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Efficacy of integrated interventions combining psychiatric care and nursing home care for nursing home residents: a review of the literature
- Authors:
- COLLET Janine, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(1), January 2010, pp.3-13.
- Publisher:
- Wiley
Nursing home residents needing both psychiatric and nursing home care for either somatic illness or dementia combined with psychiatric disorders or severe behavioural problems are referred to as Double Care Demanding (DCD) patients. This study examined which integrated interventions combining both psychiatric care and nursing home care in DCD nursing home residents are described in the research literature, and which effects of these integrated models are reported in the literature. Following a critical review of studies and a systematic literature search performed in a number of international databases, eight intervention trials were identified as relevant for the purposes of the review. Seven studies, 3 of which were randomised controlled trials, showed beneficial effects of a comprehensive, integrated multidisciplinary approach combining medical, psychiatric and nursing interventions on severe behavioural problems in DCD nursing home patients. The authors conclude that important elements of a successful treatment strategy for DCD nursing home patients include a thorough assessment of psychiatric, medical and environmental causes as well as programmes for teaching behavioural management skills to nurses, and that this review underlines the need for more rigorously designed studies.
Hearing the voice of people with dementia: a carer’s handbook
- Author:
- INNES Anthea
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 1997
- Pagination:
- 25p.
- Place of publication:
- Stirling
This handbook sets out to suggest practical ways in which communication with people with dementia is possible. Written without jargon, it also uses discussion points for use at carer support group meetings. It is written with a special emphasis for staff working in direct care in nursing homes, residential care homes, day care settings, and in home care.
Hearing the voice of people with dementia: a study guide for care staff and volunteers who work with people with dementia
- Authors:
- GOLDSMITH Malcolm, KINDRED Michael, INNES Anthea
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 1997
- Pagination:
- 40p.
- Place of publication:
- Stirling
Written with a special emphasis for staff working in direct care in nursing homes, residential care homes, day care settings, and in home care, this workbook highlights important ways in which communication is possible with people with dementia. Activity based exercises throughout prompt thinking about personal care practice.
The impact of depression and anxiety on well being, disability and use of health care services in nursing home patients
- Authors:
- SMALBRUGGE Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(4), April 2006, pp.325-332.
- Publisher:
- Wiley
The study-population consisted of 350 elderly nursing home patients from 14 nursing homes in the Netherlands. Well being, disability, use of health care services (i.e. assistance in ADL, paramedical care, number of medications) and depression and anxiety and other relevant characteristics (gender, age, education, marital status, urbanization, cognition, morbidity, social support) were measured cross-sectionally. Associations of well being, disability and use of health care services with independent baseline characteristics were assessed with bivariate and with multivariate analyses. Results found that the presence of depression and/or anxiety was associated with significantly less well being, but not with more disability. Presence of depression and/or anxiety was also significantly associated with four of the seven indicators of health care service use measured in this study: less assistance in ADL, more consultation of medical specialists, a higher mean number of medications and more use of antidepressants. It is concluded that presence of depression and/or anxiety has a statistically and clinically significant negative impact on well being, but not on disability. Future studies should focus on interventions for improving the detection, diagnosis and treatment of depression and/or anxiety in the nursing home.
Supported living in residential homes for the elderly: impact on patients and elder care workers
- Authors:
- DELPA M. F. I. A., et al
- Journal article citation:
- Aging and Mental Health, 8(5), September 2004, pp.460-468.
- Publisher:
- Taylor and Francis
To enable older people with severe and persistent mental illness to live in the community, the Dutch mental health sector has developed a program for supported living in residential homes for the elderly. It provides for the permanent stationing of mental health workers (MHWs) in elder care facilities to support both the resident patients and the elder care staff. The authors examined associations between the number of MHW staff and the degree to which (1) patients were integrated into the community and (2) elder care workers had developed effective working alliances with their patients. Participants included 110 patients participating in 18 supported living programs in the Netherlands. Community integration was assessed in face-to-face interviews with the patients about their perceived influence over daily life, involvement in social activities, and social network size. The quality of the worker-patient relationship was assessed using the Dutch Working Alliance Questionnaire for Community Care, completed by the elder care worker primarily responsible for each patient. After differentiation of the MHW staff into medically trained and nurse-trained professionals, associations with outcome measures were found only for the nurse-trained staff. The more hours of nurse-trained staff capacity per patient, the more influence perceived by the patients, and the more directiveness shown by the elder care workers in their contacts with patients. The impact of supported living programs in residential homes for the elderly appears to be determined in part by the caseloads of the on-site MHWs.
Do out-of-pocket health expenditures rise with age among older Americans?
- Author:
- STEWART Susan T.
- Journal article citation:
- Gerontologist, 44(1), February 2004, pp.48-57.
- Publisher:
- Oxford University Press
Relationships are examined between age and out-of-pocket costs for different health goods and services among the older population. Age patterns in health service use and out-of-pocket costs are examined by use of the 1990 Elderly Health Supplement to the Panel Study of Income Dynamics (N = 1,031, age 66+). Multivariate regression is used to examine how age effects are mediated by health, insurance, and socioeconomic variables. Although long-term care expenditures increased with age, out-of-pocket costs for most other services did not. Total out-of-pocket costs increased with age only when nursing home costs were included. Increases with age in hospital and prescription costs were explained by declining health. Patterns of service use suggested reduced access to discretionary care among the oldest old. Although expenditures did not increase with age for most services, the high personal cost for nursing home care among the oldest old underlines the need for increased efforts to support them in the community. Greater spending by those in poor health highlights the importance of preventing age-related health conditions and their complications. Improved access to discretionary care among the oldest old may help to reduce the need for care in higher cost settings. The high prevalence of out-of-pocket prescription spending across the age range provides impetus for current efforts to reduce these costs.
Linkages in the rural continuum: the Balanced Budget Act and beyond
- Authors:
- ANGELELLI Joseph, et al
- Journal article citation:
- Gerontologist, 43(2), April 2003, pp.151-157.
- Publisher:
- Oxford University Press
This American study examined how rural hospitals altered their postacute and long-term care strategies after the Balanced Budget Act of 1997 (BBA97). Methods:A nationally representative sample of 540 rural hospital discharge planners were interviewed in 1997. In the year 2000, 513 of 540 discharge planners were reinterviewed. The study is a descriptive analysis of how rural hospitals formed new and altered existing organizational strategies during a time of turbulent changes in federal government reimbursement policy. The authors classify rural hospital strategic behavior in 1997 according to the Miles and Snow typology of Prospectors, Analyzers, Defenders, and Reactors, and then examine how the various hospital types altered key strategies following BBA97. Between 1997 and 2000, more than 26% of sampled rural hospitals that did not participate in the swing-bed programme in 1997 (44/167) had chosen to do so in 2000, whereas only 3% of those using swing beds in 1997 had eliminated them (12/346). Other strategies such as divestiture of hospital-based nursing homes were related to concurrent swing-bed adoption. Rural hospitals also increased their reliance on formal linkages with external providers of long-term care. After the BBA97 reimbursement changes, rural hospitals increased their reliance on swing beds and formal linkages to external providers. We observed changes in overall strategy types, away from the Defender and toward the Prospector and Analyzer strategy types. Our findings illustrate the importance of swing beds as a critical buffer for rural hospitals challenged by the uncertainty of the post-BBA97 environment.
Psychiatric symptomatology in elderly people admitted to nursing and residential homes
- Authors:
- MOZLEY C. Godlove, et al
- Journal article citation:
- Aging and Mental Health, 4(2), May 2000, pp.136-141.
- Publisher:
- Taylor and Francis
Reports the prevalence of psychiatric morbidity in a cohort of elderly new admissions to nursing and residential homes. Almost two-thirds of the cohort, and 61 percent of those in residential, as opposed to nursing, homes showed clinically significant cognitive impairment. Just under 45 percent were identified as depression 'cases'. More respondents in the lower of two social class categories were found in both cognitively impaired and depressed groups. The high level of psychiatric morbidity in this new admission cohort raises questions about the availability of specialist expertise for this population, for both treatment and pre-admission assessment.
Is aggressive behaviour influenced by the use of a behaviour rating scale in patients in a psychogeriatric nursing home?
- Author:
- SIVAL Rob C.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(2), February 2000, pp.108-111.
- Publisher:
- Wiley
Examines the influence of the introduction of a behaviour rating scale on reported incidence and management of aggressive behaviours in patients in a psychogeriatric nursing home in the Netherlands. Concludes that the introduction of a behaviour rating scale does influence the reported incidence and management of aggressive behaviour. Prospective intervention studies should include a stabilization phase for measurements prior to any planned trial.
Strike up the bands
- Authors:
- DENHAM Michael, NEWITT Angela, RYAN Cathy
- Journal article citation:
- Health Service Journal, 1.7.99, 1999, pp.26-28.
- Publisher:
- Emap Healthcare
Deciding who is eligible for long-term care and how it should be funded is a crucial issue for Health Authorities. Explains how one Health Authority has tackled it, using panels to assess patients against a banding system.