1
|
Chan TC, Yu VMW, Luk JKH, Chu LW, Yuen JKY, Chan FHW. Effectiveness of Partially Hydrolyzed Guar Gum in Reducing Constipation in Long Term Care Facility Residents: A Randomized Single-Blinded Placebo-Controlled Trial. J Nutr Health Aging 2022; 26:247-251. [PMID: 35297467 DOI: 10.1007/s12603-022-1747-2] [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] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the effectiveness of partially hydrolyzed guar gum (PHGG) in improving constipation and reducing the use of laxatives among long term care facility (LTCF) residents. DESIGN A single-center, prospective, randomized, placebo-controlled, single-blinded parallel-group trial from September 2021 to November 2021. SETTING Four LTCF in Hong Kong. PARTICIPANTS Fifty-two LTCF residents with chronic constipation (mean age: 83.9±7.6 years, male 38%). INTERVENTION 5g PHGG mixed with 200ml water per day for 4 weeks was given to intervention group participants. Control group received 200ml water for 4 weeks. Participants continued their usual as-needed laxative (lactulose, senna or dulcolax) on their own initiative. MEASUREMENTS Baseline measurements included age, gender, Charlson comorbidity index, Roackwood's Clinical Frailty Scale, body mass index and daily dietary fiber intake. Outcome measures were fecal characteristics assessed by Bristol Stool Form Scale, bowel opening frequency and laxative use frequency at baseline, first, second, third and fourth week of trial. Adverse events were measured. The study was registered on ClinicalTrial.gov; identifier: NCT05037565. RESULTS There was no significant difference in bowel frequency and stool characteristics between the treatment group and control group. However, there was a significantly lower frequency of lactulose, senna, and total laxative use in the treatment group compared with controls in the third and fourth week. There was no significant difference in adverse effects between the two groups. CONCLUSION This study showed that daily dietary fibre supplementation by using PHGG for 4 weeks in LTCF residents results in significantly less laxative use than placebo. It may be an effective way to reduce laxative dependence among older people living in LTCFs.
Collapse
Affiliation(s)
- T C Chan
- Tuen-Ching Chan, Department of Medicine and Geriatrics, Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong, , Tel: 28556133, Fax: 28196182
| | | | | | | | | | | |
Collapse
|
2
|
Hedna K, Fastbom J, Jonson M, Wilhelmson K, Waern M. Psychoactive medication use and risk of suicide in long-term care facility residents. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5684. [PMID: 35142388 PMCID: PMC9306521 DOI: 10.1002/gps.5684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate psychoactive medication use and risk of suicide in long-term care facility (LTCF) residents aged 75 and above. A second aim was to investigate the role of psychiatric and medical conditions in the occurrence of suicide in LTCF residents. METHODS A Swedish national register-based cohort study of LTFC residents aged ≥75 years between 1 January 2008 and 31 December 2015, and followed until 31 December 2016 (N = 288,305). Fine and Gray regression models were used to analyse associations with suicide. RESULTS The study identified 110 suicides (15.8 per 100,000 person-years). Half of these occurred during the first year of residence. Overall, 54% of those who died by suicide were on hypnotics and 45% were on antidepressants. Adjusted sub-hazard ratio (aSHR) for suicide was decreased in those who were on antidepressants (aSHR 0.64, 95% confidence interval 0.42-0.97), even after the exclusion of residents who had healthcare contacts for dementia or were on anti-dementia drugs. The aSHR for suicide was more than two-fold higher in those who were on hypnotics (2.20, 1.46-3.31). Suicide risk was particularly elevated in those with an episode of self-harm prior to LTCF admittance (15.78, 10.01-24.87). Specialized care for depression was associated with increased risk, while medical morbidity was not. CONCLUSIONS A lower risk of suicide in LTCF residents was found in users of antidepressants, while elevated risk was observed in those on hypnotics. Our findings suggest that more can be done to prevent suicide in this setting.
Collapse
Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Statistikkonsulterna ABGothenburgSweden
| | - Johan Fastbom
- Aging Research CenterKarolinska Institute and Stockholm UniversityStockholmSweden
| | - Mattias Jonson
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and NeurochemistrySahlgrenska Academy, University of GothenburgGothenburgSweden,Affective ClinicRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Katarina Wilhelmson
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Department of Health and RehabilitationInstitute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden,Department of Acute Medicine and GeriatricsRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Psychosis ClinicRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| |
Collapse
|
3
|
Gramaglia C, Gattoni E, Marangon D, Concina D, Grossini E, Rinaldi C, Panella M, Zeppegno P. Non-pharmacological Approaches to Depressed Elderly With No or Mild Cognitive Impairment in Long-Term Care Facilities. A Systematic Review of the Literature. Front Public Health 2021; 9:685860. [PMID: 34336772 PMCID: PMC8322575 DOI: 10.3389/fpubh.2021.685860] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Compared to old people who live at home, depressive symptoms are more prevalent in those who live in long-term care facilities (LTCFs). Different kinds of non-pharmacological treatment approaches in LTCFs have been studied, including behavioral and cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and life review/reminiscence. The aim of the current review was to systematically review non-pharmacological treatments used to treat depressed older adults with no or mild cognitive impairment (as described by a Mini Mental State Examination score > 20) living in LTCFs. Methods: A research was performed on PubMed and Scopus databases. Following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) flowchart, studies selection was made. The quality of each Randomized Controlled Trial was scored using the Jadad scale, Quasi-Experimental Design studies and Non-Experimental studies were scored based on the Newcastle-Ottawa Scale (NOS) Results: The review included 56 full text articles; according to the type of intervention, studies were grouped in the following areas: horticulture/gardening (n = 3), pet therapy (n = 4), physical exercise (n = 9), psychoeducation/rehabilitation (n = 15), psychotherapy (n = 3), reminiscence and story sharing (n = 14), miscellaneous (n = 8). Discussion and Conclusion: Despite mixed or negative findings in some cases, most studies included in this systematic review reported that the non-pharmacological interventions assessed were effective in the management of depressed elderly in the LTCFs context. Regrettably, the limitations and heterogeneity of the studies described above hinder the possibility to generalize and replicate results.
Collapse
Affiliation(s)
- Carla Gramaglia
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Eleonora Gattoni
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Debora Marangon
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Diego Concina
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Elena Grossini
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Carmela Rinaldi
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Massimiliano Panella
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| |
Collapse
|
4
|
König E, Medwed M, Pux C, Uhlmann M, Schippinger W, Krause R, Zollner-Schwetz I. Prospective Surveillance of Healthcare-Associated Infections in Residents in Four Long-Term Care Facilities in Graz, Austria. Antibiotics (Basel) 2021; 10:544. [PMID: 34067175 DOI: 10.3390/antibiotics10050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 12/05/2022] Open
Abstract
Healthcare-associated infections (HCAI) are a common cause for residents’ mortality and morbidity associated with a significant socio-economic burden. Data on HCAIs in Austrian long-term care facilities are scare. Therefore, we evaluated the incidence rate of HCAIs per 1000 resident days in four LTC facilities in Graz, Austria, characterized the spectrum of HCAIs and the use of antimicrobial substances. We conducted a prospective surveillance study from 1 January to 31 December 2018 in four LTCFs of the Geriatric Health Centre of the City of Graz (total of 388 beds). Nursing staff collected data on HCAIs once a week using an electronic reporting system. During the 12-month surveillance period, 252 infections of 165 residents were recorded. The overall incidence rate of HCAIs was 2.1 per 1000 resident days. Urinary tract infections were the most commonly recorded HCAIs (49%, 124/252, 1.03 per 1000 resident days), followed by skin and soft tissue infections and respiratory tract infections. Beta-lactams (ATC class J01C) were prescribed most frequently (63/212), followed by fluoroquinolones (J01M; 54/212). In conclusion, the overall incidence rate for HCAIs was relatively low at 2.1 per 1000 resident days. Our real-life data can serve as a basis for future antimicrobial stewardship and infection prevention interventions.
Collapse
|
5
|
Akinbami LJ, Chan PA, Vuong N, Sami S, Lewis D, Sheridan PE, Lukacs SL, Mackey L, Grohskopf LA, Patel A, Petersen LR. Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July-August 2020. Emerg Infect Dis 2021; 27:823-834. [PMID: 33622481 PMCID: PMC7920685 DOI: 10.3201/eid2703.204508] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17–August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%–5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%–3.5%) and nursing home personnel (13.1%, 95% CI 11.5%–14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%–27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.
Collapse
|
6
|
Eckardt P, Guran R, Hennemyre J, Arikupurathu R, Poveda J, Miller N, Katz R, Frum J. Hospital affiliated long term care facility COVID-19 containment strategy by using prevalence testing and infection control best practices. Am J Infect Control 2020; 48:1552-1555. [PMID: 32622836 PMCID: PMC7332435 DOI: 10.1016/j.ajic.2020.06.215] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
In a hospital affiliated long term care facility, we found an opportunity to interrupt a potential outbreak of COVID-19 using a point prevalence testing containment strategy and applying infection prevention and control best practices. Three serial point prevalence studies were conducted on all residents and employees in 14-day intervals and percent positive was used as marker for effective infection control efforts. A multidisciplinary strike team from acute care was used to disseminate infection control education and support to long term care partners. These results highlight the need for swift identification and action in congregant high risk settings to prevent rapid spread and large scale outbreaks of COVID-19.
Collapse
Affiliation(s)
- Paula Eckardt
- Division of Infectious Diseases, Infection Prevention, Memorial Healthcare System, 5647 Hollywood Boulevard, Hollywood, FL.
| | - Rachel Guran
- Infection Prevention and Epidemiology, Memorial Healthcare System, Hollywood, FL
| | - Jon Hennemyre
- Memorial Manor, Memorial Healthcare System, Hollywood, FL
| | | | - Julie Poveda
- Laboratory Services, Memorial Regional Hospital South, Memorial Healthcare System, Hollywood, FL
| | - Nancimae Miller
- Microbiology and Molecular Infectious Disease, LLC, Memorial Healthcare System, Hollywood, FL
| | - Randy Katz
- Department of Emergency Medicine, Memorial Regional Hospital, Memorial Healthcare System, City of Hollywood Fire Rescue, Hollywood, FL
| | - Judith Frum
- Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL
| |
Collapse
|
7
|
Telford C, Onwubiko U, Holland D, Turner K, Prieto J, Smith S, Yoon J, Brown W, Chamberlain A, Gandhi N, Khan S, Williams S, Khan F, Shah S. Mass Screening for SARS-CoV-2 Infection among Residents and Staff in Twenty-eight Long-term Care Facilities in Fulton County, Georgia. medRxiv 2020:2020.07.01.20144162. [PMID: 32637971 PMCID: PMC7340197 DOI: 10.1101/2020.07.01.20144162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mass screening for SARS-CoV-2 infection in long-term care facilities revealed significantly higher prevalence of infection in facilities that screened in response to a known infection compared to those that screened as a prevention measure. "Response" facilities had a SARS-CoV-2 prevalence of 28.9% while "preventive" facilities' prevalence was 1.6% (p <0.001).
Collapse
Affiliation(s)
- Carson Telford
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
| | | | - David Holland
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
- Department of Medicine, Emory University, Atlanta, GA
| | - Kim Turner
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
| | - Juliana Prieto
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
| | - Sasha Smith
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
| | - Jane Yoon
- Department of Medicine, Emory University, Atlanta, GA
| | - Wecheeta Brown
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
| | - Allison Chamberlain
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Neel Gandhi
- Department of Medicine, Emory University, Atlanta, GA
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Shamimul Khan
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
| | | | - Fazle Khan
- Office of Epidemiology, Fulton County Board of Health, Atlanta, GA
| | - Sarita Shah
- Department of Medicine, Emory University, Atlanta, GA
- Rollins School of Public Health, Emory University, Atlanta, GA
| |
Collapse
|
8
|
Tori K, Kalligeros M, Shehadeh F, Khader R, Nanda A, van Aalst R, Chit A, Mylonakis E. The process of obtaining informed consent to research in long term care facilities (LTCFs): An Observational Clinical Study. Medicine (Baltimore) 2020; 99:e20225. [PMID: 32481294 PMCID: PMC7249968 DOI: 10.1097/md.0000000000020225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We examined the process of obtaining informed consent (IC) for clinical research purposes in long-term care facilities (LTCFs) in Rhode Island (RI), USA. We assessed factors that were associated with resident ability to consent, such as Brief Interview for Mental Status scores. We used a self-administered questionnaire to further understand the effect of LTCF staff evaluation of ability to consent on residents' autonomy and control over their medical decision making.Observational clinical studyLong-term care setting.LTCF personnel provided us with residents' names, as well as their professional assessment of resident ability to consent. We used Brief Interview for Mental Status (BIMS) scores to assess the cognitive capacity of all residents to assess, and compare it to the assessment provided by LTCF personnel. A logistic regression analysis was performed to determine the relationship between LTCF assessment of resident ability to consent and BIMS score or confirmed diagnosis of dementia as seen from residents' medical charts. A self-administered questionnaire was filled out by the personnel of 10 LTCFs across RI, USA.LTCF personnel in 9 out of 10 recruited facilities reported that their assessment of resident ability to consent was based on subjective assessment of the resident as alert and oriented. There was a statistically significant relationship between the LTCF assessment of resident ability to consent and previously diagnosed dementia (OR: 0.211, 95% CI 0.107-0.415). Therefore, as BIMS scores increased, the likelihood that the resident would be deemed able to consent by LTCF personnel also increased. Furthermore, there was a statistically significant relationship between LTCF assessment of resident ability to consent and BIMS scores (OR: 1.430, 95% CI 1.274-1.605).There is no standard on obtaining IC for research studies conducted in LTCFs. We recommend that standardizing the process of obtaining IC in LTCFs can enhance the ability to perform research with LTCF residents.
Collapse
Affiliation(s)
| | | | | | | | - Aman Nanda
- Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School, Providence, Rhode Island
| | - Robertus van Aalst
- Regional Epidemiology and Health Economics, Sanofi Pasteur, Swiftwater, PA
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Ayman Chit
- Regional Epidemiology and Health Economics, Sanofi Pasteur, Swiftwater, PA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|