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Care Residents (care + resident)
Kinds of Care Residents Selected AbstractsPrevalence of psychotropic drug use in nursing homes for the aged in Quebec and in the French-speaking area of SwitzerlandINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2005Micheline Gobert Abstract Background The use of psychotropic drugs is high in institutionalised elderly, which raises the question of its appropriateness. This study aimed to: (1) estimate the use of psychotropics, for each family, in terms of the prevalence and dosage among the elderly in nursing homes in French-speaking Switzerland and Quebec; and (2) assess, for each family of psychotropic drugs and for each care facility, the prevalence of use and departure from average prescription (ratio of observed-to-expected prevalence). Method An administrative database was used for this cross-sectional analysis. The sample included 8183 Quebec and 7592 Swiss long-term care residents. Three classes of psychotropics (antipsychotics, antidepressants, hypnotics-anxiolytics) were defined as dichotomous variables. Logistic regressions were conducted to identify residents characteristics associated with the use of each psychotropic type and to compute expected prevalence. Results Swiss residents were slightly older and less dependent than Quebec residents. Use of psychotropic drugs was higher in Swiss than in Quebec residents, on the whole as well as for each family of drug. A total of 78.1% of Swiss residents used at least one drug as compared to 66.9% in Quebec. Ninety percent of residents were given less than 7 defined daily doses per week, irrespective of the drug family. According to Beer's criteria, only 4.9% of prescriptions were inadequate. In Quebec and in Switzerland, the prevalence of antidepressant use was associated with the prevalence of hypnotic-anxiolytic use. No ratios of observed-to-expected reached statistical significance. Interpretation There was a considerable use of psychotropics in Quebec and Switzerland with, seemingly, no dramatic departure from the average practice. Our data cannot tell if there is a global overuse of psychotropics, but indicated that dosage and medication selection seem adequate. Physicians should critically reassess the necessity of prescribed medications for their patients. Copyright © 2005 John Wiley & Sons, Ltd. [source] Six-month mortality risks in long-term care residents with chronic ulcersINTERNATIONAL WOUND JOURNAL, Issue 5 2008Paul Y Takahashi Abstract Chronic ulcers are a common problem in long-term care. Residents with ongoing ulcers are often frail and at risk for mortality. This study evaluated the relationship between wound characteristics and other health predictors with 6-month mortality in nursing home residents. The subjects included were nursing home residents seen by the wound consult service from 1998 to 2007 with an ongoing chronic ulcer. This was a retrospective cohort study. Data were manually and electronically abstracted for each resident. Six-month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Four hundred and forty residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6-month mortality with an odds ratio of 1·32 (95% CI 1·07,1·63). Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1·75. Higher haemoglobin and venous insufficiency were protective of 6-month mortality. Ulcer number is an important predictor for 6-month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions. [source] A Multifaceted Intervention to Implement Guidelines Improved Treatment of Nursing Home,Acquired Pneumonia in a State Veterans HomeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2006Evelyn Hutt MD OBJECTIVES: To assess the feasibility of a multifaceted strategy to translate evidence-based guidelines for treating nursing home,acquired pneumonia (NHAP) into practice using a small intervention trial. DESIGN: Pre-posttest with untreated control group. SETTING: Two Colorado State Veterans Homes (SVHs) during two influenza seasons. PARTICIPANTS: Eighty-six residents with two or more signs of lower respiratory tract infection. INTERVENTION: Multifaceted, including a formative phase to modify the intervention, institutional-level change emphasizing immunization, and availability of appropriate antibiotics; interactive educational sessions for nurses; and academic detailing. MEASUREMENTS: Subjects' SVH medical records were reviewed for guideline compliance retrospectively for the influenza season before the intervention and prospectively during the intervention. Bivariate comparisons-of-care processes between the intervention and control facility before and after the intervention were made using the Fischer exact test. RESULTS: At the intervention facility, compliance with five of the guidelines improved: influenza vaccination, timely physician response to illness onset, x-ray for patients not being hospitalized, use of appropriate antibiotics, and timely antibiotic initiation for unstable patients. Chest x-ray and appropriate and timely antibiotics were significantly better at the intervention than at the control facility during the intervention year but not during the control year. CONCLUSION: Multifaceted, evidence-based, NHAP guideline implementation improved care processes in a SVH. Guideline implementation should be studied in a national sample of nursing homes to determine whether it improves quality of life and functional outcomes of this debilitating illness for long-term care residents. [source] Multidimensional Attitudes of Medical Residents and Geriatrics Fellows Toward Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2005Ming Lee PhD Objectives: To examine dimensions of a validated instrument measuring geriatric attitudes of primary care residents and performances on these dimensions between residents and fellows. Design: Cross-sectional and longitudinal studies. Setting: An academic medical center. Participants: Two hundred thirty-eight primary care residents (n=177) and geriatrics fellows (n=61) participated in the study from 1995 to 2000. Measurements: A 14-item, 5-point Likert scale previously validated for measuring primary care residents' attitudes toward older people and geriatric patient care was used. Results: Factor analysis showed four dimensions of the scale, labeled Social Value, Medical Care (MC), Compassion (CP), and Resource Distribution, which demonstrated acceptable reliability. Both groups of subjects showed significantly (P<.001) positive (mean>3) attitudes across the dimensions and times, except for residents, who had near-neutral (mean=3) attitudes on MC. Residents' mean attitude scores on the overall scale and the MC and CP subscales were significantly (P<.001) lower than those of fellows over time. Residents and fellows showed different change patterns in attitudes over time. Residents' attitudes generally improved during the first 2 years of training, whereas fellows' attitudes declined slightly. Personal experience was a strong predictor of residents' attitudes toward older patients. Ethnicity, academic specialty, professional experience, and career interest in geriatrics were also associated with residents' attitude scores. Conclusion: The multidimensional analysis of the scale contributes to better understanding of medical trainees' attitudes and sheds light on educational interventions. [source] Nutrition Risk Factors for Survival in the Elderly Living in Canadian Long-Term Care FacilitiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004Johane P. Allard MD Objectives: To determine the role of nutritional parameters in influencing the risk of mortality in institutionalized elderly. Design: A prospective cohort study in which subjects had several nutritional parameters measured at baseline and were followed for 19 months. Time to death and mortality were recorded starting immediately after enrollment. Setting: Fourteen long-term care facilities (LTCFs). Participants: Four hundred eight elderly long-term care residents aged 60 and older who resided in the facility for more than 6 weeks. Measurements: At baseline, knee height, weight, mid-arm circumference (MAC), skin-fold thickness, and fat-free mass using bioelectric impedance analysis were measured. Covariates included demographic factors, length of stay in the facility, functional status, and medical diagnoses. Cox proportional hazards regression analysis was used to identify independent predictors of mortality. Results are reported as mean±standard error of the mean (SEM). Results: Overall, mortality rate was 28.4%. Univariate predictors included male sex, body mass index, MAC, and triceps skin fold. In multivariate analysis, male sex (hazard ratio (HR)=1.7, 95% confidence interval (CI)=1.2,2.7, P=.0096) and MAC less than 26 cm were significantly associated with increased risk of mortality (HR=4.8, 95% CI: 2.8,8.3, P<.0001). Conclusion: Among this elderly population living in LTCFs, MAC is the best nutritional predictor of mortality. [source] A comparison study of career satisfaction and emotional states between primary care and speciality residentsMEDICAL EDUCATION, Issue 1 2006Donald E Girard Objective, To evaluate career satisfaction, emotional states and positive and negative experiences among residents in primary care and speciality programmes in 1 academic medical centre prior to the implementation of the Accreditation Council for Graduate Medical Education's (ACGME) duty hour requirements. Design, Cross-sectional survey. Measurements, All 581 residents in the academic health centre were asked to participate voluntarily in a confidential survey; 327(56%) completed the survey. Results, Compared to their primary care colleagues, speciality residents had higher levels of satisfaction with career choice, feelings of competence and excitement, lower levels of inferiority and fatigue and different perceptions of positive and negative training experiences. However, 77% of all respondents were consistently or generally pleased with their career choices. The most positive residents' experiences related to interpersonal relationships and their educational value; the most negative experiences related to interpersonal relationships and issues perceived to be outside of residents' control. Age and training level, but not gender also influenced career satisfaction, emotional states and positive and negative opinions about residency. Conclusions, Less satisfaction with career choice and more negative emotional states for primary care residents compared to speciality residents probably relate to the training experience and may influence medical students' selections of careers. The primary care residents, compared to speciality residents, appear to have difficulty in fulfilling their ideals of professionalism in an environment where they have no control. These data provide baseline information with which to compare these same factors after the implementation of the ACGME duty hours' and competency requirements. [source] Are Older Workers Less Productive?THE ECONOMIC RECORD, Issue 2010A 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] Sitting position affects participative interaction of immobile aged care residents: A pilot studyAUSTRALASIAN JOURNAL ON AGEING, Issue 1 2009J Lauren Hammer Objectives:,To determine the effect of sitting position (reclined versus upright) on the levels of participative interaction and spontaneous communication of immobile and totally dependent aged care residents. Methods:,Ten frail, immobile and totally dependent female residents older than 85 years were observed in reclined and upright sitting positions. Scores measuring responsiveness to stimuli in the surrounding environment and spontaneous communication initiation were derived from observations (taken morning and afternoon). Results:,There was a significant increase in the responsiveness score in the upright sitting position (P < 0.001) but no effect of sitting position on initiative score. There was no effect of time of day on either responsiveness or initiative score. Conclusions:, An increased level of responsiveness was seen in upright sitting position in immobile and totally dependent aged care residents. The potential for participative interaction with the surrounding environment increases in this position which therefore may improve quality of life. [source] | ||||||||||