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Effects of Different Heat Treatment Methods on Organic Pollutants and Heavy Metal Content in Oil Sludge Waste and Ecotoxicological Evaluation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073609] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The discharge of large amounts of oily sludge heat treatment residues constitutes a severe threat to the environment. However, little is known about the toxicity of these heat-treated residues. Current research has mainly focused on the toxic effects of single heavy metals or single hydrocarbons on plants, whereas the phytotoxic effects of hydrocarbon–metal mixtures have remained largely unexplored. In this study, pot experiments were conducted to evaluate the effects of different proportions of heat treatment residues (pyrolysis, heat-washing, and high-temperature oxidation residues) from three kinds of oily sludge on the physiological and biochemical parameters of mung bean plants. Higher proportions of residues decreased the germination rates and enzyme activity of mung beans compared to uncontaminated soil. When pyrolysis residue, hot-washing residue, and high-temperature thermal oxidation residue are used in green planting soil, their content must be lower than 30%, 90%, and 70%, respectively. Additionally, our findings indicated that the accumulation level of pollutants in oily sludge heat treatment residues was not high. However, the three kinds of residues exhibited different degrees of plant toxicity. The pyrolysis residue still exhibited strong ecotoxicity, even at low concentrations. In contrast, the toxicity of the hot-washing residue was much lower than that of the pyrolysis residue and the high-temperature thermal oxidation residue. Our findings indicated that mung bean is highly tolerant of contaminated soil and is therefore well suited for phytoremediation applications.
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Abstract
ABSTRACTPerson-centred provision of long-term care (LTC) requires information on how individuals value respective LTC services. The literature on LTC preferences has not been comprehensively reviewed, existing summaries are contradictory. An explorative, scoping review was conducted to provide a thorough methodological description and results synthesis of studies that empirically investigated LTC preference outcomes based on respondents’ statements. A wide search strategy, with 18 key terms relating to ‘LTC’ and 31 to ‘preferences’, was developed. Database searches in PubMed, Ovid and ScienceDirect were conducted in February 2016. The 59 studies meeting the inclusion criteria were grouped and methodically described based on preference elicitation techniques and methods. Despite substantial methodological heterogeneity between studies, certain findings consistently emerged for the investigated LTC preference outcomes. The large majority of respondents preferred to receive LTC in their known physical and social environment when care needs were moderate, but residential care when care needs were extensive. Preferences were found to depend on a variety of personal, environmental, social and cultural aspects. Dependent individuals aspired to preserve their personal and social identity, self-image, independence, autonomy, control and dignity, which suggests that LTC preferences are a function of the perceived ability of a specific LTC arrangement to satisfy peoples’ basic physiological and mental/social needs. Research on LTC preferences would greatly profit from a standardisation of respective concepts and methods.
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Miller EA, Intrator O, Gadbois E, Gidmark S, Rudolph JL. VA staff perceptions of the role of the extended care referral process in home and community-based services versus nursing home use posthospital discharge. Home Health Care Serv Q 2017; 36:63-80. [PMID: 28605268 DOI: 10.1080/01621424.2017.1336960] [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: 10/19/2022]
Abstract
Little is known about how the extended care referral process-its structure and participants-influences Veterans' use of home and community-based services (HCBS) over nursing home care within the Veterans Health Administration (VHA). This study thus characterizes the extended care referral process within the VHA and its impact on HCBS versus nursing home use at hospital discharge. Data derive from 35 semistructured interviews at 12 Veterans Affairs Medical Centers (VAMCs). Findings indicate that the referral process is characterized by a commitment by care teams to consider HCBS if possible, varied practice depending on the clinician that most heavily influences care team recommendations, and care team emphasis on respecting Veteran/family preferences even when they are contrary to care team recommendations. Potential modifications include adopting systematic assessment practices; improving Veteran, family, and provider education; and promoting informed selection through shared decision making.
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Affiliation(s)
- Edward Alan Miller
- a Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies , University of Massachusetts Boston , Boston , Massachusetts , USA.,b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA
| | - Orna Intrator
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA.,c Geriatrics & Extended Care Data & Analysis Center, Canandaigua VA Medical Center , New York , USA.,d Department of Public Health Sciences, School of Medicine and Dentistry , University of Rochester , New York , USA
| | - Emily Gadbois
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA
| | - Stefanie Gidmark
- e Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center , Rhode Island , USA
| | - James L Rudolph
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA.,e Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center , Rhode Island , USA.,f The Warren Alpert Medical School , Brown University, Providence , Rhode Island , USA
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Ortoleva Bucher C, Dubuc N, von Gunten A, Trottier L, Morin D. Development and validation of clinical profiles of patients hospitalized due to behavioral and psychological symptoms of dementia. BMC Psychiatry 2016; 16:261. [PMID: 27450155 PMCID: PMC4957848 DOI: 10.1186/s12888-016-0966-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 07/12/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients hospitalized on acute psychogeriatric wards are a heterogeneous population. Cluster analysis is a useful statistical method for partitioning a sample of patients into well separated groups of patients who present common characteristics. Several patient profile studies exist, but they are not adapted to acutely hospitalized psychogeriatric patients with cognitive impairment. The present study aims to partition patients hospitalized due to behavioral and psychological symptoms of dementia into profiles based on a global evaluation of mental health using cluster analysis. METHODS Using nine of the 13 items from the Health of the Nation Outcome Scales for elderly people (HoNOS65+), data were collected from a sample of 542 inpatients with dementia who were hospitalized between 2011 and 2014 in acute psychogeriatric wards of a Swiss university hospital. An optimal clustering solution was generated to represent various profiles, by using a mixed approach combining hierarchical and non-hierarchical (k-means) cluster analyses associated with a split-sample cross-validation. The quality of the clustering solution was evaluated based on a cross-validation, on a k-means method with 100 random initial seeds, on validation indexes, and on clinical interpretation. RESULTS The final solution consisted of four clinically distinct and homogeneous profiles labeled (1) BPSD-affective, (2) BPSD-functional, (3) BPSD-somatic and (4) BPSD-psychotic according to their predominant clinical features. The four profiles differed in cognitive status, length of hospital stay, and legal admission status. CONCLUSION In the present study, clustering methods allowed us to identify four profiles with distinctive characteristics. This clustering solution may be developed into a classification system that may allow clinicians to differentiate patient needs in order to promptly identify tailored interventions and promote better allocation of available resources.
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Affiliation(s)
- Claudia Ortoleva Bucher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Nicole Dubuc
- Research Centre on Aging, Sherbrooke University Geriatrics Institute, Quebec, Canada ,School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Lise Trottier
- Research Centre on Aging, Sherbrooke University Geriatrics Institute, Quebec, Canada
| | - Diane Morin
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland ,Faculty of Nursing Sciences, Laval University, Quebec, Canada
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Vanneste D, De Almeida Mello J, Macq J, Van Audenhove C, Declercq A. Missing data at follow-up: The case of the interRAI home care assessment instrument in Belgium. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Williams A, Cooper B. Determining caseloads in the community care of frail older people with chronic illnesses. J Clin Nurs 2016; 17:60-6. [PMID: 18298756 DOI: 10.1111/j.1365-2702.2007.02221.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this paper is to discuss and critique the literature related to the measurement of caseloads by sociomedical case managers in the context of community care for frail older people. BACKGROUND As a result of reduced mortality rates, there is an ageing, chronically ill population in need of long-term continuity of care. Case management is a model of care designed to maintain the quality of life of frail older people living in the community whilst constraining the associated costs of care. METHOD A review of the literature was undertaken to examine methods of determining caseloads for frail older people in the community setting to identify where investigations are absent or not robust. CONCLUSIONS An absence of empirically tested approaches to determining caseloads and the wide variability in caseloads in caring for frail older people was evident. Predictors of variations in case management resources have been described at both the programme and client level, although controversy about the validity of these predictors, such as age and functional status, has been reported. RELEVANCE TO CLINICAL PRACTICE The ageing population is a vulnerable group, and is entitled to live out their lives in the comfort and familiarity of their own homes where possible. Coordinated and supportive healthcare organizations and health system policies are critical to support empirically tested caseload indexes. These findings have implications for quality of care, planning and workforce policy development for our increasingly aged society. Recommendations for further research conclude this paper.
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Ortoleva Bucher C, Dubuc N, von Gunten A, Morin D. Du soin pratiqué au quotidien au consensus d’experts : état de l’évidence sur les interventions infirmières et leur priorisation selon le profil clinique des personnes âgées hospitalisées pour des symptômes comportementaux et psychologiques de la démence. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.124.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Yoon JY, Brown RL, Bowers BJ, Sharkey SS, Horn SD. The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study. Int J Nurs Stud 2015; 53:238-47. [PMID: 26260709 DOI: 10.1016/j.ijnurstu.2015.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House nursing home model, has shown positive psychological outcomes. However, little is known about whether the Green House nursing home model has positive effects on physical function compared to traditional nursing homes. OBJECTIVES To examine the longitudinal effects of the Green House nursing home model by comparing change patterns of activities of daily living function over time between Green House home residents and traditional nursing home residents. DESIGN A retrospective longitudinal study. SETTINGS Four Green House organizations (nine Green House units and four traditional units). PARTICIPANTS A total of 242 residents (93 Green House residents and 149 traditional home residents) who had stayed in the nursing home at least 6 months from admission. METHODS The outcome was activities of daily living function, and the main independent variable was the facility type in which the resident stayed: a Green House or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses. RESULTS The mean activities of daily living function showed deterioration over time, and the rates of deterioration between Green House and traditional home residents were not different over time. Four different activities of daily living function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups. CONCLUSIONS Although Green House nursing homes are considered to represent an innovative model changing the nursing home environment into more person-centered, this study did not demonstrate significant differences in activities of daily living function changes for residents in the Green House nursing homes compared to traditional nursing homes. Given that the Green House model continues to evolve as it is being implemented and variations within and across Green House homes are identified, large-scale longitudinal studies are needed to provide further relevant information on the effects of the Green House model.
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Affiliation(s)
- Ju Young Yoon
- School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 3117, 701 Highland Avenue, Madison, WI 534792-2455, USA.
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 4187, 701 Highland Avenue, Madison, WI 534792-2455, USA.
| | - Barbara J Bowers
- School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 5113, 701 Highland Avenue, Madison, WI 534792-2455, USA.
| | - Siobhan S Sharkey
- Health Management Strategies, 9600 Escarpment Blvd, Suite 745-21, Austin, TX 78749, USA.
| | - Susan D Horn
- International Severity Information Systems/Institute for Clinical Outcomes Research, 699 East South Temple, Suite 300, Salt Lake City, UT 84102-1282, USA.
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Vanneste D, De Almeida Mello J, Macq J, Van Audenhove C, Declercq A. Incomplete assessments: towards a better understanding of causes and solutions. The case of the interRAI home care instrument in Belgium. PLoS One 2015; 10:e0123760. [PMID: 25875281 PMCID: PMC4395293 DOI: 10.1371/journal.pone.0123760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/21/2015] [Indexed: 11/18/2022] Open
Abstract
The chronic diseases, comorbidities and rapidly changing needs of frail older persons increase the complexity of caregiving. A comprehensive, systematic and structured collection of data on the status of the frail older person is presumed to be essential in facilitating decision-making and thus improving the quality of care provided. However, the way in which an assessment is completed has a substantial impact on the quality and value of the results. This study examines the online completion of interRAI Home Care assessments, the possible causes for incomplete assessments and the consequences of these factors with respect to the quality of care received. Our findings indicate high nurse engagement and poor physician participation. We also observed the poor completion of items in predominantly medically- oriented sections characterized by, first, the fact that the assessors felt incapable of answering certain questions, second, the absence of required data or of a competent person to fill out the data, and third, the lack of tools necessary for essential measurements. The incompleteness of assessments has a clear negative influence on outcome generation. Moreover, without the added value of support outcomes, the improvement of care quality can be impeded and information technology can easily be seen as burdensome by the assessors. We have observed that multidisciplinary cooperation is an important prerequisite to establishing high-quality assessments aimed at improving the quality of care.
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Affiliation(s)
- Dirk Vanneste
- Lucas, Center for Care Research and Consultancy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Johanna De Almeida Mello
- Lucas, Center for Care Research and Consultancy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jean Macq
- Ecole de Santé Publique, Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
| | - Chantal Van Audenhove
- Lucas, Center for Care Research and Consultancy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anja Declercq
- Lucas, Center for Care Research and Consultancy, Katholieke Universiteit Leuven, Leuven, Belgium
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Castora-Binkley M, Meng H, Hyer K. Predictors of Long-Term Nursing Home Placement Under Competing Risk: Evidence from the Health and Retirement Study. J Am Geriatr Soc 2014; 62:913-8. [DOI: 10.1111/jgs.12781] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Melissa Castora-Binkley
- School of Aging Studies; College of Behavioral and Community Sciences; University of South Florida; Tampa Florida
| | - Hongdao Meng
- School of Aging Studies; College of Behavioral and Community Sciences; University of South Florida; Tampa Florida
| | - Kathryn Hyer
- School of Aging Studies; College of Behavioral and Community Sciences; University of South Florida; Tampa Florida
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Vanneste D, Vermeulen B, Declercq A. Healthcare professionals' acceptance of BelRAI, a web-based system enabling person-centred recording and data sharing across care settings with interRAI instruments: a UTAUT analysis. BMC Med Inform Decis Mak 2013; 13:129. [PMID: 24279650 PMCID: PMC4222843 DOI: 10.1186/1472-6947-13-129] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 11/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare and social care environments are increasingly confronted with older persons with long-term care needs. Consequently, the need for integrated and coordinated assessment systems increases. In Belgium, feasibility studies have been conducted on the implementation and use of interRAI instruments offering opportunities to improve continuity and quality of care. However, the development and implementation of information technology to support a shared dataset is a difficult and gradual process. We explore the applicability of the UTAUT theoretical model in the BelRAI healthcare project to analyse the acceptance of the BelRAI web application by healthcare professionals in home care, nursing home care and acute hospital care for older people with disabilities. METHODS A structured questionnaire containing items based on constructs validated in the original UTAUT study was distributed to 661 Flemish caregivers. We performed a complete case analysis using data from 282 questionnaires to obtain information regarding the effects of performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), anxiety (ANX), self-efficacy (SE) and attitude towards using technology (ATUT) on behavioural intention (BI) to use the BelRAI web application. RESULTS The values of the internal consistency evaluation of each construct demonstrated adequate reliability of the survey instrument. Convergent and discriminant validity were established. However, the items of the ATUT construct cross-loaded on PE. FC proved to have the most significant influence on BI to use BelRAI, followed by SE. Other constructs (PE, EE, SI, ANX, ATUT) had no significant influence on BI. The 'direct effects only' model explained 30.8% of the variance in BI to use BelRAI. CONCLUSIONS Critical factors in stimulating the behavioural intention to use new technology are good-quality software, interoperability and compatibility with other information systems, easy access to computers, training facilities, built-in and online help and ongoing IT support. These findings can be used by policy makers to maximise the acceptance and the success of new technology. For researchers, the conclusions of the original UTAUT study with regards to the item and scale construction should not be copied blindly across different information systems. A bottom-up approach is preferred when building upon the UTAUT model.
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Affiliation(s)
- Dirk Vanneste
- Elderly Care Research Unit at LUCAS, KU Leuven, Kapucijnenvoer 39, 3000 Leuven, Belgium.
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Feuering R, Vered E, Kushnir T, Jette AM, Melzer I. Differences between self-reported and observed physical functioning in independent older adults. Disabil Rehabil 2013; 36:1395-401. [DOI: 10.3109/09638288.2013.828786] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Xu H, Covinsky KE, Stallard E, Thomas J, Sands LP. Insufficient help for activity of daily living disabilities and risk of all-cause hospitalization. J Am Geriatr Soc 2012; 60:927-33. [PMID: 22587855 DOI: 10.1111/j.1532-5415.2012.03926.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine whether insufficient help for activity of daily living (ADL) disability, a potentially modifiable condition, significantly increases disabled older adults' risk of future hospital admissions. DESIGN Prospective study. SETTING Community-living participants with ADL disabilities in the 1994, 1999, and 2004 National Long-Term Care Survey (NLTCS). PARTICIPANTS Medicare recipients with one or more ADL disabilities completed 5,884 surveys. MEASUREMENTS Times to hospital admission in the year after the NLTCS community survey were obtained from linked Medicare claims. Insufficient ADL help for each ADL limitation was determined from a series of questions common to the three NLTCS community surveys. RESULTS Insufficient help for one or more ADL limitations was reported in 22% of surveys. Respondents to 3,629 surveys did not experience a hospital admission in the year after the survey. Of the remaining 2,255 surveys, one admission occurred for 382 surveys, two admissions for 525 surveys, three admissions for 193 surveys, and four or more admissions for 155 surveys. Participants reporting insufficient help were 14% (hazard ratio = 1.14, 95% confidence interval = 1.01-1.28) more likely to experience one or more hospitalizations than those who did not report insufficient help after controlling for demographic characteristics, comorbidities, prior hospitalizations, and level of ADL disability. CONCLUSION Self-reports of insufficient help provide prognostic information beyond what typical health assessments can capture. Greater recognition and referral for insufficient help for ADL disability may result in lower rates of hospitalization in a population that is at high risk of hospitalization.
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Affiliation(s)
- Huiping Xu
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
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Valenzuela T. Efficacy of Progressive Resistance Training Interventions in Older Adults in Nursing Homes: A Systematic Review. J Am Med Dir Assoc 2012; 13:418-28. [DOI: 10.1016/j.jamda.2011.11.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 10/14/2022]
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Shippee TP. On the edge: Balancing health, participation, and autonomy to maintain active independent living in two retirement facilities. J Aging Stud 2012. [DOI: 10.1016/j.jaging.2011.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVES This paper addresses recent steps for reforming the eligibility criteria of the German long-term care insurance that have been initiated to overcome shortcomings in the current system. METHODS Based on findings of a survey of international long-term care systems, assessment tools and the relevant literature on care needs a new tool for determining eligibility in the German long-term care insurance was developed. RESULTS The new tool for determining long-term care eligibility broadens the understanding of what 'dependency on nursing care' implies for the person affected. The assessment results in a degree of dependency from personal help provided by formal or informal caregivers. This degree of dependency can be used for determining eligibility for and the amount of long-term care benefits. DISCUSSION The broader understanding of 'dependency on nursing care' and the new tool are important steps to adapt the German long-term care insurance to the challenges of the demographic and societal changes in the future.
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Karlsson S, Edberg AK, Hallberg IR. Professional's and older person's assessments of functional ability, health complaints and received care and service. A descriptive study. Int J Nurs Stud 2010; 47:1217-27. [DOI: 10.1016/j.ijnurstu.2010.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 02/17/2010] [Accepted: 03/05/2010] [Indexed: 11/30/2022]
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Thorsell KBE, Nordström BM, Fagerström L, Sivberg BV. Time in care for older people living in nursing homes. Nurs Res Pract 2010; 2010:148435. [PMID: 21994810 PMCID: PMC3169199 DOI: 10.1155/2010/148435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 05/16/2010] [Indexed: 11/17/2022] Open
Abstract
In order to measure actual care needs in relation to resources required to fulfill these needs, an instrument (Time in Care) with which to evaluate care needs and determine the time needed for various care activities has been developed with the aim of assessing nursing intensity in municipal care for older people. Interreliability (ICC = 0.854) of time measurements (n = 10'546) of 32 nursing activities in relation to evaluated care levels in two nursing homes (staff n = 81) has been determined. Nursing intensity for both periods at the two nursing homes comprised on average a direct care time of 75 (45%) and 101 (42%) minutes, respectively. Work time was measured according to actual schedule (462 hours per nursing home during two weeks). Given that the need for care was high, one must further investigate if the quality of care the recipients received was sufficiently addressed.
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Affiliation(s)
- K. B. E. Thorsell
- Section of Nursing, Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Baravägen 3, 221 00 Lund, Sweden
- Section of Elderly, Municipality of Hässleholm, Löjtnant Granlundsväg 14, 28152 Hässleholm, Sweden
| | - B. M. Nordström
- Section of Nursing, Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Baravägen 3, 221 00 Lund, Sweden
| | - L. Fagerström
- Department of Health Sciences, Buskerud University College, Pb 850, Papirbredden, Grønland 58, 3007 Drammen, Norway
- University of Skövde, Pb 408, Högskolevägen 1, 54128 Skövde, Sweden
| | - B. V. Sivberg
- Section of Nursing, Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Baravägen 3, 221 00 Lund, Sweden
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Cultural values and caregiver preference for Mexican-American and non-Latino White elders. J Cross Cult Gerontol 2009; 24:225-39. [PMID: 19127418 DOI: 10.1007/s10823-008-9088-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
This study examined caregiver preferences in the event of hip fracture between Mexican-American and non-Latino White elders. The differential effects of ethnicity and a cultural factor were also examined to elucidate the role of culture on caregiver preference.Data came from a cross-sectional survey of 89 Mexican-American and 30 non-Latino White elders. Hierarchical binary logistic regression was used to examine the differential impact of ethnicity and a cultural factor on caregiver preference. Fewer Mexican-American elders than non-Latino White elders preferred to rely on a formal/professional helper, and a greater proportion of Mexican-Americans than non-Latino Whites would turn to informal caregivers when faced with care needs following a hip fracture. The cultural factor significantly mediated the ethnic effect on caregiver preference. The need for culturally-relevant services based on caregiver preference for long-term care is discussed in addressing health disparities for ethnically diverse elders.
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Williams HG, Ullmann G, Gossard JL, Hussey JR, Brotherton SS, Laditka J, Cornman C. Functional status assessment for community long-term care: preliminary observations. Home Health Care Serv Q 2009; 28:151-71. [PMID: 23098288 DOI: 10.1080/01621420903579818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Community Long-Term Care (CLTC) program in South Carolina offers services to nursing home eligible persons that allow them to remain at home and receive help with activities of daily living. Variation in the ways potential clients are evaluated often produces inconsistent eligibility determinations. We developed a simple, objective assessment tool to complement CLTC evaluations. A conceptual framework, based on Nagi's model of disablement, was tested on community-dwelling healthy older adults and CLTC clients. Three simple physiologic tasks assessing mobility, functional leg strength, and manual dexterity discriminated between community-dwelling older adults and CLTC clients, classifying them with 80% to 90% accuracy.
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Thorsell KBE, Nordström B, Nyberg P, Sivberg BV. Measuring care of the elderly: psychometric testing and modification of the Time in Care instrument for measurement of care needs in nursing homes. BMC Geriatr 2008; 8:22. [PMID: 18816418 PMCID: PMC2571091 DOI: 10.1186/1471-2318-8-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 09/25/2008] [Indexed: 11/30/2022] Open
Abstract
Background Aging entails not only a decrease in the ability to be active, but also a trend toward increased dependence to sustain basic life functions. An important aspect for appropriately elucidating the individual's care needs is the ability to measure them both simply and reliably. Since 2006 a new version of the Time in Care needs (TIC-n) instrument (19-item version) has been explored and used in one additional municipality with the same structure as the one described in an earlier study. Methods The TIC-n assessment was conducted on a total of 1282 care recipients. Factor analysis (principal component) was applied to explore the construct validity of the TIC-n. Cronbach's alpha was calculated to test reliability and for each of the items remaining in the instrument after factor analysis, an inter-rater comparison was carried out on all recipients in both municipalities. Independently of each other, a weighted Kappa (Kw) was calculated. Results. The mean of each weighted Kappa (Kw) for the dimensions in the two municipalities was 0.75 and 0.76, respectively. Factor analysis showed that all 19 items had a factor loading of ≥ 0.40. Three factors (General Care, Medical Care and Cognitive Care) were created. Conclusion The TIC-n instrument has now been tested for validity and reliability in two municipalities with satisfactory results. However, TIC-n can not yet be used as a golden standard, but it can be recommended for use of measurement of individual care needs in municipal elderly care.
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Affiliation(s)
- Kajsa B E Thorsell
- Department of Health Sciences, Section of Nursing, Faculty of Medicine, Lund University, Lund, Sweden.
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22
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Bern-Klug M. State variations in nursing home social worker qualifications. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2008; 51:379-409. [PMID: 19043909 DOI: 10.1080/01634370802039734] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.
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Affiliation(s)
- Mercedes Bern-Klug
- School of Social Work, 308 North Hall, The University of Iowa, Iowa City, IA 52242, USA.
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Huang JJ, Lin KC, Li IC. Service needs of residents in community-based long-term care facilities in northern Taiwan. J Clin Nurs 2007; 17:99-108. [DOI: 10.1111/j.1365-2702.2007.01974.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alkema GE, Wilber KH, Shannon GR, Allen D. Reduced mortality: the unexpected impact of a telephone-based care management intervention for older adults in managed care. Health Serv Res 2007; 42:1632-50. [PMID: 17610441 PMCID: PMC1955273 DOI: 10.1111/j.1475-6773.2006.00668.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This analysis evaluated mortality over 24 months for Medicare managed care members who participated in the Care Advocate Program (CA Program) designed to link those with high health care utilization to home- and community-based services. DATA SOURCE Secondary data from the CA Program, part of the California HealthCare Foundation's Elders in Managed Care Initiative. STUDY DESIGN Randomized-control trial in which participants (N=781) were randomly assigned to intent-to-treat (ITT) and control groups. ITT group received telephonic social care management and 12 months of follow-up. Various multivariate analyses were used to evaluate mortality risk throughout multiple study periods controlling for sociodemographic characteristics, health status, and health care utilization. POPULATION STUDIED Older adults (65+) enrolled in a Medicare managed care plan who had high health care utilization in the previous year. PRINCIPAL FINDINGS ITT group had a significantly lower odds of mortality throughout the study (OR=0.55; p=.005) and during the care management intervention (OR=0.45; p=.006), whereas differential risk in the postintervention period was not statistically significant. Other significant predictors of mortality were age, gender, three chronic conditions (cancer, heart disease, and kidney disease), and emergency room utilization. CONCLUSIONS Findings suggest that the care advocate model of social care management affected mortality while the program was in progress, but not after completion of the intervention phase. Key model elements accounted for the findings, which include individualized targeting, assessment, and monitoring; consumer choice, control, and participant self-management; and bridging medical and social service delivery systems through direct linkages and communication.
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Affiliation(s)
- Gretchen E Alkema
- Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles, CA 90089-0191, USA
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Abstract
This paper reviews research based on the psychological autopsy (PA) method applied to the study of suicide. It evidences the presence of a number of methodological problems. Shortcomings concern sampling biases in the selection of control subjects, confounding influences of extraneous variables, and reliability of the assessment instruments. The absence of homogeneity among studies in the procedure employed, as well as the lack of defined guidelines for performing this type of inquiry are emphasized. Questions needing empirical investigation in the future are pointed out. It is concluded that the validity and reliability of findings emerging from the use of this method of investigation would benefit from a standardization of its application.
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Affiliation(s)
- Louise Pouliot
- University of Quebec at Montreal, Montreal, Quebec, Canada.
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Cravens DD, Mehr DR, Campbell JD, Armer J, Kruse RL, Rubenstein LZ. Home-based Comprehensive Assessment of Rural Elderly Persons: The CARE Project. J Rural Health 2005; 21:322-8. [PMID: 16294655 DOI: 10.1111/j.1748-0361.2005.tb00102.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CONTEXT Home-based comprehensive geriatric assessment (CGA) has been effective in urban areas but has had little study in rural areas. CGA involves medical history taking, a physical exam, and evaluation of functional status, mental status, cognitive status, gait and balance, medications, vision, extent of social supports, and home safety. We sought to develop and pilot a model of rural home-based CGA to determine whether successful urban models can be adapted to rural areas. METHODS This study was a developmental demonstration project with qualitative and quantitative evaluation components of a home-based CGA model using a home health agency and a geriatrician participating from a remote location by teleconference. Findings and recommendations were relayed to patients, caregivers, and primary physicians. The population studied was elderly volunteers (N = 51) aged 75 years and older who did not have a terminal diagnosis or immediate plans to enter a long-term care facility. Survey instruments and focus groups were used with subjects, family members or caregivers, and physicians to generate refinements and outcome measures for the model. FINDINGS Among the 51 patients undergoing CGA, Instrumental Activities of Daily Living dependency and balance and gait problems were highly prevalent. Means of 1.1 major problems and 4.9 nonmajor problems were identified per patient. Recommendations were implemented for 32% of major problems and for 35% of nonmajor problems. Primary physicians found recommendations for vaccination and home safety change helpful but were skeptical of physical examination findings by the nurse. Practitioners noted that this study resulted in several positive outcomes: (1) some subjects initiated regular clinic visits; (2) several visually impaired elders began services for the blind; (3) identification of gait and balance problems resulted in physical therapy treatment; and (4) identification of caregiver stress was addressed by social-work intervention. Potential further refinements of the model for rural home-based CGA were identified. CONCLUSIONS Home-based CGA identifies important problems of rural older adults. However, modifications are still needed to create a truly effective process.
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Affiliation(s)
- David D Cravens
- Department of Family and Community Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO 65212, USA.
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Abstract
OBJECTIVE Care preference is important for both client's satisfaction and quality of life in long-term care. This study examines preference for long-term care arrangement and its correlates for older Korean Americans. METHODS Data on two disability scenarios of hip fracture and stroke from a cross-section survey of 144 older Korean Americans were used to examine preferred care arrangement in terms of caregiver and care location, using multinomial logistic regression. RESULTS Respondents expressed stronger preferences for "all informal" or "mixed" care arrangement for hip fracture scenario, but they preferred "all formal" care arrangement in the stroke scenario. Traditional value significantly decreased the odds of choosing "all formal" or "mixed" over "all informal" care arrangement. But Medicaid coverage and an independent decision-making style increased the odds of choosing "all formal" instead of "all informal" care arrangement. DISCUSSION This study discusses the need for assessment of care preference and culturally appropriate long-term care services for minority elders.
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Li IC, Chang TM. Predictors of Home Health Care Services for Cerebral Vascular Disease Patients in Taiwan. Public Health Nurs 2004; 21:41-8. [PMID: 14692988 DOI: 10.1111/j.1525-1446.2004.21106.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The National Health Insurance in Taiwan has rigid regulations for reimbursing home nursing care with payment only for technical/skill care such as changing nasogastric tubes, urine catheters, and tracheal tubes, wound care, and specimen collection. Patients with chronic illnesses who reside at home, however, require care that is holistic and focuses on wellness rather than illness. Cerebral vascular disease (CVD) patients are the largest group receiving home nursing care. They qualify for reimbursement under NHI. The purposes of this study were to quantify the home health care (HHC) needs of CVD patients and to understand predictors for HHC services for CVD patients in Taiwan. A descriptive correlation design was used to examine the relationship between a CVD patient's health status and the need for HHC services. In total, 195 patients were interviewed by one trained research assistant, with 124 patients being from Taipei (an urban area in Taiwan) and the remaining 71 from I-lan (a rural area in Taiwan). The mean age of subjects was 74.8 years, with 60% of the sample being female. Physiological health status scores (M = 2.56, SD = 0.58, range = 1-5) were worse than the psychosocial health status scores (M = 2.37, SD = 0.91, range = 1-5), which indicates that the need for health education and skilled nursing services was higher than referral services for professional HHC services. Results suggest that there is a need to develop and shape NHI policy to cover more holistic HHC services for CVD patients.
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Affiliation(s)
- I-Chuan Li
- Institute of Community Health Nursing, National Yang-Ming University, Taipei, Taiwan.
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Involving older people in research to examine quality of life in residential aged care. QUALITY IN AGEING AND OLDER ADULTS 2003. [DOI: 10.1108/14717794200300027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hadjistavropoulos HD, Sagan M, Bierlein C, Lawson K. Development of a case management quality questionnaire. CARE MANAGEMENT JOURNALS : JOURNAL OF CASE MANAGEMENT ; THE JOURNAL OF LONG TERM HOME HEALTH CARE 2003; 4:8-17. [PMID: 14502873 DOI: 10.1891/cmaj.4.1.8.57475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study documents the development of a new tool to measure the quality of community case management for elderly clients. Information obtained from literature review, client focus groups, and pilot surveys with clients served as the basis for the development of a Case Management Quality Questionnaire (CMQQ). This measure, along with satisfaction, health status, and demographic questions, was administered to 174 home care clients and 78 family members of long term care residents for evaluation of case management services that clients had received in the last 2 to 6 months. Principal components analysis with oblique (Oblimin) rotation identified three subscales of the CMQQ: (1) accessibility, (2) efficiency, and (3) assessment/coordination skill. Study findings suggest that the CMQQ is reliable, valid, and of value in understanding satisfaction with case coordination. Based on client feedback and analysis of the results, some future modifications to the measure are worthy of study. Others interested in measuring and improving case management may similarly benefit from the use of the CMQQ.
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Ejaz FK, Straker JK, Fox K, Swami S. Developing a satisfaction survey for families of Ohio's nursing home residents. THE GERONTOLOGIST 2003; 43:447-58. [PMID: 12937324 DOI: 10.1093/geront/43.4.447] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this project was to develop a reliable and valid family satisfaction instrument for use in Ohio's nursing homes. DESIGN AND METHODS Investigators worked with an advisory council to develop the survey. Purposive sampling techniques were largely used to select 12 small, medium, and large for-profit and proprietary facilities in one large county for the pretest. A total of 239 families who were "most involved" in their relative's care completed an instrument with 97 satisfaction items. RESULTS Factor analyses identified nine factors that explained 59.44% of the variance in satisfaction. Investigator judgment modified some factors and developed scales. The scales had good internal reliability ( and above, except for one), test-retest reliability ranged from.49 to.88, and differences between families of short- and long-stay residents were in expected directions. A final instrument with 62 satisfaction and 17 background items was recommended for statewide implementation. IMPLICATIONS Findings from the project can be used to further refine the instrument and protocols for use with larger populations in other states and by the federal government.
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Affiliation(s)
- Farida K Ejaz
- Margaret Blenkner Research Institute, Benjamin Rose, 850 Euclid Avenue, Suite 1100, Cleveland, OH 44114-3301, USA.
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Courtney M, Edwards H, Stephan J, O'Reilly M, Duggan C. Quality of life measures for residents of aged care facilities: a literature review. Australas J Ageing 2003. [DOI: 10.1111/j.1741-6612.2003.tb00467.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McConnell ES, Branch LG, Sloane RJ, Pieper CF. Natural history of change in physical function among long-stay nursing home residents. Nurs Res 2003; 52:119-26. [PMID: 12657987 DOI: 10.1097/00006199-200303000-00008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few longitudinal studies exist to guide clinicians or administrators on what functional outcomes can be expected among nursing home residents with different levels of cognitive impairment. Extrapolating from cross-sectional studies or from longitudinal studies of community-dwelling residents may provide misleading estimates of prognosis, hindering efforts to target preventive care. OBJECTIVE To describe patterns of change in physical function on a quarterly basis over 1 year among long-stay nursing home residents grouped according to their level of cognitive impairment on admission. METHOD Retrospective analysis of activities of daily living dependence ratings were based on quarterly MDS+ assessments from 76,016 long-stay residents admitted to nursing homes during calendar years 1993 through 1996 in five states participating in the National Case Mix and Quality and Demonstration Project. Residents were stratified by level of cognitive impairment on admission using a 7-level Cognitive Performance Scale. The activities of daily living dependence was measured by a 20 point scale. Mean activities of daily living scores on admission to the hospital and at four quarterly intervals following admission were compared across cognitive impairment levels and by state of residence. RESULTS A change in activities of daily living dependence over 1 year in most groups averaged 1 point or less. Three patterns of activities of daily living dependence were identified consistently across five states. Those with mild cognitive impairment on admission showed an initial reduction in dependence followed by slow increase; those with moderately severe impairment showed slow linear increased dependence; and those with severe cognitive impairment showed an initial improvement in dependence, followed by stability. CONCLUSION More complex statistical models that take into account comorbid conditions at baseline, in addition to cognitive performance, might identify subgroups of nursing home residents who are at risk for rapid decline. Ways to better characterize declines in function are needed, otherwise relatively large samples will be required for intervention trials.
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Affiliation(s)
- Eleanor S McConnell
- School of Nursing, Duke University, Duke University Center for the Study of Aging and Human Development, Durham, North Carolina 27710, USA.
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Feldman PH, Kane RL. Strengthening research to improve the practice and management of long-term care. Milbank Q 2003; 81:179-220, 171. [PMID: 12841048 PMCID: PMC2690214 DOI: 10.1111/1468-0009.t01-1-00051] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Past investments in long-term care (LTC) research have improved the quality of care and the quality of life for LTC recipients by conceptualizing the goals and measuring the outcomes of care, designing practical assessment tools, testing clinical interventions, and evaluating new service delivery programs and models. To build a balanced portfolio of LTC research that will yield and sustain increased dividends in quality and outcomes will require (1) increasing investment in both basic and applied LTC research to ensure that critical service delivery issues are addressed in a rigorous and timely fashion, (2) fostering better communication between researchers and users to ensure research salience and credibility, and (3) dedicating more resources to identifying and implementing successful methods for translating LTC research into practice.
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Jörg F, Boeije HR, Huijsman R, de Weert GH, Schrijvers AJP. Objectivity in needs assessment practice: admission to a residential home. HEALTH & SOCIAL CARE IN THE COMMUNITY 2002; 10:445-456. [PMID: 12485131 DOI: 10.1046/j.1365-2524.2002.00386.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In 1997, the Dutch government installed independent agencies to assess the long-term care needs of individual clients and to give advice on the allocation of appropriate services. Needs assessors assess, among other things, the eligibility of clients requesting admission to a residential home. According to guidelines, needs assessors should do this objectively and independently from care providers and health care insurers. The present paper examines how needs assessors explore the clients' expressed needs, determine their normative needs and advise on allocation. Needs assessors perform these tasks in a situation where a clear professional framework is absent, and moreover, residential home capacity is limited. A qualitative study was undertaken, observing 13 house calls of clients requesting admission to a residential home. Furthermore, interviews were held with all needs assessors and a document analysis was made. It was found that needs assessors use comparable methods in exploring the clients' motivation and assessing their needs in the relevant areas, apparently using a professional framework. However, when transforming the needs of clients into an adequate allocation, needs assessors struggled with interpretation of criteria and included their personal ideas of services into the allocation decision. The paper concludes with the suggestion that further professionalisation may lead to a greater uniformity in needs assessment practice, and will assist needs assessors in the difficult task of transforming clients' needs into long-term care allocation advice.
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Affiliation(s)
- F Jörg
- Julius Centre for General Practice and Patient Oriented Research, University Medical Centre, Utrecht, the Netherlands
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