Neuroarchitecture Analysis in the Mis Abuelitos Nursing Home in Cochachinche, Huanuco, Peru - A Secondary Publication

Neuroarchitecture is a set of characteristics grouped into principles that seek to generate a certain behavior when applied.These principles will vary according to the type of user for whom the design is intended.In this research,these neuroarchitectural principles are identified in the nursing home Mis Abuelitos in Cochachinche,Huánuco.The home was designed and built with notions of nature and the Andean while emphasizing the occupants are the elderly.With this purpose,qualitative research was carried out using two sequential criteria,the first was to identify what these principles are and the second was to recognize the principles within the area.The principles that are assertively used for the elderly occupants were selected.The study observation was performed with observation and photographic sheets and was analyzed with ATLAS.ti processing software.It was obtained that the three neuroarchitectural principles are present in the nursing home which are 67%of the recommended characteristics for the elderly.

Application of horticulture therapy as a health intervention for elderly people in nursing homes:a scoping review

Objective:To review the scope of interventional studies on horticultural therapy(HT)applied to elderly people in nursing institutions to support the efficient implementation of HT among this target group.Methods:In accordance with the scoping review framework proposed by the Joanna Briggs Institute(JBI),the Pub Med,JSTOR,Web of Science,CNKI,and Wanfang databases were searched.Data from the retrieved literature were summarized and analyzed.Results:In all,18 studies were included in this review.The target population groups of interventions included self-supporting elderly people,cognitively impaired elderly people,elderly people with negative emotions,and elderly people with frailty living in nursing institutions.HT interventions,including planting,craft activities,derivative activities,and outdoor viewing activities,are implemented indoors,outdoors,or in mixed settings.The most common duration of the intervention was 8 weeks,the most common frequency was once per week,and the most common session duration was 60 min.Conclusions:The measurements used in HT interventions included assessments of physical,psycho-mental,and social health;quality of life;and activity effects.Future studies should include partially dependent groups and completely dependent groups of elderly individuals,interventions that last at least 6 months,scientifically designed activity intensity and safety-guarantee plans,and outcomeevaluation indicators such as compliance and intervention benefits.

Reducing Hospital Stays for Patients Discharged to Nursing Homes

This study described programs that support length of stay reduction in the metropolitan area of Syracuse, New York. It demonstrated that these initiatives could improve hospital efficiency by expediting the movement of patients from inpatient hospitals to nursing homes at the community level. The Subacute and Complex Care Programs have focused on hospital patients with some of the longest lengths of stay. The inpatient days associated with these patients have the greatest potential for moving from acute care to long-term care providers. The use of these programs has the potential for saving staff time in hospitals associated with nurses, as well as pharmaceuticals and testing. All of these resources have contributed to the high costs of inpatient acute care.

Staff characteristics and care in Chinese nursing homes: A systematic literature review

The need for institutional long-term care(LTC)services,including nursing homes(NHs),is increasing in China's Mainland in part due to the aging population and changing family structures.In developing NH staff training programs,a review is needed to synthesize knowledge about staff and resident characteristics,and care provided in NHs.This systematic review aims to describe,in Chinese NHs,(1)NH staff characteristics and the care they provide,(2)resident characteristics and care needs,and (3)the role of family members.The 45 articles included in this review covered both urban and rural areas of China's Mainland.We found that staff in Chinese NHs were older and had lower education levels in comparison with those in western countries.Most direct caregivers in urban areas were migratory workers from rural area.Chinese NHs had few qualification standards for staff preparation for their roles in NHs.Also,functional levels of residents in Chinese NHs were higher compared to NH residents in western countries.In addition,family members played important roles in caring for NH residents.These findings suggest a need for staff development programs that tailor for lower educated NH staff and care needs of residents with widely varying levels in function from independent to bedbound in China's Mainland.The findings also suggest that staff qualification standards require critically policy development to improve the capacity of Chinese NHs to provide competent and safe care.

Working experiences of nursing aides in nursing homes:A qualitative study

Objective:To examine how nursing aides in nursing homes perceived their caring work.Methods:Twenty-four nursing aides from one public and one private nursing home in Fuzhou,Fujian Province,China were selected and interviewed in focus groups.Phenomenological analysis was performed.Results:Two themes(positive and negative working experiences)and six sub-themes were drawn:companionship,happiness,trust,achievement,hard work,and grievance.Conclusion:A reasonable work arrangement,positive psychological intervention,and the strengthening of professional,medical and social supports are recommended to improve the work quality and satisfaction of nursing aides in elderly homes.

Evolution of Programs to Improve Transfers between Hospitals and Nursing Homes at the Community Level

This study described the evolution of programs to improve the efficiency of patient movement between hospitals and nursing homes in the metropolitan area of Syracuse, New York. These programs were needed in order to improve coordination among providers in the absence of networks that included both acute and long term care providers. The mechanisms included the exchange of data and monitoring the movement of Difficult to Place patients from hospitals to nursing homes. Between 2006 and 2014, the annual number of Difficult to Place patients increased from 983 to 1836. During this period, annual hospital medical/surgical discharges increased by 7.5 percent, severity of illness increased by 13.7 percent, and the population aged 65 years and over increased by 9.8 percent. Most of the Difficult to Place patients were admitted by the four largest facilities in the community, which accounted for 60 percent of the nursing home beds. The initiatives also included Subacute and Complex Care Programs that provided financial incentives for admission of certain types of patients, such as intravenous therapy and extensive wound care. The programs described how these programs were implemented using minimal financial resources and without adding positions to the participating provider organizations.

Timeslips—Comparing Agitation and Anxiety Rating Scales to Evaluate the Benefit of Non-Pharmacologic Creative Sessions in Nursing Home Patients with Dementia

TimeslipsTM is a group storytelling program that encourages creative expression among dementia patients without the pressure to recall the past. Analysis of the literature was conducted to determine the nine most relevant agitation and anxiety scales most appropriate for use with Timeslips in nursing home patients with dementia, who experience agitation and anxiety. Qualitative assessment of the nine scales was conducted to identify six criteria to determine the most pertinent characteristics for implementation of Timeslips within this patient population: 1) validity/reliability, 2) observation period, 3) training required, 4) time to administer, 5) most appropriate administrator and 6) accessibility/cost. Utilizing these six criteria, quantitative assessment was conducted using the Analytical Hierarchical Process (AHP) to identify that the Overt Agitation Severity Scale (OASS) was optimal. IRB approvals have been attained to investigate use of the OASS with Timeslips in the nursing home setting for patients with dementia, who experience agitation and anxiety.

Predictors of Falls Efficacy Scale responses among nursing home residents in China

Objectives:The objective of this study was to examine the falls efficacy of older adults in nursing homes and the related predictors of falling.Methods:A sample of 317 older adults was recruited from 18 nursing homes in the Fujian province of China.The Modified Falls Efficacy Scale(MFES)and Kessler Psychological Distress Scale(K10)were employed to collect data.Results:The falls efficacy of older adults was moderate(7.80±1.17).The falls efficacy questionnaire item“Get dressed and undressed”scored the highest(9.12±1.440),while“Crossing roads”scored the lowest(5.77±3.371).Multiple regression analysis demonstrated that mental health status,degree of self-care,age and gender were each predictors of the falls efficacy of older adults.Conclusions:Falls efficacy enhancing programs for nursing home residents should take mental health status,degree of self-care,age and gender into account.

Prevalence of frailty among nursing home residents in China:a systematic review and meta-analysis

Background:The prevalence of frailty among nursing home residents is high.However,in China,prevalence of frailty keeps unknown in this population.The purpose of this meta-analysis is to assess the prevalence of frailty and prefrailty and find out the factors related to the prevalence of frailty among nursing home residents in China.Methods:We searched both English(PubMed,Cochrane Library,Embase,Web of Science and Scopus)and Chinese(CNKI,WanFang,SinoMed,and VIP)databases from their inception date until 15 September 2020.Two reviewers independently screened literature,extracted data,and evaluated the risk of bias included studies.Stata12.0 software was used to conduct meta-analysis.Results:A total of 16 studies were included in this review,involving 7,777 nursing home residents.The prevalence of frailty ranged from 29.2% to 66.6% in the included studies.The pooled prevalence of frailty and prefrailty were 49%(95%CI:43-55%)and 42%(95%CI:34–50%),respectively.The assessment tool(P<0.001),gender(P<0.001),self-rated health(P<0.001)and type of institution(P<0.001)were significantly associated with the prevalence of frailty among nursing home residents in China.Conclusions:The prevalence of frailty among nursing home residents in China was relatively high.Considering the adverse health outcomes of frailty,nursing home administrators should screen frailty regularly,identify the risk factors of frailty,take actions accordingly and improve the frailty status for older adults.

A randomized controlled trial of group mindfulness therapy on sleep quality of the elderly in nursing homes

Background:Poor sleep quality of the elderly in nursing homes will reduce the quality of life,which needs to be treated properly.The purpose of the study is to investigate the effect of group mindfulness therapy on sleep quality of the elderly in nursing homes.Methods:A parallel randomized controlled trial was used in this study.The semi-structure interview and the mindfulness therapy intervention was used as the intervention.The Pittsburgh sleep quality index scale and Glaizzi phenoenological data for a 7-step was used to analyze the results.Results:After 8 weeks of intervention,the sleep quality of elderly people was improved to a certain extent(P<0.05).Our investigation showed that some elderly people think that through this kind of training they had reduced the frequency of taking sleeping pills.Conclusion:Group mindfulness therapy could improve sleep quality to some extent.

Functional Contentment Model: Optimizing Quality of Life for Nursing Home Residents with Dementia

The Functional Contentment Model (FCM) attains two objectives: 1) building a relationship focused plan of care for nursing home residents diagnosed with dementia;and 2) maximizing and maintaining older adults’ contentment, peace, and happiness while living in dementia care environments. There are three essential components within the FCM: 1) Person/Family Centered Care;2) Slow Medicine;and 3) Team Care Management. The principles of “Person/Family-Centered Care” are coupled with the philosophy of “Slow Medicine,” and neither can exist without the engagement of “Team Care Management.” In short, the FCM maximizes the older adult’s potential functioning in activities of daily living, cognition, gross and fine motor skills, communication, and physical well-being, while maintaining the highest possible level of contentment, peace, and happiness. This is accomplished through dynamically utilized professional modalities adapted to the changing needs of the older adult resident—pharmacologic, physical and occupational therapies, family education and involvement, dietary, spiritual, stimulating activities, as well as any individualized modality. The lead for operationalizing the Functional Contentment Model is the nursing home medical director, whose key role is assuring a team approach to care including the older adult resident, the family, and all staff (dietary, housekeeping maintenance as well as care and administrative staff). The FCM is a culture change model that has implications in practice and policy for each nursing home.

Treatment of heart failure in nursing home residents

BackgroundFor the treatment of chronic heart failure （HF）, both pharmacological and non-pharmacological treatment should be em-ployed in HF patients. Although HF is highly prevalent in nursing home residents, it is not clear whether the recommendations in the guide-lines for pharmacological therapy also are followed in nursing home residents. The aim of this study is to investigate how HF is treated in nursing home residents and to determine to what extent the current treatment corresponds to the guidelines.MethodsNursing home resi-dents of five large nursing home care organizations in the southern part of the Netherlands with a previous diagnosis of HF based on medical records irrespective of the left ventricle ejection fraction （LVEF） were included in this cross-sectional design study. Data were gathered on the （medical） records, which included clinical characteristics and pharmacological- and non-pharmacological treatment. Echocardiography was used as part of the study to determine the LVEF.ResultsOut of 501 residents, 112 had a diagnosis of HF at inclusion. One-third of them received an ACE-inhibitor and 40% used aβ-blocker. In 66%, there was a prescription of diuretics with a preference of a loop diuretic. Focusing on the residents with a LVEF￡ 40%, only 46% of the 22 residents used an ACE-inhibitor and 64% aβ-blocker. The median daily doses of prescribed medication were lower than those that were recommended by the guidelines. Non-pharmacological interventions were recorded in almost none of the residents with HF.ConclusionsThe recommended medical therapy of HF was often not prescribed; if pre-scribed, the dosage was usually far below what was recommended. In addition, non-pharmacological interventions were mostly not used at all.

Barriers and facilitators to an outreach rehabilitation program delivered in nursing homes after hip fracture surgical repair

Objective: To identify and understand facilitators and barriers to implementing an Outreach rehabilitation program designed to improve post-operative recovery following hip fracture in long-term care residents. Residents of nursing home facilities are at considerable risk of hip fracture and minimal recovery following a hip fracture. Methods: Data were gathered over June-August, 2012 through semi-structured interviews or focus groups. Fifteen persons (n = 15) who were members of the Outreach rehabilitation team (n = 8) or relevant nursing home staff (n = 7) were interviewed. Data analysis was guided by principles of grounded theory method. Findings: Three major themes that contributed to or hindered the Outreach rehabilitation program emerged, namely, 1) the division, the separate operation and delivery of rehabilitation services;2) building bridges, or negotiating ways to communicate and work together, and 3) strength in the structure, the acceptance of the program and the perceived benefits of the program. One main challenge to program implementation con- cerned coordinating additional rehabilitation with the rehabilitation provided within the nursing homes. Facility staff was largely unaware of the program and were unprepared to work with Outreach team members. As the program progressed, the facility staff and Outreach team were able to collaborate to overcome resident health issues impeding recovery such as cognitive impairment, language barriers and post-surgical pain control needs. Facilitators included the consistency of Outreach team members and accessible facility staff, which contributed to effective communication and trust between the Outreach team and facility staff. Facilitators also included support for the program by the Outreach team and facility staff, as well as the potential benefits of improved mobility and functional status among some program recipients. Conclusion: Although planning, implementation, and delivery of an Outreach rehabilitation program present some challenges, this study suggests that it is possible to deliver rehabilitation to older residents who fracture their hips in nursing homes.

Factors Affecting Verbal Agitation in Dementia Patients Living in Nursing Homes, South Korea

The purpose of this study using secondary data analysis was to identify factors affecting verbal agitation in patients with dementia staying at nursing home. This study is a secondary analysis of an existing original quantitative data set (n = 193). A total of 166 subjects’ data were included in this current study after 27 subjects’ data were excluded from the original data because they did not appear verbal agitation. Multiple regression analyses identified hallucination (β = 0.27), total number of physiologic discomforts (β = 0.19) and pain (β = 0.17) as significant predictors of verbal agitation and these factors explained 27.8% of the variance in the model. The findings of this study showed that hallucination, total number of physiologic discomforts and pain with dementia need to be considered when intervention programs to control verbal agitation in patients with dementia were developed.

Patterns of Medication Use among Romanian Nursing Home Residents

Background: the elderly are frequently exposed to drug-related problems and their consequences. Information relating to the appropriateness of the medication used by Romanian elderly is scarce. Objective: to identify the main potential inappropriate prescribing (PIP) instances in a sample of Romanian elderly nursing-home residents, concerning prevalence and subtypes. Methodology: the residents’ medical data were reviewed by a clinical pharmacist considering published geriatric pharmacotherapy recommendations, including four published PIP evaluation tools (the Beers criteria, STOPP-START tools, the PRISCUS list). Results: 91 residents were evaluated;mean age (mean ± SD) was 80.77 ± 6.82 (years), 28 (31%) were ≥85 years old and 58 (64%) had dementia. The median number of diagnoses was 6 (range 2 - 11) and the mean number (±SD) of daily medications was 8.26 (±3.52). An estimated mean (±SD) of 2 (±1.41) PIP per resident was identified, with 117 misuse-PIP (46.24%), 60 underuse-PIP (23.72%), 41 lack of monitoring-PIP (16.21%) and 35 overuse-PIP (13.83%). The most frequent PIP subtypes were the use of nonsteroidal anti-inflammatory drugs as chronic analgesic treatment in osteoarthritis (29.67%), underuse of fall prevention (100%) and analgesic therapies (23.08%), overuse of nootropic medications (26.98%) and lack of annual creatinine assessment (30.77%). Conclusion: a more geriatric-oriented care seemed to be necessary, but larger studies are needed to confirm these findings.

Healthcare Staff Perceptions of Patient Safety Culture in Nursing Home Settings—A Cross-Sectional Study

In nursing homes, knowledge about patient safety culture is still limited. This study investigates staff perceptions of patient safety culture in Norwegian nursing homes, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPSC). 466 (69%) staff from 12 different nursing homes participated. The total percentages of positive responses for each patient safety culture dimension and differences in perceptions according to staff’s educational background and position were calculated. Multiple linear regression analysis was used to test if the NHSOPSC dimensions predicted participants’ ratings of the question “Please give this nursing home an overall rating on patient safety”. The proportion of positive responses was high, with six of ten dimensions having an average percentage above 70%. “Supervisor expectations and actions promoting patient safety” (88%), “feedback and communication about incidents” (87%), and a “non-punitive response to mistakes” (78%) had high average scores, while “staffing” (46%) and “training and skills” (56%) had the lowest average scores. Managers reported higher scores on all dimensions, except for “compliance with procedures” compared with other staff groups. Educational level had less influence on staff’s perceptions of patient safety culture than management position. The ten NHSOPSC dimensions explained 47.2% of the variance for the overall rating question “Please give this nursing home an overall rating on patient safety” (F [10, 384] = 34.39, p < 0.001). “Management and organizational learning” had the strongest unique contribution (28.1%). This study suggests that staff working at the bedside have confidence in their nursing managers’ attention to patient safety issues and that a non-punitive environment is prevalent in Norwegian nursing homes.

Prevalence of Sarcopenia among Nursing Home Older Residents in Cairo, Egypt

Sarcopenia is highly prevalent in community dwelling older adults in many countries;however, the prevalence of sarcopenia in nursing home older residents is not well characterized. The aim of this study is to assess the prevalence of sarcopenia in nursing home older residents in Cairo. Cross sectional study was performed among 357 nursing home residents in Cairo. The European Working Group on Sarcopenia in Older People (EWGSOP) recommendation was used for diagnosing sarcopenia. The study showed that the prevalence of sarcopenia in nursing home older residents in Cairo was 17.7%, 22.2% in elderly men and 14.4% in elderly women. Age, underweight and lack of physical activity were found to be associated with sarcopenia among studied participants. The study concluded that sarcopenia is an emerging health problem in nursing home older residents in Cairo.

Erratum to “Prevalence of Sarcopenia among Nursing Home Older Residents in Cairo, Egypt” [Advances in Aging Research 3 (2014) 118-123]

Sarcopenia is highly prevalent in community dwelling older adults in many countries;however, the prevalence of sarcopenia in nursing home older residents is not well characterized. The aim of this study is to assess the prevalence of sarcopenia in nursing home older residents in Cairo. Cross sectional study was performed among 150 nursing homes residents in Cairo. The European Working Group on Sarcopenia in Older People (EWGSOP) recommendation was used for diagnosing sarcopenia. The study showed that the prevalence of sarcopenia in nursing home older residents in Cairo was 17.3%;22.6% in elderly men and 13.6% in elderly women. Age, underweight and lack of physical activity were found to be associated with sarcopenia among studied participants. The study concluded that sarcopenia is an emerging health problem in nursing home older residents in Cairo.

Advance Directives in the Context of Uncertain Prognosis for Residents of Nursing Homes

This report documents the findings of a mixed-methods study focused on the advanced directives of 182 residents of three LTC facilities in southern Ontario, Canada. Although almost all had a completed advance directive within 3 months of death, most did not have a palliative designation or directive until a few days before they died. Each facility’s written Progress Notes revealed staff members usually sought additional confirmation of care preferences from residents’ substitute decision-makers within a few days of the death. It was thus common for advance directives to change from a more interventionist approach to the least interventionist approach near death. This change indicates that the meaning and significance of advance care planning and resulting advance directives must be considered in light of the processes and temporal factors involved in their completion and use within this distinct population. The relational nature of advance care planning and concern about ageism as a factor for withholding or withdrawing life support for LTC residents are considered as possible explanatory factors. These findings and their implications are described in relation to end-of-life care policies and practices in LTC facilities.

When Home Hospice Patients Discharge to Nursing Home: A Mixed Method

Background: Hospice care is to provide necessary medical care and support for patients and the families at the end of life (EOL). Hospice care patients typically withdraw from aggressive treatment. Even though home hospice has been shown to improve the quality of care, home hospice patients still revoke the services for various reasons. A little is known about where home hospice patients are being transferred. This study aims to address this gap and explore common reasons for home hospice discharge and placements, where patients being transferred other than home. Methods: Data were retrieved from the 2007 National Home and Hospice Care Survey (NHHCS). NHHCS is one in a series of nationally representative sample surveys of U.S. home health and hospice agencies. Results: Within identified home hospice patients, approximately 82.1% were deceased at discharge, and 846 (18.2%) were discharged for other reasons, including patients being stabilized or improved (30.2%), aggressive treatment (31.8%), moved (e.g., geographically, 13.5%) and others. Patients lived with a spouse were less likely to utilize external resources, like volunteers, thereby more likely to discharge patients to long-term facilities. Discussion: The current study suggest that it is difficult for the family to give all remaining care for their loved ones despite the support and resources for those home hospice patients. The characteristics of those who transferred to nursing facilities from home hospice will be discussed throughout.