Among elderly residents of long term care facilities, a visit to the emergency department is associated with an increased risk of acquiring a new respiratory or gastrointestinal infection

2012 ◽  
Vol 16 (1) ◽  
pp. 33-34
Author(s):  
Gail Lusardi
Keyword(s):  
Emergency Department ◽  
Long Term Care ◽  
Gastrointestinal Infection ◽  
Term Care ◽  
Increased Risk ◽  
Care Facilities

scholarly journals Case–control study to estimate odds of death within 28 days of positive test for SARS-CoV-2 prior to vaccination for residents of long-term care facilities in England, 2020–2021

2021 ◽  
pp. jech-2021-218135
Author(s):  
Karthik Paranthaman ◽  
Hester Allen ◽  
Dimple Chudasama ◽  
Neville Q Verlander ◽  
James Sedgwick
Keyword(s):  
Long Term Care ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Positive Test ◽  
Mortality Data ◽  
Multivariable Logistic Regression Analysis ◽  
Term Care ◽  
Increased Risk ◽  
Care Facilities

BackgroundPersons living in long-term care facilities (LTCFs) are presumed to be at higher risk of adverse outcomes from SARS-CoV-2 infection due to increasing age and frailty, but the magnitude of increased risk is not well quantified.MethodsAfter linking demographic and mortality data for cases with confirmed SARS-CoV-2 infection between March 2020 and January 2021 in England, a random sample of 6000 persons who died and 36 000 who did not die within 28 days of a positive test was obtained from the dataset of 3 020 800 patients. Based on an address-matching process, the residence type of each case was categorised into one of private home and residential or nursing LTCF. Univariable and multivariable logistic regression analysis was conducted.ResultsMultivariable analysis showed that an interaction effect between age and residence type determined the outcome. Compared with a 60-year-old person not living in LTCF, the adjusted OR (aOR) for same-aged persons living in residential and nursing LTCFs was 1.77 (95% CI 1.21 to 2.6, p=0.0017) and 3.95 (95% CI 2.77 to 5.64, p<0.0001), respectively. At 90 years of age, aORs were 0.87 (95% CI 0.72 to 1.06, p=0.21) and 0.74 (95% CI 0.61 to 0.9, p=0.001), respectively. The model had an overall accuracy of 94.2% (94.2%) when applied to the full dataset of 2 978 800 patients.ConclusionThis study found that residents of LTCFs in England had higher odds of death up to 80 years of age. Beyond 80 years, there was no difference in the odds of death for LTCF residents compared with those in the wider community.

scholarly journals Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities

2019 ◽  
Vol 16 (23) ◽  
pp. 4623 ◽  
Author(s):  
Jiang ◽  
Xia ◽  
Wang ◽  
Zhou ◽  
Jiang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Long Term Care ◽  
Term Care ◽  
Injurious Falls ◽  
Increased Risk ◽  
Care Facilities ◽  
Benzodiazepine Use ◽  
Risk Of Falls ◽  
One Year

Background: Falls are leading cause of injury among older people, especially for those living in long-term care facilities (LTCFs). Very few studies have assessed the effect of sleep quality and hypnotics use on falls, especially in Chinese LTCFs. The study aimed to examine the association between sleep quality, hypnotics use, and falls in institutionalized older people. Methods: We recruited 605 residents from 25 LTCFs in central Shanghai and conducted a baseline survey for sleep quality and hypnotics use, as well as a one-year follow-up survey for falls and injurious falls. Logistic regression models were applied in univariate and multivariate analysis. Results: Among the 605 participants (70.41% women, mean age 84.33 ± 6.90 years), the one-year incidence of falls and injurious falls was 21.82% and 15.21%, respectively. Insomnia (19.83%) and hypnotics use (14.21%) were prevalent. After adjusting for potential confounders, we found that insomnia was significantly associated with an increased risk of falls (adjusted risk ratio (RR): 1.787, 95% CI, 1.106–2.877) and the use of benzodiazepines significantly increased the risk of injurious falls (RR: 3.128, 95% CI, 1.541–6.350). Conclusion: In elderly LTCF residents, both insomnia and benzodiazepine use are associated with an increased risk of falls and injuries. Adopting non-pharmacological approaches to improve sleep quality, taking safer hypnotics, or strengthening supervision on benzodiazepine users may be useful in fall prevention.

Iron deficiency is associated with increased risk for cardiovascular disease and all-cause mortality in the elderly living in long-term care facilities

Nutrition ◽  
2013 ◽  
Vol 29 (5) ◽  
pp. 737-743 ◽  
Author(s):  
Hua-Shui Hsu ◽  
Chia-Ing Li ◽  
Chiu-Shong Liu ◽  
Cheng-Chieh Lin ◽  
Kuo-Chin Huang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Iron Deficiency ◽  
Long Term Care ◽  
The Elderly ◽  
Term Care ◽  
Increased Risk ◽  
Care Facilities ◽  
All Cause Mortality ◽  
Elderly Living

scholarly journals Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 680
Author(s):  
Ángel Rodríguez-Villodres ◽  
Cecilia Martín-Gandul ◽  
Germán Peñalva ◽  
Ana Belén Guisado-Gil ◽  
Juan Carlos Crespo-Rivas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Multidrug Resistant ◽  
Term Care ◽  
Extended Spectrum ◽  
Increased Risk ◽  
Modifiable Factors ◽  
Care Facilities ◽  
Multidrug Resistant Organisms

Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.

Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

2018 ◽  
Vol 40 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Bo R. Weber ◽  
Brie N. Noble ◽  
David T. Bearden ◽  
Christopher J. Crnich ◽  
Katherine D. Ellingson ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Long Term Care ◽  
Antibiotic Prescription ◽  
Antibiotic Prescribing ◽  
Day Hospital ◽  
Post Discharge ◽  
Term Care ◽  
Increased Risk ◽  
Care Facilities

AbstractObjectiveTo quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).DesignRetrospective cohort study.SettingA 576-bed, academic hospital in Portland, Oregon.PatientsAdult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.MethodsOur primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge.ResultsAmong 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02–1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02–2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9–1.2).ConclusionsAntibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.

scholarly journals Variation and appropriateness of antipsychotic use in long-term care facilities across Newfoundland and Labrador

2021 ◽  
pp. 171516352110051
Author(s):  
Zachary E. M. Giovannini-Green ◽  
John-Michael Gamble ◽  
Brendan Barrett ◽  
Zhiwei Gao ◽  
Susan Stuckless ◽  
...  
Keyword(s):  
Newfoundland And Labrador ◽  
Long Term Care ◽  
Assessment Instrument ◽  
Linear Regression Models ◽  
Term Care ◽  
Data Set ◽  
Increased Risk ◽  
Care Facilities ◽  
Risk Of Falls

Objective: The use of antipsychotics to treat seniors in long-term care facilities (LTCFs) has raised concern because of health consequences (i.e., increased risk of falls, stroke, death) in this vulnerable population. This study measured geographic patterns of antipsychotic utilization among seniors living in LTCFs in Newfoundland and Labrador (NL) and assessed potential inappropriateness. Method: We analyzed prescription records among adults 66 years and older with provincial prescription drug coverage admitted to LTCFs in NL between April 1, 2011, and March 31, 2014. Patterns of use were analyzed across the 4 regional health authorities (RHAs) in NL and LTCFs. Logistic, Poisson and linear regression models were used to test variations in prevalence, rate and volume of antipsychotic utilization. To assess potential inappropriateness of antipsychotic use, we analyzed data from Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0 forms from NL LTCFs between January 1, 2016, and December 31, 2018. Pearson chi-squared analysis was performed at the RHA and LTCF levels to determine changes in percentage of total prescriptions or antipsychotic prescriptions without psychosis. Results: Between 2011 and 2014, 2843 seniors were admitted to LTCFs across NL; of these, 1323 residents were prescribed 1 or more antipsychotics. Within the 3-year period, the percentage of antipsychotic use across facilities ranged from 35% to 78%. Using data from 27,260 RAI-MDS 2.0 assessments between 2016 and 2018, 71% (6995/9851) of antipsychotic prescriptions were potentially inappropriate. Discussion: There is substantial variation across NL regions concerning the utilization of antipsychotics for senior in LTCFs. Facility size and management styles may be reasons for this. Conclusion: With nearly three-quarters of antipsychotic prescriptions shown to be potentially inappropriate, systematic interventions to assess indications for antipsychotic use are warranted. Can Pharm J (Ott) 2021;154:xx-xx.

Existing Warfarin Therapy in Long-Term Care Facilities Maybe Inadequate.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4160-4160
Author(s):  
Bahareh Motlagh ◽  
Madeleine M. Verhovsek ◽  
Alexandra Papaioannou ◽  
Crowther Mark ◽  
Lisa Dolovich ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Warfarin Therapy ◽  
Long Term Care ◽  
The Elderly ◽  
Term Care ◽  
Increased Risk ◽  
Dosing Algorithm ◽  
Care Facilities

Abstract Despite evidence-based guidelines derived from large clinical trials supporting the use of warfarin for stroke prophylaxis, studies in elderly patients have shown that oral anticoagulants are not used optimally. The risk associated with inappropriate use is compounded by the observation that the elderly are at enhanced risk of thromboembolic complications compared with younger atrial fibrillation patients. All patients with atrial fibrillation who do not have a contraindication to warfarin, and who meet inclusion criteria, should be treated with warfarin to achieve a target International Normalized Range (INR) of 2.5 (range 2.0–3.0). INR levels of 2.0–3.0 have been shown to be relatively safe and more efficacious than lower target INR values in all age groups including the elderly. Patients with INR values below this range remain at increased risk of thrombosis, while those with INR values above the given range are at increased risk of bleeding. The primary objective of this study was to determine the achieved intensity of warfarin therapy in a cohort of patients living at long-term care facility. In such facilities optimal anticoagulation should be achievable, since laboratory monitoring, dose adjustment, and compliance can be achieved. In this study, data were collected on physicians’ warfarin prescribing practices as well as INR levels of 108 residents in five long-term care facilities in the Hamilton-Wentworth area over a period of 12 months. In total, 3146 INR values, extending over 28,256 patient-days of monitoring, were analyzed. Indications for warfarin were atrial fibrillation, transient ischemic attack, pulmonary embolus, cardiac valve replacement, myocardial infarction, and deep vein thrombosis. In general, the warfarin dosage was not determined using an established dosing algorithm. Our findings revealed that LTC residents spent approximately 40 percent of the time with INR values below 2.0. We therefore conclude, that the overall quality of anticoagulant therapy in long-term care patients may be inadequate. Our observations suggest that organized dosing algorithms may be of benefit in such settings, however this hypothesis needs to be confirmed in prospective studies. For this purpose we plan to implement a warfarin dosing algorithm in order to determine whether the percentage of time spent within the therapeutic INR range can be improved.

scholarly journals Timeline of COVID-19 Incidence and Mortality among Residents and Staff of South Carolina Long-term Care Facilities

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 733-733
Author(s):  
Matthew Lohman ◽  
Nicholas Resciniti ◽  
Morgan Fuller ◽  
Joshua Sellner
Keyword(s):  
Older Adults ◽  
South Carolina ◽  
Long Term Care ◽  
Health Conditions ◽  
Infection Rates ◽  
Term Care ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Care Facilities

Abstract The COVID-19 pandemic has disproportionately impacted older adults living in long-term care facilities (LTCFs), but little research has described parallel infection rates and mortality among LTCF residents and staff in relation to state-level mitigation measures. This study used comprehensive COVID-19 tracking data from the South Carolina Department of Health and Environmental Control (SCDHEC), including case report information on demographics, symptoms, comorbidities, and employment. We included all confirmed or probable COVID-19 cases and deaths among adult SC residents reported between 3/15/2020 and 1/2/2021. Residence or employment in LTCF, including nursing homes, assisted living, or skilled nursing facilities, were confirmed by SCDHEC. Cox proportional hazards models were used to compare mortality between residents/staff and counterparts in the community. Overall, 54,514 cases of COVID-19 were identified among older adults in SC. Of these, 13.5% (n = 7,366) resided in a LTCF. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR= 1.74, 95% CI: 1.59-1.90), after controlling for age, gender, race, and chronic health conditions. LTCF staff had greater infection rates but lower risk of mortality (HR=0.58; 95% CI: 0.39-0.88) compared to the general population. Differences in COVID-19 incidence and mortality between residents/staff and the community decreased after statewide mitigation policies. This study indicates that LTCF residents are at increased risk of COVID infection and mortality, even accounting for pre-existing health conditions. LTCF settings are key sites for prioritizing prevention, vaccination, and training plans to prepare for future pandemics.

scholarly journals A pulmonary tuberculosis outbreak in a long-term care facility

2015 ◽  
Vol 144 (7) ◽  
pp. 1455-1462 ◽  
Author(s):  
C.-C. LAI ◽  
Y.-C. HSIEH ◽  
Y.-P. YEH ◽  
R.-W. JOU ◽  
J.-T. WANG ◽  
...  
Keyword(s):  
Long Term Care ◽  
Latent Tuberculosis ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Ltbi Treatment ◽  
Long Term Care Facility ◽  
Increased Risk ◽  
Care Facilities

SUMMARYIn long-term care facilities (LTCFs), the elderly are apt to be infected because those with latent tuberculosis infections (LTBIs) are at an increased risk for reactivation and post-primary TB disease. We report an outbreak of TB in staff and residents in a LTCF. An outbreak investigation was conducted after two TB cases were reported from the LTCF. A tuberculin skin test (TST), bacteriological examination and chest radiograph were administered to all facility staff and residents. An outbreak is defined as at least two epidemiologically linked cases that have identicalMycobacterium tuberculosisgenotype isolates. This outbreak infected eight residents and one staff member, who were confirmed to have TB in a LTCF between September 2011 and October 2012. Based on the Becker method, the latent and infectious periods were estimated at 223·6 and 55·9 days. Two initial TST-negative resident contacts were diagnosed as TB cases through comprehensive TB screening. Observing elderly people who have a negative TST after TB screening appears to be necessary, given the long latent period for controlling a TB outbreak in a LTCF. It is important to consider providing LTBI treatment for elderly contacts.

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