Advance Directives among Nursing Home Residents with Mild, Moderate, and Advanced Dementia

Tjia, Jennifer; Dharmawardene, Marisa; Givens, Jane L.

doi:10.1089/jpm.2016.0473

Cited by 30 publications

(29 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is consistent to the results of Cohen et al (2017) which illustrated that even "Do-Not-Hospitalize Orders" cannot guarantee treatment in NHs [46]. Issues of unknown resident' wishes were also found in other studies [47,48].…”

Section: Discussionsupporting

confidence: 91%

Paramedics's perspectives on hospital transfers of nursing home residents - a qualitative focus group study

Pulst

Fassmer

Hoffmann

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Emergency department (ED) visits and hospital admissions are common among nursing home residents (NHRs). These transfers are often considered avoidable and can have negative effects on residents’ health status. Emergency medical services (EMS) are an important linking profession between nursing homes (NHs) and hospitals and responsible for transports. So far, little is known about the perspectives of paramedics in this context. The aim of this qualitative study is to explore how paramedics experience hospital transfer process of NHRs and how hospitalizations could be avoided from their point of view. Methods: A qualitative study with three focus groups was conducted with paramedics. The focus groups followed a semi-structured question guide focusing on issues during transfer process, avoidable hospital transfers and potential interventions which might reduce transfers from NHs. Discussions were audio recorded and transcribed verbatim. Data were analyzed by content analysis using the software MAXQDA. Results: In total, 18 paramedics (mean age: 33 years, male n=14) participated in the focus groups. Paramedics mainly reported about perceived structural reasons (e.g. understaffing or lack of time) in NHs which led to initiation of an emergency call. Paramedics were often faced with poorly organized handovers because of lacking or incomplete information. In many cases, nursing staff was perceived as insufficiently qualified and not well-prepared regarding health status of NHRs. Throughout transfer process, the behavior of all involved professional groups (dispatcher/ambulance control center, nurses, physicians and paramedics) was influenced by legal uncertainties. Paramedics rated hospital transfers as avoidable in case of urinary catheter complications, exsiccosis/infections and partially in case of falls. Emergency standards in NHs, trainings for nursing staff, improvement of working conditions and legal conditions were discussed as potential interventions which could reduce hospital transfers of NHRs. Conclusion: Paramedics are faced with complex issues when transporting a NHR to hospital. According to their point of view staff shortage and legal uncertainties play a relevant role in transfer decisions. Interventions reducing (avoidable) hospital transfers of NHRs have to take these factors into account. Keywords: nursing home residents, hospitalization, hospital admission, patient transfer, referral, transition, emergency department, emergency medical services, decision making, advance care planning

show abstract

Section: Discussionsupporting

confidence: 91%

Paramedics's perspectives on hospital transfers of nursing home residents - a qualitative focus group study

Pulst

Fassmer

Hoffmann

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…35e38 However, approximately 4 of 10 nursing home residents fail to have any advance care plan documented. 39,40 A major barrier to advance care planning is choosing the correct time to initiate it. Discussions occurring too early may not accurately reflect patient preferences over time and discussions that occur too late fail to protect patients from receiving care that was not consistent with their wishes.…”

Section: Discussionmentioning

confidence: 99%

Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia

Griffith

Levy

Parikh

et al. 2020

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

Objectives: Pneumonia is a common cause of hospitalization for nursing home residents and has increased as a cause for hospitalization during the COVID-19 pandemic. Risks of hospitalization, including significant functional decline, are important considerations when deciding whether to treat a resident in the nursing home or transfer to a hospital. Little is known about postdischarge functional status, relative to baseline, of nursing home residents hospitalized for pneumonia. We sought to determine the risk of severe functional limitation or death for nursing home residents following hospitalization for treatment of pneumonia. Design: Retrospective cohort study. Setting and Participants: Participants included Medicare enrollees aged 65 years, hospitalized from a nursing home in the United States between 2013 and 2014 for pneumonia. Methods: Activities of daily living (ADL), patient sociodemographics, and comorbidities were obtained from the Minimum Data Set (MDS), an assessment tool completed for all nursing home residents. MDS assessments from prior to and following hospitalization were compared to assess for functional decline. Following hospital discharge, all patients were evaluated for a composite outcome of severe disability (4 ADL limitations) following hospitalization or death prior to completion of a postdischarge MDS. Results: In 2013 and 2014, a total of 241,804 nursing home residents were hospitalized for pneumonia, of whom 89.9% (192,736) experienced the composite outcome of severe disability or death following hospitalization for pneumonia. Although we found that prehospitalization functional and cognitive status were associated with developing the composite outcome, 53% of residents with no prehospitalization ADL limitation, and 82% with no cognitive limitation experienced the outcome. Conclusions and Implications: Hospitalization for treatment of pneumonia is associated with significant risk of functional decline and death among nursing home residents, even those with minimal deficits prior to hospitalization. Nursing homes need to prepare for these outcomes in both advance care planning and in rehabilitation efforts.

show abstract

“…23 The CPS is a valid and reliable seven-point hierarchical scale derived from the MDS that rates impairment from intact memory to very severe memory loss. 24 The CPS collates data on comatose status, short-term memory, cognitive skills for daily decision making, being understood by others, and self-performance in eating; with scores ranging from 0 (intact memory) to 6 (very severe memory impairment). The CPS has been shown to be highly correlated with the Mini-Mental State Examination in a number of validation studies.…”

Section: Diagnosis Of Dementiamentioning

confidence: 99%

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment

Bala

Jamieson

Nishtala

2018

Int J Geriat Psychiatry

View full text Add to dashboard Cite

Objective To identify the prevalence and predictors of prescribing potentially inappropriate medications (PIMs) in a nationwide cohort of community dwellers with dementia requiring complex care needs. Methods A cross‐matched data of the International Resident Assessment Instrument‐Home Care (9.1) (interRAI‐HC) and prescribing data obtained from the Pharmaceutical Claims Data Mart (Pharms) extract files for older adults (≥65 y) requiring complex care needs were utilized for this study. The 2015 Beers criteria were applied to identify the prevalence of PIMs in older adults with dementia. Sociodemographic and clinical predictors of PIMs were analysed using a logistic regression model. Results The study population consisted of 16 568 individuals who had their first interRAI assessment from 1 January 2015 to 31 December 2015. The estimated prevalence of dementia was 13.2% (2190/16 568). 66.9% (1465/2190) of the older adults diagnosed with dementia were prescribed PIMs, of which anticholinergic medications constituted 59.6% (873/1465). Males and individuals who were prescribed a greater number of medications were more likely to be prescribed PIMs. Individuals over 85 years of age, Māori ethnic group of individuals, older adults who were being supervised with respect to their activities of daily living, and individuals who reported good or excellent self‐reported health had a lesser likelihood of being prescribed PIMs. Conclusion We found that PIMs are prescribed frequently in older adults with dementia. Comprehensive geriatric assessments can serve as a potential tool to decrease the occurrence of PIMs in vulnerable groups with poor functional and cognitive status.

show abstract

Advance Directives among Nursing Home Residents with Mild, Moderate, and Advanced Dementia

Cited by 30 publications

References 17 publications

Paramedics's perspectives on hospital transfers of nursing home residents - a qualitative focus group study

Paramedics's perspectives on hospital transfers of nursing home residents - a qualitative focus group study

Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment

Contact Info

Product

Resources

About