Journal of the American Medical Directors Association
-
To determine the demographic and clinical predictors of in-hospital mortality among hospitalized nursing home (NH) residents. ⋯ Among hospitalized NH residents, age 85 years or older and several acute conditions, but not chronic morbidities, predicted in-hospital mortality. Elderly NH residents at risk of developing these acute conditions may benefit from palliative care.
-
To examine the association of family members' perception about the adequacy of home health services at the last place of care before death. ⋯ The perception that home health services before death did not meet the decedent's needs may contribute to greater nursing home use.
-
Two aspiration syndromes have been identified: Aspiration pneumonia is infectious caused by micro-aspiration of oral bacteria secondary to neurogenic dysphagia or sedation. Infectious bacteria may also be aspirated from the stomach. ⋯ Large bolus gastric aspiration events may have an acute/dramatic onset. This article discusses (1) prevention of recurrent aspiration events caused by 2 common motility disorders: neurogenic dysphagia and gastro esophageal reflux; (2) mechanical source control (debridement/drainage) of sites that may harbor large collections of bacteria protected from antibiotics in biofilm including dental plaque, coated tongue, and chronic sinusitis.
-
Comparative Study
Reducing potentially avoidable hospitalizations of nursing home residents: results of a pilot quality improvement project.
Hospitalizations expose nursing home (NH) residents to disruptions in care, iatrogenic events and related morbidity, and result in excess health care costs. Research has shown that a substantial proportion of these hospitalizations may be avoidable and that reducing such hospitalizations could save Medicare dollars that could be re-invested in improving the quality of care in US NHs. The objective of this project was to pilot test tools and strategies designed to assist NH professionals in reducing potentially avoidable hospitalizations. ⋯ The quality improvement strategies and tools tested in this pilot project show promise for assisting NHs in reducing potentially avoidable hospitalizations. The results must be interpreted cautiously because this was not a controlled study, and was conducted in only 3 highly selected NHs. Refinement of the tools and implementation strategies and testing in a larger and more diverse sample of NHs is under way.
-
Comparative Study
A comparison of the nursing home evacuation experience between hurricanes katrina (2005) and gustav (2008).
One of the tragic legacies of Hurricane Katrina was the loss of life among Louisiana (LA) nursing home (NH) residents. Katrina revealed a staggering lack of emergency preparation and understanding of how to safely evacuate frail populations. Three years later, LA braced for Hurricane Gustav, a storm heralded to rival Katrina's power. Although its magnitude of destruction ultimately paled to Katrina, the warnings and predicted path preceding Gustav yielded a process of NH evacuations similar to Katrina. The goal of this article was to ascertain whether NH administrative directors (ADs) felt more prepared to evacuate before Gustav. ⋯ NH ADs felt more prepared to evacuate their residents for Gustav, owing partly to improved communication and collaboration with state agencies; however, significant morbidity and logistical problems remain with evacuating frail NH residents before hurricanes.