摘要:

This historical cohort study investigated the relationship between nursing home quality and the group outcomes of mortality, rehospitalization, and discharge. Multiple logistic regression was used to determine if nursing home quality indices increased the prediction of these outcomes when patient severity of illness and case‐mix differences were in the model. Three hundred ninety veterans discharged to 11 nursing homes were followed for 6 months. Nursing home quality was assessed using indices from the Multiphasic Environmental Assessment Procedure and the Rush‐Medicus Methodology for Monitoring Quality of Nursing Care. An increased likelihood of death was associated with the diagnoses of cancer and heart disease and with being rehospitalized. Four nursing home quality indices significantly improved the prediction of mortality (RN hours, nursing process, security, and mean quality). Rehospitalization was associated with the patient factors of heart disease, hypertension, race, and level of care and with size of the nursing home. Discharge from the facility was inversely associated with the diagnosis of cancer and directly related to the index of nursing process. The results support the notion that group outcomes may be related to nursing home quality and suggest the need for further studies to investigate the specific elements of nursing home quality which relate to improved outc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02896.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Although a great number of psychometric tests and rating scales for the assessment of psychogeriatric patients is available, there is still an urgent need, in research and practice, for a clinical rating instrument that meets the following main requirements: (1) applicable to institutionalized and community patients and covering a wide range of behavioral pathology; (2) acceptable and easy to use for professionals and lay persons alike; (3) covering a wide range of behavior relevant to daily functioning but independent of sex or social status of the individual assessed. The NOSGER contains 30 items of behavior, each rated on a 5‐point scale according to frequency of occurrence. Item scores are summarized into 6 Dimension scores (memory, instrumental activities of daily life, self‐care, mood, social behavior, and disturbing behavior) which are clinically relevant in dementia, depression, and other psychiatric disorders of old age. Validation studies with a preliminary version of the NOSGER indicated good acceptance of the scale, high inter‐rater and test‐retest reliability, and high correlations of all NOSGER Dimension scores with results of a variety of established assessment instruments. The NOSGER is currently being used in a number of European and North American centers and should turn out to be a useful instrument for longitudinal studies in psychoger

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02897.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A frequently cited example of physicians' alleged disinterest in nursing home patients is their failure to respond rapidly or appropriately to telephone calls about acute events or important changes in patient status.This study of 45 SNFs and their 15 attached ICFs evaluated the length of time required to reach physicians by phone about significant clinical changes in patients' conditions and the appropriateness and timeliness of action taken by the physicians once contact was made. Calls on administrative matters, updating of orders, and similar routine calls were excluded. Seven hundred and fifty calls were identified from 24‐hour nursing reports; the nature of the problem and the time and details of physicians' responses were recorded from patient charts. Judgment on the quality of physicians' responses was made by consensus of the regional UR committee except in the case of infections where decisions were based on detailed criteria developed in a previous study. The most frequent clinical problems were acute infections (32%), trauma (12%), GI tract disorders (11%), cardiorespiratory problems (10%), neurological disorders (7%), and diabetic control (7%). Results were very encouraging: 96% of physicians' call‐backs and actions were judged to be timely, and 87% of physicians' actions taken were judged to be appropriate. However, actions taken were judged inappropriate for certain specific clinical problems, ie, in 22% (54/243) of infections, 24% (4/17) of CVA's, and 12% (6/49) of diabetic control problems. Implications for nursing home care and recommendations for improving the response to acute problems are discus

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02898.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

To investigate the effects of aging on the secretion of the common alpha‐subunit of the glycoprotein hormones, we measured basal levels of luteinizing hormone (LH), testosterone (T) and alpha‐subunit in 176 normal men aged 19 to 89 years. In addition, in two groups of young(80 years; (3) the delay in the timing of peak responses of LH and alpha‐subunit after LHRH administration; and (4) the disproportionate increase in the secretion of alpha subunit rela

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02899.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

We conducted a quasi‐experiment to evaluate the impact of a Medicare waiver which allowed the use of nurse practitioners (NPs) and physicians assistants (PAs) to deliver primary care to Massachusetts nursing home patients and removed the limits on the reimbursable numbers of visits per month. A carefully matched set of 1,327 Medicaid patients from 95 non‐participating homes in the same areas of Massachusetts was compared to 1,324 Medicaid demonstration patients from 75 homes. Information came from specially designed record reviews and the Medicaid and Medicare information systems. Separate analyses were done for newly admitted cases and rollovers. Comparisons of quality of care suggested that the medical groups using NPs and PAs provided as good or better care than did the physicians in the control group. There were no differences in functional status changes or in the use of medications. The demonstration patients received more attention, as reflected in more orders written and an average of one additional visit a month. Demonstration patients showed higher scores on three of seven specially designed quality tracers, congestive heart failure and hypertension for both new admissions and rollovers, and new urinary incontinence for new admissions. Rollovers had significantly fewer emergency and total hospital days. A cost analysis suggests that the use of NPs and PAs saves at least as much as it costs and may save additional money with more sustained

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02900.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The London Psychogeriatric Rating Scale (LPRS) was administered to 76 probable Alzheimer's patients, 59 patients with dementia unrelated to Alzheimer's, 102 neurologically normal subjects, and 27 patients with symptoms of both Alzheimer's and dementia of other etiologies. By examining the relationships among the four subscales of the LPRS and conducting factor analyses, it was demonstrated that the four subscales were not measuring different phenomena. The internal consistency of the full 36‐item scale was high (Cronbach's Alpha = 0.96) indicating the total LPRS score provided a reliable global index of behavioral function. The total LPRS scores correlated with the independently administered Goldfarb Mental Status Examination scores (r = −0.79). The LPRS differentiated between the normals and the combined demented groups and between inpatients and outpatients. The LPRS continues to have clinical value for functional assessments in a non‐intrusive manner. The LPRS may be particularly useful in situations where direct assessment of mental status is not prac

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02901.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Considering the limited success of cardiopulmonary resuscitation (CPR) in achieving survival to hospital discharge in older persons, it is appropriate to educate, discuss and determine patients' wishes at a time when they are able. Sixty‐four ambulatory, non‐depressed, non‐demented veterans>74 years of age were interviewed and educated. Knowledge of CPR at baseline was variable, and most overestimated their survival chances. Most subjects desired routine CPR discussions with physicians. Only 17% had previously discussed their CPR preferences, and none had done so with physicians. Knowledge of CPR increased (P = 0.01) after educational intervention. There was no change in subjects' CPR decisions after education and presentation of current CPR outcome data. In considering five hypothetical scenarios, 9% never wanted CPR, and 17% always wanted CPR. Those who never wanted CPR were more realistic about their suspected survival chance (P = 0.003) and had higher educational levels (P = 0.03) Folstein (P = 0.05) and Geriatric Depression Scale (P = 0.04) scores. With the dependent variable being the number of hypothetical situations in which the patient desired CPR, a regression analysis (adjusted r2= 0.72) limited significant variables to the patient's current CPR decision, Folstein score, religion, marital status, and previous ICU admissions. This study emphasizes that most elderly male veterans are willing and want to discuss their CPR attitude with physicians and that most have fixed CPR decisions which may be elicited under stable clinical condi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02902.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The objectives of this paper were to assess the quality of life of community‐living women with urinary incontinence according to age, symptom group, amount of leakage, and duration, by use of the Sickness Impact Profile (SIP). Thirty‐six women aged between 40 and 60 years and 40 women aged 70 years or more were randomly selected from the clients attending an incontinence clinic and interviewed using the SIP questionnaire. Urge and stress incontinence subgroups were defined by means of a symptom questionnaire. Total, psychosocial, and physical dysfunctions were moderate (8%, 7%, and 8% respectively) in general, but major differences were found when age and symptom groups were analysed. Urge symptoms were associated with more impairment than symptoms of stress incontinence. The elderly women with symptoms of stress incontinence were relatively little affected, while their younger counterparts were severely affected, especially in the categories of emotional behavior and recreation and pastimes. We conclude that urinary incontinence in women adversely affects quality of life to a significant degree; the extent depends on the nature of incontinence and the age of the per

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02903.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Body core temperature was measured in healthy elderly men and women under entrained conditions. Female subjects showed a larger amplitude and a higher peak temperature than male subjects. In addition, acrophase was advanced for females by an average of 49 minutes. Variability in acrophase was greater for males than females. This pattern of gender differences varies considerably from the pattern others have observed in young subjects, suggesting that aging may affect the circadian timing system of males and females differently.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02904.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

We studied asymptomatic bacteriuria in elderly ambulatory women residents without indwelling catheters in self‐contained apartment houses at the Philadelphia Geriatric Center (PGC), in the nursing home at PGC, and in several life‐care communities (LCC). Subjects were studied every 6 months from January 1983 through January 1989, and since enrollment was continuous some participated in more surveys than others. PGC residents were middle class and lived either in a self care apartment house (CL) or nursing home (NH); LCC residents were middle or upper class. Antimicrobial therapy for asymptomatic bacteriuria was not given by the study team.The ages of the 865 women studied averaged 80.3, 82.8, and 83.3 years in LCC, CL, and NH, respectively. On each survey about 11% at LCC, 18% at CL, and 25% at NH sites had positive cultures. Turnover was high. The conversion rate from a negative to a positive culture was 5% at LCC, 11% at CL, and 8% at NH. The reversion rate from a positive to a negative culture was 33% at LCC, 34% at CL and 31% at NH (P>0.05). Persistent infection with the same organism was uncommon. Infection risk was associated with residence, which was partially explained by a factor evaluating mobility, but was unrelated to age or scores evaluating activities of daily living or mental status. Besides mobility, other more complex factors play a role in the acquisition of infect

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb02905.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY