scholarly journals Older Emergency Department Patients: Does Baseline Care Status Matter?

2020 ◽  
Vol 23 (4) ◽  
pp. 289-296
Author(s):  
Fabrice Immanuel Mowbray ◽  
Komal Aryal ◽  
Eric Mercier ◽  
George Heckman ◽  
Andrew P. Costa
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Nursing Home ◽  
Home Care ◽  
Support Services ◽  
Service Use ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Post Discharge ◽  
Formal Support

Background Little is known about the prognostic differences between older emergency department (ED) patients who present with different formal support requirements in the community. We set out to describe and compare the patient profiles and patterns of health service use among three older ED cohorts: home care clients, nursing home residents and those receiving no formal support. Methods We conducted a secondary analysis of the Canadian cohort from the interRAI multinational ED study. Data were collected using interRAI ED contact assessment on patients 75 years of age and older (n = 2,274), in eight ED sites across Canada. A series of descriptive statistics were reported. Adjusted as­sociations were determined using logistic regression. Results Older adults receiving no formal support services were most stable. However, they were most likely to be hospitalized. Older home care clients were most likely to report depressive symptoms and distressed caregivers. They also had the great­est odds of frequent ED visitation post-discharge (OR=1.9; 95% CI=1.39–2.59). Older adults transferred from a nursing home were the frailest but had the lowest odds of hospital admission (OR=0.14; 95% CI=0.09–0.23). Conclusion We demonstrated the importance of inquiring about commu­nity-based formal support services and provide data to support decision-making in the ED.  

scholarly journals Nurse-Patient Interaction: A Vital Salutogenic Resource in Nursing Home Care

2021 ◽  
pp. 117-136
Author(s):  
Gørill Haugan
Keyword(s):  
Older Adults ◽  
Health Promotion ◽  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Nursing Home Residents ◽  
Nursing Home Care ◽  
Patient Interaction ◽  
Health Promoting ◽  
To Come

AbstractWe are now witnessing a major change in the world’s population. Many people globally grow very old: 80, 90, and 100 years. Increased age is followed by an increased incidence of functional and chronic comorbidities and diverse disabilities, which for many leads to the need for long-term care in a nursing home. Quality of life and health promotive initiatives for older persons living in nursing homes will become ever more important in the years to come. Therefore, this chapter focuses on health promotion among older adults living in nursing homes. First, this chapter clarifies the concepts of health, salutogenesis, and pathogenesis, followed by knowledge about health promotion. Then insight and knowledge about the nursing home population is provided; what promotes health and well-being in nursing home residents?Health promotion in the health services should be based on integrated knowledge of salutogenesis and pathogenesis. The salutogenic understanding of health is holistic and considers man as a wholeness including physical, mental, social, and spiritual/existential dimensions. Research indicates that various health-promoting interventions, specifically the nurse–patient interaction, influence on older adults in nursing homes as a wholeness of body–soul–spirit, affecting the whole being. Hence, dimensions such as pain, fatigue, dyspnea, nausea, loneliness, anxiety, and depressive symptoms will be influenced through health-promoting approaches. Therefore, two separate studies on the health-promoting influences of nurse–patient interaction in nursing home residents were conducted. In total, nine hypotheses of directional influence of the nurse–patient interaction were tested, all of which finding support.Along with competence in pain and symptom management, health-promoting nurse–patient interaction based on awareness and attentional skills is essential in nursing home care. Thus, health care workers should be given the opportunity to further develop their knowledge and relational skills, in order to “refine” their way of being present together with residents in nursing homes. Health professionals’ competence involves the “being in the doing”; that is, both the doing and the way of being are essential in health and nursing care.

scholarly journals Indicators of paramedic service use by community dwelling older adults

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Matthew S Leyenaar ◽  
Walter Tavares ◽  
Gina Agarwal ◽  
Andrew P Costa
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Home Care ◽  
Service Use ◽  
Community Dwelling ◽  
Care Providers ◽  
Community Paramedicine ◽  
Care Assessment ◽  
Ed Visits ◽  
Community Dwelling Older Adults

<p>Introduction:  Home care clients represent a patient group that may be served through community paramedicine (CP) programs.  The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population.  This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.</p><p>Methods: A retrospective cohort study was conducted using regularly collected administrative data.  Home care assessment data were supplemented with data on emergency department (ED) visits.  Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.</p><p>Results:  Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year.  About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation.  DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78</p><p>Conclusion:  DIVERT was not developed to consider means of transportation to the ED.  The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED.  Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted.  Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.</p>

Pain-Associated Clusters Among Nursing Home Residents and Older Adults Receiving Home Care in Germany

2020 ◽  
Vol 60 (1) ◽  
pp. 48-59
Author(s):  
Andrea Budnick ◽  
Ronny Kuhnert ◽  
Arlett Wenzel ◽  
Mimi Tse ◽  
Juliana Schneider ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Home Care ◽  
Nursing Home Residents

The Use of Support Services by Careproviders of the Aged

1985 ◽  
Vol 52 (3) ◽  
pp. 138-143
Author(s):  
Catherine J. Hill ◽  
Anne Martin Matthews
Keyword(s):  
Home Care ◽  
Support Services ◽  
Service Use ◽  
Family Care ◽  
The Elderly ◽  
Formal Support ◽  
Mutual Dependency ◽  
Care Support

Provision of home care support services is currently propounded as a means of facilitating family care of the dependent aged. In this study, interviews were carried out with forty two providers of care and accommodation for an elderly relative. The data indicate that those careproviders who were extensive users of formal support services were also likely to express the need for still more help with their careproviding task. Although increased cost, level of co-operation from the elderly relative, and reluctance, to introduce change into the routine of these dependants were cited as reasons for not satisfying the need for help, it is plausible that mutual dependency between the careproviders and the elderly relative also influenced service use. Recognition and acknowledgement of such a relationship has implications for the planning and delivery of home care support services.

Deficits in Selective Attention Alter Gait in Frail Older Adults

GeroPsych ◽  
2016 ◽  
Vol 29 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Véronique Cornu ◽  
Jean-Paul Steinmetz ◽  
Carine Federspiel
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Selective Attention ◽  
Dual Task ◽  
Nursing Home Residents ◽  
Gait Rehabilitation ◽  
Rehabilitation Programs ◽  
Gait Parameters ◽  
Growing Body ◽  
Task Conditions

Abstract. A growing body of research demonstrates an association between gait disorders, falls, and attentional capacities in older adults. The present work empirically analyzes differences in gait parameters in frail institutionalized older adults as a function of selective attention. Gait analysis under single- and dual-task conditions as well as selective attention measures were collected from a total of 33 nursing-home residents. We found that differences in selective attention performances were related to the investigated gait parameters. Poorer selective attention performances were associated with higher stride-to-stride variabilities and a slowing of gait speed under dual-task conditions. The present findings suggest a contribution of selective attention to a safe gait. Implications for gait rehabilitation programs are discussed.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

scholarly journals Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

2020 ◽  
pp. 084456212094942
Author(s):  
Connie Schumacher ◽  
Aaron Jones ◽  
Andrew P. Costa
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Service Use ◽  
Urinary Catheter ◽  
Community Dwelling ◽  
Care Needs ◽  
Home Care Nursing ◽  
Nursing Visit ◽  
Ed Visits ◽  
Care Nursing

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. Purpose The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. Conclusions The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.

scholarly journals Repeat emergency department visits by nursing home residents: a cohort study using health administrative data

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Andrea Gruneir ◽  
Candemir Cigsar ◽  
Xuesong Wang ◽  
Alice Newman ◽  
Susan E. Bronskill ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Nursing Home ◽  
Administrative Data ◽  
Nursing Home Residents ◽  
Emergency Department Visits ◽  
Health Administrative Data
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