On and shortly after the 6th May 1990, 16 people were affected by food poisoning in an old peoples' residential home, of whom two died. The vehicle of infection was identified as a baked Alaska contaminated by Salmonella enteritidis phage type (PT) 8 and, at an early stage of the investigation, the source was attributed to a single infected egg. A separate investigation by the author, however, revealed that the baked Alaska meringue had been dispensed from an inadequately cleaned piping bag which had been recovered from the kitchen a month after the outbreak. A pure, profuse culture of S. enteritidis PT8 was isolated from it. At least one secondary case may have been attributable to food made with this bag. Ministry of Agriculture Investigations of the flocks suspected of producing the eggs used for the baked Alaska demonstrated an absence of S. enteritidis. On this basis, the author considered a more likely cause of the outbreak to be the piping bag, contaminated from source or sources unknown within the kitchen. Furthermore, the possibility of human carrier transmission cannot be wholly ruled out. The incident underlines the dangers of jumping to conclusions at the outset of food poisoning investigations and emphasises that hypotheses formulated on sources of contamination must be properly tested, the absence of which, in this instance, led the investigators to unwarranted conclusions as to the cause of the outbreak.
To analyse the association between quality of care and technical (productive) efficiency in institutional long-term care wards for the elderly.
One hundred and fourteen public health centre hospitals and residential homes in Finland.
Wards were divided into two categories according to their rank in the quality distribution, considering 41 quality variables separately. The technical efficiency scores of the good- and poor-quality groups were compared using cross-sectional data.
Data envelopment analysis was used for calculating technical efficiency. The Mann-Whitney test and correlation coefficients were used to explore the association between quality and efficiency.
The wards where quality indicators indicated less pro-active (passive) nursing practice and more dependent patients-for instance, in terms of very high prevalence of bedfast residents or very high prevalence of daily physical restraints-performed more efficiently than the comparison group.
The results suggest that an association may exist between technical efficiency and unwanted dimensions of quality. Hence, the efficiency and quality of care are essential aspects of management and performance measurement in elderly care.
Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.
To examine the use of and compliance with a new comprehensive health care directive by residents of a home for the aged and to determine the effect of the directive on the use of health care services.
Descriptive study with a before-after design.
A home for the aged providing residential care to women.
All 119 residents (ages 71 to 103 years, mean age 87.5 years).
Introduction of a comprehensive health care directive and follow-up at 1 year.
Residents' treatment choices, compliance with the directive, number of hospital admissions and length of hospital stay, number of deaths and places where deaths occurred.
Ninety (76%) of the residents completed the directive. In the event of reversible life-threatening illness 34, 24, 11 and 21 residents requested supportive, limited, maximum and intensive care respectively. For irreversible illness the numbers were 75, 12, 3 and 0 respectively. In case of cardiac arrest 88% requested that cardiopulmonary resuscitation not be done. In the year before the introduction of the directive there were nine deaths, one in the home and eight in hospitals. In the year after there were 17 deaths, 11 in the home and 6 in hospitals. The mean length of hospital stay was significantly lower in that year than in the year before implementation (p less than 0.001).
This innovative health care directive seems to be feasible, practical and well supported by residents, their families and health care professionals. Further studies are required to establish the generalizability and reproducibility of the data to other elderly people in institutions, to chronically ill patients and to the community at large.
Cites: Ann Intern Med. 1979 Jun;90(6):957-64443692
Cites: N Engl J Med. 1979 May 31;300(22):1270-2431686
Cites: CMAJ. 1991 May 1;144(9):1133-82018965
Cites: J Am Geriatr Soc. 1991 Apr;39(4):396-92010590
Cites: CMAJ. 1990 Oct 1;143(7):653-42119874
Cites: N Engl J Med. 1991 Mar 28;324(13):889-952000111
Cites: N Engl J Med. 1991 Mar 28;324(13):882-82000110
Cites: Milbank Q. 1990;68(1):1-282215425
Cites: J Am Geriatr Soc. 1988 Aug;36(8):747-522457044
On the basis of 7-day menu actual nutrition was studied in 39 old people's homes in the Ukrainian SSR in 1984-1985. The composition of the food rations was analyzed. It has been established that the nutrition in the old people's homes does not completely meet the requirements of the present-day science on nutrition for old age. High consumption of grain products, groats, maccaroni products and fats has been recorded along with insufficient consumption of vegetables, fruit, meat, fish and lactic acid products. The total amount of fat in the ration exceeds the values recommended more than by 60%; the level of simple carbohydrates is rather high, while that of animal protein is low. The authors have recommended a new balanced composition of products, meeting the current requirements of gerodietetics, enriched with food substances possessing geroprotective properties, that will promote normalization of metabolism in old subjects and prevention of age-dependent diseases.
The purpose of our study was to examine whether severity of dementia, behavioral and psychological symptoms and depression can predict falls among nursing home residents, such as demographic variables, activities of daily living, and use of psychotropic drugs, when potential confounders are controlled for.
1147 nursing home residents were examined in this one-year follow-up study. All residents were examined with the Physical Self-Maintenance scale (Activities of Daily Living - ADL), Clinical Dementia Rating Scale (CDR), Neuropsychiatric Inventory (NPI) and Cornell Scale for Depression in Dementia. Demographic data, gender, education, physical health and use of medication were collected from medical records.
40% of participants had at least one fall during the one-year follow-up period. Bivariate survival analysis revealed that low level of education, severe dementia, severe behavioral and psychological symptoms, severe depression, greater functional impairment, age, worsening in physical health, and use of sedatives, significantly predict one or more falls. Multivariate Cox regression analyses showed that age, higher scores on NPI and CDR, use of sedatives and dependency in ADL were all, independently of each other, predictors of an increased risk of falling.
Having a high NPI score was identified as a significant and independent predictor of falls. Since falling is a common event which causes considerable morbidity and mortality in older people, these findings are important for healthcare and for the individuals concerned. To prevent falling in nursing homes, special attention must be paid to residents with severe dementia, to behavioral symptoms and use of sedatives.