De Richtlijn Mondzorg voor zorgafhankelijke cliënten in verpleeghuizen, 2007: bittere noodzaak!

The oral health status of residents in Dutch nursing homes is rather poor, especially of those depending on caregivers for their oral health care. Moreover, when care dependency is rising, the provision of good oral health care becomes more difficult. With more elderly people still having (parts of) their natural teeth, the need for good oral health care is increasing even more. Therefore a specific guideline was developed. The ultimate aim of the guideline "Oral health care for dependent residents in long term care facilities" is to improve the oral health of nursing home residents. Oral health care needs to be incorporated in daily nursing home care routine and in the integral care plan of every resident. Attention is given to the importance of an adequate implementation of this guideline as well as to the necessity of research evaluating the effects of it's implementation.     

Oral hygiene of elderly people in long-term care institutions--a cross-sectional study

Objective: The aim of this cross‐sectional study was to assess the level of oral hygiene in elderly people living in long‐term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness. Materials and methods: Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes. Results: Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score = 3) and the mean denture plaque score was 2.13 (maximum possible score = 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43). Conclusion: Oral hygiene was poor, both for dentures and remaining teeth in residents in long‐term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively.     

Secure Surveillance of Antimicrobial Resistant Organism Colonization or Infection in Ontario Long Term Care Homes

Background

There is stigma attached to the identification of residents carrying antimicrobial resistant organisms (ARO) in long term care homes, yet there is a need to collect data about their prevalence for public health surveillance and intervention purposes.

Objective

We conducted a point prevalence study to assess ARO rates in long term care homes in Ontario using a secure data collection system.

Methods

All long term care homes in the province were asked to provide colonization or infection counts for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) as recorded in their electronic medical records, and the number of current residents. Data was collected online during the October-November 2011 period using a Paillier cryptosystem that allows computation on encrypted data.

Results

A provably secure data collection system was implemented. Overall, 82% of the homes in the province responded. MRSA was the most frequent ARO identified at 3 cases per 100 residents, followed by ESBL at 0.83 per 100 residents, and VRE at 0.56 per 100 residents. The microbiological findings and their distribution were consistent with available provincial laboratory data reporting test results for AROs in hospitals.

Conclusions

We describe an ARO point prevalence study which demonstrated the feasibility of collecting data from long term care homes securely across the province and providing strong privacy and confidentiality assurances, while obtaining high response rates.     

Residential care for elderly people: a decade of change.

OBJECTIVE--To determine the changes between 1979 and 1990 in demography and dependency levels in elderly people in residential care. DESIGN--Censuses of those aged 65 years and over in any type of residential care at midnight on 11 December 1979 and 27 November 1990. SETTING--Leicestershire District Health Authority (population 865,133, 1991 census), coterminous with county and social services boundaries. MAIN OUTCOME MEASURES--Age, sex, length of stay, and dependency levels (measured by activities of daily living). RESULTS--In 1990 (1979), 6079 (4678) elderly people were enumerated in 241 (133) establishments, a 30% increase in the numbers of elderly people in residential care and an 82% increase in the number of establishments between 1979 and 1990. Dependency levels rose between 1979 and 1990 in all but the geriatric sector, the greatest increases being found in private residential homes where the largest percentage increase in the number of residents had occurred. CONCLUSIONS--Dependency levels in residential care have risen substantially, particularly in the private sector, even beyond levels expected from the greater numbers of elderly people. With the impending move to community care, dependency levels are likely to rise further, and more appropriate staff training and medical input to homes will become necessary.     

Boom in private rest homes in Southampton: impact on the elderly in residential care

A survey in 1986 of 450 elderly people in 51 private rest homes and 206 residents of seven local authority (part III) homes in the Southampton area showed no significant difference in overall dependency between the two populations. Although age and sex distributions of the residents of part III homes had remained the same between 1982 and 1986, the average level of dependency had fallen significantly. Since the provision of places increased because of expansion in the private sector residential care institutions are generally catering for a more independent population.     

Psychiatric consultation in the nursing home. An inquiry among Amsterdam nursing home physicians

Psychiatric disorders are common among nursing home residents. However, little is known about psychiatric consultation in Dutch nursing homes. As an exploration of the topic, Amsterdam-based nursing home physicians were asked to rate a number of aspects of psychiatric consultation as performed in their nursing home. Striking differences are reported between 14 participating nursing homes with regard to the intensity of psychiatric consultation and the number of consultation requests, which seems low compared with the perceived psychiatric problems. Somatically ill and psychogeriatric residents are estimated to generate an equal number of consultation requests. Psychiatric consultation appears to be characterized by diagnostic clarification, medication recommendations and behavioral management advice whereas staff-directed activities are scarce. Physicians report shortcomings in psychiatric skills among care staff. Research is necessary concerning the psychiatric care delivered to nursing home residents, as well as with regard to the optimal model for psychiatric consultation services. Integration of psychiatric care in nursing homes with mental health care services appears to be desirable.     

Role of local authority homes in the care of the dependent elderly: a prospective study.

A two-year prospective study of 11 local authority homes showed no increase in the degrees of behavioural disabilities or the prevalence of dependency or dementia among the residents. This finding, which differed from trends reported in other studies, was unlikely to be due to the design of the study and occurred in the absence of a co-ordinated service for the elderly. It was probably the effect of changes in the admission policy of the social-work services and suggests that, in some parts of Britain at least, residential homes are no longer absorbing additional numbers of dependent or demented old people in need of institutional care.     

Change in Care Dependency and Nursing Care Problems in Nursing Home Residents with and without Dementia: A 2-Year Panel Study

Over time, chronic conditions like dementia can lead to care dependency and nursing care problems, often necessitating nursing home admission. This panel study (2012–2014) aims to explore changes in care dependency and nursing care problems (incontinence, malnutrition, decubitus, falls and restraints) in residents with and without dementia over time. In total, nine Austrian nursing homes participated, including 258 residents (178 with, 80 without dementia) who completed all five measurements. Data were collected with the International Prevalence Measurement of Care Problems questionnaire, the Care Dependency Scale and the Mini-Mental State Examination-2. Repeated measures ANOVA and crosstabs were used to analyse changes. The results showed that care dependency in dementia residents increased significantly for all 15 items of the Care Dependency Scale, with the highest increase being residents’ day-/night pattern, contact with others, sense of rules/values and communication. In contrast, care dependency in residents without dementia increased for four of the 15 items, with the highest increase being for continence, followed by getting (un)dressed. With respect to the assessed nursing care problems, residents with dementia and those without only differed significantly in terms of an increase in urinary- (12.3% vs. 14.2%), fecal- (17.4% vs. 10%), and double incontinence (16.7% vs. 11.9%). The results indicated that residents with dementia experienced increased care dependency in different areas than residents without dementia. Furthermore, residents with dementia experienced a lower increase in urinary incontinence but a higher increase in fecal- and double incontinence. These results help professionals to identify areas for improvement in dementia care.     

Treatment of residents in 74 nursing homes: the opinion of caregivers

This study is based on the outcomes of the program "Privacy In Nursing Homes" that has been initiated by the Dutch Department of Health in the late 90's. In this study, personnel of 74 nursing homes were asked to reflect on the way they treat residents. The attitudes of personnel were measured with a questionnaire that contains 80 propositions about their behaviour towards residents. The propositions can be reduced to five factors: kindness, structural environment, control, freedom to choose, and respect. First, we give the general results on these five factors. After that we give insight in the correlations between the five different aspects of treatment and the results of regression analysis. The general conclusion is that the behaviour towards residents in nursing homes at the beginning of the 21st Century is far from optimal. Residents most notably lack personal freedom and control over their received care and their way of living. This result is especially worrying because client conformed care has been an important point of attention for some time now. Another important conclusion is that the care for residents has a positive relation with the mangement policy of an organization and so, it is possible to improve the care.     

Continuing dental care for Highlands elderly: current practice and attitudes of dental practitioners and home supervisors

Objective : To investigate current practice and attitudes of Highland dentists and home supervisors to continued dental care of elderly residents. Methods : A cross‐sectional questionnaire was designed to survey the current practice and attitudes of Highland dentists and residential care supervisors in their provision of dental care for the elderly at home and in long stay accommodation. Results : The response rate was 94% of dentists and 79% of homes. Despite 86% of dentists providing domiciliary care and 93% of homes transport to a surgery, no more than a quarter of residents had had contact with a dentist in the previous year. The distribution of residents varied with dependant individuals living in nursing units and the least dependant in residential homes. Only 1% of all residents were totally bed bound. Domiciliary patients were less likely to receive continuing care compared with those seen in a surgery and 75% of homes had to initiate dental care. In terms of patient referral, the majority of GDPs would refer uncooperative patients, salaried dentists would refer those with complex medical histories and community dentists would refer those requiring complex treatments. A dental assessment was undertaken in 46% of homes and 81% of these kept a record of dental care. Conclusion : This study highlights the need for a co‐ordinated, seamless continuing dental care service, tailored to the actual needs of the elderly individuals it is designed to serve, particularly in a remote and rural area.     

A psychogeriatric survey of old people's homes.

An assessment of mental impairment and behavioral disabilities in 289 residents in six old people''s homes indicated that 50.6% were probably demented and 54% needed considerable help in daily living, 74% were taking prescribed medication, and 11% were taking four or more prescribed drugs. There was a wide variation between homes in those rated as behaviourally disabled, and in the amount of medication prescribed. A follow-up of 60 mentally impaired residents showed few remediable psychiatric disorders or psychotoxic drug effects. A community psychiatric nurse working with the psychogeriatric team would provide a useful support service to old people''s homes, particularly where there is a high proportion of disturbed residents and where the staff lack nursing experience.     

Private nursing homes: contribution to long stay care of the elderly in the Brighton Health District.

Two surveys of private nursing homes, designated geriatric wards, and a sample of social service part III homes were carried out in the Brighton Health District using questionnaires supplemented (in the second survey) by some interviews. The dependency of old people in the private nursing homes was more like that of long stay hospital patients rather than that of residents in social services homes. In the private nursing homes, however, a smaller proportion of patients were in the medium to heavy nursing category (178 (31%) compared with 158 (63%) in the hospital long stay wards) and a larger proportion in the heavy nursing category (170 (30%) compared with 44 (17%) in the long stay wards). Of the patients in private nursing homes, 401 (82%) were local residents, 488 (86%) were long stay, and 459 (88%) were women; their mean age was 88 years. Two thirds of the patients were over 80. There were no significant differences between the private nursing homes and the wards in nursing workloads or staffing, except for a slightly higher provision of state registered nurses in the private sector. In the private nursing homes 348 (63%) of the patients had fees paid by private funds, 26 (5%) were in contract beds paid for by the National Health Service, and 176 (32%) were subsidized by the Department of Health and Social Security. Private nursing homes make a substantial contribution to the care of the elderly in the Brighton Health District, and the health authority should develop a more active partnership with this sector.     

The health of the very aged.

Little information is available on the health status of persons 85 years or over. Recent United States data indicate that 20% of individuals 85 years of age or over reside in nursing and personal care homes and that among these institutional residents 31% are bedfast, 11% are chairfast and 71% manifest evidence of senility. An investigation into the health of persons 85 years of age or over in two Ontario counties revealed that 39% resided in long-stay institutions, and that one of the main differences between old people living independently in the community and those in institutions was the higher proportion of the latter needing help with the activities of daily living and showing mental disorientation. Of those individuals 85 years of age or over in institutions for 1 year, 26% acknowledged often feeling depressed and 18% acknowledged often wishing they were dead, but these tendencies were not more frequent in those 85 years of age or over than in those 65 to 84 years of age. These findings have implications for service and research needs and attitudes towards death.     

Resident Assessment Instrument (RAI): a review of international research on the psychometric qualities and effects of implementation in nursing homes

This article is a review of the available literature on psychometric qualities and effects of implementation of the Resident Assessment Instrument (RAI) on quality of care and health of nursing homes residents. The RAI was developed in the USA to assess the needs of nursing home residents. It consists of a comprehensive assessment of the resident (the Minimum Data Set) and 18 protocols (Resident Assessment Protocols) for further analysis of major problem areas. RAI is implemented in nursing homes in the United States, Canada, Japan and several European countries. The interrater reliability was adequate for clinical use in several studies. The validity is good for the appraisal of ADL- and cognitive functions, but moderate for mood and behaviour. In Japan and the United States positive effects were found after implementation of the RAI, especially on the care process. Implementation of RAI has shown to have positive effects on the physical and cognitive function of the resident, but there were negative effects on a number of psychosocial domains. Fourteen Dutch nursing homes have recently implemented the RAI. Studies concerning reliability, validity and effects on quality of care and quality of life are underway.     

Dental Status in the Elderly: A Review of the Swedish Literature1

1. Elderly persons living in their own homes have over the past 20 years tended to retain an increased number of natural teeth. This tendency is confirmed especially in the ongoing studies by Tor Österberg, nr 12 and 13. These studies indicate a decreasing edentulous part of the 70-year old cohorts from 1971, 1976 and 1981. 2. Elderly persons dependent on institutional care are edentulous in as high degree today as 20 years ago. According to this criterion, therefore, their dental health has not improved. 3. Dentures worn by elderly persons frequently are defective in fit and function. For the general wellbeing and health in later life, mastication of a well-balanced diet and lack of discomfort from denture-bearing mucosal surfaces are important. Information in this respect and measures to improve masticating function are greatly needed among persons in the higher age groups, whether living at home or in institutional care. 4. Caries activity is increasing among elderly persons. 5. Periodontitis (loosening of the teeth) is very frequently found in elderly persons. 6. Oral hygiene requires improvement. 7. Among the elderly, living in their own homes or in institutions, the need for odontologic care is objectively great, but the demands currently made are remarkably low. 8. Of the aged in institutional care, about 75 per cent are suitable for measures of oral care. A change in dental health seems to be slowly taking place among the elderly, in that increasing numbers keep more of their own teeth longer in life. The demands made by the high age groups on the odontologic services, though increasing, are still very low relative to the objective and consequently great accumulated needs. This contrast is especially pronounced among geriatric patients in institutions. An aggressive, searching approach to both restorative and preventive oral care in the higher age groups is of pressing importance if optimum conditions for eating and chewing late in life are to be achieved. For timely counteraction of the tendency to a more passive attitude t o dental care that commonly accompanies rising age, information on these matters should be energetically disseminated among persons due for retirement or new-l y retired.     

Impact of dry mouth conditions on oral health-related quality of life in older people

Objective: The aim of the present study was to evaluate the impact of dry mouth conditions on oral health‐related quality of life in frail old people, residents at community care centers. Further, reliability and validity of a visual analogue scale (VAS) for dry mouth symptoms were determined within the study cohort. Background: In old people functional, social and psychological impacts of oral conditions are associated with an overall sense of well being and general health. Subjective dry mouth and reduced saliva flow are common disorders in old people caused by disease and medication. Thus, dry mouth conditions may be determinants for compromised oral health‐related quality of life in old people. Method: In total, 50 old people living at service homes for the old people were asked to answer questionnaires on subjective dry mouth (VAS) and Oral Health Impact Profile (OHIP14) for oral health‐related quality of life. Saliva flow was estimated by absorbing saliva into a pre‐weighed cotton roll. Results: The final study cohort comprised 41 old people (aged 83–91 years). Significant associations were identified between both objective and subjective dry mouth and overall or specific aspects of oral health‐related quality of life. Conclusion: Dry mouth (objective and subjective) is significantly associated with oral health‐related quality of life strengthening the value of monitoring dry mouth conditions in the care of frail old people.     

The effects of immersive garden experience on the health care to elderly residents with mild-to-moderate cognitive impairment living in nursing homes after the COVID-19 pandemic

Elderly patients living in long-term care facilities have been restricted from leaving to comply with social distancing guidelines during the COVID-19 pandemic. This has led to a worsening of disorders, such as anxiety and depression. This study aims to understand the health benefits of an immersive garden experience to elderly nursing home residents with mild-to-moderate cognitive impairments. Virtual reality devices were used to provide immersive garden experiences for the residents who were unable to go outside. The heart rate and heart rate variability (HRV) data of the participants of the participants were collected using biofeedback instruments, and changes in the low frequency/high frequency (LF/HF) and the standard deviation of the NN interval (SDNN) values caused by immersive garden experiences were discussed. The results show that the immersive garden experiences were beneficial to these elderly residents. Within 6 min of completing the experiment, we found that the heart rates of participants had dropped slightly, while SDNN and HF values continued to rise. SDNN values before and after the experiment demonstrated a statistically significant improvement. Furthermore, participants expressed their satisfaction with the video intervention program. The results indicated that nursing homes can provide immersive landscape experiences to help increase HRV and SDNN of their elderly residents. This will not only help these residents recall beautiful memories of their past, but will also improve their quality of life.

     

Quality of care in unlicensed homes for the aged in the Eastern Townships of Quebec

BACKGROUND: The recent proliferation of unlicensed homes for the aged in Quebec, coupled with the increased needs of the population they serve, has raised concerns about the quality of case these homes provide. The authors compared the quality of care in unlicensed homes with that in licensed long-term care facilities in a region of Quebec. METHODS: The study involved 301 impaired people aged 65 and over in 88 residential care facilities (52 unlicensed, 36 licensed) in the Eastern Townships of Quebec. Study participants were chosen according to a 2-stage sampling scheme: stratified sampling of the primary units (facilities) and random sampling of the secondary units (residents). Quality of care was measured using the QUALCARE scale, a multidimensional instrument that uses a 5-point scale to assess 6 dimensions of care: environmental, physical, medical management, psychosocial, human rights and financial. A mean score of more than 2 was considered indicative of inadequate care. RESULTS: Overall, the quality of care was similar in the unlicensed and licensed facilities (mean global score 1.61 [standard error of the mean (SEM) 0.06] and 1.47 [SEM 0.09] respectively). Examination of dimension-specific quality-of-care scores revealed that the unlicensed homes performed worse than the licensed facilities in 2 areas of care: physical care (mean score 1.80 [SEM 0.08] v. 1.51 [SEM 0.09] respectively, p = 0.017) and medical management (1.37 [SEM 0.06] v. 1.14 [SEM 0.05], p = 0.004). The dimension-specific scores also revealed that both types of homes lacked appropriate attention to the psychosocial aspect of care. Overall, 25% of the facilities provided inadequate care to at least one resident. This situation was especially prevalent among homes with fewer than 40 residents, where up to 20% of the residents received inadequate care. INTERPRETATION: Most of the unlicensed homes for the aged that were studied delivered care of relatively good quality. However, some clearly provided inadequate care.     

Historical gender change in West Frisian

In Frisian, grammatical gender is an abstract lexical property, which is not spelled out on the noun. It manifests itself in an indirect way, through the agreement relations the noun enters into. It is, thus, understandable that phonological regularities and residual (abstract) case marking in a prepositional context can be crucial for two instances of historical gender change in Frisian. In the Dutch–Frisian language contact situation, however, factors which are strictly speaking non-linguistic in nature play a role as well. These are, first, the low degree of standardisation of Frisian at the time the gender change set in and, secondly, distancing from Dutch at the time when Frisian developed its own standard vis-à-vis Dutch, which implies the propagation of the gender which diverges from the Dutch one. It is the interplay between these factors which lends the case of gender change in Frisian an inherent linguistic significance. Not every Frisian de-word could become an it-word and vice versa, since the language system puts its limits here. For instance, all nouns ending in schwa are de-words, a formal regularity which prevented them from switching to it-words. Neither are there only regular patterns of gender change in Frisian. The general tendencies are clear, but as far as individual words are concerned, there is much which must be left unexplained.