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A critical review of research on hospitalization from nursing homes; what is missing?
- Authors:
- AGOTNES Gudmund, et al
- Journal article citation:
- Ageing International, 41(1), 2016, pp.3-16.
- Publisher:
- Springer
- Place of publication:
- New York
In this paper the authors seek to summarise research literature on hospitalisation from nursing homes, to identify shared themes, findings and approaches, and to analyse strengths and weaknesses of the literature. The main aim of the article is to critically review current research on the topic of hospitalisation from nursing homes, based on a variety of original research articles and literature overviews. First, the authors examine why studies of hospitalisation from nursing homes are considered to be important in the literature, focusing on what is described as large variation in rates of hospitalisation between institutions and geographical areas as well as the occurrence of unwanted and avoidable hospitalisations. Second, the authors present studies on reasons for rates of hospitalisations of nursing home patients based on patient characteristics. Third, studies that have focused on institutional characteristics that may explain rates of hospitalisations are presented. Fourth, the authors examine factors and conditions highlighted in parts of the literature on hospitalisation, more closely than others connected to practice and decision making. Finally, some of the weaknesses of these hospitalisation studies are discussed and areas for future research studies are discussed. (Edited publisher abstract)
Burden of care, social support, and sense of coherence in elderly caregivers living with individuals with symptoms of dementia
- Authors:
- STENSLETTEN Kari, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(6), 2016, pp.1422-1435.
- Publisher:
- Sage
Family members are often the care providers of individuals with dementia, and it is assumed that the need for this will increase. There has been little research into the association between the burden of care and the caregiver’s sense of coherence or receipt of social support. This study examined the relationship between the social support subdimensions and sense of coherence and the burden of care among older people giving care to a partner with dementia. The study was a cross-sectional observation study of 97 individuals, ≥65 years old and living with a partner who had symptoms of dementia. The authors used the Informant Questionnaire on Cognitive Decline in the Elderly, the Relative Stress Scale, the Social Provisions Scale, the Sense of Coherence Scale, and a questionnaire on sociodemographic variables. They used multiple regression analysis in a general linear model procedure. The authors defined statistical significance as p < 0.05. With adjustments for sociodemographic variables, the association with burden of care was statistically significant for the subdimension attachment (p < 0.01) and for sense of coherence (p < 0.001). The burden of care was associated with attachment and with sense of coherence. Community nurses and other health professionals should take necessary action to strengthen attachment and sense of coherence among the caregivers of people with dementia. Qualitative studies could provide deeper understanding of the variation informal caregivers experience when living together with their partner with dementia. (Edited publisher abstract)
Anxiety among older psychiatric patients: a hidden comorbidity?
- Authors:
- BENDIXEN Anette Bakkane, ENGEDAL Knut
- Journal article citation:
- Aging and Mental Health, 20(11), 2016, pp.131-1138.
- Publisher:
- Taylor and Francis
Objectives: The authors' aims were to explore prevalence of anxiety among patients admitted to departments of geriatric psychiatry for treatment of various diagnoses and to examine how often anxiety was registered as a previous or ongoing diagnosis. Method: In all, 473 patients admitted to one of five departments of geriatric psychiatry were included in a quality register and examined according to a standardised protocol. The Geriatric Anxiety Inventory (GAI) was used to measure anxiety during the first week after admission. Diagnoses were made at discharge. Results: Using a cutoff on the GAI of 8/9, the prevalence of anxiety for the following diagnostic groups was depression 65.3%, psychosis 28%, dementia 38.8% and mania 33.3%. Of 24 patients with a primary diagnosis of anxiety, 66.7% scored above 8 on the GAI. Of 236 patients with a GAI score above 8, only 22 (9.3%) were reported to have a comorbid anxiety disorder by the treating psychiatrist. In a multiple regression analysis, we found that the severity of depression (beta 0.585, p < 0.001), being female (beta 0.096, p 0.028) and the use of antipsychotic drugs (beta 0.129, p 0.006) and anxiolytic drugs (beta 0.129, p 0.005) were associated with a higher GAI score. Conclusion: Anxiety is common in geriatric psychiatric patients, regardless of the primary diagnosis. The findings suggest that anxiety is often a hidden comorbidity in various psychiatric disorders. A high score on the GAI was associated with the severity of depression, female gender and the use of antipsychotic and anxiolytic drugs. (Edited publisher abstract)
Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality
- Authors:
- DOHL Oystein, et al
- Journal article citation:
- Health and Social Care in the Community, 24(3), 2016, pp.297-308.
- Publisher:
- Wiley
This study reports an analysis of factors associated with home care use in a setting in which long-term care services are provided within a publicly financed welfare system. The study considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long-term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. The study identified a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, results also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. The analysis showed that routinely collected data capture important predictors of home care use and thus facilitate both short-term budgeting and long-term planning of home care services. (Edited publisher abstract)
Comparing nursing home assistive personnel in five countries
- Authors:
- LAXER Katherine, et al
- Journal article citation:
- Ageing International, 41(1), 2016, pp.62-78.
- Publisher:
- Springer
- Place of publication:
- New York
Assistive personnel are the primary caregivers in long-term residential care (LTRC) in industrialised countries. The authors' goal is to describe and compare the work-related characteristics of assistive personnel in LTRC in five countries (Canada, Germany, Norway, U.K., and U.S), which may reflect how various societies view their responsibility to ageing populations and the workers who care for them. OECD and national statistical databases are used to assess and compare the work context for assistive personnel. Analysis of the statistical data is informed by on-site observations in nursing homes with reputations for high quality, close readings of these organisations’ documents and records, and interviews with LTRC staff. Pay is generally low and the work required of assistive personnel is often demanding in all countries studied. While most assistive personnel have completed high school, formal certification requirements vary considerably. Professionalisation is increasing in Norway with its high school major in eldercare, and in Germany, which has a 2-year certificate programme. Financial compensation for assistive personnel in Norway and Canada is greater than in the other countries. Union membership for assistive personnel ranges from very high in Canada to negligible in the U.S. Some countries studied have training programs of only a few months duration to prepare assistive personnel for highly demanding jobs. However, in Germany and Norway, training aims to professionalise the work of assistive personnel for the benefit of workers, employers, and residents. There are high rates of part-time and/or casual work among assistive personnel, associated with reduced employment-related benefits, except in Germany and Norway, where these benefits are statutory for all. Data suggest that unionisation is protective for assistive personnel, however union coverage data were not available for all countries. The need to improve the qualifications and training of assistive personnel was observed to be a national priority everywhere except in the U.S. Compensation is relatively low in the U.K., the U.S. and Germany, despite the important jobs performed by assistive personnel. Finally, to improve future research, statistical mapping of this critical component of the labour force in LTRC should be a greater priority across high-income countries. (Edited publisher abstract)
Physical environments for long-term care: ideas worth sharing
- Editors:
- ARMSTRONG Pat, BRAEDLEY Susan
- Publisher:
- Canadian Centre for Policy Alternatives
- Publication year:
- 2016
- Pagination:
- 114
- Place of publication:
- Montreal
This report provides examples of promising practice which show how planning physical environments in long term care homes can contribute to quality of life and care of residents. The examples demonstrate how environments can shape how care and life in nursing homes are understood, and how they can have a positive impact on residents. It draws on evidence gathered from international ethnographic research carried out in 27 different sites in the six countries of Norway, Germany, the UK, the US, and Canada. Chapters cover a range of issues, including: location of a care home; space; staff - environments for staff to carry out their work and interact with residents; food and residents connections with where food is prepared; locks and doors; clothing and laundry - its role in dignity and identity; and cleaning - the need for both a clean and attractive environment; and environments that meet the needs of those at the end of life. Each chapter includes key questions for consideration to help care homes to improve their practice. The final chapter identifies key lessons from the examples and reflects some of the tensions identified when designing physical environments for long-term residential care. (Edited publisher abstract)
Comparison of nursing home financial transparency and accountability in four locations
- Authors:
- HARRINGTON Charlene, et al
- Journal article citation:
- Ageing International, 41(1), 2016, pp.17-39.
- Publisher:
- Springer
- Place of publication:
- New York
The marketisation and privatisation of nursing home care has grown in many countries along with expenditures. Using documents and government reports, this study explored three research questions about nursing homes in California, Ontario, England, and Norway. What were: (1) the contextual and privatisation differences; (2) payment methods and trends in revenues and expenditures for direct care, administration, and profits; and (3) the financial reporting and accountability systems? The findings showed nursing homes were highly privatised in all locations except Norway. Revenues and expenditures increased steadily in all locations. Direct care services were lower in California and England where privatisation was highest. Administrative costs were high especially in for-profit companies, except in Norway’s municipal nursing homes. Profit margins were generally not reported or under reported, but high margins were found in for-profits and chains where reports were available. Contrary to the hypothesis that financial transparency and accountability would increase with privatisation, only California and the U.S. had developed detailed public financial reporting, although these reports could be improved. Ontario required detailed financial reporting except for administration and profits and the information was not publicly available. England and Norway had no public systems for financial reporting. None of the locations had cost controls on administration and profits, except for Medicaid administration controls in California. Policy makers need to focus on improvements in financial transparency and accountability to assure value for expenditures and to potentially improve quality. (Edited publisher abstract)
Mapping nursing home inspections & audits in six countries
- Authors:
- CHOINIERE Jacqueline A., et al
- Journal article citation:
- Ageing International, 41(1), 2016, pp.40-61.
- Publisher:
- Springer
- Place of publication:
- New York
International quality concerns regarding long-term residential care, home to many of the most vulnerable among us, prompted the authors to examine the audit and inspection processes in six different countries. Drawing on Donabedian’s (Evaluation & Health Professions, 6(3), 363–375, 1983) categorisation of quality criteria into structural, process and outcome indicators, this paper compares how quality is understood and regulated in six countries occupying different categories according to Esping Andersen’s (1990) typology: Canada, England, and the United States (liberal welfare regimes); Germany (conservative welfare regime); Norway, and Sweden (social democratic welfare regimes). In general, our review finds that countries with higher rates of privatisation (mostly the liberal welfare regimes) have more standardised, complex and deterrence-based regulatory approaches. The authors identify that even countries with the lowest rates of for profit ownership and more compliance-based regulatory approaches (Norway and Sweden) are witnessing an increased involvement of for-profit agencies in managing care in this sector. The authors' analysis suggests there is widespread concern about the incursion of market forces and logic into this sector, and about the persistent failure to regulate structural quality indicators, which in turn have important implications for process and outcome quality indicators. (Edited publisher abstract)