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Determinants of remaining in the community after discharge: results from New Jersey's nursing home transition program
- Authors:
- HOWELL Sandra, et al
- Journal article citation:
- Gerontologist, 47(4), August 2007, pp.535-547.
- Publisher:
- Oxford University Press
To inform states with nursing home transition programs, this study aimed to determine what risk factors are associated with participants' long-term readmission to nursing homes within 1 year after discharge. The authors obtained administrative data for all 1,354 nursing home residents who were discharged, and interviewed 628 transitioning through New Jersey's nursing home transition program in 2000. The Andersen behavioral model was used to select predictors of long-term nursing home readmission, and the Cox proportional hazards regressions was used to examine the relative risk of experiencing such readmissions. Overall, 72.6% of the 1,354 individuals remained in the community, with 8.6% readmitted to a nursing home for long stays (>90 days) and 18.8% dying during the study year. Cox proportional hazards regression analysis showed that being male, single, and dissatisfied with one's living situation; living with others; and falling within 8 to 10 weeks after discharge were significant predictors of long-term nursing home readmission during the first year after discharge. Most of the factors predicting long-term readmission were predisposing, not need, factors. This fact points to the limits of formulaic approaches to assessing candidates for discharge and the importance of working with clients to understand and address their particular vulnerabilities. Consumers, state policy makers, nursing home transition staff, discharge planners, and caregivers can use these findings to understand and help clients understand their particular risks and options, and to identify those individuals needing the greatest attention during the transition period as well as risk-specific services such as fall-prevention programs that should be made available to them.
Switching on a light: an introduction to life story work
- Authors:
- UNIVERSITY OF STIRLING. Dementia Services Development Centre, (Producer)
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 2007
- Pagination:
- DVD, booklet
- Place of publication:
- Stirling
This new DVD demonstrates what is meant by life story work and how this can be used with people with dementia. Filmed in a nursing home and using interviews with practitioners and people with dementia, the benefits for those involved are considered. The accompanying booklet gives more detailed information about getting started and the issues to be considered. An outline for a suggested training session is also included.
Old age in a new age: the promise of transformative nursing homes
- Author:
- BAKER Beth
- Publisher:
- Vanderbilt University Press
- Publication year:
- 2007
- Pagination:
- 248p.
- Place of publication:
- Nashville, TN
For this book, the author visited more than two dozen nursing homes across the United States and interviewed residents, caregivers, administrators, advocates and gerontological experts. Her visits include those associated with the Eden Alternative, Green House, Kendal, and the Pioneer Network. She concludes that there are profound changes going on. Nursing homes do not have to be institutionalised places, unhealthy for residents and staff alike. They can be extraordinary places where people live in dignity and greet the day with contentment, assisted by employees who feel valued and appreciated. Common threads running through the successful transformative models she visited are strong leadership, environments that encourage interpersonal relationships, and commitment to creating a real home for residents. Perhaps most surprising, these homes prove that a high quality of life does not have to cost more. Some of the best homes in the nation serve primarily low-income people who are on Medicaid. Although each home is different, they share common values: respecting individual choices; empowering staff; fostering a strong community of elders, staff, family members, and volunteers; redesigning buildings from a hospital model to a home (where pets and children are part of everyday life); and honouring people when they die.
The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes
- Authors:
- SALBAEK Geir, KIRKEVOLD Oyvind, ENGEDAL Knut
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.843-849.
- Publisher:
- Wiley
Psychiatric and behavioural symptoms in dementia are associated with a range of negative outcomes, including institutional placement and the widespread use of psychotropic drugs in spite of limited evidence for their efficacy. The aim was to determine the prevalence of psychiatric and behavioural symptoms and the pattern of psychotropic drug prescription in patients with various degrees of dementia. A sample of 1,163 non-selected nursing home patients were assessed by means of the Neuropsychiatric Inventory, the Clinical Dementia Rating scale and Lawton's activities of daily living scale. In addition, information was collected from the patients' records. Dementia was found in 81% of the patients and 72% of them had clinically significant psychiatric and behavioural symptoms. The frequencies of symptoms increased with the severity of the dementia. Psychotropic medication was being prescribed to 75% of patients with dementia. There was a significant relationship between the type of drug and the symptom for which it had been dispensed. Psychiatric and behavioural symptoms are frequent in nursing homes and the rate increases with the progression of the dementia. Systematic programmes are needed for disseminating skills and providing guidance regarding the evaluation and treatment of these symptoms in nursing homes.
Dementia and depression among nursing home residents in Lebanon: a pilot study
- Authors:
- CHAHINE L.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(4), April 2007, pp.283-285.
- Publisher:
- Wiley
The aim of this study was to investigate the prevalence of dementia and depression among a portion of nursing home residents (NHR) in Lebanon and describe the characteristics of NHR afflicted with dementia and depression. Of 200 NHR from three NH in Lebanon, 117 were selected by random sampling. Data on demographics and medical history were collected. An Arabic version of the Mini-Mental Status Examination and Geriatric Depression Scale (GDS) were administered. The final sample consisted of 102 NHR. Sixty-one (59.8%) had dementia of some kind. Seventeen (27.9%) had mild dementia, 14 (22.9%) had moderate dementia, and 30 (49.2%) had severe dementia. Forty-five (57.7%) of the NHR tested had depression as measured by a GDS score of more than 10. Dementia and depression were present in more than half of the NHR in our sample. The results highlight the importance of screening NHR for dementia and depression on admission and at regular time intervals.
Regulating aged care: ritualism and the new pyramid
- Authors:
- BRAITHWAITE John, MAKKAI Toni, BRAITHWAITE Valerie
- Publisher:
- Edward Elgar
- Publication year:
- 2007
- Pagination:
- 372p., bibliog.
- Place of publication:
- Cheltenham
This book is a major contribution to regulatory theory from three members of the world-class regulatory research group based in Australia. It marks a new development in responsive regulatory theory in which a strengths-based pyramid complements the regulatory pyramid. The authors compare the accomplishments of nursing home regulation in the US, the UK and Australia during the last 20 years and in a longer historical perspective. They find that gaming and ritualism, rather than defiance of regulators, are the greatest challenges for improving safety and quality of life for the elderly in care homes. Regulating Aged Care shows how good regulation and caring professionalism can transcend ritualism. Better regulation is found to be as much about encouragement to expand strengths as incentives to fix problems. The book is underpinned by one of the most ambitious, sustained qualitative and quantitative data collections in both the regulatory literature and the aged care literature. This study provides an impressive evidence base for both theory development and reassessment of policy and practitioner responses in the field.
Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents
- Authors:
- PAGUAY Louis, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(4), April 2007, pp.286-293.
- Publisher:
- Wiley
This study aimed to compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly - Revised (CAMDEX-R) was used as the reference standard. This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for older people in Belgium. Main outcome measures used were indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). The CAMDEX-based prevalence of cognitive impairment was 75%. The results found that CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents.
Nursing homes and assisted living facilities: planning and decision making for sheltering in place or evacuation
- Authors:
- HYER Kathryn, POLIVKA-WEST LuMarie
- Journal article citation:
- Generations, 31(4), Winter 2007, pp.29-33.
- Publisher:
- American Society on Aging
This article addresses the challenges facing those in charge of long-term care facilities as they decide whether "to stay or go" - evaluating risk to residents from potential evacuation, weighing storm path and intensity projections, and reviewing their emergency preparedness plans. It draws on experiences in the United States.
Elder mistreatment in the nursing home: a systematic review
- Authors:
- LINDBLOOM Erik J., et al
- Journal article citation:
- Journal of the American Medical Directors Association, 3(4), 2007, pp.610-616.
- Publisher:
- Elsevier (for the American Medical Directors Association)
This systematically conducted scoping review of the literature (mainly, but not exclusively, North American) looks at types of abuse in the nursing home environment (physical, sexual, psychological, neglect, financial abuse), at possible forensic markers of abuse, and at promising preventive interventions. The limited nature of the evidence base, and the need for more research, is emphasised.
Motivational style, length of residence, voluntariness, and gender as influences on adjustment to long term care: a pilot study
- Authors:
- CURTISS Karin, HAYSLIP Bert, DOLAN Diana C.
- Journal article citation:
- Journal of Human Behavior in the Social Environment, 15(4), 2007, pp.13-34.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
A range of measurement instrument was administered to 75 nursing home residents (mean age 79.08 years; 25 men, 50 women) who varied by length of residence, gender and motivational style. The aim was to examine the impact of these variables on indicators of adjustment such as health, life satisfaction, desired and expected control, self-esteem, activities of daily living and positive/negative affect. MANCOVAs (controlling for social desirability) showed that a self-determined motivational style had a positive impact on adjustment, and interacted with gender in this respect. Length of residence and gender influenced activities of daily living, and motivational style also affected desired/expected control and self-esteem, where those with higher self-determined motivational styles had expectations for, and desirability of, control. Voluntariness of the decision to move into a nursing home generally had a positive impact on adjustment but was moderated by motivational style. The implications for nursing homes are discussed. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).