Factors that Influence Sleep among Residents in Long-Term Care Facilities.
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ABSTRACT:
SUBMITTER: Kim DE
PROVIDER: S-EPMC7142890 | biostudies-literature | 2020 Mar
REPOSITORIES: biostudies-literature
Publications
Factors that Influence Sleep among Residents in Long-Term Care Facilities.
Kim Da Eun DE Yoon Ju Young JY
International journal of environmental research and public health 20200314 6
Long-term care residents often experience sleep disturbances as they are vulnerable to a variety of physical, psychosocial, and environmental factors that contribute to sleep disturbances. However, few studies have examined the combined impact of multiple factors on sleep among long-term care residents. This study aimed to identify the factors that influence sleep efficiency and sleep quality based on a modified senescent sleep model. A total of 125 residents were recruited from seven long-term ...[more]
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Project description:BACKGROUND:Antimicrobial resistance (AMR) is a major public health problem. Elderly residents in long-term-care facilities (LTCFs) are frequently prescribed antibiotics, particularly for urinary tract infections. Optimizing appropriate antibiotic use in this vulnerable population requires close collaboration between NHS healthcare providers and LTCF providers. OBJECTIVES:Our aim was to identify and quantify antibiotic prescribing in elderly residents in UK LTCFs. This is part of a wider programme of work to understand opportunities for pharmacy teams in the community to support residents and carers. METHODS:This was a retrospective longitudinal cohort study. Data were extracted from a national pharmacy chain database of prescriptions dispensed for elderly residents in UK LTCFs over 12 months (November 2016-October 2017). RESULTS:Data were analysed for 341536 residents in LTCFs across the four UK nations, from which a total of 544796 antibiotic prescriptions were dispensed for 167002 residents. The proportion of residents prescribed at least one antibiotic over the 12 month period varied by LTCF, by month and by country. CONCLUSIONS:Whilst national data sets on antibiotic prescribing are available for hospitals and primary care, this is the first report on antibiotic prescribing for LTCF residents across all four UK nations, and the largest reported data set in this setting. Half of LTCF residents were prescribed at least one antibiotic over the 12 months, suggesting that there is an opportunity to optimize antibiotic use in this vulnerable population to minimize the risk of AMR and treatment failure. Pharmacy teams are well placed to support prudent antibiotic prescribing and improved antimicrobial stewardship in this population.
| S-EPMC6477989 | biostudies-literature
Project description:ObjectivesThe integrated model of frailty shifted the physiologically-dominated view to an integrated and multidisciplinary view of frailty and adopted an integrated and holistic approach to the complex challenges facing frail older adults and their caregivers. There is an urgent need for researchers to identify multi-faceted frailty among older adults and to explore contributors to it. We assessed the level of frailty among older residents in long-term care (LTC) facilities in Shanghai, China and explored risk factors of multiple dimensions of frailty among older residents.MethodsIt is a cross-sectional descriptive study. We interviewed 218 older residents from nine LTC facilities. We used Tilburg Frailty Indicator to assess older residents' physiological, psychological, and social frailty. The Geriatric Depression Scale, Mini-Mental state examination, Athens Insomnia Scale, and Activity of Daily Living (ADL) Scale were used to assess their depressive symptoms, cognitive function, sleep quality and ADL abilities, respectively.ResultsOlder residents have a moderate level of frailty in physiological, psychological and social domains. There is a high correlation among dimensions of frailty. Older residents' depressive symptoms have remained positively associated with their overall and each domain of frailty. Older residents' actual activity participation and exercise in LTC facilities are negatively associated with older residents' overall, physiological and social frailty.ConclusionsFrailty is a multi-dimensional concept and is prevalent among older residents in LTC facilities. It is important to take an integrated view on frailty and carry out appropriate and comprehensive interventions to prevent adverse outcomes and provide holistic care for frail older residents in LTC facilities. There is an urgent need to improve the quality and expand the number of activities offered within LTC facilities that would engage older residents in a person-centered way, despite their age, ADL abilities, frailty and functional limitations.
| S-EPMC8283709 | biostudies-literature
Project description:BackgroundShared decision-making, a communicative process to reach decisions based on informed preferences, evidence, and co-created goals, improves care satisfaction and patients' quality of life. However, shared decision-making has not been widely implemented in long-term care facilities, and few studies have examined how to promote the shared decision-making practice. This study aimed to identify the influencing factors of shared decision-making based on the Person-centered Practice Framework in long-term care facilities.MethodsA total of 300 staff (nursing staff, social workers, and personal care workers) in 13 Korean long-term care facilities participated in this study. Data from 280 respondents were finally analyzed, excluding respondents with missing values. Data were collected using structured questionnaires that included items on shared decision-making, personal factors (e.g., knowledge about dementia, person-centered care education, person-centered attitude, communication behavior, and job tenure), and care environment factors (e.g., person-centered climate, staffing level, effective staff relationships, supportive supervisors, and power-sharing). Multilevel linear regression analyses were performed using Mplus Version 8.8.ResultsThe mean shared decision-making score was 35.78 (range 8-45). Staff with experience of person-centered care education (β = 0.198, p = 0.034), a higher person-centered attitude score (β = 0.201, p = 0.007), and a higher communication behavior score (β = 0.242, p < 0.001) were more likely to report a higher shared decision-making score. In addition, staff who viewed their care environment as more person-centered were more likely to report a higher shared decision-making score (β = 0.416, p < 0.001).ConclusionsThis study highlights that personal (e.g., person-centered care education, person-centered attitude, and communication behavior) and care environment (e.g., person-centered climate) factors could influence shared decision-making for long-term care residents. These findings could be foundational evidence for facilitating shared decision-making practice in long-term care settings.
| S-EPMC10508015 | biostudies-literature
Project description:BackgroundLong term care (LTC) facilities provide health services and assist residents with daily care. At times residents may require transfer to emergency departments (ED), depending on the severity of their change in health status, their goals of care, and the ability of the facility to care for medically unstable residents. However, many transfers from LTC to ED are unnecessary, and expose residents to discontinuity in care and iatrogenic harms. This knowledge translation project aims to implement a standardized LTC-ED care and referral pathway for LTC facilities seeking transfer to ED, which optimizes the use of resources both within the LTC facility and surrounding community.Methods/designWe will use a quasi-experimental randomized stepped-wedge design in the implementation and evaluation of the pathway within the Calgary zone of Alberta Health Services (AHS), Canada. Specifically, the intervention will be implemented in 38 LTC facilities. The intervention will involve a standardized LTC-ED care and referral pathway, along with targeted INTERACT® tools. The implementation strategies will be adapted to the local context of each facility and to address potential implementation barriers identified through a staff completed barriers assessment tool. The evaluation will use a mixed-methods approach. The primary outcome will be any change in the rate of transfers to ED from LTC facilities adjusted by resident-days. Secondary outcomes will include a post-implementation qualitative assessment of the pathway. Comparative cost-analysis will be undertaken from the perspective of publicly funded health care.DiscussionThis study will integrate current resources in the LTC-ED pathway in a manner that will better coordinate and optimize the care for LTC residents experiencing an acute change in health status.
| S-EPMC7685962 | biostudies-literature
Project description:IntroductionElderly residents of nursing homes (NHs) and long-term care units (LTCUs) have been shown to have a high risk of mortality and morbidity in cases of SARS-CoV-2 infection. The objective of this study was to examine the kinetics of neutralizing antibodies (NAbs) directed against the SARS-CoV-2 virus in residents of the NH and LTCU units of our University Hospital who were identified with positive serology after the first epidemic outbreak.Materials and methodsThe participants included were sampled every three months for qualitative serological testing, as well as quantitative testing by neutralization tests using retroviral particles containing the S glycoprotein of SARS-CoV-2. Vaccination using the Comirnaty (Pfizer BNT162b2) vaccine begun before the last serological follow-up.ResultsThe median NAb titer in June 2020 was 80 [40; 60] versus 40 [40; 160] three months later, showing a statistically significant decline (p < 0.007), but remained stable between the three- and six-month timepoints (p = 0.867). By nine months after vaccination, we observed a significant difference between vaccinated residents known to have positive serology before vaccination (SERO+, Vacc+) and those vaccinated without having previously shown COVID-19 seroconversion (SERO-, Vacc+), the latter group showing similar titers to the SERO+, Vacc- participants (p=0.166). The median antibody titer in SERO+, Vacc+ patients increased 15-fold following vaccination.DiscussionHumoral immunity against SARS-CoV-2 appears to be persistent in elderly institutionalized patients, with a good post-vaccination response by residents who had already shown seroconversion but a notably diminished response by those who were seronegative before vaccination. To evaluate immunity in its entirety and elaborate a sound vaccination strategy, the cellular immune response via T cells specific to SARS-CoV-2 merits analysis, as this response is susceptible to being affected by immunosenescence.
| S-EPMC8683825 | biostudies-literature
Project description:IntroductionResidents in long-term care facilities (LTCFs) are likely to suffer from drug-related problems, such as inappropriate polypharmacy and potential prescribing omissions due to multimorbidity and high-level frailty. Medication reviews are thus necessary to identify and resolve drug-related problems in LTCF residents. In this study, we aimed to develop a medication review tool for older adults in LTCFs in Korea.MethodsWe did a systematic review to identify previously developed explicit criteria and devised preliminary potentially inappropriate medications (PIMs) list for the LTCF elderly from previous tools. Each item on this list was categorized into 23 underlying diseases/conditions, and the interventions necessary for each PIM were included. A two-round modified Delphi survey was performed sequentially for consensus evaluation of clinical appropriateness and feasibility of the list items by 12 experts (seven physicians in different specialties and five pharmacists specialized in geriatrics) and seven pharmacists, respectively.ResultsWe identified 22 existing tools and devised a preliminary PIM list including 100 items. Ninety-one items were derived from the two-round Delphi survey for clinical appropriateness. In the feasibility test, 77 items were integrated into the final medication review tool for the LTCF elderly. The final list was composed of items relating to PIMs in general (18), potential drug interactions (14), PIMs under specific diseases/conditions (26), a need for dose adjustment (2), and potential omissions (17).ConclusionsWe developed a disease-category-based explicit medication review tool for detecting PIM use for LTCF residents. This tool may be helpful in implementing medication review practices to assist pharmacists or physicians for the elderly in LTCFs. Further research is required to validate the effectiveness of our tool in clinical practice.
| S-EPMC9549204 | biostudies-literature
Project description:ImportanceResidents of long-term care facilities (LTCFs) experience high hospitalization rates, yet little is known about the effects of transitional care interventions for these residents.ObjectiveTo assess the association of transitional care interventions with readmission rates and other outcomes for residents of LTCFs who are 65 years and older and LTCF staff and to explore factors that potentially mitigate the association.Data sourcesMEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature were searched for English-language studies published until July 21, 2021. Associated qualitative studies were identified using aspects of the CLUSTER (citations, lead authors, unpublished materials, searched Google Scholar, tracked theories, ancestry search for early examples, and follow-up of related projects) methodology.Study selectionControlled design studies evaluating transitional care interventions for residents of LTCFs 65 years and older were included. Records were independently screened by 2 reviewers; disagreements were resolved through discussion and involvement of a third reviewer. From 14 538 records identified, 15 quantitative and 4 qualitative studies met the eligibility criteria.Data extraction and synthesisThe study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data were extracted by one reviewer and checked by a second reviewer. Fixed-effect and random-effects models were used according to the number of studies reporting the outcomes of interest.Main outcomes and measuresThe primary outcome consisted of 30-, 60-, and 90-day readmission rates (hospital and emergency department [ED]). Other outcomes included length of stay, functional independence (Barthel score), and quality of life. The I2 statistic was used to quantify heterogeneity.ResultsOf 14 538 records identified from searches, 15 quantitative studies (totaling 32 722 participants or records) and 4 qualitative studies were included. People allocated to transitional care interventions were 1.7 times less likely to be readmitted to the hospital or ED compared with those in control groups (14 studies; odds ratio, 1.66 [95% CI, 1.18-2.35]; I2 = 81% [95% CI, 70%-88%]). Length of stay in the ED was significantly decreased for intervention groups (3 studies; standardized mean difference, -3.00 [95% CI, -3.61 to -2.39]; I2 = 99% [95% CI, 98%-99%]). There were no significant differences for other outcomes. Factors associated with outcomes included communication and referral processes between health care professionals.Conclusions and relevanceEmerging evidence suggests that transitional care interventions are associated with lower readmissions for residents of LTCFs 65 years and older. Despite this and with aging populations, investment in such interventions has been remarkably low across most countries.
| S-EPMC9069255 | biostudies-literature
Project description:In long-term care facilities, elderly mistreatment occurs routinely and frequently. However, few studies have empirically explored the multifaceted risk factor of mistreatment. The purpose of this paper was to explore the factors affecting elderly mistreatment by care workers in Japanese long-term care facilities and to examine the relationship between these factors and mistreatment. This analysis was based on a sample of 1473 care workers from long-term care facilities and used multiple regression analyses. The results revealed that the nursing care level, work period, resilience, and attitude towards mistreatment among residents and staff were factors significantly associated with the degree of mistreatment. Facility size, an institutional environment that does not limit the behavior of residents, and family and community support for the elderly were among the institutional environment factors that had significant relationships with mistreatment. Staff gender, care-related qualifications, and workload were not associated with mistreatment. These findings suggest that strengthening the staff's attitude and coping skills to prevent mistreatment, as well as interventions for changes in the institutional environment, are needed to prevent and reduce the prevalence of mistreatment in Japan. In addition, raising staff resilience to stress situations and building a resident-centered facility care environment is an important measure to reduce mistreatment.
| S-EPMC7551777 | biostudies-literature
Project description:BackgroundThe population aging, together with the shrinking caring potential of families, is a major challenge for social policy in the coming years. The aim of the study is to identify the factors that determine not only the use of long-term care (LTC) but also the selection of individual types of such care in Poland.MethodsUsing unique data collected from inpatient LTC facilities in Poland and the Survey on Health, Ageing and Retirement in Europe (SHARE) database, we estimate logistic regressions explaining the choice of LTC solution.ResultsOur results suggest that social inequalities play a role in choosing the type of LTC. Better educated people choose private institutions, while people without support network use more often social residential homes. The impact of multimorbidity on choosing different types of inpatient facilities is limited, thus the number of ADL limitations remains a better indicator of long term care utilization.ConclusionsThe study confirms that social inequalities influence decisions about the choice of LTC. However, multi-morbidity is a predictor of using LTC to a limited extent. The differences in LTC selection determinants between women and men are noticeable.
| S-EPMC10463875 | biostudies-literature
Project description:BackgroundDespite vaccination, residents of long-term-care facilities (LTCFs) remain at high risk of influenza-related morbidity and mortality. More-effective vaccine options for this population are needed.MethodsWe conducted a single-blinded, randomized, controlled trial comparing high-dose (HD) to standard-dose (SD) inactivated influenza vaccine (IIV) in 205 frail, elderly residents of LTCFs during the 2011-2012 and 2012-2013 influenza seasons. Hemagglutination inhibition (HI) antibody titers were measured at baseline and 30 and 180 days following vaccination.ResultsA total of 187 subjects (91%) completed the study. The mean age was 86.7 years. Geometric mean titers (GMTs) were significantly higher (P < .05) at day 30 for HD recipients, compared with SD recipients, for all comparisons except influenza A(H1N1) during 2012-2013 (the HD formulation was noninferior to the SD formulation for influenza A[H1N1] during 2012-2013). GMTs for HD and SD recipients during 2011-2012 were as follows: influenza A(H1N1), 78 (95% confidence interval [CI], 45-136) and 27 (95% CI, 17-44), respectively; influenza A(H3N2), 26 (95% CI, 17-40) and 10 (95% CI, 7-15), respectively; and influenza B, 26 (95% CI, 19-35) and 14 (95% CI, 11-18), respectively. During 2012-2013, GMTs for HD and SD recipients were as follows: influenza A(H1N1), 46 (95% CI, 33-63) and 50 (95% CI, 37-67); influenza A(H3N2), 23 (95% CI, 18-31) and 14 (95% CI, 11-18), respectively; and influenza B, 26 (95% CI, 21-32) and 17 (95% CI, 14-22), respectively. GMTs were significantly higher at day 180 for HD recipients, compared with SD recipients, for influenza A(H3N2) in both years (P < .001).ConclusionsAmong frail, elderly residents of LTCFs, HD influenza vaccine produced superior responses for all strains except influenza A(H1N1) in 2012-2013.Clinical trials registrationNCT01654224.
| S-EPMC4539906 | biostudies-literature