The role of frailty in predicting 3 and 6 months functional decline in hospitalized older adults: findings from a secondary analysis

Frailty represents one of the most relevant geriatric syndromes in the 21st century and is a predictor of adverse outcomes in hospitalized older adult, such as, functional decline (FD). This study aimed to examine if frailty, evaluated with the Frailty Index (FI), can predict FD during and after hospitalization (3 and 6 months). Secondary data analysis of a prospective cohort study of 101 hospitalized older adults was performed. The primary outcome was FD at discharge, 3 and 6 months. The FI was created from an original database using 40 health deficits. Functional decline models for each time-point were examined using a binary logistic regression. The prevalence of frailty was 57.4% with an average score of 0.25 (±0.11). Frail patients had significant and higher values for functional decline and social support for all time periods and more hospital readmission in the 3 month period. Multivariable regression analysis showed that FI was a predictor of functional decline at discharge (OR = 1.07, 95% CI = 1.02-1.14) and 3-month (OR = 1.05, 95% CI = 1.01-1.09) but not 6-month (OR = 1.03, 95% CI = 0.99-1.09) follow-up. Findings suggest that frailty at admission of hospitalized older adults can predict functional decline at discharge and 3 months post-discharge.publishe

Non-pharmacological solutions to sleep and circadian rhythm disruption: voiced bedside experiences of hospice and end-oflife staff caregivers

Background: Sleep disturbance is a significant issue, particularly for patients with advanced terminal illness. Currently, there are no practice-based recommended approaches for managing sleep and circadian disruptions in this population. To address this gap, a cross-sectional focus group study was performed engaging 32 staff members at four hospices/end-of-life programs in three demographically diverse counties in New York State. Methods: Participants responded to structured open-ended questions. Responses were transcribed and subjected to qualitative content analysis. The themes and recommendations for improved practice that emerged were tabulated using Atlas TI qualitative software. Results: This report details the experiences of hospice and end-of-life care staff in managing sleep and circadian disruptions affecting patients and analyzes their recommendations for improving care. Caregivers involved in the study described potential interventions that would improve sleep and reduce circadian disruptions. They particularly highlighted a need for improved evaluation and monitoring systems, as well as sleep education programs for both formal and informal caregivers. Conclusions: The voiced experiences of frontline hospice and end-of-life caregivers confirmed that disruption in sleep and circadian rhythms is a common issue for their patients and is not effectively addressed in current research and practice. The caregivers’ recommendations focused on management strategies and underscored the need for well-tested interventions to promote sleep in patients receiving end-of-life care. Additional research is needed to examine the effectiveness of systematic programs that can be easily integrated into the end-of-life care process to attenuate sleep disturbances

Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes

Researchers have demonstrated that the use of physical restraints in nursing homes can be reduced, particularly where advanced practice nurses (APNs) are utilized. We examined the link between APN practice, siderail reduction, and the costs of siderail alternatives in 273 residents in four Philadelphia nursing homes. The majority of participants were cognitively and physically impaired with multiple co-morbidities. APNs recommended a total of 1,275 siderail-alternative interventions aimed at reducing fall risk. The median cost of siderail alternatives to prevent falls per resident was $135. Residents with a fall history experienced a significantly higher cost of recommendation compared to non-fallers. Findings suggest that an APN consultation model can effectively be implemented through comprehensive, individualized assessment without incurring substantial costs to the nursing home. © 2007 Wiley Periodicals, Inc. Res Nurs Health 30: 131–140, 2007Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56001/1/20185_ftp.pd

Nurse perception of care of hospitalized older adults – a comparative study between northern and central regions of Portugal

Objective: to analyze the relationship between the perceptions of nurses about geriatric care (GC) environment and geriatric nurses’ knowledge and attitudes according to unit type considering the northern and central regions of Portugal. Method: a cross-sectional study was developed among 1068 Portuguese’s nurses in five hospitals. The instrument was Geriatric Institutional Assessment Profile – Portuguese version. The independent samples t-test was when the assumption of normality was verified, otherwise, the Mann-Whitney U test was used. The level of significance was 5%. Results: the profile of perceptions of GC showed a relatively homogeneous pattern (no statistically significant results were found). For the geriatric care environment scale, only the CC/ED units presented significant differences in all considered subscales (resource availability; aging-sensitive care; institutional values; and continuity of care), with more positive perceptions among nurses in the northern region. In Professional Issues scales, only the scale perception of burden related with upsetting behaviors revealed significant differences between regions in all specialties. Conclusion: the findings suggest the need for increased investment by hospital leaders to promote a geriatric nursing practice environment that supports the specialized needs of hospitalized older adults

The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study

Background Physical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily. Methods We conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated. Results The prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7–88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1–87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents. Conclusions The prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.Sociedad Canaria de Geriatría y Gerontología and the Fundación Canaria de Investigación Sanitaria financed this study.S

Belt restraint reduction in nursing homes: design of a quasi-experimental study

<p>Abstract</p> <p>Background</p> <p>The use of physical restraints still is common practice in the nursing home care. Since physical restraints have been shown to be an ineffective and sometimes even hazardous measure, interventions are needed to reduce their usage. Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. However, the success rate of these interventions has been inconsistent. We developed a new multi-component intervention (EXBELT) comprising an educational intervention for nursing home staff in combination with a policy change (belt use is prohibited by the nursing home management), availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes. However, the reduction of belts should not result in an increase of other restrictive restraints (such as a chair with locked tray table) or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes.</p> <p>Methods and design</p> <p>Effects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement. Furthermore, changing attitudes will become an important addition to the educational part of EXBELT.</p> <p>Discussion</p> <p>A quasi-experimental study is presented to investigate the effects of EXBELT on the use of belts on wards in psychogeriatric nursing homes. The study will be conducted in 26 wards in 13 psychogeriatric nursing homes. We selected the wards in a manner that contamination between control- and intervention group is prevented.</p> <p>Trial registration</p> <p>(NTR2140)</p

Nurse perception of care of hospitalized older adults: a comparative study between northern and central regions of Portugal

Objective: to analyze the relationship between the perceptions of nurses about geriatric care (GC) environment and geriatric nurses’ knowledge and attitudes according to unit type considering the northern and central regions of Portugal. Method: a cross-sectional study was developed among 1,068 Portuguese’s nurses in five hospitals. The instrument was Geriatric Institutional Assessment Profile – Portuguese version. The independent samples t-test was when the assumption of normality was verified, otherwise, the Mann-Whitney U test was used. The level of significance was 5%. Results: the profile of perceptions of GC showed a relatively homogeneous pattern (no statistically significant results were found). For the geriatric care environment scale, only the CC/ED units presented significant differences in all considered subscales (resource availability; aging-sensitive care; institutional values; and continuity of care), with more positive perceptions among nurses in the northern region. In Professional Issues scales, only the scale perception of burden related with upsetting behaviors revealed significant differences between regions in all specialties. Conclusion: the findings suggest the need for increased investment by hospital leaders to promote a geriatric nursing practice environment that supports the specialized needs of hospitalized older adults

Percepção dos enfermeiros sobre o cuidado a idosos hospitalizados - estudo comparativo entre as regiões Norte e Central de Portugal

Resumo Objetivo: analisar a relação entre as percepções dos enfermeiros sobre o ambiente de cuidado geriátrico (CG) e os conhecimentos e atitudes destes de acordo com o tipo de unidade, considerando as regiões Norte e Central de Portugal. Método: estudo transversal, desenvolvido com 1068 enfermeiros portugueses em cinco hospitais. O instrumento foi o Geriatric Institutional Assessment Profile - versão em Português. Foi utilizado o teste t para amostras independentes quando a suposição de normalidade foi verificada; caso contrário, utilizou-se o teste de Mann-Whitney. O nível de significância foi de 5%. Resultados: o perfil de percepções de cuidado geriátrico mostrou um padrão relativamente homogêneo (não foram encontrados resultados estatisticamente significantes). Para a escala de ambiente de cuidado geriátrico, apenas as unidades de cuidados intensivos e serviço de urgência apresentaram diferenças significativas em todas as subescalas consideradas (disponibilidade de recursos, cuidado sensível à idade, valores institucionais; e continuidade do cuidado), com percepções mais positivas entre os enfermeiros da região Norte. Nas escalas de Questões Profissionais, somente a escala percepção da sobrecarga relacionada aos comportamentos perturbadores revelou diferenças significativas entre as regiões em todas as especialidades. Conclusão: os resultados sugerem a necessidade de maior investimento pelos gerentes hospitalares para promover um ambiente de prática de enfermagem geriátrica e que vá ao encontro das necessidades e especificidades das pessoas idosas hospitalizadas.Resume Objetivo: analizar la relación entre la percepción de los enfermeros sobre el entorno de la atención geriátrica y el su conocimiento y actitudes según el tipo de unidad tomando en cuenta las regiones del Norte y Centro de Portugal. Método: estudio transversal desarrollado con 1068 enfermeros portugueses en cinco hospitales. El instrumento fue Geriatric Institutional Assessment Profile - versión en portugués. Se utilizo la prueba t para muestra independientes cuando fue verificada la supuesta normalidad; de lo contrario, se utilizó la prueba de Mann-Whitney. El nivel de significancia fue del 5 %. Resultados: el perfil de las percepciones de atención geriátrica mostró un patrón relativamente homogénea (no se encontraron resultados estadísticamente significativos). Para la escala de entorno atención geriátrica, solo las unidades de cuidados intensivos y servicios de urgencias presentaron diferencias significativas en todas las subescalas estudiadas (disponibilidad de recursos; cuidado sensible a edad; valores institucionales y continuidad del cuidado), con una percepción más positiva entre los enfermeros en la región Norte. En las escalas de las cuestiones de carácter profesional, solo la escala percepción de la sobrecarga relacionada con comportamientos desconcertantes reveló diferencias significativas entre las regiones en todas las especialidades. Conclusión: los hallazgos sugieren la necesidad de una mayor inversión por parte de los gerentes del los hospitales para promover un entorno de la práctica de enfermería geriátrica que sea compatible con las necesidades específicas de los adultos mayores hospitalizados.Resume Objective: to analyze the relationship between the perceptions of nurses about geriatric care (GC) environment and geriatric nurses’ knowledge and attitudes according to unit type considering the northern and central regions of Portugal. Method: a cross-sectional study was developed among 1068 Portuguese’s nurses in five hospitals. The instrument was Geriatric Institutional Assessment Profile - Portuguese version. The independent samples t-test was when the assumption of normality was verified, otherwise, the Mann-Whitney U test was used. The level of significance was 5%. Results: the profile of perceptions of GC showed a relatively homogeneous pattern (no statistically significant results were found). For the geriatric care environment scale, only the CC/ED units presented significant differences in all considered subscales (resource availability; aging-sensitive care; institutional values; and continuity of care), with more positive perceptions among nurses in the northern region. In Professional Issues scales, only the scale perception of burden related with upsetting behaviors revealed significant differences between regions in all specialties. Conclusion: the findings suggest the need for increased investment by hospital leaders to promote a geriatric nursing practice environment that supports the specialized needs of hospitalized older adults