm.0000000000000192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We sought to understand strategies reported by members of the nursing home management team used to prevent falls in short-stay nursing home patients. Using Donabedian's model of structure, process, and outcomes, we interviewed 16 managers from 4 nursing homes in central North Carolina. Nursing home managers identified specific barriers to fall prevention among short-stay patients including rapid changes in functional and cognitive status, staff unfamiliarity with short-stay patient needs and patterns, and policies impacting care. Few interventions for reducing falls among short-stay patients were used at the structure level (eg, specialized units, workload ratio, and staffing consistency); however, many process-level interventions were used (eg, patient education on problem solving, self-care/mobility, and safety). We described several barriers to fall prevention among short-stay patients in nursing homes. From these descriptions, we propose three interventions that might reduce falls for short-stay patients and could be tested in future research: (1) clustering short-stay patients within a physical location to permit higher staff-patient ratios and enhanced surveillance, (2) population-based prevention interventions to supplement existing individually tailored prevention strategies (eg, toileting schedules, medication review for all), and (3) transitional care interventions that transmit key information from hospitals to nursing homes.
Collapse
|
22
|
Baixinho CL, Dixe MDA. PRÁTICAS DAS EQUIPAS NA PREVENÇÃO DE QUEDA NOS IDOSOS INSTITUCIONALIZADOS: CONSTRUÇÃO E VALIDAÇÃO DE ESCALA. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017002310016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: construir e determinar as características psicométricas da escala de práticas e comportamentos das equipes na gestão do risco de queda dos idosos institucionalizados. Método: a escala foi desenhada com base na revisão da literatura e na observação do trabalho das equipes numa instituição de longa permanência para idosos. Foi realizada a análise de conteúdo e a verificação do índice de concordância dos 14 itens iniciais por nove juízes. A escala foi aplicada a uma amostra de 152 cuidadores de seis instituições de longa permanência para idosos. A investigação respeitou os princípios éticos. Garantiu-se o anonimato e a confidencialidade dos dados. Resultados: após a determinação das caraterísticas psicométricas, verificámos que a escala, unidimensional, ficou constituída por seis itens, com um Alfa de Cronbach de 0,918, pontua entre 6 e 30 pontos. A análise dos resultados permite constatar que a informação sobre os fatores de risco e a discussão em equipe sobre as medidas preventivas nem sempre são mantidas, possibilitando que elementos diferentes da equipe possam valorizar medidas diferentes, o que não garante a continuidade de cuidados e a individualização das medidas face ao risco avaliado. Conclusão: a escala tem boas características psicométricas, podendo ser usada na investigação e na prática clínica para avaliar as práticas e os comportamentos das equipes na gestão do risco de queda em idosos institucionalizados.
Collapse
|
23
|
Baixinho CRSL, Dixe MDACR, Henriques MAP. Falls in long-term care institutions for elderly people: protocol validation. Rev Bras Enferm 2017; 70:740-746. [DOI: 10.1590/0034-7167-2017-0109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/02/2017] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objectives: To validate the content of a fall management risk protocol in long-term institutions for elderly people. Methods: Methodological, quanti-qualitative study using the Delphi technique. The tool, based on the literature, was sent electronically to obtain consensus among the 14 experts that meet the defined inclusion criteria. Results: The 27 indicators of the protocol are organized in three dimensions: prepare for the institutionalization (IRA=.88); manage the risk of falls throughout the institutionalization (IRA=.9); and lead the communication and formation (IRA=1), with a CVI=.91. Two rounds were performed to get a consensus superior to 80% in every item. Conclusion: The values obtained in the reliability test (>0.8) show that the protocol can be used to meet the intended goal. The next step is the clinic validation of the protocol with residents of long-term care institutions for elderly people.
Collapse
|
24
|
Mackenzie LA, Byles JE. Circumstances of Falls With Fractured Femur in Residents of Australian Nursing Homes: An Analysis of Falls Reports. J Aging Health 2017; 30:738-757. [PMID: 28553802 DOI: 10.1177/0898264317690667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to explore the circumstances and characteristics of falls with fractured femur reported in nursing homes. METHOD Mixed methods were used. There were reports on 401 eligible falls from 88 residential care facilities in the Hunter region of Australia. A falls report form was developed for the study and was completed by nursing staff. Information was collected about the circumstances of falls with fractured femur and resident data. Descriptive and qualitative analyses were used. RESULTS Falls with fractured neck of femur were associated with being ambulant, having dementia, increasing age, and a high falls risk assessment. Themes from the falls report data were resident-related factors, organizational or environmental issues, and activities at the time of the fall. DISCUSSION Falls in residential care settings are very complex and difficult to prevent. Attention should be given to the needs of recently admitted residents and management of the facility environment.
Collapse
Affiliation(s)
| | - Julie E Byles
- 2 University of Newcastle, New South Wales, Australia
| |
Collapse
|
25
|
Lepore M, Leland NE. Nursing Homes That Increased The Proportion Of Medicare Days Saw Gains In Quality Outcomes For Long-Stay Residents. Health Aff (Millwood) 2017; 34:2121-8. [PMID: 26643633 DOI: 10.1377/hlthaff.2015.0303] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nursing homes are increasingly providing rehabilitative care to short-stay residents under Medicare's skilled nursing facility coverage, which is much more generous than Medicaid's coverage for long-stay residents. This shift creates the potential for both beneficial and detrimental effects on outcomes for such residents. Examining nationwide facility-level nursing home data for the period 2007-10, we found that increasing the proportion of Medicare-covered patient days in a nursing home was significantly associated with improvements in the quality of the three outcomes we considered for long-stay residents. We saw significant decreases in the percentages of long-stay residents with daily pain (from 5.1 percent to 3.4 percent), with worsening pressure ulcers (from 2.5 percent to 2.0 percent), and with a decline in performing activities of daily living (from 15.9 percent to 14.9 percent). These findings reinforce previous research indicating that quality outcomes tend to be superior in nursing homes with greater financial resources. They also bolster arguments for financial investments in nursing homes, including increases in Medicaid payment rates, to support better care for long-stay residents.
Collapse
Affiliation(s)
- Michael Lepore
- Michael Lepore is a senior health policy and health services researcher in the Aging, Disability, and Long-Term Care program at RTI International in Washington, D.C., and an adjunct assistant professor in the Department of Health Services, Policy, and Practice at Brown University, in Providence, Rhode Island
| | - Natalie E Leland
- Natalie E. Leland is an assistant professor with a joint appointment in the Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy and the Davis School of Gerontology at the University of Southern California, in Los Angeles, and an adjunct assistant professor in the Department of Health Services, Policy, and Practice at Brown University
| |
Collapse
|
26
|
Kim LH, Leland NE. Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017; 34:155-168. [PMID: 28989216 DOI: 10.1080/02703181.2016.1267295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS Occupational and physical therapy in post-acute care (PAC) has reached the point where quality indicators for hip fracture are needed. This study characterizes the practitioners' prioritized hip fracture rehabilitation practices, which can guide future quality improvement initiatives. METHODS Ninety-two practitioners participating in a parent mixed methods study were asked to rank a series of evidence-based best practices across five clinical domains (assessment, intervention, discharge planning, caregiver training and patient education). RESULTS Prioritized practices reflected patient-practitioner collaboration, facilitating an effective discharge, and preventing adverse events. The highest endorsed care processes include: developing meaningful goals with patient input (84%) in assessment, using assistive devices in intervention (75%) and patient education (65%), engaging the patient and caregiver (50%) in discharge planning, and fall prevention (60%) in caregiver education. CONCLUSIONS Practitioners identified key care priorities. This study lays the foundation for future work evaluating the extent to which these practices are delivered in PAC.
Collapse
Affiliation(s)
- Lauren H Kim
- Davis School of Gerontology, University of Southern California
| | - Natalie E Leland
- Davis School of Gerontology, University of Southern California.,Chan Division of Occupational Science and Occupational Therapy.,Health Services Policy & Practice, Brown University
| |
Collapse
|
27
|
Backhaus R, van Rossum E, Verbeek H, Halfens RJG, Tan FES, Capezuti E, Hamers JPH. Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities. BMC Health Serv Res 2017; 17:53. [PMID: 28103856 PMCID: PMC5244701 DOI: 10.1186/s12913-016-1947-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
Collapse
Affiliation(s)
- Ramona Backhaus
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Erik van Rossum
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Zuyd University of Applied Sciences, Research Centre on Autonomy and Participation, P.O. Box 550, 6400 AN, Heerlen, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Ruud J G Halfens
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Frans E S Tan
- Department of Methodology and Statistics, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Elizabeth Capezuti
- Hunter College, City University of New York, Brookdale Campus West, Room 526, 425 E. 25th Street # 925, New York, NY, 10010, USA
| | - Jan P H Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| |
Collapse
|
28
|
Tonni V, Cè E, Limonta E, Bisconti AV, Longo S, Rampichini S, Magri A, Brasioli A, Muti E, Esposito F, Venturelli M. Fall-risk factors in hospitalized elderly: the role of adapted physical activity. SPORT SCIENCES FOR HEALTH 2016. [DOI: 10.1007/s11332-016-0324-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
29
|
Banerjee G, Zullo AR, Berry SD, Lee Y, McConeghy K, Kiel DP, Mor V. Geographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents. J Am Med Dir Assoc 2016; 17:865.e1-3. [PMID: 27461867 DOI: 10.1016/j.jamda.2016.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/09/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Despite high rates of hip fracture among United States (US) nursing home (NH) residents, little is known about geographic variation in hip fracture incidence. We used nationally representative data to identify geographic variation in hip fracture among US NH residents. DESIGN AND SETTING Retrospective cohort study using Part A claims for a 100% of Medicare enrollees in 15,289 NHs linked to NH minimum data set and Online Survey, Certification, and Reporting databases. PARTICIPANTS A total of 891,085 long-stay (continuous residence of ≥100 days) NH residents ≥65 years old. MEASUREMENTS Medicare Part A claims documenting a hip fracture. Mean incidence rates of hip fracture for long-stay NH residents were calculated for each state and US Census Division from 2007 to 2010. RESULTS The age-, sex-, and race-adjusted incidence rate of hip fracture ranged from 1.49 hip fractures/100 person-years (Hawaii) to 3.60 hip fractures/100 person-years (New Mexico), with a mean of 2.38 (standard deviation 0.43) hip fractures/100 person-years. The mean incidence of hip fracture was 1.7-fold greater in the highest quintile than the lowest. CONCLUSIONS We observed modest US state and regional variation in hip fracture incidence among long-stay NH residents. Future studies should assess whether state policies or NH characteristics explain the variation.
Collapse
Affiliation(s)
- Geetanjoli Banerjee
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI.
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI
| | - Sarah D Berry
- Hebrew Senior Life, Institute for Aging Research and Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA
| | - Yoojin Lee
- Center for Gerontology Health Care Research, Brown University, Providence, RI
| | - Kevin McConeghy
- Providence VA Medical Center, Brown University, Providence, RI
| | - Doug P Kiel
- Hebrew Senior Life, Institute for Aging Research and Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA
| | - Vincent Mor
- Center for Gerontology Health Care Research, Brown University, Providence, RI
| |
Collapse
|
30
|
Berry SD, Lee Y, Zullo AR, Kiel DP, Dosa D, Mor V. Incidence of Hip Fracture in U.S. Nursing Homes. J Gerontol A Biol Sci Med Sci 2016; 71:1230-4. [PMID: 26980299 DOI: 10.1093/gerona/glw034] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/11/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hip fractures are associated with significant morbidity and mortality in the nursing home. Our objective was to describe the incidence rate (IR) of hip fracture according to age, sex, and race in a nationwide sample of long-stay nursing home residents. METHODS Using 2007-2010 Medicare claims data linked with the Minimum Data Set, we identified 892,837 long-stay residents (≥100 days in the same nursing facility) between May 1, 2007 and April 30, 2008. Hip fractures were defined using Part A diagnostic codes (ICD-9). Residents were followed from the date they became a long-stay resident until the first event of death, discharge, hip fracture, or 2 years of follow-up. RESULTS Mean age was 84 years (range 65-113 years), and 74.5% were women. 83.9% were white and 12.0% were black. The overall IR of hip fracture was 2.3/100 person years. The IR was similar in men and women across age groups. The IR of hip fracture was highest in Native Americans aged 85 years or older (3.7/100 person years), in whites (2.6/100 person years), and during the first 100 days of institutionalization (2.7/100 person years). IRs of hip fracture were lowest in blacks (1.3/100 person years). CONCLUSIONS In nursing home residents surviving 100 days or more in a facility, the incidence of hip fracture is high, particularly among older white, Native American, and newly admitted residents. This is the first nationwide study to provide sex- and age-specific estimates among U.S. nursing home residents, and it underscores the magnitude of the problem.
Collapse
Affiliation(s)
- Sarah D Berry
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Doug P Kiel
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David Dosa
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Vincent Mor
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| |
Collapse
|
31
|
Marier A, Olsho LEW, Rhodes W, Spector WD. Improving prediction of fall risk among nursing home residents using electronic medical records. J Am Med Inform Assoc 2015; 23:276-82. [PMID: 26104743 DOI: 10.1093/jamia/ocv061] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/04/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Falls are physically and financially costly, but may be preventable with targeted intervention. The Minimum Data Set (MDS) is one potential source of information on fall risk factors among nursing home residents, but its limited breadth and relatively infrequent updates may limit its practical utility. Richer, more frequently updated data from electronic medical records (EMRs) may improve ability to identify individuals at highest risk for falls. METHODS The authors applied a repeated events survival model to analyze MDS 3.0 and EMR data for 5129 residents in 13 nursing homes within a single large California chain that uses a centralized EMR system from a leading vendor. Estimated regression parameters were used to project resident fall probability. The authors examined the proportion of observed falls within each projected fall risk decile to assess improvements in predictive power from including EMR data. RESULTS In a model incorporating fall risk factors from the MDS only, 28.6% of observed falls occurred among residents in the highest projected risk decile. In an alternative specification incorporating more frequently updated measures for the same risk factors from the EMR data, 32.3% of observed falls occurred among residents in the highest projected risk decile, a 13% increase over the base MDS-only specification. CONCLUSIONS Incorporating EMR data improves ability to identify those at highest risk for falls relative to prediction using MDS data alone. These improvements stem chiefly from the greater frequency with which EMR data are updated, with minimal additional gains from availability of additional risk factor variables.
Collapse
Affiliation(s)
| | | | - William Rhodes
- Abt Associates, U.S. Health Division, Cambridge, MA, USA
| | - William D Spector
- Agency for Healthcare Research & Quality, U.S. Department of Health & Human Services, Rockville, MD, USA
| |
Collapse
|
32
|
Leland NE, Gozalo P, Bynum J, Mor V, Christian TJ, Teno JM. What happens to patients when they fracture their hip during a skilled nursing facility stay? J Am Med Dir Assoc 2015; 16:767-74. [PMID: 25944177 DOI: 10.1016/j.jamda.2015.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To characterize outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home receiving skilled nursing facility (SNF) services. DESIGN Observational study. PARTICIPANTS Short-stay fee-for-service Medicare beneficiaries who experienced their first hip fracture during an SNF stay. MEASUREMENTS Outcomes measured in the 90 days after the hip fracture hospitalization included community discharge (with a stay in the community <30 days), successful community discharge (in the community ≥30 days), death, and institutionalization. RESULTS Between 1999 and 2007, 27,305 hip fractures occurred among short-stay nursing home patients receiving SNF care. After surgical repair of the hip fracture, 83.9% of these patients were discharged from the hospital back to an SNF, with most (99%) returning to the facility where the hip fracture occurred. In the first 90 days after hospitalization, 24.1% of patients died, 7.3% were discharged to the community but remained fewer than 30 days, 14.0% achieved successful community discharge, and 54.6% were still in a health care institution with almost 46.4% having transitioned to long-term care. CONCLUSION SNF care aims to maximize the short-stay patient's independence and facilitate a safe community transition. However, experiencing a fall and hip fracture during the SNF stay was a sentinel event that limited the achievement of this goal. There is an urgent need to ensure the integration of fall prevention into the patient's plan of care. Further, falls among SNF patients may serve as indicator of quality, which consumers and payers can use to make informed health care decisions.
Collapse
Affiliation(s)
- Natalie E Leland
- T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry and Davis School of Gerontology, University of Southern California, Los Angeles, CA; Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI.
| | - Pedro Gozalo
- Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Julie Bynum
- Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Vincent Mor
- Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI; Providence Veteran's Administration Medical Center, Providence, RI
| | | | - Joan M Teno
- Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI
| |
Collapse
|
33
|
Delphi-Based Assessment of Fall-Related Risk Factors in Acute Rehabilitation Settings According to the International Classification of Functioning, Disability and Health. Arch Phys Med Rehabil 2014; 95:50-7. [DOI: 10.1016/j.apmr.2013.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/13/2013] [Accepted: 09/11/2013] [Indexed: 01/21/2023]
|
34
|
Schwendimann R, Zúñiga F, Ausserhofer D, Schubert M, Engberg S, de Geest S. Swiss Nursing Homes Human Resources Project (SHURP): protocol of an observational study. J Adv Nurs 2013; 70:915-26. [PMID: 24102650 DOI: 10.1111/jan.12253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2013] [Indexed: 11/26/2022]
Abstract
AIM To explore the relationships among various nursing homes characteristics including work environment, careworker outcomes and resident outcomes in Swiss nursing homes. BACKGROUND In Switzerland, a growing number of older people live in nursing homes. Although research has addressed the issue of quality of nursing care in such facilities, few have integrated a range of interrelated factors that may influence the quality and safety of residential care. The Swiss Nursing Homes Human Resources Project will comprehensively assess key organizational factors, their interrelationships and the associations between these factors and careworker and resident outcomes. DESIGN Cross-sectional design. METHODS Three-year multi-centre study (2011-2013) including a representative sample of approximately 160 nursing homes across the three language regions in Switzerland. Survey data will come from approximately 6000 careworkers and 160 administrators. Survey questionnaires will include variables on organizational facility characteristics and resident outcomes, careworker socio-demographic and professional characteristics, the quality of their work environments, resident safety climates and careworker outcomes. Appropriate descriptive and comparative analysis will be used and multivariate and multilevel analyses will be applied to examine the relationships among the various factors including quality of the work environment, safety climate, work stressors, rationing of care, workload, careworker and resident characteristics, as well as resident and careworker outcomes. DISCUSSION The study results will contribute to a comprehensive understanding of the interrelationships between key organizational factors and resident/careworker outcomes and will also support planning and conducting interventions to improve quality of care concerning organizational factors affecting careworkers in daily practice.
Collapse
|
35
|
Leland NE, Kaldenberg J, Lee I. Watching Their Steps: Integrating Vision Intervention Into Daily Practice to Limit Fall Risk at Skilled Nursing Facilities. OT PRACTICE 2012; 17:7-16. [PMID: 25574119 PMCID: PMC4285353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Strategies that address decreased vision are an important part of multifactorial interventions to prevent falls and facilitate safe participation in valued occupations.
Collapse
Affiliation(s)
- Natalie E Leland
- the Division of Occupational Science and Occupational Therapy at the Herman Ostrow School of Dentistry & Davis School of Gerontology at the University of Southern California in Los Angeles
| | - Jennifer Kaldenberg
- occupational therapy services at the New England Eye Institute in Boston, Massachusetts, and an adjunct assistant professor of vision rehabilitation at the New England College of Optometry in Boston
| | - Irene Lee
- the Division of Occupational Science and Occupational Therapy at the University of Southern California
| |
Collapse
|