Physical restraint use among nursing home residents: A comparison of two data collection methods

BACKGROUND: In view of the issues surrounding physical restraint use, it is important to have a method of measurement as valid and reliable as possible. We determined the sensitivity and specificity of physical restraint use a) reported by nursing staff and b) reviewed from medical and nursing records in nursing home settings, by comparing these methods with direct observation. METHODS: We sampled eight care units in skilled nursing homes, seven care units in nursing homes and one long-term care unit in a hospital, from eight facilities which included 28 nurses and 377 residents. Physical restraint use was assessed the day following three periods of direct observation by two different means: interview with one or several members of the regular nursing staff, and review of medical and nursing records. Sensitivity and specificity values were calculated according to 2-by-2 contingency tables. Differences between the methods were assessed using the phi coefficient. Other information collected included: demographic characteristics, disruptive behaviors, body alignment problems, cognitive and functional skills. RESULTS: Compared to direct observation (gold standard), reported restraint use by nursing staff yielded a sensitivity of 87.4% at a specificity of 93.7% (phi = 0.84). When data was reviewed from subjects' medical and nursing records, sensitivity was reduced to 74.8%, and specificity to 86.3% (phi = 0.54). Justifications for restraint use including risk for falls, agitation, body alignment problems and aggressiveness were associated with the use of physical restraints. CONCLUSIONS: The interview of nursing staff and the review of medical and nursing records are both valid and reliable techniques for measuring physical restraint use among nursing home residents. Higher sensitivity and specificity values were achieved when nursing staff was interviewed as compared to reviewing medical records. This study suggests that the interview of nursing staff is a more reliable method of data collection

L’incontinence urinaire, parlons-en!

L’incontinence urinaire est la diffculté à contrôler sa vessie, un problème fréquent chez la personne âgée. Même si elle ne fait pas partie du vieillissement normal, plusieurs problèmes liés à l’âge augmentent le risque d’en souffrir. L’incontinence urinaire peut avoir un impact important sur la qualité de vie. Elle cause des émotions négatives chez les personnes touchées. Plusieurs hésitent à discuter de ce problème, car elles pensent qu’il n’existe aucune solution. Au contraire, l’incontinence urinaire peut être guérie, traitée ou contrôlée de diverses façons

Vitamin D status, cognitive decline and incident dementia : the Canadian Study of Health and Aging

Objective: Vitamin D could prevent cognitive decline because of its neuroprotective, anti-inflammatory and antioxidant properties. This study aimed to evaluate the associations of plasma 25-hydroxyvitamin D (25(OH)D) concentrations with global cognitive function and incident dementia, including Alzheimer’s disease (AD). Methods: The Canadian Study of Health and Aging is a 10-year cohort study of a representative sample of individuals aged 65years or older. A total of 661 subjects initially without dementia with frozen blood samples and follow-up data were included. Global cognitive function was measured using the validated Modified Mini-Mental State (3MS) examination. A consensus diagnosis of all-cause dementia and AD was made between the physician and the neuropsychologist according to published criteria. Cognitive decline for a 5-year increase in age at specific 25(OH)D concentrations was obtained using linear mixedmodels with repeated measures. Hazard ratios of incident dementia and AD were obtained using semi-parametric proportionalhazards models with age as time scale. Results: Over a mean follow-up of 5.4 years, 141 subjects developed dementia of which 100 were AD. Overall, no significant association was found between 25(OH)D and cognitive decline, dementia or AD. Higher 25(OH)D concentrations were associated with an increased risk of dementia and AD in women, but not in men. Conclusion: This study does not support a protective effect of vitamin D status on cognitive function. Further research is needed toclarify the relation by sex.Objectif : La vitamine D pourrait avoir un effet protecteur sur le déclin cognitif en raison de ses propriétés neuroprotectrices, anti-inflammatoires et antioxydantes. L’objectif de cette étude était d’évaluer les associations entre la concentration plasmatique de 25-hydroxyvitamine D (25(OH)D), la fonction cognitive globale et l’incidence de la démence incluant la maladie d’Alzheimer (MA). Méthodes: L’Étude sur la santé et le vieillissement au Canada est une étude de cohorte de 10 ans réalisée dans un échantillon représentatif des Canadiens âgés de 65 ans et plus. Un total de 661 participants sans démence, pour lesquels un échantillon sanguin congelé et des données au suivi étaient disponibles, ont été inclus dans l’analyse. La fonction cognitive globale a été mesurée à l’aide d’un outil validé, le Modified Mini-Mental State(3MS) Examination. Les diagnostics de démence toutes cause set de MA ont été obtenus par consensus entre un médecin généraliste et un neuropsychologue selon des critères publiés. Le déclin cognitif pour chaque augmentation de 5 ans d’âge à des concentrations spécifiques de 25(OH)D a été mesuré à l’aide de modèles linéaires mixtes avec données répétées. Des rapports de risques de la démence et de la MA ont été obtenus à l’aide de modèles à risques proportionnels semi-paramétriques en utilisant l’âge comme échelle du temps. Résultats : En cours de suivi (moyenne : 5,4 ans), 141 individus ont développé une démence dont 100 étaient la MA. Globalement, aucune association statistiquement significative n’a été observée entre le 25(OH)D et le déclin cognitif, la démence ou la MA. Des concentrations plus élevées de 25(OH)D étaient associées à une augmentation du risque de démence et de MA chez les femmes, mais pas chez les hommes. Conclusion : Cette étude n’appuie pas l’hypothèse d’un effet protecteur de la vitamine D sur la fonction cognitive. D’autres études seraient nécessaires pour clarifier la relation selon le sexe

La santé mentale à l’école : « Apprivoiser la complexité! » Évaluation d’une formation-accompagnement

Cet article présente l’évaluation en méthode mixte d’une formation-accompagnement en santé mentale à l’école, proposée aux enseignants, aux équipes-écoles et à leurs partenaires des Centres de santé et des services sociaux (CSSS). Les résultats démontrent que la formation a augmenté le sentiment de compétence des participants quant à leurs interventions, leur confort par rapport aux décisions partagées avec leurs partenaires et leur motivation face aux collaborations interdisciplinaires. Ces résultats suggèrent que cette formation peut améliorer l’arrimage entre les milieux de l’éducation et de la santé face aux problèmes de santé mentale des jeunes à l’école

Associations between circulating cardiovascular disease risk factors and cognitive performance in cognitively healthy older adults from the NuAge study

IntroductionCardiovascular disease risk factors (CVRFs) contribute to the development of cognitive impairment and dementia.MethodsThis study examined the associations between circulating CVRF biomarkers and cognition in 386 cognitively healthy older adults (mean age = 78 ± 4 years, 53% females) selected from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge). Memory, executive function, and processing speed were assessed at baseline and 2-year follow-up. CVRF biomarkers included total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides, glucose, insulin, high sensitivity C-reactive protein (hs-CRP), homocysteine, protein carbonyls, and cortisol. Linear mixed models were used to determine associations between individual CVRF biomarkers and cognition at both time points.ResultsHDL-C was most consistently associated with cognition with higher values related to better performance across several domains. Overall, stronger and more consistent relationships between CVRF biomarkers and cognition were observed in females relative to males.DiscussionFindings suggest that increases in the majority of circulating CVRFs are not associated with worse cognition in cognitively healthy older adults

Potentially inappropriate prescriptions for older patients in long-term care

BACKGROUND: Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs) in long-term care in metropolitan Quebec. METHODS: A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs. RESULTS: Almost all residents (94.0%) were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7%) of treated patients had a potentially inappropriate prescription (PIP). Most common PIPs were drug interactions (33.9% of treated patients), followed by potentially inappropriate duration (23.6%), potentially inappropriate medication (14.7%) and potentially inappropriate dosage (9.6%). PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication). The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33 – 1.43) and with the length of stay (OR: 1.78, CI: 1.43 – 2.20). On the other hand, the risk of receiving a PIP decreased with age. CONCLUSION: Potentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety

Blood n-3 fatty acid levels and total and cause-specific mortality from 17 prospective studies.

The health effects of omega-3 fatty acids have been controversial. Here we report the results of a de novo pooled analysis conducted with data from 17 prospective cohort studies examining the associations between blood omega-3 fatty acid levels and risk for all-cause mortality. Over a median of 16 years of follow-up, 15,720 deaths occurred among 42,466 individuals. We found that, after multivariable adjustment for relevant risk factors, risk for death from all causes was significantly lower (by 15-18%, at least p < 0.003) in the highest vs the lowest quintile for circulating long chain (20-22 carbon) omega-3 fatty acids (eicosapentaenoic, docosapentaenoic, and docosahexaenoic acids). Similar relationships were seen for death from cardiovascular disease, cancer and other causes. No associations were seen with the 18-carbon omega-3, alpha-linolenic acid. These findings suggest that higher circulating levels of marine n-3 PUFA are associated with a lower risk of premature death.The EPIC Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136). NJW, NGF, and FI were supported by the Medical Research Council Epidemiology Unit core funding [MC_UU_12015/1 and MC_UU_12015/5]. NJW and NGF acknowledge support from the National Institute for Health Research Cambridge Biomedical Research Centre [IS-BRC-1215-20014] and NJW is an NIHR Senior Investigator

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

Meeting Abstracts: Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo Clearwater Beach, FL, USA. 9-11 June 201