Care Homes (care + home)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Homes

  • aged care home
  • residential care home

  • Terms modified by Care Homes

  • care home resident

  • Selected Abstracts


    Delivering ,Gold Standards' in end-of-life care in care homes: a question of teamwork?

    JOURNAL OF CLINICAL NURSING, Issue 12 2009
    Alistair Hewison
    Aim., This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end-of-life care into care homes in England. Background., The Gold Standards Framework was developed in primary care to improve the care provided for people at the end-of-life. Following its successful introduction to this setting it was adapted and implemented in care homes. Design., A case study approach was appropriate for this study of a care programme into a ,real life' setting. Method., Fourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used. Results., It was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established. Conclusion., Effective teamwork was necessary for changes in end-of-life care to be achieved in the care homes. If end-of-life care and other improvements in practice are to continue, teamwork will need to be supported and developed. Relevance to clinical practice., Effective teamwork appears to be a pre-requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first. [source]


    The feasibility of developing a standards rating system for all Australian government aged care homes

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2008
    FRCNA, Susan Koch BA (Ed Studies)
    Aims and objectives., The main objective of this project was to investigate the likelihood of creating an easily understood rating system for all aged care homes. A secondary objective was to canvas the feasibility of alternative systems that could better inform aged care consumers. Background., Standards rating systems are used internationally to enable comparisons in healthcare. In Australia, the performance of numerous services and products are measured according to the star system of ratings, yet despite their widespread use, star ratings remain absent from the healthcare industry. Methods., A National Consultative Group (NCG) consisting of key stakeholder representatives was consulted, and a literature review performed on existing standards (or ,star') rating systems. Telephone interviews were conducted with representatives from aged care homes, as well as consumers. Results., A standards rating system for aged care homes was not found to be feasible in the current climate. However, an alternative system that emphasises empowering aged care consumers, such as one that allows consumers to search for an aged care home using their own criteria of preference, was considered more feasible. Conclusion., The need for information to assist consumer choice , limited as it may be , is real. Ways of providing more consumer friendly, useful information need to be further explored and developed. Recommendations are made for future work in this area. [source]


    Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands

    JOURNAL OF ADVANCED NURSING, Issue 12 2009
    Velibor P.J.M. Peters
    Abstract Title.,Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands. Aim., This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. Background., Shiftwork contributes to health problems, decreased well-being and poorer health habits. It also affects employees' decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. Methods., A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. Results., All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics ,job demands' and the home characteristics ,autonomy at home' and ,home demands' were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. Conclusions., Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes. [source]


    The role of community staff in care home placement in Sweden

    JOURNAL OF CLINICAL NURSING, Issue 4 2002
    J. SANDBERG BSc
    ,,The role of community staff in placing a relative in a care home is a relatively unexplored area of practice. ,,Interviews with a variety of community staff in Sweden suggest that they play a significant role in helping family carers, particularly spouses, research the decision about the need for placement. ,,This role can include recognition that placement is required (seeing the need), initiating and sustaining discussions about placement (sowing the seed and nurturing the seed) and legitimating the decision. ,,However, once the decision has been made relatively little attention is given to the emotional consequences of the move and attention is focused largely on instrumental aspects. ,,Despite showing sensitivity in the decision-making phase, community staff could do more to help carers deal with the guilt they experience and to initiate contact with the care home. [source]


    Understanding consumption within a care home: an interpretation of George's experiences of life and death

    JOURNAL OF CONSUMER BEHAVIOUR, Issue 4 2009
    Tim Stone
    We are witnessing perhaps the most important shift in the history of mankind , the rapid ageing of the earth's population. This trend raises such issues as elderly care giving and living arrangements in old age. By virtue, the author suggests that managing service provision for elderly consumers within care homes is going to become an increasingly important issue as more consumers live longer and require care. Moreover, given the paucity of literature related to elderly consumers' understandings of such institutions this research aims to illuminate and distil this issue. Based on interpretive methods the author reveals that elderly consumers such as George actively consume life and death related experiences in order to create a meaningful existence within the context of a care home. Copyright 2009 John Wiley & Sons, Ltd. [source]


    Quality of life of older people in residential care home: a literature review

    JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2009
    Diana TF Lee MSc, PRD (HCE)
    Aim., To integrate the research evidence on quality of life of older people living in a residential care home setting. Background. Residential care is provided for older people who are unable to live in their own home due to various health and social reasons. A number of studies have been published that have focused on diverse quality of life issues of residential care home elders. Consolidating the evidence from these studies may provide insights into enhancing quality of life of this particular group of older people. Design. A literature review of research evidence on quality of life issues among residential care home elders. Method. A systematic search of the literature published between 1994,January 2008 was undertaken to identify research evidence on quality of life of older people living in residential care home. Information about the study design, research objectives, study setting, sample characteristics, and key findings were extracted for comparison and integration. Three aspects about quality of life of the residential care home elders were identified: views of residential care home elders on quality of life, factors affecting quality of life of residential care home elders and methods to improve quality of life in residential care home elders. Results. Eighteen publications were identified. Older people perceived their ability to maintain independence, autonomy and individuality as the most important criteria for determining quality of life. Interventions designed to improve quality of life of older people living in residential facilities corresponded to these criteria. A range of interventions including a walking program, mental stimulation and environmental modification were proposed and evaluated to improve quality of life of residential care home elders. Among these interventions, environmental modification that targeted at improving the residential care homes and quality of services appears to be promising. Conclusion. Quality of life in residential care home elders is a complex issue that may be determined by the elders' independence, individuality and autonomy, and influenced by quality of residential care and facilities. Environmental modification appears to be a way to improve the quality of life of residential care home elders. Relevance to clinical practice. The knowledge of understanding quality of life of residential care home elders provides insights into the implementation of appropriate residential care services. Programs that aim to de-institutionalise the residential care home settings are important to the enhancement of residential care services. [source]


    The (dis)appearance of the dying patient in generalist hospital and care home nurses' talk about the patient

    NURSING PHILOSOPHY, Issue 4 2008
    Kirsten Schou PhD
    Abstract, This article explores interview data from a study of 50 Norwegian generalist nurses' focus group accounts of caring for dying patients in the hospital and care home. An eclectic discourse analytic approach was applied to nurses' accounts of the patient and three discursive contexts of reference to the patient were identified: the ,taken as read' patient, the patient paired with particular characteristics and the patient as psychologically present. Talk about the patient falls mainly into the first two contexts, which position the patient in relation to three closely related discursive processes: individualization, anonymization and objectification. The third context presents the patient as a person with a particular identity. The analysis is discussed in a broader philosophical and sociological context in which we return to some of the theoretical work on death and dying of the 1990s and the topic of sequestration. We suggest that nurses' talk about the patient can be heard to participate in a continuing sequestration of the dying patient in healthcare institutions focused on ,result-oriented' care. [source]


    Relationship between intensity of physical activity and health-related quality of life in Portuguese institutionalized elderly

    GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2008
    Alexandrina Lobo
    Aims: Health-related quality of life (HRQOL) is considered to be the key goal for health promotion in older people. This study explores the relationship between HRQOL and objectively measured intensity of physical activity (PA) in institutionalized older adults. The analysis of the PA patterns of the subjects in relation to recommended levels of PA was also performed. Methods: One hundred and eighty-five residents of long-term care homes aged 65 years or more, volunteered for this study. The Medical Outcome Study Short Form 36-Item health survey (MOS SF-36) questionnaires and the uni-axial MTI Actigraph were used to assess HRQOL and PA, respectively. Participants were classified as less active, reasonably active and more active by tertile of moderated physical activity (MPA). Results: (i) The men represented a greater number of counts/h and min of MPA in all the tertile groups; (ii) men from the less active group had a significantly higher body mass index; (iii) women came third and exhibited less total activity even though they used this time in more intense activities; (iv) there was a higher significant correlation between MPA, physical function and negative association with body pain in relation to the time of institutionalization in both sexes but was more strongly visible in men; and (v) only men presented a significant positive association with physical health, mental health and vitality. Conclusion: Any intensity of PA seems to be better than no activity for HRQOL, but MPA confers greater benefits for the perception of physical function and body pain in the case of institutionalized elderly persons. [source]


    Independent sector mental health care: a 1-day census of private and voluntary sector placements in seven Strategic Health Authority areas in England

    HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2007
    Barbara Hatfield PhD
    Abstract The aims of this study were (i) to map the extent of all mental health placements in the independent sector, for adults of working age, and elderly people (excluding those with a diagnosis of dementia placed in Local Authority care homes), on a census date, across the areas in which the study was commissioned; (ii) to identify the characteristics of the population in placements; (iii) to explore some of the characteristics of the placements and the patterns of use within the private and voluntary sectors; and (iv) to identify the funding source of placements, and cost differences between the private and voluntary sector. The study took place in seven Strategic Health Authority areas, and information was sought from all Primary Care Trust and Social Services commissioners of mental health services, including regional secure commissioning teams, within those areas. A cross-sectional sample was used. Information was requested in relation to every individual meeting the inclusion criteria, placed in independent (private or voluntary) psychiatric hospitals, registered mental nursing homes and care homes on a specified study ,census date' of 28 June 2004 in six of the Strategic Health Authority areas, and 7 October 2004 in the seventh. Information was recorded on a standard questionnaire specifically designed for the study. Information was obtained on 3535 adults and 1623 elderly people in private or voluntary facilities. The largest groups of adults and elderly people had diagnoses of severe mental illnesses (42.1% and 30.5%, respectively), and placements were described as ,continuing care' or rehabilitation, with a ,niche' in specialist forensic care. Around four-fifths of units were in the private sector, which for adults was significantly more expensive than the voluntary sector. A large proportion of units (47.2% of adult placements and 59.3% of placements for elderly people) had only single placements from particular commissioning authorities, whilst others had large numbers, raising issues for effective commissioning. The distance of placements from patients' area of origin, is also an issue highlighted by the study. The study findings are discussed in relation to commissioning practice, and the development of the independent sector in mental health care. [source]


    Shift in the burden of cancer towards older people , a retrospective population-based study

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2007
    S. Ahmad
    Summary Cancer is age-related. However, oncology and palliative medicine services focus on the needs of younger and middle-aged adults. This study examined trends in cancer deaths across age in Wales over the last 20 years. All Wales death certificates from 1981 to 2001 were examined for total and cancer deaths. Place of death and age were noted. Total deaths decreased from 35 015 in 1981 to 32 966 in 2001 while cancer deaths increased from 7369 (21.1% of all deaths) to 8292 (25.2%). Deaths due to cancer increased in the over 85 years from 9.1% to 13.1%, 75,84 years (17.1,25.2%), 65,74 years (25,35.7%), 45,64 years (33.5,40.4%) and fell from 18.3% to 16.1% in those under 44 years. Cancer deaths over 75 years increased from 33.6% of cancer deaths in 1981 to 50.1% in 2001. Cancer deaths in the community decreased from 2713 in 1981 to 2153 in 2001 and increased in hospital from 4398 to 5185 and care homes from 258 to 954. The increase in hospital cancer deaths is mainly because of 75,84 year olds (1207,1840), and the over 85 years (294,740). Half of all cancer deaths are now in those over 75 years. Cancer deaths have shifted from the community to hospital and care homes mainly because of cancer in older people. Services need to be developed to target this population. [source]


    Developing clinical leaders in Australian aged care homes

    INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2006
    Alan Pearson RN PhD FRCNA FAAG FRCN
    Abstract The role of clinical leadership in implementing evidence based practice is increasingly recognised in the health and social care fields. This paper briefly reviews the literature on clinical leadership and evidence-based practice in aged care and describes the established of an aged care clinical fellowship program in Australia. The purpose of this paper is to introduce the reports of four aged care clinical fellows reported elsewhere in this issue of the International Journal of Evidence-Based Healthcare. [source]


    Determinants of antipsychotic medication use among older people living in aged care homes in Australia

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2010
    Prasad S. Nishtala
    Abstract Objective To investigate determinants of antipsychotic medication use among older people living in aged care homes in Australia. Design Retrospective study of a random sample of de-identified medication reports using cross-sectional data gathered between 1 January 2008 and 30 June 2008 in Australia. Subjects The mean (SD) age of the residents was 84.0 (9.0) years. Seventy-five per cent were females. Measures Resident demographics, clinical characteristics, medical diagnoses and prescribed medication were systematically recorded. Logistic regression (LR) models were used to determine predictors for any antipsychotic, atypical and conventional antipsychotic use. Results Twenty-three per cent of the residents were prescribed one or more antipsychotics. In the LR model, factors for predicting the odds ratio and 95% confidence interval (CI) for any antipsychotic medication use were agitation (7.11, 95% CI 3.15,16.03), challenging behaviours (7.47, 95% CI 2.53,22.10), dementia (2.35, 95% CI 1.36,4.06), dementia with mood disorder (0.39, 95% CI 0.16,0.92), paranoia (6.70, 95% CI 1.08,41.55), psychosis (14.79, 95% CI 3.64,60.00) and any psychiatric diagnosis (3.30, 95% CI 1.82,6.00). Use of atypical antipsychotic medication was significant for agitation (4.58, 95% CI 2.05,10.23), aggression (2.25, 95% CI 1.05,4.78), challenging behaviours (8.01, 95% CI 2.76,23.24), dementia (3.64, 95% CI 1.99,6.67), dementia with mood disorder (0.16, 95% CI 0.06,0.43), psychosis (16.51, 95% CI 4.28,63.66) and any psychiatric diagnosis (4.44, 95% CI 2.33,8.46). Conclusions Psychiatric diagnosis, psychosis and dementia were associated with significantly greater odds for the use of antipsychotic medications. Older people suffering from dementia and comorbid mood disorders treated with antidepressants were less likely to be prescribed atypical antipsychotics. Copyright 2009 John Wiley & Sons, Ltd. [source]


    Norms for the mini-mental state examination from a sample of Sri Lankan older people

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2009
    Ranil De Silva
    Abstract Objective To derive norms for the Mini Mental State Examination (MMSE) based on age, gender and level of formal education among the elderly in Sri Lanka. Method A validated Sinhalese version of the MMSE was administered to people aged 55 years and above residing in 14 randomly selected elders' homes. Effects of age, gender and level of formal education on MMSE scores were compared using multiple linear regression analysis. Results A total of 446 subjects [male/female,=,136/320] formed the final sample. Level of education and gender exerted a significant influence on MMSE scores, but not age. The median and 10th percentile scores on the Sinhalese MMSE for the education groups were as follows: education <5 years,=,19 and 12; education >5 years,=,24 and 16, respectively. Conclusion The findings confirm the influence of level of education on MMSE scores among the elderly living in care homes in Sri Lanka, and suggest that education stratified cut-off scores should be used while screening for cognitive impairment in this population. Copyright 2009 John Wiley & Sons, Ltd. [source]


    The needs of older people with dementia in residential care

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2006
    Geraldine A. Hancock
    Abstract Background People with dementia often move into care homes as their needs become too complex or expensive for them to remain in their own homes. Little is known about how well their needs are met within care homes. Method The aim of this study was to identify the unmet needs of people with dementia in care and the characteristics associated with high levels of needs. Two hundred and thirty-eight people with dementia were recruited from residential care homes nationally. Needs were identified using the Camberwell Assessment of Needs for the Elderly (CANE). Results Residents with dementia had a mean of 4.4 (SD 2.6) unmet and 12.1 (SD 2.6) met needs. Environmental and physical health needs were usually met. However, sensory or physical disability (including mobility problems and incontinence) needs, mental health needs, and social needs, such as company and daytime activities, were often unmet. Unmet needs were associated with psychological problems, such as anxiety and depression, but not with severity of dementia or level of dependency. Conclusion Mental health services and residential home staff need to be aware that many needs remain unmet and much can be done to improve the quality of life of the residents with dementia. Copyright 2005 John Wiley & Sons, Ltd. [source]


    Guest Editorial: Privacy and dignity in residential care homes: cross-cultural issues

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2010
    Diana T.F. Lee
    No abstract is available for this article. [source]


    Current situation of German care homes

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 4 2008
    Barbara Klein Dipl-Soz, Dr. Phil
    Aim., The aim of this paper is to explore the situation of and current developments in the German care home sector. Background., Germany, like other Western countries, faces demographic change and subsequently tries to develop structures and processes to achieve a care system which can tackle the increasing number of people in need of care with a variety of quality services. Policy strives to set up structures and instruments to enhance the quality of service provision. Discussion., Figures show that the structures in the care sector are changing in favour to increased privatization of homes, a slight increase in size and improved building structures. In order to tackle the expected changes, a mix of low and high skilled qualification and new job profiles arise in the care sector. Other changes to be observed are the development of new living arrangements and the utilization of new technologies to support the care process. Conclusion., This contribution looks at the socio-demographic changes in care, the statutory developments and the structures of care homes as well as current discussions on future developments. [source]


    Calling for an international dialogue on quality of life in care homes

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 4 2008
    CertEd(FE), Julienne Meyer BSc
    meyer j. & owen t. (2008) International Journal of Older People Nursing 3, 291,294 Calling for an international dialogue on quality of life in care homes [source]


    The feasibility of developing a standards rating system for all Australian government aged care homes

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2008
    FRCNA, Susan Koch BA (Ed Studies)
    Aims and objectives., The main objective of this project was to investigate the likelihood of creating an easily understood rating system for all aged care homes. A secondary objective was to canvas the feasibility of alternative systems that could better inform aged care consumers. Background., Standards rating systems are used internationally to enable comparisons in healthcare. In Australia, the performance of numerous services and products are measured according to the star system of ratings, yet despite their widespread use, star ratings remain absent from the healthcare industry. Methods., A National Consultative Group (NCG) consisting of key stakeholder representatives was consulted, and a literature review performed on existing standards (or ,star') rating systems. Telephone interviews were conducted with representatives from aged care homes, as well as consumers. Results., A standards rating system for aged care homes was not found to be feasible in the current climate. However, an alternative system that emphasises empowering aged care consumers, such as one that allows consumers to search for an aged care home using their own criteria of preference, was considered more feasible. Conclusion., The need for information to assist consumer choice , limited as it may be , is real. Ways of providing more consumer friendly, useful information need to be further explored and developed. Recommendations are made for future work in this area. [source]


    Clinical medication review by a pharmacist of elderly people living in care homes: pharmacist interventions

    INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2007
    David P Alldred research clinical pharmacist
    Objectives To describe the rate and nature of pharmacist interventions following clinical medication review of elderly people living in care homes. Setting Care home residents aged 65+ years, prescribed at least one repeat medication, living in nursing, residential and mixed care homes for older people in Leeds, UK. Method Analysis of data from care home residents receiving clinical medication review in the intervention arm of a randomised controlled trial. Intervention outcomes for each medicine were evaluated for each resident. Key findings Three-hundred and thirty-one residents were randomised to receive a clinical medication review and 315 (95%) were reviewed by the study pharmacist; 256 (77%) residents had at least one recommendation made to the general practitioner. For the 2280 medicines prescribed, there were 672 medicine-related interventions: medicines for cardiovascular system (167 (25%)), nutrition and blood (121 (18%)), central nervous system (113 (17%)) and gastrointestinal conditions (86 (13%)) accounted for 487 (73%) of medicine-related interventions. There were 75 non-medicine-related interventions. The most common interventions were ,technical' (225 (30%)), ,test to monitor medicine' (161 (22%)), ,stop drug' (100 (13%)), ,test to monitor conditions' (75 (10%)), ,start drug' (76 (10%)), ,alter dose' (40 (5%)) and ,switch drug' (37 (5%)). Recommendations to stop a medicine were most common for CNS drugs (32 (32%)). The most common medicine to be recommended to be started was calcium and vitamin D (45 (59%)). Following a recommendation to test to monitor a medicine, 23 (14%) medicines required a change. Conclusions This study has demonstrated that clinical medication review by a pharmacist can identify medicine problems in approximately 80% of care home residents, requiring intervention in 1 in 4 of their prescribed medications. [source]


    An assessment of pharmaceutical inspection reports from nursing and residential homes for the elderly in Northern Ireland

    INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2004
    Anna K. Schweizer Phd student
    Objectives To highlight issues currently being inspected in nursing, residential and dual-registered homes (care homes) for the elderly in Northern Ireland as part of a pharmaceutical inspection. Methods A cross-sectional survey and analysis of reports from pharmaceutical inspections in Northern Ireland care homes between January 1999 and December 2000 was undertaken, using reports provided by the four Registration and Inspection Units (R & I Units 1,4) within the region. Reports were reviewed and all recommendations made by inspectors were classified into 11 main categories. Binary logistic regression was used to examine possible relationships between the type of home (nursing, residential or dual-registered) or the R & I unit and the recommendations made by the inspectors, with corresponding odds ratios and 95% confidence intervals. Key findings Reports from 415 homes (one report per home) formed the final sample for analysis. Each R & I unit used different documentation to conduct a pharmaceutical inspection. Homes received the majority of recommendations from inspectors in the categories ,Records' (66.7% of all homes), ,Policies and protocols' (39.3%) and ,Medication' (31.8%). More recommendations in a number of categories emanated from R & I unit 4 compared with R & I unit 1 (referent). Dual-registered homes (those registered as a nursing and residential facility) were more likely to receive a recommendation in the categories ,Storage of medicine', ,Order and receipt of medication' and ,Equipment' than nursing or residential homes. Conclusion Inspections of care homes should be standardised in terms of documentation used and facilities should be given guidance on issues that are likely to result in recommendations from inspectors. In the longer-term, pharmaceutical inspections should move from a focus on structure/process measures to those that emphasise quality in prescribing. [source]


    Flu: Effect of Vaccine in Elderly Care Home Residents: A Randomized Trial

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007
    Fiona Gaughran MD
    OBJECTIVES: To determine whether assessing seroprotection after influenza vaccine and administering booster vaccination where not achieved reduces hospitalization and death. To estimate the overall seroprotection rate of influenza vaccine. DESIGN: A two-arm, partially blind, randomized, multicenter, parallel-group, controlled trial. SETTING: Twenty-six care homes in three South London boroughs in fall 2004. PARTICIPANTS: Two hundred seventy-seven elderly permanent care home residents meeting eligibility criteria. INTERVENTION: Postvaccination blood samples were randomized to booster evaluation or no booster evaluation (control). If evaluation revealed inadequate seroprotection, a booster vaccine was administered. MEASUREMENTS: Primary outcome was hospitalization to end April 2005; secondary outcomes were death, antibiotic use, and seroprotection. RESULTS: Sixty percent of the controls and 41% of the booster evaluation group responded to routine vaccination. Booster vaccination where indicated increased seroprotection rates in the booster evaluation group to 66%. Treatment groups did not differ in any outcome measures in the intention-to-treat analysis (hospitalization odds ratio=1.02, 95% confidence interval=0.55,1.87). There was a tendency towards greater differences between groups in the per-protocol analysis than in the intention-to-treat analysis, particularly regarding seroprotection rates. The same effect was observed in the a priori exploratory analysis of residents not seroprotected after routine vaccination alone. CONCLUSION: In a year without circulating influenza, there is no clinical benefit of administering a booster vaccine if routine trivalent vaccination fails to result in seroprotection. Hemagglutination titers rose in two strains postbooster vaccination but fell against the novel strain, Wyoming. The benefit of such a booster strategy when influenza is prevalent thus remains unc ertain. [source]


    Care Standards in Homes for People with Intellectual Disabilities

    JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2008
    Julie Beadle-Brown
    Background, National minimum standards for residential care homes were introduced following the Care Standards Act 2000 in response to concern about the lack of consistency and poor quality services. These standards are intended to reflect outcomes for service users and to be comprehensive in scope. Method, This study compared ratings made by care standards inspectors with research measures for 52 homes for people with intellectual disabilities serving 299 people. The research measures focused on the lived experience of residential care, including engagement in meaningful activity, choice and participation in activities of daily living. They also included measures of related care practices and organizational arrangements. Results, The research measures were in general significantly correlated with each other. Most of the care standards ratings were also correlated with each other. However, only two of 108 correlations between care standards and research measures were significant. Possible reasons for this are discussed. Conclusions, This study confirms that the review of national minimum standards and modernization of inspection methods recently announced by the Department of Health and the Commission for Social Care Inspection are timely and appropriate. [source]


    Response to Ingleton C & Froggatt K (2009) Commentary on Hewison A, Badger F, Clifford C & Thomas K (2009) Delivering ,Gold Standards' in end-of-life care in care homes: a question of teamwork?

    JOURNAL OF CLINICAL NURSING, Issue 22 2009
    1765 in Journal of Clinical Nursing 1, Journal of Clinical Nursing 1
    [source]


    Delivering ,Gold Standards' in end-of-life care in care homes: a question of teamwork?

    JOURNAL OF CLINICAL NURSING, Issue 12 2009
    Alistair Hewison
    Aim., This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end-of-life care into care homes in England. Background., The Gold Standards Framework was developed in primary care to improve the care provided for people at the end-of-life. Following its successful introduction to this setting it was adapted and implemented in care homes. Design., A case study approach was appropriate for this study of a care programme into a ,real life' setting. Method., Fourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used. Results., It was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established. Conclusion., Effective teamwork was necessary for changes in end-of-life care to be achieved in the care homes. If end-of-life care and other improvements in practice are to continue, teamwork will need to be supported and developed. Relevance to clinical practice., Effective teamwork appears to be a pre-requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first. [source]


    Understanding consumption within a care home: an interpretation of George's experiences of life and death

    JOURNAL OF CONSUMER BEHAVIOUR, Issue 4 2009
    Tim Stone
    We are witnessing perhaps the most important shift in the history of mankind , the rapid ageing of the earth's population. This trend raises such issues as elderly care giving and living arrangements in old age. By virtue, the author suggests that managing service provision for elderly consumers within care homes is going to become an increasingly important issue as more consumers live longer and require care. Moreover, given the paucity of literature related to elderly consumers' understandings of such institutions this research aims to illuminate and distil this issue. Based on interpretive methods the author reveals that elderly consumers such as George actively consume life and death related experiences in order to create a meaningful existence within the context of a care home. Copyright 2009 John Wiley & Sons, Ltd. [source]


    Quality of life of older people in residential care home: a literature review

    JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2009
    Diana TF Lee MSc, PRD (HCE)
    Aim., To integrate the research evidence on quality of life of older people living in a residential care home setting. Background. Residential care is provided for older people who are unable to live in their own home due to various health and social reasons. A number of studies have been published that have focused on diverse quality of life issues of residential care home elders. Consolidating the evidence from these studies may provide insights into enhancing quality of life of this particular group of older people. Design. A literature review of research evidence on quality of life issues among residential care home elders. Method. A systematic search of the literature published between 1994,January 2008 was undertaken to identify research evidence on quality of life of older people living in residential care home. Information about the study design, research objectives, study setting, sample characteristics, and key findings were extracted for comparison and integration. Three aspects about quality of life of the residential care home elders were identified: views of residential care home elders on quality of life, factors affecting quality of life of residential care home elders and methods to improve quality of life in residential care home elders. Results. Eighteen publications were identified. Older people perceived their ability to maintain independence, autonomy and individuality as the most important criteria for determining quality of life. Interventions designed to improve quality of life of older people living in residential facilities corresponded to these criteria. A range of interventions including a walking program, mental stimulation and environmental modification were proposed and evaluated to improve quality of life of residential care home elders. Among these interventions, environmental modification that targeted at improving the residential care homes and quality of services appears to be promising. Conclusion. Quality of life in residential care home elders is a complex issue that may be determined by the elders' independence, individuality and autonomy, and influenced by quality of residential care and facilities. Environmental modification appears to be a way to improve the quality of life of residential care home elders. Relevance to clinical practice. The knowledge of understanding quality of life of residential care home elders provides insights into the implementation of appropriate residential care services. Programs that aim to de-institutionalise the residential care home settings are important to the enhancement of residential care services. [source]


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    PRESCRIBER, Issue 8 2007
    Article first published online: 23 JUL 200
    Lamotrigine for partial, valproate for generalised A large UK trial has shown that lamotrigine is the most effective choice in the treatment of partial epilepsy (Lancet 2007;369: 1000-15). The SANAD trial, commissioned by the National Institute for Health Research's Health Technology Assessment programme, randomised 1721 patients (for whom carbamazepine monotherapy would have been the treatment of choice) to treatment with carbamazepine, gabapentin, lamotrigine, oxcarbazepine (Trileptal) or topiramate (Topamax). Lamotrigine was associated with a longer time to treatment failure, though time to 12-month remission favoured carbamazepine. Over four years' follow-up, lamotrigine was numerically but not significantly superior. The authors concluded lamotrigine is clinically superior to carbamazepine for partial epilepsy A second arm of the trial, yet to be published, evaluated the treatment of generalised epilepsy and found valproate to be clinically most effective, though topiramate was cost effective for some patients. Chronic pain common in nursing homes Most residents in nursing homes say they have long- term pain but only one in seven say a health professional has ever discussed its treatment with them, according to a report by the Patients' Association (www.patients-association.org.uk). Pain in Older People ,A Hidden Problem was a qualitative study of 77 older residents in care homes in England. Most were frail and suffered long-term illness. The study found that 85 per cent of residents said they were often troubled by aches or pains and these lasted over a year in 74 per cent. Most described their pain as moderate (33 per cent) or severe (38 per cent) but 8 per cent said it was excruciating. Many reported limitations on mobility and social activities despite a high level of stoicism. All but one were taking medication to relive pain; one-third experienced adverse effects but 78 per cent believed drugs offered the most effective treatment. One-quarter said a doctor or nurse had discussed how to stop their pain worsening, and 15 per cent said they had discussed how to treat their pain. Visits from GPs appeared to be uncommon. Atherothrombotic events despite treatment Between one in five and one in seven of high-risk patients experience atherothrombotic events despite evidence-based treatment, the REACH study has shown (J Am Med Assoc 2007;297:1197-1206). REACH (REduction of Atherothrombosis for Continued Health) is an international observational study involving 68 236 patients with atherothrombotic disease or at least three risk factors. Most were taking conventional evidence-based medication. After one year, the incidence of the combined endpoint of cardiovascular death, myocardial infarction, stroke or hospitalisation for atherothrombotic events was approximately 15 per cent for patients with coronary artery disease or cardiovascular disease, and 21 per cent in patients with peripheral artery disease and established coronary disease. Event rates increased with the number of vascular beds affected, rising to 26 per cent in patients with three symptomatic arterial disease locations. Extended CD prescribing by nurses and pharmacists The Medicines and Healthcare products Regulatory Agency (MHRA) is consulting on expanding the prescribing of controlled drugs (CDs) by nonmedical prescribers. Currently, nurse independent prescribers can prescribe 12 CDs, including diamorphine and morphine, but pharmacist independent prescribers may not prescribe any CDs. The proposal is to allow both professions to prescribe any CDs within their competence, with the exception of cocaine, diamorphine or dipipanone for the management of addiction. The closing date for consultation is 15 June. Consultation is also underway on expanding the range of CDs nurses and pharmacists can prescribe under a patient group direction (PGD), and their use for pain relief. The closing date for consultation is 20 April. Intrinsa: transdermal testosterone for women A transdermal formulation of testosterone has been introduced for the treatment of low sexual desire associated with distress in women who have experienced an early menopause following hysterectomy involving a bilateral oophorectomy and are receiving concomitant oestrogen therapy. Manufacturer Procter & Gamble says that Intrinsa, a twice-weekly patch, delivers testosterone 300g every 24 hours, achieving premenopausal serum testosterone levels. Clinical trials showed that Intrinsa reduced distress in 65-68 per cent and increased satisfying sexual activity in 51-74 per cent of women. A month's treatment (eight patches) costs 28.00. Fish oil for secondary ,not primary ,prevention of CHD Supplementing statin therapy with eicosapentaenoic acid (EPA) reduces the risk of major coronary events in patients with coronary heart disease (CHD) ,but not in patients with no history of CHD Lancet 2007;369:1090-8). The five-year study in 18 645 patients with total cholesterol levels of 6.5mmol per litre or greater found that the incidence of sudden cardiac death, fatal and nonfatal myocardial infarction in CHD patients treated with EPA plus a statin was 8.7 per cent compared with 10.7 per cent with a statin alone (relative risk reduction 19 per cent). A similar relative risk reduction in patients with no CHD was not statistically significant. There was no difference in mortality between the groups but EPA did reduce unstable angina and nonfatal coronary events. Department pilots information prescriptions The Department of Health has announced 20 sites to pilot information prescriptions prior to a nationwide roll-out in 2008. The prescriptions will guide people with long-term conditions such as diabetes and cancer to sources of support and information about their condition. The Department hopes the project will increase patients' understanding of their discussions with health professionals, empower them to locate the information they need, and provide long-term support. NPSA guidelines for safer prescribing The National Patient Safety Agency (www.npsa.nhs.uk) has published five guidelines to improve medication safety in the NHS. Targeting ,high-risk issues', the guidance covers anticoagulant prescribing, liquid medicines for oral or enteral administration, injectable medicines, epidural injections and infusions, and paediatric intravenous infusions. The implementation of each guide is supported by additional tools and resources. Better adherence not matched to outcomes A systematic review has found that interventions can increase adherence to prescribed medication but there is no evidence that clinical outcomes also improve (Arch Intern Med 2007;167:540-9). The review of 37 trials identified 20 reporting increased adherence. The most effective interventions were behavioural changes to reduce dose demands and those involving monitoring and feedback. Improvements in clinical outcomes were variable and did not correspond to changes in adherence. Antidepressant plus mood stabiliser no better US investigators have found that combining a mood stabiliser with an antidepressant is no more effective than a mood stabiliser alone in preventing mood changes (N Engl J Med 2007; published online 28 March, doi.10.1056/NEJMoa064135). The study found durable recovery occurred in 23.5 per cent of patients treated with a mood stabiliser and adjunctive antidepressant therapy for six months compared with 27.3 per cent of those taking a mood stabiliser plus placebo. [source]


    Are Older Workers Less Productive?

    THE ECONOMIC RECORD, Issue 2010
    A Case Study of Aged Care Workers in Australia
    Employers are reluctant to employ older workers. Is this because they are less productive than equivalent younger workers? This paper uses data from a 2007 census of residential aged care homes in Australia to examine the productivity differentials of workers at different ages. We estimate production functions that take into account the age profile of the workforce in each aged care residential facility. We find that for the facilities having high care residents only, the productivity of nurses, whose work is more demanding of specialist knowledge, keeps increasing with age while the rate of increase declines after age 50. In contrast, the productivity of carers, whose work is more demanding of physical capacity, is highest in middle age. The facilities with low care residents only provide a much lower level of services because their residents are less frail and more independent. In this case, none of the coefficients regarding the impacts of age on productivity is statistically significant , suggesting that older workers are good substitutes for younger ones. [source]


    Child Care in Poor Communities: Early Learning Effects of Type, Quality, and Stability

    CHILD DEVELOPMENT, Issue 1 2004
    Susanna Loeb
    Young children in poor communities are spending more hours in nonparental care because of policy reforms and expansion of early childhood programs. Studies show positive effects of high-quality center-based care on children's cognitive growth. Yet, little is known about the effects of center care typically available in poor communities or the effects of home-based care. Using a sample of children who were between 12 and 42 months when their mothers entered welfare-to-work programs, this paper finds positive cognitive effects for children in center care. Children also display stronger cognitive growth when caregivers are more sensitive and responsive, and stronger social development when providers have education beyond high school. Children in family child care homes show more behavioral problems but no cognitive differences. [source]