[Home visit in the nursing home - Adapted medication and timely switch to palliative treatment goals important].
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ABSTRACT:
SUBMITTER: Zeeh D
PROVIDER: S-EPMC8266415 | biostudies-literature | 2021 Jul
REPOSITORIES: biostudies-literature
Publications
[Home visit in the nursing home - Adapted medication and timely switch to palliative treatment goals important].
Zeeh Dorothea D Zeeh Joachim J
MMW Fortschritte der Medizin 20210701 13
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Project description:Prevalence of multidrug resistant organisms (MDRO) in nursing homes in Ireland and the Netherlands
| PRJEB31196 | ENA
Project description:ContextU.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice.ObjectivesThe objective of this study was to examine the value of expanded palliative care access for NH residents with moderate-to-very severe dementia.MethodsWe merged palliative care consultation data in 31 NHs in two states to Medicare data to identify residents with consultations, moderate-to-very severe dementia, and deaths in 2006-2010. Initial palliative consultations were identified as occurring later and earlier (1-30 days and 31-180 days before death, respectively). Three controls for each consultation recipient were selected using propensity score matching. Weighted multivariate analyses evaluated the effect of consultations on hospital or acute care use seven and 30 days before death and on (potentially) burdensome transitions (i.e., hospital or hospice admission three days before death or two plus acute care transitions 30 days before death).ResultsWith earlier consultation (vs. no consultation), hospitalization rates in the seven days before death were on average 13.2 percentage points lower (95% confidence interval [CI] -21.8%, -4.7%) and with later consultation 5.9 percentage points lower (95% CI -13.7%, +4.9%). For earlier consultations (vs. no consultations), rates were 18.4 percentage points lower (95% CI -28.5%, -8.4%) for hospitalizations and 11.9 lower (95% CI -20.7%, -3.1%) for emergency room visits 30 days before death; they were 20.2 percentage points lower (95% CI -28.5%, -12.0%) for burdensome transitions.ConclusionConsultations appear to reduce acute care use and (potentially) burdensome transitions for dying residents with dementia. Reductions were greater when consultations were earlier.
| S-EPMC5663286 | biostudies-literature
Project description:Background and objectivesPalliative care addresses physical, emotional, psychological, and spiritual suffering that accompanies serious illness. Emphasis on symptom management and goals of care is especially valuable for seriously ill nursing home residents. We investigated barriers to nursing home palliative care provision highlighted by the coronavirus disease 2019 (COVID-19) pandemic and the solutions nursing home staff used to provide care in the face of those barriers.Research design and methodsFor this descriptive qualitative study, seven Massachusetts nursing home directors of nursing were interviewed remotely about palliative care provision before and during the COVID-19 pandemic. Interview data were analyzed using thematic analysis.ResultsBefore the pandemic, palliative care was delivered primarily by nursing home staff depending on formal and informal consultations from palliative care specialists affiliated with hospice providers. When COVID-19 lockdowns precluded these consultations, nursing staff did their best to provide palliative care, but were often overwhelmed by shortfalls in resources, resident decline brought on by isolation and COVID-19 itself, and a sense that their expertise was lacking. Advance care planning conversations focused on hospitalization decisions and options for care given resource constraints. Nevertheless, nursing staff discovered previously untapped capacity to provide palliative care on-site as part of standard care, building trust of residents and families.Discussion and implicationsNursing staff rose to the palliative care challenge during the COVID-19 pandemic, albeit with great effort. Consistent with prepandemic analysis, we conclude that nursing home payment and quality standards should support development of in-house staff capacity to deliver palliative care while expanding access to the formal consultations and family involvement that were restricted by the pandemic. Future research should be directed to evaluating initiatives that pursue these aims.
| S-EPMC9273407 | biostudies-literature
Project description:BackgroundThe use of medicines is crucial in treatment, but nonadherence poses an important challenge, particularly when managing polypharmacy and long-term conditions. Pharmacist-led home visit services offer a promising solution to enhance the outcomes associated with medication use. However, the effects and the factors contributing to this improvement remain unclear.ObjectiveThis study assessed the effects of pharmacist-led home visit services on medication adherence and general medication knowledge. Additionally, we analyzed the factors associated with improved medication adherence.MethodsFace-to-face, pharmacist-led home visit services were conducted via opportunistic sampling in community settings. Data were collected between 2017 and 2019. The program included participants aged ≥65 years or taking ten or more medications, in need of care, and who were willing to participate. We estimated the effects of the program by improved medication adherence and general knowledge about taking medications. Medication adherence was measured using the Morisky Scale. We used McNemar's test to evaluate the statistical differences in outcomes before and after consultation. To identify factors influencing improvements in medication adherence, odds ratios (OR) with 95% confidence intervals (CI) were calculated using multivariate logistic regression with adjustments for covariates.ResultsAmong the 1,194 participants in the program, 874 were included in the analysis. Pharmacist-led home visit services improved both medication adherence (from 69.2% to 85.8%) and mean scores for general knowledge of taking medications (from 65.3% to 89.5%). Participants aged ≥70 years showed less improvement in overall adherence than those aged <70 years (OR = 0.51; 95% CI = 0.317-0.817). The program was significantly more effective at improving adherence for participants with higher level of medication knowledge (OR = 2.93; 95% CI = 1.78-4.81) compared to those with lower level of knowledge.ConclusionThese quantitative findings highlight the importance of pharmacist-led interventions and suggest a framework for future programs about medication management.
| S-EPMC11584129 | biostudies-literature
Project description:Medication reconciliation is a safety practice to identify medication order discrepancies when patients' transitions between settings. In nursing homes, registered nurses (RNs) and licensed practical nurses (LPNs), each group with different education preparation and scope of practice responsibilities, perform medication reconciliation. However, little is known about how they differ in practice when making sense of medication orders to detect discrepancies. Therefore, the purpose of this study was to describe differences in RN and LPN sensemaking when detecting discrepancies.We used a qualitative methodology in a study of 13 RNs and 13 LPNs working in 12 Midwestern United States nursing homes. We used both conventional content analysis and directed content analysis methods to analyze semi-structured interviews. Four resident transfer vignettes embedded with medication order discrepancies guided the interviews. Participants were asked to describe their roles with medication reconciliation and their rationale for identifying medication order discrepancies within the vignettes as well as to share their experiences of performing medication reconciliation. The analysis approach was guided by Weick's Sensemaking theory.RNs provided explicit stories of identifying medication order discrepancies as well as examples of clinical reasoning to assure medication order appropriateness whereas LPNs described comparing medication lists. RNs and LPNs both acknowledged competing demands, but when performing medication reconciliation, RNs were more concerned about accuracy and safety, whereas LPNs were more concerned about time.Nursing home nurses, particularly RNs, are in an important position to identify discrepancies that could cause resident harm. Both RNs and LPNs are valuable assets to nursing home care and keeping residents safe, yet RNs offer a unique contribution to complex processes such as medication reconciliation. Nursing home leaders must acknowledge the differences in RN and LPN contributions and make certain nurses in the most qualified role are assigned to ensure residents remain safe.
| S-EPMC5545015 | biostudies-other
Project description:BackgroundDespite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal.ObjectiveTo examine the characteristics and effectiveness of nursing home interventions that incorporated multiple palliative care domains (eg, physical aspects of care-symptom management, and ethical aspects-advance care planning).DesignSystematic review.MethodsWe searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library's CENTRAL from inception through January 2019. We included all randomized and nonrandomized trials that compared palliative care to usual care and an active comparator. We assessed the type of intervention, outcomes, and the risk of bias.ResultsWe screened 1167 records for eligibility and included 13 articles. Most interventions focused on staff education and training strategies and on implementing a palliative care team. Many interventions integrated advance care planning initiatives into the intervention. We found that palliative care interventions in nursing homes may enhance palliative care practices, including processes to assess and manage pain and symptoms. However, inconsistent outcomes and high or unclear risk of bias among most studies requires results to be interpreted with caution.Conclusions and implicationsHeterogeneity in methodology, findings, and study bias within the existing literature revealed limited evidence for nursing home palliative care interventions. Findings from a small group of diverse clinical trials suggest that interventions enhanced nursing home palliative care and improved symptom assessment and management processes.
| S-EPMC9614729 | biostudies-literature
Project description:IntroductionMany nursing home residents do not receive timely palliative care despite their need and eligibility for such care. Screening tools as well as other methods and guidelines can facilitate early identification of nursing home residents unmet palliative care needs.AimTo map and summarise the evidence on identifying unmet palliative care needs of nursing home residents.MethodsAny paper reporting on nursing home residents' unmet palliative care needs were eligible for inclusion. CINAHL, MEDLINE, Embase, Web of Science, APA PsycINFO, and APA PsycArticles and grey literature were systematically searched over two months, February and March 2024. Data were extracted using data extraction forms. Data were synthesised using descriptive analysis and basic content analysis.ResultsForty six records were included in this review. Nineteen methods, five screening tools, and four guidelines related to identifying residents unmet palliative care needs were identified. Most methods such as the Minimum Data Set and Palliative Care Needs Rounds were implemented as part of an intervention. Limited evidence was identified on what methods healthcare professionals use in daily practice. In total, 117 non-disease specific indicators for identifying residents unmet palliative care needs were identified, with physical indicators such as pain and weight loss being the most represented.ConclusionWhile developments have been made related to the concept of 'unmet palliative care needs', a clear definition is required. Evidence-based standardisation of methods for identifying unmet palliative care needs would ensure timely and equitable access to palliative care for nursing home residents worldwide. Achieving this goal requires incorporating screening for unmet palliative care needs into routine care.
| S-EPMC11856323 | biostudies-literature
Project description:Background: Approximately one-quarter of all deaths in the United States occur in nursing homes (NHs). Palliative care has the potential to improve NH end-of-life care, but more information is needed on the provision of palliative care in NHs serving Black and Hispanic residents. Objective: To determine whether palliative care services in United States NHs are associated with differences in the concentrations of Black and Hispanic residents, respectively, and the impact by region. Design: We conducted a cross-sectional analysis. The outcome was NH palliative care services (measured by an earlier national survey); total scores ranged from 0 to 100 (higher scores indicated more services). Other data included the Minimum Data Set and administrative data. The independent variables were concentration of Black and Hispanic residents (i.e., <3%, 3-10%, >10%), respectively, and models were stratified by region (i.e., Northeast, Midwest, South and West). We compared unadjusted, weighted mean palliative care services by the concentration of Black and Hispanic residents and computed NH-level multivariable linear regressions. Setting/Subjects: Eight hundred sixty-nine (weighted n = 15,020) NHs across the United States. Results: Multivariable analyses showed fewer palliative care services provided in NHs with greater concentrations of Black and Hispanic residents. Fewer palliative care services were reported in NHs in the Northeast, for which >10% of the resident population was Black, and NHs in the West for which >10% was Hispanic versus NHs with <3% of the population being Black and Hispanic (-13.7; p < 0.001 and -9.3; p < 0.05, respectively). Conclusion: We observed differences in NH palliative care by region and with greater concentration of Black and Hispanic residents. Our findings suggest that greater investment in NH palliative care services may be an important strategy to advance health equity in end-of-life care for Black and Hispanic residents.
| S-EPMC9347389 | biostudies-literature
Project description:Background/objectivesSecondary prevention medications are recommended for older adults after acute myocardial infarction (AMI), but little is known about whether nursing home (NH) residents receive these medications. The objective was to evaluate new use of secondary prevention medications after AMI in NH residents who were previously nonusers and to evaluate what factors were associated with use.DesignRetrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting records; and Medicare claims.SettingU.S. NHs.ParticipantsNational cohort of 11,192 NH residents aged 65 and older who were hospitalized for an AMI between May 2007 and March 2010, had no beta-blocker or statin use for 4 months or longer before the hospitalization, and survived 14 days or more after NH readmission.MeasurementsThe outcome was the number of secondary prevention medications initiated within 30 days of NH readmission.ResultsThirty-seven percent of residents had no secondary prevention medications initiated after AMI, 41% had 1 initiated, and 22% had 2 initiated. After covariate adjustment, fewer secondary prevention medications were used in older residents (proportional odds ratio (POR) = 0.48, 95% confidence interval (CI) = 0.40-0.57 for ≥95 vs 65-74); women (POR = 0.88, 95% CI = 0.80-0.96);and those with a do-not-resuscitate (DNR) order (POR = 0.90, 95% CI = 0.83-0.98), functional impairment (dependent or totally dependent vs independent to limited assistance, POR = 0.77, 95% CI = 0.69-0.86), and cognitive impairment (moderate to severe vs no impairment, POR = 0.79, 95% CI = 0.70-0.89).ConclusionMore than one-third of older NH residents in the United States do not have any secondary prevention medications initiated after AMI, with fewer medications initiated in older residents; women; and those with, DNR orders, poor physical function, and cognitive impairment. A lack of evidence about the safety and effectiveness of secondary preventions medications in the NH population and unmeasured person-centered goals of care are plausible explanations for these findings.
| S-EPMC5683399 | biostudies-literature
Project description:IntroductionNursing home residents often have life limiting illnesses in combination with multiple comorbidities, cognitive deficits, and frailty. Due to these complex characteristics, a high proportion of nursing home residents require palliative care. However, many do not receive palliative care relative to this need resulting in unmet care needs. To the best of our knowledge, there have been no literature reviews to synthesise the evidence on how nursing home staff identify unmet palliative care needs and to determine what guidelines, policies, and frameworks on identifying unmet palliative care needs of nursing home residents are available.AimThe aim of this scoping review is to map and summarise the evidence on identifying unmet palliative care needs of residents in nursing homes.MethodsThis scoping review will be guided by the JBI Manual for Evidence Synthesis. The search will be conducted in CINAHL, MEDLINE, Embase, Web of Science, APA PsycINFO, and APA PsycArticles. A search of grey literature will also be conducted in databases such as CareSearch, Trip, GuidelineCentral, ClinicalTrials.gov, and the National Institute for Health and Care and Excellence website. The search strategy will be developed in conjunction with an academic librarian. Piloting of the screening process will be conducted to ensure agreement among the team on the eligibility criteria. Covidence software will be used to facilitate deduplication, screening, and blind reviewing. Four reviewers will conduct title and abstract screening. Six reviewers will conduct full text screening. Any conflicts will be resolved by a reviewer not involved in the conflict. One reviewer will conduct data extraction using pre-established data extraction tables. Results will be synthesised, and a narrative synthesis will be used to illustrate the findings of this review. Data will be presented visually using tables, figures, and word clouds, as appropriate.
| S-EPMC11309440 | biostudies-literature