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Trajectories of at-homeness and health in usual care and small house nursing homes
- Authors:
- MOLONY Sheila, et al
- Journal article citation:
- Gerontologist, 51(4), August 2011, pp.504-515.
- Publisher:
- Oxford University Press
Long-term care providers across the United States are building new residential environments that weave humanistic person-centred philosophies into clinical care, organisational policies, and built environments. The small house model (SmH) relocates the resident from institutional care to a place that is believed to better emulate home. The aim of this study was to compare and contrast trajectories of at-homeness and health over time between residents remaining in a usual care nursing home and residents moving from that home to a SmH. The setting for the study was a 100-bed nursing home in a continuing care retirement community in the Midwest. Five new SmHs were built as part of this retirement community. Interviews were conducted with residents before the move to the SmHs and 1, 3, and 6 months after the move. The findings showed that prior to the move individuals who decided to relocate to the SmH had more depressive symptoms and lower levels of at-homeness. Their levels of at-homeness increased after the move, and, in addition, their levels of functional dependence decreased. Most participants who chose to stay in the nursing home reported high baseline levels of at-homeness and maintained this over the next 6 months. Qualitative findings highlight the variables that contributed to at-homeness in both groups. The study demonstrates that a ‘one size fits all’ approach may not be best because at-homeness is an individualised construct.
Neglect of older adults in Michigan nursing homes
- Authors:
- ZHANG Zhenmei, et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 23(1), January 2011, pp.58-74.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Although research on domestic elder abuse and neglect is a rapidly growing area, it is relatively poorly understood in the nursing home environment. The purpose of this study was to estimate the incidence of elder neglect in nursing homes and to identify the individual and contextual risks associated with elder neglect. Data came from a 2005 random digit dial survey of individuals in Michigan who had relatives in long term care. The sample included 414 family members who had a relative aged 65 or older in a nursing home. The collated responses suggest that about 21% of nursing home residents were neglected on one or more occasion in the last 12 months. Two nursing home residents' characteristics reported by family members appear to significantly increase the odds of neglect: functional impairments in activities of daily living and previous resident-to-resident victimisation. Behaviour problems were also associated with higher odds of neglect. However there was no strong evidence that social support reduced the risk of abuse except perhaps a suggestion of a link with frequency of visits. The authors emphasise that estimates of neglect were based solely on family reports and this may be a limitation of the study. Policy implications of these results are discussed.
Self-injurious behavior in the nursing home setting
- Authors:
- MAHGOUB Nahla, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(1), January 2011, pp.27-30.
- Publisher:
- Wiley
Self-injurious behaviour in older adults is defined as harm inflicted on oneself without conscious suicidal intent. In this literature search aiming to determine the scope of the literature, online database searches identified 10 publications concerning self-injurious behaviour in older adults, 4 of which included studies investigating this in nursing homes. The results showed that there are few clinical studies of self-injurious behaviour in older adult nursing home residents, but that the limited literature suggests that it is a prevalent phenomenon, reported to be strongly associated with dementia and a risk of accidental death. The authors conclude that there is little evidence-based treatment guidance for self-injurious behaviour in older populations, and that clinical studies are urgently needed to help clarify causes and treatment approaches.
Reasons for psychiatric medication prescription for new nursing home residents
- Authors:
- MOLINARI Victor A., et al
- Journal article citation:
- Aging and Mental Health, 15(7), September 2011, pp.904-912.
- Publisher:
- Taylor and Francis
There are concerns about the high use of psychoactive medications in nursing home settings. The aim of this study was to investigate the justification of psychoactive medication prescription for nursing home residents during their first 3 months post-admission. Data was extracted from the charts of a convenience sample of 73 individuals who were residents of 7 nursing homes for at least 3 months during 2009. In addition, 6 focus groups with nursing home staff were conducted to explore rationales for psychoactive medication usage. The results found that 89% of the residents who received psychoactive medications during the first 3 months of residence had a psychiatric diagnosis. All residents who received psychoactive medications had a written physician's order. Mental status was monitored by staff, and psychoactive medications were titrated based on changes in mental status. One concern was that no Level II Preadmission Screening and Annual Resident Review (PASRR) evaluations were completed during the admissions process. Further, while 73% had mental health diagnoses at admission, 85% of the NH residents were on a psychoactive medication 3 months after admission, and 19% were on 4 or more psychoactive medications. Although over half of the residents had notes in their charts regarding non-psychopharmacological strategies to address problem behaviours, this number was eclipsed by the number receiving psychopharmacological treatment.
Development and validation of an instrument to detect depression in nursing homes. Nursing homes short depression inventory
- Authors:
- PRADO-JEAN Annie, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(8), August 2011, pp.853-859.
- Publisher:
- Wiley
Symptoms of depression are often missed in older nursing home residents because they may be dismissed as an inevitable consequence of ageing. This paper describes the construction of an instrument (NH-SDI) to detect depression in older nursing home residents. Three hundred and twenty eight older people were selected at random from 17 nursing homes in France, and examined by a single investigator. The examination included a psychiatric assessment, an evaluation of cognitive function, an evaluation of depressive state using four different instruments, and assessment of any changes in behaviour in those suffering from dementia. A scale of 16 dichotomous items (NH-SDI) was created. The internal consistency was satisfactory, as was its reliability with a sensitivity of 85% and a specificity of 87% for a cut-off score above 5. The authors concluded that the NH-SDI appeared to be a useful instrument for the detection of depression in nursing homes and could easily be used by staff as part of routine procedures.
The living–dying interval in nursing home-based end-of-life care: family caregivers' experiences
- Authors:
- WALDROP Deborah P., KUSMAUL Nancy
- Journal article citation:
- Journal of Gerontological Social Work, 54(8), November 2011, pp.768-787.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Most chronic care nursing home residents are in the living-dying interval, which encompasses the period of chronic morbidity prior to the dying process. Enhanced care during the transition from routine to palliative care is important for nursing home residents and their family members. The aim of this study was to explore family members' experiences with a loved one who died in a nursing home, and the nature of the living-dying interval from their perspectives. In-depth interviews were conducted with 31 caregivers of residents who had died. The interviews were audiotaped and transcribed. Analysis revealed 3 main themes and their subthemes that illuminated the families' experiences on the living–dying interval. The acute medical crisis which preceded the nursing home admission included: trigger events; accumulation of stressors; and level of care crisis. The living–dying phase included: advance care planning; hospitalisation; and end-stage decisions. Finally, the terminal phase included: beginning of the end; and awareness of dying. These results illustrate critical periods for social work intervention with families of dying nursing home residents.
Understanding the impact of early-life trauma in nursing home residents
- Authors:
- ANDERSON Keith A., FIELDS Noelle L., DOBB Lynn A.
- Journal article citation:
- Journal of Gerontological Social Work, 54(8), November 2011, pp.755-767.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The effects of traumas can be manifested in a number of physical, emotional, and social ways across individuals’ lives. There is a growing body of evidence showing that responses and symptoms to early life trauma can emerge, reemerge, or be exacerbated in later life as coping resources and abilities are compromised by age-related changes and declines in health. For newly admitted nursing home residents, this can impact their receptiveness to assistance with care and elicit challenging reactions to environmental and situational triggers. The aim of this article is to review the literature on early-life trauma and ageing in order to increase awareness of the challenges in caring for ageing trauma survivors. The article discusses: the intersection of trauma and ageing; caregiving for ageing trauma survivors; and identifying early-life trauma in the nursing home setting. A hypothetical case is used to illustrate the importance of identifying nursing home residents with past trauma experiences.
Identifying elderly depression using the Depression Rating Scale as part of comprehensive standardised care assessment in nursing homes
- Authors:
- HUANG Yachien, CARPENTER Iain
- Journal article citation:
- Aging and Mental Health, 15(8), November 2011, pp.1045-1051.
- Publisher:
- Taylor and Francis
This study explored the benefits of using the Depression Rating Scale (DRS) as part of a standardised needs assessment in UK nursing homes to assess resident’s depression. Participants included 499 residents in nine nursing homes in south-east England who were assessed with a standardised assessment tool. A list of characteristics associated with depression was then examined using bivariate analysis and logistic regression. Findings revealed that 68% were not depressed and 32% might suffer from depression. Being never married, diagnosed of chronic obstructive pulmonary disease, feelings of pain, and trouble sleeping were significantly associated with reporting depression. The DRS had distinctive advantages for use in UK nursing homes where a majority of residents are cognitively impaired. The authors outline policy implications in improving care quality and management for older residents of nursing homes.
Need support and wellbeing during morning care activities: an observational study on resident–staff interaction in nursing homes
- Authors:
- CUSTERS Annette F. J., et al
- Journal article citation:
- Ageing and Society, 31(8), November 2011, pp.1425-1442.
- Publisher:
- Cambridge University Press
One of the main influences on residents' wellbeing and quality of life in nursing homes is the interaction with professional carers. This study investigated to what extent care-givers support the residents' needs of relatedness, autonomy and competence, and how this need support is related to wellbeing. Participants included residents and professional carers of four nursing homes in the Netherlands. Three video-observations of each resident with different cares were made during morning care. Additional data were collected by means of questionnaires. Findings revealed that the needs of residents were mostly fulfilled during care interactions. More support by carers was related to better resident wellbeing. Carers provided more support to residents with stronger functional impairments, and more support was provided by higher-educated carers and carers in higher job functions. The results highlighted the importance of need support for wellbeing, but the contribution to the general subjective wellbeing of residents remained unclear.
Advance care planning with residents in nursing homes in Singapore
- Authors:
- WEE Ng Tzer, WENG Suew Chee, HUAT Laurence Lim Eng
- Journal article citation:
- Asia Pacific Journal of Social Work and Development, 21(1), June 2011, pp.97-104.
- Publisher:
- Taylor and Francis
Project CARE is a pilot project which aims to promote advance care planning and to improve end-of-life care in 7 nursing homes managed by voluntary welfare organisations. Advance care planning refers to the process of discussion about future healthcare between an individual, their loved ones, and their care providers. The aim is to enable a person to make clear their wishes with regards to future treatment and care. This article provides preliminary observations from this project relating to the implementation of advance care planning and its challenges. Selected staff from the nursing homes received training to apply the Respecting Choices advance care planning framework. Since the implementation of Project CARE in September 2009, there have been approximately 400 advance care planning discussions held with residents and their family members. These discussions included exploring the preferred place of care at the end of life. The paper illustrates the range of challenges faced in these discussions. It also presents the roles of social workers in advance care planning, and concludes with factors that contribute to effective advance care planning facilitation.