Associations between provision of independent access to outdoor areas and frequency of Australian nursing home (NH) residents going outdoors with health-related quality of life (HR-QoL, EQ-5D-5L) are examined in a cross-sectional study (541 participants, 17 homes, 84% with cognitive impairment) using multilevel models. After adjustments for potential confounders (including comorbidities and home location), independent access to outdoor areas was not associated with HR-QoL (β=-0.01, 95% CI, -0.09–0.07). Going outdoors daily (β=0.13, 95% CI 0.06–0.21), but not multiple times a week (β=0.03; 95% CI, -0.03–0.09), was associated with better HR-QoL. Residents living in small-scale, clustered, homelike facilities had greater odds of going outdoors daily (odds ratio 15.1; 95% CI, 6.3–36.2). Provision of independent access to outdoor areas alone may be insufficient to achieve HR-QoL benefits of NH residents venturing outdoors, in a pre-COVID era. Staffing structures, organizational attitudes, environmental design, and activities to support residents of NHs venturing outdoors frequently, despite any COVID-19-related restrictions, are needed.
This study aimed to identify interventions that are effective in improving the transitions of care for patients from nursing homes (NHs) to emergency departments (EDs). A total of 607 studies were identified, from which 19 studies were included for full-text review. Nine pre-post intervention studies and two retrospective cohort studies met all criteria for inclusion. In the quality assessment, two (18.2%) were assessed as good quality; seven (63.6%) were fair; and two (18.2%) were poor. Nine studies (81.2%) had a severe risk of bias, primarily due to confounding and deviation from the intended intervention. Pre-post intervention studies utilized transfer checklists/forms, web-based communication networks, and multimodal approaches to improve transitions of care. Eight studies reported significant improvement in critical NH-ED transfer information completeness after intervention implementation. Three studies assessed health care utilization after intervention implementation with two studies reporting no reduction in utilization and one study reporting decreased 30-day hospital readmission and ED revisit rates. Studies evaluating patient-centered outcomes, such as whether interventions reduced harm to patients by decreasing medical errors, hospital length of stay, or the overall number of facility transfers, are needed.
This study sought to understand the consistency of ratings over a 3-day test-retest period for how satisfied long-term care recipients were with the fulfillment of important everyday preferences. Pearson correlations were assessed for reports of satisfaction on 16 everyday preference items by 49 older adults (aged 62-104). Participants received services from skilled nursing, assisted living, or an adult day health program provided by a single long-term care organization. Results indicate that participants in this sample were consistent in reports of satisfaction of preference fulfillment over 3 days on 13 of 16 preferences. This finding indicates that ratings of satisfaction with preference fulfillment are reliable indicators to use in care planning.
Ensuring that older adults in long-term care settings can effectively communicate is important. The goal of this study was to characterize key modifiable factors that could affect verbal communication in an adult day care setting, namely prevalence of audiometric hearing loss and the acoustic characteristics in the activity hall. The prevalence of age-related hearing loss among participants (n=51) was 71%, although only 15% of enrollees at the group care setting (n=21 of 140) used amplification. The noise and reverberation characteristics of the activity hall revealed signal-to-noise ratios of -3.1 decibels (dB) and -2.4 dB during morning activity and lunch, respectively, which are poorer than the recommended levels for understanding speech in background noise. Older adults attending adult day services are likely to spend the day in a room with acoustics that are too challenging to understand speech clearly. Opportunities to improve listening environments in group care settings for older adults are discussed.
Cell phones, smartphones, tablets, and other personal electronic devices (PEDs) are commonplace in health care and other workplaces. Use of PEDs has numerous benefits for both caregivers and residents. For staff, advantages include easier communication among themselves, instant access to reference materials, and quicker access to health data. For residents, use of PEDs can be a source of empowerment and freedom, and PEDs also allow residentsto stay easily connected with friends and family.
Providing care to patients with morbid obesity is uniquely challenging due to multimorbidity, functional impairment, and high mortality rates in this population. Older adults with morbid obesity, accelerated health decline, and malnutrition often approach the end of life before palliative and hospice services are initiated. Having a better understanding of the role of palliative and hospice care in the care of patients with morbid obesity is important for health care professionals. We describe an older adult with morbid obesity who experienced a steady health decline during his last year of life, requiring recurrent hospitalizations, subacute rehabilitation, and subsequent transition to long-term care and hospice. This case serves to demonstrate gaps in care for this population and provides recommendations for intervention.
This article describes a support group facilitated by a chaplain and a psychotherapist at On Lok Lifeways, a comprehensive long-term health program for frail adults aged 55 and older in the San Francisco Bay Area. This spirituality and aging group has been running since 2013 with the goal of reducing depressive symptoms and enhancing the total well-being of older individuals. This paper addresses the format, content, and clinical implications of the group.
The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma released through her blog a description of CMS’ refocused regulatory efforts for skilled nursing facilities (SNFs). Her blog begins with a description of the CMS duty to monitor safety especially in the care for some of the most vulnerable in our society, ie, Americans residing in nursing homes (NHs).
As social media engagement plays an increasingly bigger role in our personal lives, it should be no surprise that use is growing among older adults as well. According to the Pew Research Center, as of January 2018 (the most recent data available), 37% of adults aged 65 or older use at least one social media platform; the most common was Facebook, at 41%, followed by Instagram at 10%.
Depression is a common medical condition present in about 14% of nursing home patients. Many older patients prescribed antidepressants (AD) rarely have them discontinued. The goal of this quality improvement project was to implement a process in a long-term care (LTC) facility in rural New York to decrease use of ADs among 55 residents by 25% within 3 months of implementation, while monitoring their overall health and well-being. The project resulted in a higher success rate than what had been previously achieved. This process can be implemented for other medications and at other LTC facilities.
Polypharmacy in older nursing home patients is a well-documented concern. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia, and the economic impact of polypharmacy is also substantial, with annual medicationrelated issues costing $7.6 billion in nursing facilities alone. We chose to use the Assess, Review, Minimize, Optimize, Reassess (ARMOR) protocol for our team-based intervention to address inappropriate prescribing in older residents. A reduction in the use of psychotropic medications was associated with an improvement in activities of daily living and fewer reports of depression but was also linked to an increase in the rate of falls and reports of pain. The lower use of antipsychotics also appears to unmask untreated anxiety, expressed in the results as the increased rate of antianxiety medications.
With a projection short fall of between 46,900 and 121,900 physicians in the health care workforce by 2032, who will fill the gap?1 One answer could be nurse practitioners (NPs). NPs are advanced practice registered nurses (APRNs) who are prepared through advanced graduate education and clinical training to provide a range of health services, including the diagnosis and management of common as well as complex medical conditions to people of all ages. They hold advanced degrees, either an MSN (Master of Science in Nursing) or DNP (Doctor of Nursing Practice), national certification in a patient population focus, and state APRN licensure. APRNs are helping to mitigate the effects of the national physician shortage by serving as primary care providers (PCPs).
Skilled nursing facilities (SNFs) increasingly provide care to patients after hospitalization. The Centers for Medicare & Medicaid Services reports ratings for SNFs for overall quality, staffing, health inspections, and clinical quality measures. However, the relationship between these ratings and patient outcomes remains unclear. In this retrospective cohort study, we reviewed the electronic health records of 3,923 adult patients discharged from the hospital and admitted to 9 SNFs served by a health care delivery system. We used Cox proportional hazards models to examine associations between the overall quality and individual ratings and our primary outcomes of 30-day rehospitalizations and 30-day emergency department visits. Patients in higher-rated facilities had a 13% lower risk of 30-day rehospitalization than patients in lower-rated facilities (hazard ratio, 0.87; 95% CI, 0.76-0.99). The risk of emergency department visits was also lower for patients in facilities with a higher overall quality rating and a higher quality measures rating. Staffing and health inspection ratings were not associated with our primary outcomes. These findings may help inform providers and nursing home policy makers.
Many older adults taking antiseizure medication have a diagnosis of seizure disorders that are not supported by objective diagnostic evidence. These “seizure disorders” are the result of years of misdiagnosis and a belief that the benefits of medication outweigh the potential for a seizure event. However, as the adverse effects of antiseizure medications increase with age and raise the risk of debilitating injury, re-evaluation of patients should be performed to ensure appropriate management. This article provides a foundation for geriatrics providers to appropriately manage misdiagnosed seizures as well as true seizures in older adults. Specific considerations for professionals working in long-term care are included.
The perspectives of all stakeholders are important to ensuring that developed interventions are relevant in long-term care (LTC). The purpose of this study was to determine resident and family member priorities for improvements to promote food and fluid intake in LTC and to compare them with the previously published priorities of experts and health care professionals. Four discussion groups (n=12 LTC residents; n=7 family members) were conducted; participants ranked priorities identified by the International Dining in Nursing Homes Experts Consortium. Residents prioritized choice and variety in the dining experience as well as the sensory properties of food. Family members ranked dining environment and staff attitude, knowledge, and skills as their top priorities. In a similar exercise, these priorities were ranked much lower by LTC researchers and health care professionals. The need for collaboration among researchers, health care professionals, LTC residents, and families is indicated when developing feasible and acceptable mealtime interventions to optimize food and fluid intake in LTC.
