Aging

Collection of articles on Aging is available here.

Do prescription rates of psychotropic drugs change over three years from nursing home admission?
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Callegari E, Saltytė Benth Jūratė, Selbaek G, Gronnerod C, Bergh S.
BMC geriatrics 2021 sep;21(1):496.
BACKGROUND: In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription. METHODS: We used data from the Resource Use and Disease Course in Dementia – Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period. RESULTS: PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%-42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92-0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85-0.94, p < 0.001). CONCLUSIONS: PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01920100

Malnutrition Prevalence Rates among Dutch Nursing Home Residents: What Has Changed over One Decade? A Comparison of the Years 2009, 2013 and 2018.
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Everink IHJ, van Haastregt JCM, Manders M, de van der Schueren,M A E., Schols JMGA.
J Nutr Health Aging 2021;25(8):999-1005.
OBJECTIVES: To assess changes in prevalence of malnutrition and its associated factors among people living in Dutch nursing homes in 2009, 2013 and 2018. DESIGN: Secondary data analysis of the International Prevalence Measurement of Care Quality (LPZ) study. SETTING: Dutch nursing homes. PARTICIPANTS: Residents living at a psychogeriatric or somatic ward in Dutch nursing homes in 2009, 2013 or 2018. MEASUREMENTS: weight and height, unintentional weight loss over the last month and last six months, age, sex, length of stay up to the measurement day, care dependency, and the presence of various diseases (dementia, diabetes mellitus, stroke, diseases of the respiratory system, respiratory diseases and pressure ulcers). RESULTS: In total, 14,317 residents were included in this study with a mean age of 82.2, 70.9 female and 66.8% was living on a psychogeriatric ward. Results of this study show relative stability in background characteristics of the nursing home population over the last decade. In the total sample, 16.7% was malnourished and these percentages were 16.6% in 2009, 17.5% in 2013 and 16.3% in 2018. Multiple binary logistic regression analyses revealed having a pressure ulcer, female sex and living on a psychogeriatric department to be positively associated and having diabetes mellitus to be negatively associated with malnutrition throughout the years. These associations were strong and similar across years. CONCLUSION: Even though much attention has been paid to prevent malnutrition in Dutch nursing homes over the last decades, results show a relatively stable malnutrition prevalence rate of around 16%. This leads to the question if nursing staff is able to sufficiently recognize residents with (a risk of) malnutrition, and if they are aware of interventions they could perform to decrease this rate.

Activity and Social Responsibility in the Discourse on Health Care, Long-Term Care and Welfare Services for Older Immigrants.
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Goettler A.
BioMed research international 2021;2021:5241396.
Ageing well has been associated with the responsibility to age actively, successfully, or healthily in public and research discourses. This connection of individual responsibility with ageing has been criticised in Social Gerontology for neglecting the access to social, economic, and health resources. This paper investigates (individual) responsibility, informal support, and public initiatives in discourses on older immigrants in Germany. The research framework employs a sociology of knowledge approach to discourse, which guided the discourse analysis of German policy reports, guidelines and handbooks on ageing and migration from 2000 to 2019 (43 documents in total). The results reveal that besides public initiatives concerning long-term care, health promotion, and social services, informal solutions through social networks are frequently emphasised in the data. The focus, thereby, is on long-term care, which is presented as a responsibility of the extended family. Thus, resources are situated in the family, social networks, and ethnic group, which should be opened and connected with public services; however, the focus is shifting from older immigrants towards local municipalities. This study provides a discourse perspective on the construction of resources and challenges for older immigrants concerning health, care, and social services and offers an assessment of the cultural and integrating/excluding qualities in active ageing discourses.

Ethical advocacy in the end-of-life nursing care: A concept analysis.
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Hatefimoadab N, Cheraghi MA, Benton DC, Pashaeypoor S.
Nurs Forum 2021 sep.
AIM: This concept analysis was conducted to identify and define the features and functions of ethical advocacy in the end-of-life nursing care. BACKGROUND: Ethical advocacy is key to the role of the nurse in delivering quality and competent care. Despite this, the dimensions of this concept are poorly understood. DESIGN/DATA SOURCE: Databases such as Google Scholar, Scopus, Web of Science, Science Direct, and PubMed were searched systematically. To search these databases, the following keywords were used: “patient advocacy,” “nursing,” “ethics,” “end-of-life care,” and their combinations. REVIEW METHODS: Walker and Avant’s method was utilized as a comprehensive review of the literature to explore how ethical advocacy in nursing can be used to improve the quality of care. RESULTS: The defining attributes of the concept of ethical advocacy included adhering to ethical principles of nursing, championing social justice in the provision of healthcare, safeguarding and defending patient’s rights by applying collective wisdom, and involving hospital ethics committees. Antecedents are organizational and personal power and ethical leadership. The optimal consequence of ethical advocacy can be getting the best ethical governance. CONCLUSION: Based on this analysis, the concept of ethical advocacy is one of the most important roles for nurses which requires their awareness of this concept.

What Predicts Health Care Transitions for Older Adults Following Introduction of LTSS?
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Hirschman KB, Toles MP, Hanlon AL, Huang L, Naylor MD.
Journal of applied gerontology : the official journal of the Southern Gerontological Society 2020 jul;39(7):702-711.
Objective: To determine predictors of health care transitions (i.e., acute care service use, transfers from lower to higher intensity services) among older adults new to long-term services and supports [LTSS]. Method: 470 new LTSS recipients followed for 24 months. Multivariable Poisson regression modeling within a generalized estimating equation framework. Results: Being male, having multiple chronic conditions, lower self-reported physical health ratings and lower quality of life ratings at baseline were associated with increased risk of health care transitions. Older adults in assisted living communities and nursing homes experienced decreases in health care transitions over time, while LTSS recipients at home had no change in risk. LTSS recipients who had orders to receive therapy, compared with those who did not, had a lower relative risk of transitions over time. Discussion: Predictors of future health care transitions support the need for LTSS providers to anticipate and monitor this risk for LTSS recipients.

Where were you during the Queen’s visit? Using photographs to facilitate collective storytelling, resident identity and positive care relationships in aged care.
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King T, Miller E.
Australasian journal on ageing 2021 sep;40(3):e269-e272.
OBJECTIVES: This paper explores the potential of photographs as a tool to facilitate storytelling, reminiscence and social connections for older residents living in residential aged care and caregiving staff. METHODS: Fourteen residents and three staff attended two sessions in which residents brought and shared personal photographs. Narrative enquiry was used to elicit individual and collective stories. RESULTS: Narrative analysis of residents’ selected photographs overwhelmingly showed a younger self (n = 6), highlighting relationships (n = 6) and achievements (n = 6). Sharing images with other residents and staff enhanced new connections and personal communications. CONCLUSION: This research highlights the communicative value of photographs in aged care. Residents were able to reflect upon shared personal and global events-from the role of pets in their lives to public events such as the Queen’s visit to Australia-and through discussion build a collective shared narrative. This enabled new connections and sharing of stories between staff and residents.

A culinary twist of a two-course meals-on-wheels menu in a cluster-randomized controlled trial influencing health-related quality of life in nursing home residents.
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Okkels SL, Dybdal DR, Pedersen RJ, Klausen TW, Olsen A, Beck AM, et al.
Clinical nutrition ESPEN 2021 jun;43:137-147.
BACKGROUND AND AIMS: Meals-on-wheels in nursing homes are sensory diminished because of the packaging and reheating of the food, which creates less appetite stimulation and an impaired meal experience for nursing home residents. This background is crucial since nursing home residents are a frail and often malnourished group that is physiologically affected by sensory, physical and mental alterations. The study aimed to increase health-related quality of life in nursing home residents receiving meals-on-wheels using an intervention menu with favourite meals that added a culinary twist and were sensory improved by chefs. METHODS: A double-blinded cluster-randomized controlled trial with two arms, one group receives an intervention menu, and the other group receives a non-optimized menu. The intervention menu included popular meals-on-wheels (a main meal for dinner and a starter/dessert before or after dinner with culinary improvements). The participants received the same meals without culinary improvements in the control group. Health-related quality of life (EQ5D3L) was the primary outcome of the study. Secondary outcomes were mental and nutritional status and muscle strength. The measurements were assessed at a baseline and end visit (12 weeks after baseline visit). RESULTS: Fifty-two nursing home residents were included in the study (There are 20 in the intervention group and 32 in the control group). Following the principle of intention-to-treat, a significant decreasing effect (p-value 0.026) was found between the groups on health-related quality of life. The treated group experienced the largest decrease from the baseline to the end visit. The intervention group had a significant decrease in the second item on Satisfaction With Food-related Life (SWFL2) (I am very pleased with my food). No changes were found either within or between the groups, on the rest of the measured parameters. CONCLUSIONS: Nursing home residents are a target group experiencing natural aggravation, why the health-related quality of life might be difficult to improve using a culinary meal intervention. The decreasing effect of Satisfaction With Food-related Life found in the intervention group could be related to these older adults being too unfamiliar with the culinary twist added to the intervention menu. The study was registered on ClinTrials.gov (Identifier NCT03133364).

Longitudinal Comparison of Stability and Sensitivity in Quality of Life Scores Among Nursing Home Residents With and Without Diagnoses of Alzheimer’s Disease and Related Dementias.
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Qin X, Baker ZG, Jarosek S, Woodhouse M, Chu H, McCarthy T, et al.
Innovation in aging 2021;5(3):gab024.
BACKGROUND AND OBJECTIVES: Prevalence of nursing home residents with Alzheimer’s disease and related dementias (ADRD) has increased along with a growing consensus that person-centered ADRD care in nursing homes should maximize quality of life (QoL). However, concerns about whether residents with ADRD can make appropriate QoL judgments persist. This study assesses the stability and sensitivity of a self-reported, multidomain well-being QoL measure for nursing home residents with and without ADRD. RESEARCH DESIGN AND METHODS: This study linked the 2012-2015 Minnesota Nursing Home Resident QoL and Satisfaction with Care Survey, Minimum Data Set 3.0 (nursing home assessments), and Minnesota Department of Human Services Cost Reports. The QoL survey included cohort-resident pairs who participated for 2 consecutive years (N = 12 949; 8 803 unique residents from 2012-2013, 2013-2014, and 2014-2015 cohorts). Change in QoL between 2 years was conceptualized as stable when within 1.5 SD of the sample average. We used linear probability models to estimate associations of ADRD/Cognitive Function Scale status with the stability of QoL summary and domain scores (eg, social engagement) and the absolute change in QoL summary score, controlling for resident and facility characteristics. RESULTS: Most (86.82%) residents had stable QoL summary scores. Residents with moderate to severe cognitive impairment, irrespective of ADRD, were less likely to have stable summary scores than cognitively capable residents without ADRD (p < .001), but associations varied by QoL domains. Among those with stable summary QoL scores, changes in health/functional status were associated with absolute changes in summary QoL score (p < .001), suggesting sensitivity of the QoL measure. DISCUSSION AND IMPLICATIONS: QoL scores were similarly stable over time for most residents with and without ADRD diagnoses and were sensitive to changes in health/functional status. This self-reported QoL measure may be appropriate for nursing home residents, regardless of ADRD diagnosis, and can efficaciously be recommended to other states.

Effects of dance intervention on agitation and cognitive functioning of people living with dementia in institutional care facilities: Systematic review.
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Salihu D, Wong EML, Bello UM, Kwan RYC.
Geriatr Nurs 2021 sep;42(6):1332-1340.
INTRODUCTION: Agitation and impaired cognitive functioning are common symptoms of dementia, which require costly medication regimens that are associated with adverse effects. This study investigates the effects of dance interventions on agitation and cognitive function in people living with dementia in institutional care facilities. METHODS: Five electronic databases were searched for eligible studies on dance interventions for people living with dementia published between 2002 and 2021. Standard deviation and post mean values were extracted. Within-group Hedges’ g was computed for individual studies. RESULTS: Six randomised controlled trials and three non-randomised studies of satisfactory quality, with a total of 610 participants, were included. Statistical analysis found significant improvements in agitation and cognitive functioning with dance interventions. DISCUSSION: This review provided favourable evidence on the effects of dance interventions on agitation and cognitive functions in people with dementia. However, given the limited evidence, more studies are needed to confirm the effects.