Obesity and its associated factors in older nursing home residents in three European countries—Secondary data analyses from the “International Prevalence Measurement of Care Quality”

Background: The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. Objective: Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0–34.9 kg/m2), class II (BMI 35.0–39.9 kg/m2), and class III (BMI >40.0 kg/m2)) amongst older nursing home residents in European countries. Methods: We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the “International Prevalence Measurement of Care Quality”, a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD‐10, and care dependency. Descriptive and logistic regression analyses were performed. Results: Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p = .006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p < .05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p < .05). Conclusions: This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. Implications for practice: The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents

Benchmarking the prevalence of care problems in UK care homes using the LPZ-i: a feasibility study

Background: UK care homes have no mechanism for counting, collating or analyzing prevalence of care problems to benchmark quality of care. This study investigated the feasibility of the International Prevalence Measurement of Quality of Care (LPZ-i) for benchmarking in UK care homes and described facilitators and challenges to implementation. Method: The pressure care and incontinence modules of the LPZ-i were implemented in a purposive sample of UK care homes. Interviews and focus groups with regional co-ordinators, NHS and care home staff who had been involved in implementation. Data were analysed using a framework approach. Results: 26 care homes and 489 residents implemented the LPZ-I modules. 60 pressure ulcers were reported in 41 (8.4%) of residents.325(66% of residents were incontinent of urine, faeces or both. It was demonstrated that it was possible to use prevalence data to benchmark care between UK care homes and against homes overseas. 38 participants took part in focus groups and interviews which revealed the importance of existing relational working with care homes as a basis for implementation. Care homes reported improved identification and management of pressure ulcers and incontinence in response to the audit. However, care home staff could not interpret or analyse data from the audit or use it to drive quality improvement. Conclusion: Implementing the LPZ-i was possible, delivered data appropriate for benchmarking, was well received by care home and NHS staff, and appeared to lead to changes in practice. More widespread implementation of the LPZ-i is feasible, subject to improving the data and quality improvement competencies amongst care home staff

Which factors influence the prevalence of institution‐acquired falls? Results from an international, multi‐center, cross‐sectional survey

Purpose: Falls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution-acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries. Design: This study reports the outcome of a secondary data analysis of cross-sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents. Methods: Descriptive statistics, statistical tests, logistic regression and generalised estimating equation (GEE) models were used to analyse the data. Findings: IAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7·7 %) had the highest IAF prevalence rate for hospitals and Switzerland (15·8 %), for nursing homes. In hospitals, our model revealed that IAF prevalence was associated with country, age, care dependency, number of medical diagnoses, surgery in the last two weeks, and fall history factors. In nursing homes, care dependency, diseases of the nervous system, and fall history were identified as significant risk factors for IAF prevalence. Conclusions: This large-scale study reveals that the most important IAF risk factor is an existing history of falls, independent of the setting. Whether a previous fall has occurred within the last 12 months is a simple question that should be included on every (nursing) assessment at the time of patient or resident admission. Our results guide the development of tailored prevention programs for persons at risk of falling in hospitals and nursing homes

The quality of nutritional care in hospitals: Austria, Switzerland, and Turkey compared

Objective: The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey.Methods: This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed.Results: Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-proteinenriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention.Conclusions: The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies. (C) 2020 Elsevier Inc. All rights reserved

Urinary incontinence prevalence and management in nursing homes in Austria, the Netherlands, Turkey and the United Kingdom:A multi-site, cross-sectional study

OBJECTIVES: The aim of this study is to describe and compare the prevalence rates of urinary incontinence as well as the management of urinary incontinence in the nursing home setting in Austria, the Netherlands, Turkey and the UK.METHODS: This study is a secondary analysis of the 2017 and 2018 data from a multi-site, cross-sectional study which is performed annually in the nursing home setting in Austria, the Netherlands, Turkey and the UK.RESULTS: A total of 23,334 nursing home residents was included in this study, most of whom were female. The urinary incontinence prevalence rates ranged from 13.8% in Turkey to 35.1% in Austria. In all countries, the most frequently used intervention for urinary incontinence management was the use of absorbent products and/or catheters (ranging from 81% in Turkey to 94.5% in Austria). The countries differed with regard to the methods used to assess the type of urinary incontinence, scheduled individual bathroom visits and medication evaluation. In the UK (77.1%), scheduled individual bathroom visits were a more frequent measure than in Austria (51.3%), the Netherlands (24.4%) and Turkey (10.2%).CONCLUSION: The most frequently used nursing intervention in all countries was the use of absorbent products and/or catheters. Future studies on the over- or misuse of these products are warranted. In order to avoid the over- or misuse of these products in the nursing home setting, the use of the evidence- and consensus-based algorithm provided by the Wound, Ostomy and Continence Nurses Society™ is recommended.</p

Benchmarking the prevalence of care problems in UK care homes using the LPZ-i: a feasibility study

Background: UK care homes have no mechanism for counting, collating or analyzing prevalence of care problems to benchmark quality of care. This study investigated the feasibility of the International Prevalence Measurement of Quality of Care (LPZ-i) for benchmarking in UK care homes and described facilitators and challenges to implementation. Method: The pressure care and incontinence modules of the LPZ-i were implemented in a purposive sample of UK care homes. Interviews and focus groups with regional co-ordinators, NHS and care home staff who had been involved in implementation. Data were analysed using a framework approach. Results: 26 care homes and 489 residents implemented the LPZ-I modules. 60 pressure ulcers were reported in 41 (8.4%) of residents.325(66% of residents were incontinent of urine, faeces or both. It was demonstrated that it was possible to use prevalence data to benchmark care between UK care homes and against homes overseas. 38 participants took part in focus groups and interviews which revealed the importance of existing relational working with care homes as a basis for implementation. Care homes reported improved identification and management of pressure ulcers and incontinence in response to the audit. However, care home staff could not interpret or analyse data from the audit or use it to drive quality improvement. Conclusion: Implementing the LPZ-i was possible, delivered data appropriate for benchmarking, was well received by care home and NHS staff, and appeared to lead to changes in practice. More widespread implementation of the LPZ-i is feasible, subject to improving the data and quality improvement competencies amongst care home staff