Identifying longitudinal sustainable hierarchies in activities of daily living

© 2017 Elsevier B.V. Activities of daily living serve as an indicator of progression in disability and rehabilitation. It is know that some of the measurement scales used show hierarchical properties indicating that activities of daily living are lost and gained in a consistent pattern. Few studies have investigated the extent to which these patterns are sustained across time and across a range of disability. The study aimed to investigate the hierarchical properties of the activity of daily living items in the ValGraf functional ability scale, to establish if there is a hierarchy of items in the scale and to study the sustainability of the hierarchy over time. Secondary analysis of a retrospective database from 13,113 people over 65 years in 105 nursing homes in northern Italy, between 2008 and 2013 was conducted. Data were gathered 6-monthly and analysed using Mokken scaling to identify a hierarchy of items in the scale and if this was sustainable over time. A sustainable hierarchy of items was observed running in difficulty from urinary incontinence to feeding. The hierarchical structure of the activities of daily living observed in the present study is stable over time meaning that changes in total score for these items can be compared meaningfully across time

High feeding dependence prevalence in residents living in Italian nursing homes requires new policies: findings from a regionally based cross-sectional study

Objectives: An increased amount of functional dependence has been reported among residents living in nursing homes. Among others, feeding dependence is one of the most complex needs to satisfy: behind the attempt to personalise meals with individual preferences and clinical regimens, all residents require help at the same moment and for long periods of time, three or more times a day. With the intent of debating policy implications, the aims of this study were to advance the knowledge in the field of feeding dependence prevalence and predictors in Italy, a country where life expectancy is among the highest in the World.Method: A large retrospective regionally-based study approaching all nursing homes (n=105) was performed in 2014; all residents (n=10,900) were eligible and those with a completed assessment recorded in the regional database and aged > 65 years (n=8,875) were included. Results: 1,839 residents (20.7%) were in total need of help in feeding on a daily basis. At the multilevel analysis, predictors were moderate/severe dementia (OR 4.044, CI 95% 3.213–5.090); dysphagia (OR 4.003 CI 95% 3.155–5.079); pressure sores (OR 2.317 CI 95% 1.803–2.978); unintentional weigh loss (OR 2.197 CI 95% 1.493–3.233); unsociability (OR 1.561 CI 95% 1.060–2.299); and clinical instability (OR 1.363 CI 95% 1.109–1.677). Conclusions: The feeding dependence prevalence emerged seem to be unique compared to that documented at the international levels. Modifiable and unmodifiable predictors found require new policies regarding workforce skills-mix and shifts schedules; as well as alliances with families, associations and communities’ stakeholders. According to the complexity of the resident profile emerged, staff education and training is also recommended

Daily crying prevalence and associated factors in older adult persons living in nursing homes: findings from a regional study

Objectives: The study aims to evaluate the prevalence of nursing home (NH) resident crying and associated factors at the individual and NH levels. Design: A regional retrospective study design has been used. Participants and setting: A total of 8875 residents, living in 105 NHs, were included. Measurements: The occurrence of an episode of crying on at least a daily basis in the last month was the dependent variable; independent variables were set at individual and at the NH levels as reported in the Val.Graf regional database. Results: A total of 1,443 (16.3%) residents reported daily episodes of crying over the last month. Several individual variables were significantly associated with crying; female gender (odds ratio [OR] 2.535, 95% confidence interval [CI] 2.069\ue2\u80\u933.107); sad, pained or worried facial expressions (OR 1.885, 95% CI 1.785\ue2\u80\u932.021); negative thoughts (OR 1.650, 95% CI 1.508\ue2\u80\u931.804); unrealistic fears (OR 1.410, 95% CI 1.295\ue2\u80\u931.534); anger with self or others (OR 1.141, 95% CI 1.043\ue2\u80\u931.248); repetitive anxious complaints/concerns (OR 1.136, 95% CI 1.045\ue2\u80\u931.235); clinical instability (OR 1.186, 95% CI 1.018\ue2\u80\u931.381); pain (OR 1.183, 95% CI 1.058\ue2\u80\u931.323); night restlessness (OR 1.180, 95% CI 1.100\ue2\u80\u931.267); communication problems (OR 1.169, 95% CI 1.051\ue2\u80\u931.300); and cognitive impairment (OR 1.086, 95% CI 1.019\ue2\u80\u931.156); all increased the likelihood of crying. Conversely, sociability (OR 0.866, 95% CI 0.805\ue2\u80\u930.932) and being involved in social based activities (OR 0.882, 95% CI 0.811\ue2\u80\u930.960) were protective against crying. However, the previously mentioned variables have explained only 35.9% of variance in daily crying. Conclusions: Around one out of six residents living in NH cries on a daily basis, and the reasons are also at the individual level. Residents seem to cry for attachment and clinical needs and to express stress and unhappiness; more research is needed, aiming at discovering other factors associated with resident's daily crying. Copyright \uc2\ua9 2017 John Wiley & Sons, Ltd

Inactive residents living in nursing homes and associated predictors: findings from an Italian regional-based retrospective study

Objectives: It has been amply reported that nursing home (NH) residents are largely inactive, a condition that may further increase functional decline, behavioral disorders, and risk of death. To date, studies have mainly focused on individual characteristics that may decrease residents\u2019 involvement in activities. Therefore, the aim of this study is to describe the prevalence of inactive NH residents in an Italian context, identifying predictors of inactivity at the individual and NH levels. Design: Retrospective regional-based study performed in 2014. Setting: All NHs (n \ubc 105) located in the Friuli Venezia Giulia Region, northeastern region of Italy. Participants: A total of 8875 residents with at least 1 nursing assessment and living in an NH for at least 1 year. Measurements: The dependent variable was inactivity in the last week, defined as the resident not being involved in any socially or individually based, or meaningful recreational (eg, gardening) activities. The independent variables were set at individual and NH levels. Aiming at identifying predictors of inactivity, a hierarchical generalized linear (mixed-effects) model incorporating both fixed-effect parameters and random effects, was performed. Results: A total of 4042 (45.6%) residents were inactive during the week before the evaluation. At the resident level, those with severe cognitive impairment [odds (OR) 4.462, 95% confidence interval (CI) 3.880e5.132], unsociable behavior (OR 2.961, 95% CI 2.522e3.473), night restlessness (OR 1.605, 95% CI 1.395e1.853), lack of cooperation in daily care (OR 1.408, 95% CI 1.199e1.643), pressure sores (OR 1.314, 95% CI 1.065e1.622), depressive disorders (OR 1.242, 95% CI 1.089e1.416), and clinical instability (OR 1.110, 95% CI 1.037-1.188) reported an increased risk of being inactive. At the NH level, for each additional hour of care offered by professional educators, there was 1% less likelihood of inactive residents (OR .964, 95% .933-.996). Conclusions: Approximately one-half of the residents in this study living in Italian NHs are inactive. Inactivity is significantly associated with the presence of severe cognitive impairment, behavioral disorders (eg, unsociability, night restlessness, and lack of cooperation in daily care), pressure sores, depressive symptoms, and clinical instability. Moreover, receiving care from professional educators whose aim in their training program and professional mission is to improve individual and social engagement, decreased the likelihood of resident inactivity

Description and validation of a geriatric multidimensional graphical instrument for promoting longitudinal evaluation

The debate about the adoption of standard multidimensional geriatric assessment instruments is mainly due to the lack of consensus on the feasibility and requirements for such instruments by both the health and the social care professions. A tool called ValGraf was developed in the attempt to give an original answer to these and other controversial issues. The aim of this study was to evaluate the ValGraf for acceptability, concurrent validity and factorial structure. The functional and cognitive impairments as ascertained by the ValGraf were compared with Katz index and Folstein\u2019s Mini Mental State Examination (MMSE). Subjects (N = 210) of four nursing homes were assessed by two independent teams of nurses. The factorial validity study involved 8280 subjects living in nursing homes. Assessments were conducted throughout the 2001 by 20 geriatricians. The agreement between the ValGraf sections concerning independence in daily living and Katz\u2019s index was almost total (r = 0.96) and that between ValGraf items on cognition andMMSE was very good (0.73). Factor analysis revealed that 13 coherent factors explained 53% of total variance. ValGraf was proved to be acceptable and comprehensive, criterion valid, at least as daily activities and cognitive status are concerned, and to have a coherent factorial structure