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Rutten JJS, Smalbrugge M, van Buul LW, van Eijk J, Geerlings SE, Natsch S, Sloane PD, van der Wouden JC, Hertogh CMPM, Gerritsen DL. A Process Evaluation of an Antibiotic Stewardship Intervention for Urinary Tract Infections in Nursing Homes. J Am Med Dir Assoc 2024; 25:146-154.e9. [PMID: 38173264 DOI: 10.1016/j.jamda.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To assess the internal and external validity of a cluster randomized controlled trial (cRCT) evaluating a decision tool with supportive interventions for the empirical treatment of urinary tract infections (UTIs) in nursing homes (NHs), and to identify facilitators and barriers in implementing this antibiotic stewardship intervention. DESIGN Mixed-methods process evaluation study. SETTING AND PARTICIPANTS Physicians, nursing staff, client council members, and residents of Dutch NHs. METHODS We used cRCT data of the ANNA study (Antibiotic Prescribing and Non-prescribing in Nursing Home Residents With Signs and Symptoms Ascribed to Urinary Tract Infection). In addition, we sent out an online evaluation questionnaire, conducted semistructured interviews with physicians and nursing staff, and consulted client council members. RESULTS Internal validity was lowered: control group physicians participated in several non-study-related activities regarding UTI. External validity was good: almost all intervention components had a high fidelity (52%-74%) and were perceived as relevant (physicians: 7.2-8.6 of 10, nursing staff: 6.5-8.5 of 10) and feasible (physicians: 7.5 of 10, nursing staff 6.4 of 10), with feasibility for residents with dementia and urine incontinence needing attention. The most common reason for deviating from the advice generated by the decision tool was an unclear illness presentation. Identified facilitators to implementation were confidence in the intervention, repeated intervention encounter, and having "champions" in the NH. Barriers were limited involvement of nursing staff, unstable nursing teams, residents' and representatives' belief that antibiotics should be prescribed, and a low antibiotic prescribing threshold within the NH culture. CONCLUSIONS AND IMPLICATIONS Lowered internal validity may have reduced the study effect. Attention should be paid to the feasibility of the intervention in residents with dementia and urinary incontinence. Improvement opportunities for implementation were higher nursing staff involvement and repeated intervention offering.
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Affiliation(s)
- Jeanine J S Rutten
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Laura W van Buul
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Jorna van Eijk
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Suzanne E Geerlings
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Stephanie Natsch
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philip D Sloane
- Department of Family Medicine, School of Medicine, and the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community care, Radboudumc Alzheimer Center, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Xie F, Shu Q, Li J, Chen ZY. An exploration of status of chronic diseases and its influencing factors of older people in Chinese home care and long-term care facilities: a cross-sectional study. Front Public Health 2023; 11:1321681. [PMID: 38186706 PMCID: PMC10768002 DOI: 10.3389/fpubh.2023.1321681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background As the population ages, the proportion of chronic diseases becomes more prevalent. This study aimed to investigate the current status of chronic diseases among the older people in home care (HC) and long-term care facilities (LTCFs) in China and to analyze its influencing factors. Methods This cross-sectional study was conducted between 2021 and 2022. A multi-stage stratified random sampling and census sampling approach was used in this survey of the health of 389 older people in HC and 202 older people in LTCFs from Western Hunan, respectively. The following instruments were included in the survey "International Resident Assessment Instrument for Home Care (interRAI-HC)" and the "International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF)." Univariate analysis was used to examine the prevalence of chronic diseases among older people with different characteristics. Data were analyzed by IBM SPSS version 25.0 software. A p-value of <0.05 was considered statistically significant. Results The survey results showed that the prevalence of chronic diseases among older people in HC was 73.26% (95% CI, 68.85-77.68), and the top five chronic diseases were hypertension (26.36%), bone and joint disease (23.36%), gastrointestinal and gallbladder disease (11.78%), heart disease (11.21%), and diabetes (8.97%). The prevalence of chronic diseases among older people in LTCFs was 77.23% (95% CI, 77.23-83.06), and the top five chronic diseases were hypertension (33.11%), bone and joint disease (13.25%), cerebrovascular disease (12.91%), diabetes (11.26%), and heart disease (10.26%). The results showed that long time spent alone, having sleep disorders, and self-rated health status significantly increased HC in older people with the prevalence of chronic diseases (p < 0.05). Having marital status, non-healthy BMI, having sleep disorder, walking with the use of assistive devices, and self-rated health status significantly increased older people in LTCFs with the prevalence of chronic diseases (p < 0.05). Conclusion There are differences in the prevalence and distribution of chronic diseases among older people in two different aged care models in China, and there are various risk factors for chronic diseases. Therefore, chronic disease healthcare strategies should be tailored to two different aged care models for older people. Further summary found that older people in HC spend a lot of time alone and suffer from loneliness, which ultimately causes psychological disorders. Thus, psychological adaptation interventions are needed for older people in HC. Besides, older people in LTCFs lack social support from their families (divorced/widowed) and have activity disorders (walking with the use of assistive devices). Thus, social adaptation interventions are needed for older people in LTCFs. This study provides a theoretical basis for the distribution of healthcare and the prevention and treatment of chronic diseases in Chinese older people.
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Affiliation(s)
- Fen Xie
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Jishou University School of Medicine, Jishou, China
| | - Qingxia Shu
- Hunan University of Medicine General Hospital, Huaihua, China
| | - Jinxiu Li
- Jishou University School of Medicine, Jishou, China
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Venditti N, Petronio GP, Pinti M, Cutolo G, Pietrangelo L, Massini L, Magnifico I, Cutuli MA, Petrone F, Papini S, Di Marco R, Corbi G. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes. Open Med (Wars) 2023; 18:20230822. [PMID: 37900963 PMCID: PMC10612528 DOI: 10.1515/med-2023-0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
The aim of this retrospective cohort study is to understand if and how much the preventive self-isolation approach might have been a valid model to avoid care-related infection, not only from COVID-19 but also from other non-viral infectious diseases. From March to May 2020, the healthcare and management staff of the Villa Santa Maria long-term care facilities, located in the village of Montenero di Bisaccia (Campobasso, Molise, Italy), decided to carry out a preventive self-isolation plan to safeguard the residents from SARS-CoV-2. The impact on other infectious diseases was evaluated by analyzing the antibiotic therapies prescription trend among the inpatients. Our data showed that although self-isolation protected residents and caregivers from SARS-CoV-2, it can also be associated with mobility reduction, leading to an increase in bedridden pathologies, namely, pressure ulcers and pressure sores. The simultaneous isolation of residents and caregivers in the same location significantly reduced any outside influence as a cause of possible infections.
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Affiliation(s)
- Noemi Venditti
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Giulio Petronio Petronio
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Melania Pinti
- Istituto Dottrina Cristiana (Largo Istituto Dottrina Cristiana, 1, 67100 L’Aquila AQ), U.O. RSD e Casa di Riposo “Villa Santa Maria”, Montenero di Bisaccia (CB)86036, Italy
| | - Giovanni Cutolo
- Istituto Dottrina Cristiana (Largo Istituto Dottrina Cristiana, 1, 67100 L’Aquila AQ), U.O. RSD e Casa di Riposo “Villa Santa Maria”, Montenero di Bisaccia (CB)86036, Italy
| | - Laura Pietrangelo
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Laura Massini
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Irene Magnifico
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Marco Alfio Cutuli
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Federica Petrone
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Stefano Papini
- UO Laboratorio Analisi, Responsible Research Hospital, Campobasso, Italy
| | - Roberto Di Marco
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Graziamaria Corbi
- Department of Translational Medical Sciences, University of Naples Federico IINapoli80126, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Campania Region section, Florence, Italy
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Morris JN, Howard EP, Schachter E, Burney S, Laytham A, Fialova D, Hoogendijk EO, Liperoti R, van Hout HPJ, Vetrano DL. Cognitive Change Among Nursing Home Residents: CogRisk-NH Scale Development to Predict Decline. J Am Med Dir Assoc 2023; 24:1405-1411. [PMID: 37517808 DOI: 10.1016/j.jamda.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES Examine cognitive changes over time among nursing home residents and develop a risk model for identifying predictors of cognitive decline. DESIGN Using secondary analysis design with Minimum Data Set data, cognitive status was based on the Cognitive Performance Scale (CPS). SETTING AND PARTICIPANTS Baseline and 7 quarterly follow-up analyses of US and Canadian interRAI data (N = 1,257,832) were completed. METHODS Logistic regression analyses identified predictors of decline to form the CogRisk-NH scale. RESULTS At baseline, about 15% of residents were cognitively intact (CPS = 0), and 11.2% borderline intact (CPS = 1). The remaining more intact, with mild impairment (CPS = 2), included 15.0%. Approximately 59% residents fell into CPS categories 3 to 6 (moderate to severe impairment). Over time, increasing proportions of residents declined: 17.1% at 6 months, 21.6% at 9 months, and 34.0% at 21 months. Baseline CPS score was a strong predictor of decline. Categories 0 to 2 had 3-month decline rates in midteens, and categories 3 to 5 had an average decline rate about 9%. Consequently, a 2-submodel construction was employed-one for CPS categories 0 to 2 and the other for categories 3 to 5. Both models were integrated into a 6-category risk scale (CogRisk-NH). CogRisk-NH scale score distribution had 15.9% in category 1, 26.84% in category 2, and 36.7% in category 3. Three higher-risk categories (ie, 4-6) represented 20.6% of residents. Mean decline rates at the 3-month assessment ranged from 4.4% to 28.3%. Over time, differentiation among risk categories continued: 6.9% to 38.4.% at 6 months, 11.0% to 51.0% at 1 year, and 16.2% to 61.4% at 21 months, providing internal validation of the prediction model. CONCLUSIONS AND IMPLICATIONS Cognitive decline rates were higher among residents in less-impaired CPS categories. CogRisk-NH scale differentiates those with low likelihood of decline from those with moderate likelihood and, finally, much higher likelihood of decline. Knowledge of resident risk for cognitive decline enables allocation of resources targeting amenable factors and potential interventions to mitigate continuing decline.
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Affiliation(s)
- John N Morris
- Hebrew SeniorLife, The Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Elizabeth P Howard
- Hebrew SeniorLife, The Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA; Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.
| | | | - Sharran Burney
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Anna Laytham
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Daniela Fialova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Prague, Czech Republic; Department of Geriatrics and Gerontology, 1(st) Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Emiel O Hoogendijk
- Department of General Practice and Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hein P J van Hout
- Amsterdam University Medical Center, Departments of General Practice and Medicine for Older Persons, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
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Bossuyt FM, Bogdanova Y, Kingsley KT, Bergquist TF, Kolakowsky-Hayner SA, Omar Z, Popova ES, Tobita M, Constantinidou F. Evolution of rehabilitation services in response to a global pandemic: reflection on opportunities and challenges ahead. Front Rehabil Sci 2023; 4:1173558. [PMID: 37255738 PMCID: PMC10226080 DOI: 10.3389/fresc.2023.1173558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/21/2023] [Indexed: 06/01/2023]
Abstract
The rapidly evolving COVID-19 public health emergency has disrupted and challenged traditional healthcare, rehabilitation services, and treatment delivery worldwide. This perspective paper aimed to unite experiences and perspectives from an international group of rehabilitation providers while reflecting on the lessons learned from the challenges and opportunities raised during the COVID-19 pandemic. We discuss the global appreciation for rehabilitation services and changes in access to healthcare, including virtual, home-based rehabilitation, and long-term care rehabilitation. We illustrate lessons learned by highlighting successful rehabilitation approaches from the US, Belgium, and Japan.
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Affiliation(s)
- Fransiska M. Bossuyt
- Neuro-musculoskeletal Functioning and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Yelena Bogdanova
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
- Physical Medicine & Rehabilitation, VA Boston Healthcare System, Boston, MA, United States
| | - Kristine T. Kingsley
- Institute of Emotional and Cognitive Wellness, New York, NY, United States
- Department of Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Thomas F. Bergquist
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | | | - Zaliha Binti Omar
- Department of Rehabilitation Medicine, University Malaya, Kuala Lumpur, Malaysia
- Department of Rehabilitation Medicine 1, Fujita Health University, Aichi, Japan
| | - Evguenia S. Popova
- Department of Occupational Therapy, Rush University, Chicago, IL, United States
| | - Mari Tobita
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
- Rancho Research Institute, Downey, CA, United States
| | - Fofi Constantinidou
- Center for Applied Neuroscience & Department of Psychology, University of Cyprus, Nicosia, Cyprus
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Ratti M, Concina D, Rinaldi M, Salinelli E, Di Brisco AM, Ferrante D, Volpe A, Panella M. Vaccination Strategies against Seasonal Influenza in Long Term Care Setting: Lessons from a Mathematical Modelling Study. Vaccines (Basel) 2022; 11:vaccines11010032. [PMID: 36679877 PMCID: PMC9861048 DOI: 10.3390/vaccines11010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND seasonal influenza in nursing homes is a major public health concern, since in EU 43,000 long term care (LTC) facilities host an estimated 2.9 million elderly residents. Despite specific vaccination campaigns, many outbreaks in such institutions are occasionally reported. We explored the dynamics of seasonal influenza starting from real data collected from a nursing home located in Italy and a mathematical model. Our aim was to identify the best vaccination strategy to minimize cases (and subsequent complications) among the guests. MATERIALS AND METHODS after producing the contact matrices with surveys of both the health care workers (HCW) and the guests, we developed a mathematical model of the disease. The model consists of a classical SEIR part describing the spreading of the influenza in the general population and a stochastic agent based model that formalizes the dynamics of the disease inside the institution. After a model fit of a baseline scenario, we explored the impact of varying the HCW and guests parameters (vaccine uptake and vaccine efficacy) on the guest attack rates (AR) of the nursing home. RESULTS the aggregate AR of influenza like illness in the nursing home was 36.4% (ward1 = 56%, ward2 = 33.3%, ward3 = 31.7%, ward4 = 34.5%). The model fit to data returned a probability of infection of the causal contact of 0.3 and of the shift change contact of 0.2. We noticed no decreasing or increasing AR trend when varying the HCW vaccine uptake and efficacy parameters, whereas the increase in both guests vaccine efficacy and uptake parameter was accompanied by a slight decrease in AR of all the wards of the LTC facility. CONCLUSION from our findings we can conclude that a nursing home is still an environment at high risk of influenza transmission but the shift change room and the handover situation carry no higher relative risk. Therefore, additional preventive measures in this circumstance may be unnecessary. In a closed environment such as a LTC facility, the vaccination of guests, rather than HCWs, may still represent the cornerstone of an effective preventive strategy. Finally, we think that the extensive inclusion of real life data into mathematical models is promising and may represent a starting point for further applications of this methodology.
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Affiliation(s)
- Matteo Ratti
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
- Correspondence:
| | - Diego Concina
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Maurizio Rinaldi
- Department of Pharmaceutical Science (DSF), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Ernesto Salinelli
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Agnese Maria Di Brisco
- Department of Studies for Economics and Business (DiSEI), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Alessandro Volpe
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Massimiliano Panella
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
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Tanunliong G, Liu A, Vijh R, Pidduck T, Kustra J, Márquez AC, Choi A, McLennan M, Hayden A, Kearney C, Gantt S, Krajden M, Morshed M, Jassem AN, Sekirov I. Persistence of Anti-SARS-CoV-2 Antibodies in Long Term Care Residents Over Seven Months After Two COVID-19 Outbreaks. Front Immunol 2022; 12:775420. [PMID: 35046939 PMCID: PMC8763385 DOI: 10.3389/fimmu.2021.775420] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/10/2021] [Indexed: 01/08/2023] Open
Abstract
Background As part of the public health outbreak investigations, serological surveys were carried out following two COVID-19 outbreaks in April 2020 and October 2020 in one long term care facility (LTCF) in British Columbia, Canada. This study describes the serostatus of the LTCF residents and monitors changes in their humoral response to SARS-CoV-2 and other human coronaviruses (HCoV) over seven months. Methods A total of 132 serum samples were collected from all 106 consenting residents (aged 54-102) post-first outbreak (N=87) and post-second outbreak (N=45) in one LTCF; 26/106 participants provided their serum following both COVID-19 outbreaks, permitting longitudinal comparisons between surveys. Health-Canada approved commercial serologic tests and a pan-coronavirus multiplexed immunoassay were used to evaluate antibody levels against the spike protein, nucleocapsid, and receptor binding domain (RBD) of SARS-CoV-2, as well as the spike proteins of HCoV-229E, HCoV-HKU1, HCoV-NL63, and HCoV-OC43. Statistical analyses were performed to describe the humoral response to SARS-CoV-2 among residents longitudinally. Findings Survey findings demonstrated that among the 26 individuals that participated in both surveys, all 10 individuals seropositive after the first outbreak continued to be seropositive following the second outbreak, with no reinfections identified among them. SARS-CoV-2 attack rate in the second outbreak was lower (28.6%) than in the first outbreak (40.2%), though not statistically significant (P>0.05). Gradual waning of anti-nucleocapsid antibodies to SARS-CoV-2 was observed on commercial (median Δ=-3.7, P=0.0098) and multiplexed immunoassay (median Δ=-169579, P=0.014) platforms; however, anti-spike and anti-receptor binding domain (RBD) antibodies did not exhibit a statistically significant decline over 7 months. Elevated antibody levels for beta-HCoVs OC43 (P<0.0001) and HKU1 (P=0.0027) were observed among individuals seropositive for SARS-CoV-2 compared to seronegative individuals. Conclusion Our study utilized well-validated serological platforms to demonstrate that humoral responses to SARS-CoV-2 persisted for at least 7 months. Elevated OC43 and HKU1 antibodies among SARS-CoV-2 seropositive individuals may be attributed to cross reaction and/or boosting of humoral response.
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Affiliation(s)
- Guadalein Tanunliong
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Aaron Liu
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Tamara Pidduck
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada
| | - Jesse Kustra
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada
| | - Ana Citlali Márquez
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada
| | - Alexandra Choi
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Meghan McLennan
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada
| | - Althea Hayden
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, Vancouver, BC, Canada
| | | | - Soren Gantt
- Centre de Recherche de Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, QC, Canada
| | - Mel Krajden
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada
| | - Muhammad Morshed
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada
| | - Agatha N. Jassem
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada
| | - Inna Sekirov
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada
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Pu D, Choi YY, Chan KMK, Poon MMW. Modifying Puree Meals in Residential Aged Care Facilities: A Multi-Centre Feasibility and Acceptability Study. Geriatrics (Basel) 2021; 6:geriatrics6040108. [PMID: 34842703 PMCID: PMC8628769 DOI: 10.3390/geriatrics6040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Purees are often recommended for older adults in residential aged care facilities (RACFs) to target swallowing difficulties and nutrition. However, they lack appeal and may have negative impacts on nutritional intake. This study investigated the subjective experiences and objective swallowing function and safety of older adults in response to a modified puree. Twenty-eight residents from three RACFs whose regular diets consisted of purees were recruited. Purees were modified to improve visual appeal by adding a commercial enzyme gellant. Each participant was observed during three puree and three modified puree meals, and completed a brief questionnaire after each meal. A videofluoroscopic swallowing study (VFSS) was performed with 16 of the participants. Compared to purees, modified purees were observed to be easier for oral processing and intake amount was higher, but participants required assistance more often and mealtimes were longer. Participants did not show preference for either type of puree. VFSS showed similar swallowing responses between the two puree types; however, a distinction was observed for modified pureed meat compared to other ingredients. Modifying puree meals in RACFs is a feasible approach to improve nutritional intake while maintaining swallowing safety, but their appeal to consumers is not definitive.
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Affiliation(s)
- Dai Pu
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston 3199, Australia
- Correspondence: (D.P.); (M.M.-W.P.)
| | - Yuen-Yu Choi
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong, China; (Y.-Y.C.); (K.M.-K.C.)
| | - Karen Man-Kei Chan
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong, China; (Y.-Y.C.); (K.M.-K.C.)
| | - May Man-Wai Poon
- ENT Laser Hearing & Speech Therapy Centre, 59–65 Queen’s Road Central, Hong Kong, China
- Correspondence: (D.P.); (M.M.-W.P.)
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Lindquist LA, Liggett A, Muhammad R, Seltzer A, Kim KYA, Barish B, Wagner A, Ramirez-Zohfeld V. Effects of Improv Training on Older Adults in a Long Term Care Facility. Gerontol Geriatr Med 2021; 7:23337214211016111. [PMID: 34104682 PMCID: PMC8155780 DOI: 10.1177/23337214211016111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022] Open
Abstract
Adjusting to life in a long term care facility (LTCF) can be challenging for older adults. Improvisation (shortened to improv) is a unique activity that encourages creativity and adaptive cognitive stimulation, through performing short scenes with content suggestions. We sought to assess whether improv training, in the form of a course entitled Humor Doesn't Retire (HDR), could impact patient-centered outcomes in a LTCF. About 15 adults (mean age 83.6 years) living in a LTCF participated in the 8-week HDR course with pre and 1-month post mixed method surveys assessing validated Patient Reported Outcomes Measurement Information System (PROMIS) measures and qualitative open-ended responses. Participants experienced significant improvements in social isolation and perceived stress (p < .05), and trend improvements in positive affect, self-efficacy, and anxiety. Participants described themes of increased attentiveness, becoming more relaxed, increased cognitive stimulation, and improved communication skills. In conclusion, LTCFs may want to consider offering improv training to positively improve the lives of older adult residents.
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Rodríguez-Villodres Á, Martín-Gandul C, Peñalva G, Guisado-Gil AB, Crespo-Rivas JC, Pachón-Ibáñez ME, Lepe JA, Cisneros JM. Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review. Antibiotics (Basel) 2021; 10:antibiotics10060680. [PMID: 34200238 PMCID: PMC8228357 DOI: 10.3390/antibiotics10060680] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 01/03/2023] Open
Abstract
Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.
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Affiliation(s)
- Ángel Rodríguez-Villodres
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain; (Á.R.-V.); (C.M.-G.); (G.P.); (A.B.G.-G.); (J.C.C.-R.); (M.E.P.-I.); (J.A.L.)
| | - Cecilia Martín-Gandul
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain; (Á.R.-V.); (C.M.-G.); (G.P.); (A.B.G.-G.); (J.C.C.-R.); (M.E.P.-I.); (J.A.L.)
| | - Germán Peñalva
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain; (Á.R.-V.); (C.M.-G.); (G.P.); (A.B.G.-G.); (J.C.C.-R.); (M.E.P.-I.); (J.A.L.)
| | - Ana Belén Guisado-Gil
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain; (Á.R.-V.); (C.M.-G.); (G.P.); (A.B.G.-G.); (J.C.C.-R.); (M.E.P.-I.); (J.A.L.)
- Department of Pharmacy, University Hospital Virgen del Rocío, 41013 Seville, Spain
| | - Juan Carlos Crespo-Rivas
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain; (Á.R.-V.); (C.M.-G.); (G.P.); (A.B.G.-G.); (J.C.C.-R.); (M.E.P.-I.); (J.A.L.)
| | - María Eugenia Pachón-Ibáñez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain; (Á.R.-V.); (C.M.-G.); (G.P.); (A.B.G.-G.); (J.C.C.-R.); (M.E.P.-I.); (J.A.L.)
| | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain; (Á.R.-V.); (C.M.-G.); (G.P.); (A.B.G.-G.); (J.C.C.-R.); (M.E.P.-I.); (J.A.L.)
| | - José Miguel Cisneros
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain; (Á.R.-V.); (C.M.-G.); (G.P.); (A.B.G.-G.); (J.C.C.-R.); (M.E.P.-I.); (J.A.L.)
- Correspondence: ; Tel.: +34-697-958-658
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Stowers BA, Giblin L, Laspina L, Perry K. Perceptions of Program Directors and Educators Regarding the Adequacy of Oral Health Education in Nursing Assistant Curricula. J Dent Hyg 2017; 91:21-28. [PMID: 29118080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/02/2017] [Indexed: 06/07/2023]
Abstract
Purpose: National data indicate that the oral health status of the aging population in long term care facilities (LTCF) is poor in the majority of cases. Nursing assistants are considered to be the primary caregivers of oral health care to elders residing in LTCF's. The aim of this research was to explore the perspectives among nursing educators and program directors on the adequacy of oral health education in nursing assistant curricula.Methods: This exploratory, cross-sectional study utilized a web-based questionnaire adapted, with permission, from a prior study conducted in 2009. The 17- question survey regarding the adequacy of oral health education, was e-mailed to 253 nursing educators and program directors in 71 locations in the New England area with an explanation of the study and a link to SurveyMonkey®.Results: Of the 253 surveys e-mailed, 100 surveys (n=100) were returned giving an overall response rate of 40%. Fourteen respondents (n=14) indicated that their program did not include oral health education in their curriculum and were excluded from the study. The remaining 86 participants (program directors n=26 and educators n=60) indicated that oral health education was included in their nursing assistant curricula. Respondents who reported spending more time on both didactic (P<0.001) and clinical instruction in oral health (P<0.001) were more likely to agree that the oral health care education provided in their program was adequate (P<0.001).Conclusion: The results indicate that the perception of nursing educators and program directors is that the level of oral health education within the nursing assistant curricula is adequate in preparing students with the skills and knowledge needed to provide oral health care to patients.
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Giannella M, Tedeschi S, Bartoletti M, Viale P. Prevention of infections in nursing homes: antibiotic prophylaxis versus infection control and antimicrobial stewardship measures. Expert Rev Anti Infect Ther 2016; 14:219-30. [PMID: 26655286 DOI: 10.1586/14787210.2016.1132161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Because of the lack of structural and human resources for implementing more effective and safe preventive procedures, antimicrobial prophylaxis is often used to prevent infections in nursing homes. However, if data on the efficacy of antibiotic prophylaxis in nursing homes are null, there is a plenty of evidence that the inappropriate use of antimicrobials in this setting is associated with a high rate of colonization and infection with multi-drug-resistant organisms (MDROs), and of Clostridium difficile infection (CDI). Here, we have reviewed the infection epidemiology, the burden of MDROs and CDI, the antibiotic use and some potential infection preventive measures in nursing homes, pointing up the peculiarities of this setting and the absolute need of a more prudential use of antimicrobials.
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Affiliation(s)
- Maddalena Giannella
- a Clinic of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna , Bologna , Italy
| | - Sara Tedeschi
- a Clinic of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna , Bologna , Italy
| | - Michele Bartoletti
- a Clinic of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna , Bologna , Italy
| | - Pierluigi Viale
- a Clinic of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna , Bologna , Italy
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Weerkamp NJ, Tissingh G, Poels PJE, Zuidema SU, Munneke M, Koopmans RTCM, Bloem BR. Parkinson disease in long term care facilities: a review of the literature. J Am Med Dir Assoc 2013; 15:90-4. [PMID: 24314699 DOI: 10.1016/j.jamda.2013.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/14/2013] [Accepted: 10/04/2013] [Indexed: 10/25/2022]
Abstract
Parkinson disease (PD) is common in long term care (LTC) facilities. The number of institutionalized patients with PD will rise sharply in the coming decades because of 2 concurrent phenomena: aging of the population leads to an increased PD prevalence and improved quality of care has led to a prolonged survival in advanced disease stages. Only a few studies have investigated the prevalence and clinical characteristics of patients with PD in LTC facilities. Even fewer studies have addressed the treatment strategies used to support these institutionalized patients, who are mostly in advanced stages of the disease. The available evidence suggests that current management of patients with PD in LTC facilities is less than optimal. In the Netherlands, and we suspect in many other countries, there are no formal guidelines for treating patients with PD who have been admitted to a LTC facility. In this review, we describe the epidemiology, clinical characteristics, and clinical management of patients with PD in LTC settings. We also address potentially modifiable elements of care and provide several recommendations to improve the management of PD in these facilities. We conclude by suggesting a possible guide for future research in this area.
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Affiliation(s)
- Nico J Weerkamp
- Department of Neurology, Atrium Medical Center, Heerlen, The Netherlands; Department of Neurology, Nijmegen Center for Evidence Based Practice, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Gerrit Tissingh
- Department of Neurology, Atrium Medical Center, Heerlen, The Netherlands
| | - Petra J E Poels
- Department of Neurology, Nijmegen Center for Evidence Based Practice, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Syste U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Nijmegen Center for Evidence Based Practice, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Nijmegen Center for Evidence Based Practice, Radboud University Nijmegen, Nijmegen, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Lukas A, Mayer B, Fialová D, Topinkova E, Gindin J, Onder G, Bernabei R, Nikolaus T, Denkinger MD. Treatment of pain in European nursing homes: results from the Services and Health for Elderly in Long TERm Care (SHELTER) study. J Am Med Dir Assoc 2013; 14:821-31. [PMID: 23746948 DOI: 10.1016/j.jamda.2013.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/18/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify pharmacological and nonpharmacological pain management approaches and associated factors in nursing home residents across Europe. SETTING, PARTICIPANTS, AND MEASUREMENTS Cross-sectional study with 4156 residents who were assessed using the interRAI instrument for Long Term Care Facilities (interRAI LTCF), including pharmacological and nonpharmacological pain management modalities. Those reporting pain were included in the analyses (n = 1900). A deeper analysis was performed for the subsample of residents who reported "current pain," defined as pain at least 1 day within the past 3 days (n = 838), and those who reported "current pain of moderate to severe intensity" (n = 590). RESULTS Up to 24% of residents who reported pain did not receive any pain medication and up to 11% received it only PRN (as-needed basis), independent of current pain-intensity levels; 61% did not receive any nonpharmacological treatment and 21% received neither pharmacological nor nonpharmacological pain modalities. Considerable differences could be demonstrated across European countries. Factors positively associated with pharmacological pain management were being of female gender, reporting cancer, and having moderate or severe pain. High turnover rates of regular staff and low-to-moderate physicians' availability were negatively associated. Factors positively associated with nonpharmacological treatment were fractures and need of assistance in activities of daily living. Dementia, large nursing home facilities, above-average and high turnover rates of nursing staff, a low physicians' availability, and severe pain intensity were negatively associated. CONCLUSION Despite some advances in recent years, pain treatment in European nursing home residents remains to be suboptimal and requires further improvement.
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Affiliation(s)
- Albert Lukas
- Agaplesion Bethesda Clinic, Competence Center of Geriatrics and Aging Research, University of Ulm, Ulm, Germany.
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