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Use of physical restraints and antipsychotic medication is in nursing homes: a cross-national study
- Authors:
- FENG Zhanlian, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(10), October 2009, pp.1110-1118.
- Publisher:
- Wiley
This study compared inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, looking at aggregated residence conditions and organisational characteristics correlated with these treatments. Data were collected from long-term care facilities providing nursing home services in five countries. The findings were that the prevalence of physical restraint use varied more than five-fold across the study countries with an average 6% in Switzerland, 9% in the United States (US), 20% in Hong Kong (China), 28% in Finland, and over 31% in Canada. Prevalence of antipsychotic use ranged from 11% in Hong Kong, between 26-27% in Canada and the US, 34% in Switzerland, and nearly 38% in Finland. Within each country, substantial variations existed, but neither facility case mix nor organisational characteristics were particularly predictive of the prevalence of either treatment. The study concluded that there is large, unexplained variability in the prevalence of physical restraint and antipsychotic use in nursing home facilities both between and within countries, and that since restraints and antipsychotics are associated with adverse outcomes, it is important to understand the factors specific to each country that contribute to variation in use rates.
Family members’ reports of abuse in Michigan nursing homes
- Authors:
- GRIFFORE Robert J., et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 21(2), April 2009, pp.105-114.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Data on the abuse and neglect of people aged 65 and over in Michigan nursing homes over a 12-month period were collected using list-assisted random-digit dialling of relatives. Most of the residents represented in the study were female, widowed and Caucasian. Neglect and caretaking mistreatment were the most frequent types of abuse reported. Comparison of the data with information from the National Ombudsman Reporting System suggests that the incidence of abuse is substantially higher than reflected in official data and warrants further research to investigate reasons for this discrepancy to provide accurate and validated data on abuse in nursing homes.
The social networks of nursing-home residents in Hong Kong
- Author:
- CHENG Sheung-Tak
- Journal article citation:
- Ageing and Society, 29(2), February 2009, pp.163-178.
- Publisher:
- Cambridge University Press
The degree of social support available to older persons who are institutionalised is under-researched. This study investigated the structural and functional support exchanges with their social network members of 72 nursing home residents in Hong Kong (58 women, 14 men). They were asked to identify their network members, to evaluate the degree to which each one was important in their lives, and to rate the support received from and provided to each individual. The participants reported few network members (average 2.6) and in many cases neither a spouse nor children were included. Only one-fifth of the participants reported a social network member in the nursing home, and most of those who did nominated a member of the staff. There were also few friends in their networks. On the whole, the participants were comparatively socially isolated. The findings were explained in terms of the shame associated by the Chinese with placement in an institutional home, cultural patterns of social support, changes in children's filial attitudes, home placement policies, and the management practices that accentuate the distance between the older person and family members around the time of institutionalisation. These inculcate a feeling of abandonment, and discourage family visits as well as social interactions within the home.
Factors associated with long-stay nursing home admissions among the U.S. elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work
- Authors:
- CAI Qian, SALMON J. Warren, RODGERS Mark E.
- Journal article citation:
- Social Work in Health Care, 48(2), February 2009, pp.154-168.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Demographic shifts and rising health care costs mean that care for the elderly will become a great societal challenge. This study investigated key factors associated with long-stay nursing home (LSNH) admission among the U.S. elderly population. Two statistical methods, multivariable logistic regression and Cox proportional hazards model, were performed and compared. Secondary data analyses using four waves (1995, 1998, 2000, and 2002) of the Health Retirement Study (HRS) coupled with the Assets and Health Dynamics among the Oldest Old (AHEAD) surveys were conducted. A total of 5980 respondents with a mean age of 78 were included, and during the study period 9.9% of these became a LSNH resident. Older age, lower self-perceived health, worse instrumental activities of daily living, psychiatric problems, and living alone were found significantly associated with increased risk of LSNH admission. In contrast, being female, African American, or Hispanic, owning a home, and having lower level of cognitive impairment reduced the admission risk. The Cox model generally provided more precise parameter estimates than logistic regression. Logistic regression can provide a good approximation to the Cox model in identifying factors of LSNH admission, however, the Cox model gives more information on how soon the LSNH admission may happen. These analyses, based on two models, dually identified the factors associated with LSNH admission, and therefore the results discussed confidently provide implications for both public and private long-term care policies.
Facilitating transition from hospital stay to nursing home admission: a hospital-based long-term care ombudsman program
- Authors:
- COX Carolyn, et al
- Journal article citation:
- Journal of Gerontological Social Work, 52(8), November 2009, pp.849-858.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The Older Americans Act requires all US states to establish Long-Term Care Ombudsman Programs in nursing homes and personal care homes to resolve complaints of residents in nursing home or residential care facilities, but does not specify that hospitals that have special beds to provide skilled nursing care need such programmes, although many of these hospital patients subsequently enter a nursing or personal care home. This article describes how a medical centre in Missouri established a hospital-based Long-Term Care Ombudsman Program to address the need for patient advocacy in its skilled nursing facility, and looks at specific actions social workers can take to facilitate the establishment of such a programme in a hospital-based long-term care unit.
Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity
- Authors:
- ZUIDEMA Sytse, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(10), October 2009, pp.1079-1086.
- Publisher:
- Wiley
This study aimed to assess the influence of dementia severity and gender on neuropsychiatric symptoms in demented nursing home patients. It assessed a sample of Dutch nursing home patients using the Cohan-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version. The influence of gender and severity of cognitive decline, assessed with the Global Deterioration Scale (GDS), was investigated with correction for factors such as age, duration of institutionalisation, and psychoactive medication use. The results showed that while physically aggressive behaviour was more common in patients with very severe cognitive deterioration, disinhibition, irritability, physically non-aggressive and verbally agitated behaviour were more common in patients with moderately severe and severe cognitive decline. Physically aggressive behaviour was more common in men, whereas female patients demonstrated more verbally agitated behaviour. The study concluded that neuropsychiatric symptoms were associated with the severity of dementia, with most symptoms occurring in patients showing moderately severe cognitive decline, that only physical aggression, anxiety and apathy were more common in patients with very severe cognitive decline and that dementia severity and gender were important predictors of neuropsychiatric symptoms in this patient cohort.
Is there agreement between Canadian older adults and their primary informal caregivers on behaviour towards institutionalisation?
- Authors:
- DUBOIS Marie-France, et al
- Journal article citation:
- Health and Social Care in the Community, 16(6), November 2009, pp.610-618.
- Publisher:
- Wiley
Behaviour towards institutionalisation between frail older adults and their informal caregivers, and identify correlates of differential behaviour. Five hundred and ninety three participants and their primary informal caregivers involved in a longitudinal study following older adults identified at risk of functional decline, were asked separately if they thought about institutionalisation placement, discussed it with someone or visited an institution during the previous year. Compared with neither person thinking about it, the care-receiver alone thinking about placement was associated with using voluntary services, receiving help for home maintenance and visits to the emergency room during the previous year, along with the caregiver being aged 70 years or over. Compared with neither person thinking about it, the caregiver alone thinking about placement was associated with being male, not residing with the care-receiver, sensing a higher subjective burden, along with the care-receiver being 85 years or older, not being able to feed him/herself independently and visits to the emergency room during the previous year. Identified correlates can be useful in targeting dyads likely to behave differently. Communication within these dyads needs to be enhanced, as it is crucial to ensure that both parties are comfortable with possible future institutionalisation. In this regard, health professionals could play a role in bringing the issue to discussion.
How consultation liaison meetings improved staff knowledge, communication and care
- Authors:
- RANDS Gianetta, et al
- Journal article citation:
- Nursing Times, 27.10.09, 2009, pp.18-20.
- Publisher:
- Nursing Times
The evolution of a multiprofessional group in a psychiatric nursing home for older people with challenging behaviours is described. The results of a small staff survey which evaluated the meetings are presented. The findings illustrate how the group has helped improve care.
A framework for categorizing social interactions related to end-of-life care in nursing homes
- Author:
- BERN-KLUG Mercedes
- Journal article citation:
- Gerontologist, 49(4), August 2009, pp.495-507.
- Publisher:
- Oxford University Press
This study aimed to develop a framework for organizing social interactions related to end-of-life care and to characterize the social construction of dying in two nursing homes in the US. Secondary analysis of qualitative ethnographic data collected before the death of 45 residents who were selected for the study on account of their "declining" health status. Field notes, medical chart data, and transcribed interviews were analyzed using qualitative descriptive methods guided by symbolic interaction and role theory. The data were also grouped by resident to facilitate the development of cases that illustrate the categories of social interactions. A second reader also categorized all the resident cases into one of five categories as a means of verifying the model. A new framework of five categories to name the stance toward the possibility of dying is then presented and illustrated with cases. The categories include: dying allowed, dying contested, mixed message dying, not dying, and not enough information. Over half the resident cases were classified as mixed message dying or not enough information, which speaks to the ambiguity regarding care plan goals found in the two nursing homes in the study. It is concluded that conversations about goals of care, and how these goals will be operationalized are important issues for discussion among residents (to the extent able), family, staff, and physicians.
Resident choice and the survey process: the need for standardized observation and transparency
- Authors:
- SCHNELLE John F., et al
- Journal article citation:
- Gerontologist, 49(4), August 2009, pp.517-524.
- Publisher:
- Oxford University Press
This American study aims to describe a standardized observation protocol to determine if nursing home (NH) staff offer choice to residents during 3 morning activities of daily living (ADL) and compare the observational data with deficiency statements cited by state survey staff. Morning ADL care was observed in 20 NHs in 5 states by research staff using a standardized observation protocol. The number of observations in which choice was not offered was documented for 3 morning ADL care activities and compared with deficiency statements made by surveyors. Staff failed to offer choice during morning ADL care delivery for at least 1 of 3 ADL care activities in all 20 NHs. Observational data showed residents were not offered choice about when to get out of bed (11%), what to wear (25%), and breakfast dining location (39%). In comparison, survey staff issued only 2 deficiencies in all 20 NHs relevant to choice in the targeted ADL care activities, and neither deficiency was based on observational data. Survey interpretative guidelines instruct surveyors to observe if residents are offered choice during daily care provision, but standardized observation protocols are not provided to surveyors to make this determination. The use of a standardized observation protocol in the survey process similar to that used by research staff in this study would improve the accuracy and transparency of the survey process.