Accidental falls in 54 nursing homes with 2228 elderly residents aged 65 years and over were registered during a period of seven months. During the seven months, 512 of the elderly residents fell on a total of 934 occasions. Forty-two fractures of the neck of the femur occurred. The risk of falls for elderly residents of nursing homes is very high, but the majority of falls do not result in permanent damage. In this investigation, no differences could be demonstrated between staff groups or circumstances concerning falls with and without resultant damage. All falls should be regarded as warnings and result in detailed investigation of the circumstances of the fall in view of prophylactic measures. Accidental falls are caused by a complex interaction between a series of health, therapy, furnishing and attitudes. Various circumstances are emphasized in this investigation which are connected with an increased risk of falling, e.g. vertigo, problems of balance, certain aids and activities in connection with toileting.
The drug consumptions of 2228 residents in nursing homes aged 65 years and over were investigated and related to accidental falls during a period of seven months. 95% of the residents received treatment with one or more drugs and 33% with six or more drugs. The risk of accidental falls was significantly increased in persons receiving hypnotics, psychomarmaca and anti-Parkinson medicine. Individuals receiving diuretics, particularly thiazides, were less at risk for accidental falls. This investigation revealed an increased risk of falls particularly when residents were receiving treatment with a short-term hypnotic (Triazolam). It is recommended that this finding should be investigated further.
169 "injury situations" involving 61 patients were registered in a nursing home during one year. Four patients were sent to hospital. A few patients had several falls. Men were more prone to injury than women. Age itself seemed to be of no importance. Patients on shortterm admittance were at high risk. In general patients with dementia were not at higher risk but suffered the more serious injuries and were also involved in various episodes of patient violence. The risk of injuries is generally high in nursing homes. A certain risk must be accepted, but it is important to introduce prophylactic measures. A larger nursing staff might have prevented some of the situations.
Comment In: Tidsskr Nor Laegeforen. 1991 Oct 10;111(24):29991948912
Studies of hospitalisation of cognitively intact nursing home (NH) residents with cancer are scarce. Knowledge about associations between socio-demographic, medical and social support variables and hospital admissions aids in preventing unnecessary admissions. This is part of a prospective study from 2004 to 2005 with follow-up to 2010 for admission rates. We studied whether residents with cancer have more admissions and whether socio-demographic and medical variables and social support subdimensions are associated with admission among cognitively intact NH residents with (n = 60) and without (n = 167) cancer aged =65 years scoring =0.5 on the Clinical Dementia Rating Scale and residing =6 months. We measured social support by face-to-face interview. We identified all respondents through NH medical records for hospital admission, linking their identification numbers to the hospital record system to register all admissions. We examined whether socio-demographic and medical variables (medical records) and social support subscales were associated with the time between inclusion and first admission. Residents with cancer had more admissions (25/60) than those without (53/167) (odds ratio 1.7). Social integration was correlated with admission (P = 0.04) regardless of cancer diagnosis. Residents with cancer had more hospital admissions than those without. Higher social integration gave more admissions independent of cancer diagnosis.
Nursing home residents are prone to acute illness due to their high age, underlying illnesses and immobility. We examined the incidence of acute hospital admissions among nursing home residents versus the age-matched community dwelling population in a geographically defined area during a two years period. The hospital stays of the nursing home population are described according to diagnosis, length of stay and mortality. Similar studies have previously not been reported in Scandinavia.
The acute hospitalisations of the nursing home residents were identified through ambulance records. These were linked to hospital patient records for inclusion of demographics, diagnosis at discharge, length of stay and mortality. Incidence of hospitalisation was calculated based on patient-time at risk.
The annual hospital admission incidence was 0.62 admissions per person-year among the nursing home residents and 0.26 among the community dwellers. In the nursing home population we found that dominant diagnoses were respiratory diseases, falls-related and circulatory diseases, accounting for 55% of the cases. The median length of stay was 3 days (interquartile range = 4). The in-hospital mortality rate was 16% and 30 day mortality after discharge 30%.
Acute hospital admission rate among nursing home residents was high in this Scandinavian setting. The pattern of diagnoses causing the admissions appears to be consistent with previous research. The in-hospital and 30 day mortality rates are high.
The geriatric nursing home population is frail and vulnerable to sudden changes in their health condition. Very often, these incidents lead to hospitalization, in which many cases represent an unfavourable discontinuity of care. Analysis of variation in hospitalization rates among nursing homes where similar rates are expected may identify factors associated with unwarranted variation.
To 1) quantify the overall and diagnosis specific variation in hospitalization rates among nursing homes in a well-defined area over a two-year period, and 2) estimate the associations between the hospitalization rates and characteristics of the nursing homes.
The acute hospital admissions from 38 nursing homes to two hospitals were identified through ambulance records and linked to hospital patient journals (n = 2451). Overall variation in hospitalization rates for 2 consecutive years was tested using chi-square and diagnosis-specific variation using Systematic Component of Variation. Associations between rates and nursing home characteristics were tested using multiple regression and ANOVA.
Annual hospitalization rates varied significantly between 0.16 and 1.49 per nursing home. Diagnoses at discharge varied significantly between the nursing homes. The annual hospitalization rates correlated significantly with size (r = -0.38) and percentage short-term beds (r = 0.41), explaining 32% of the variation observed (R (2) = 0.319). No association was found for ownership status (r = 0.05) or location of the nursing home (p = 0.52).
A more than nine-fold variation in annual hospitalization rates among the nursing homes in one municipality suggests the presence of unwarranted variation. This finding demands for political action to improve the premises for a more uniform practice in nursing homes.
To examine antibiotic prescribing in nursing homes and determine to what degree the prescribing was in accordance with the national guidelines for antibiotic prescribing.
Retrospective examination of patients' records who were prescribed antibiotics in the period 1 March 2007 to 28 February 2008.
Patients residing in the nursing homes of Arendal, Norway.
Choice of antibiotic in respect of the recommendations in the national guidelines for antibiotic prescribing.
A total of 714 antibiotic courses were prescribed to 327 patients yielding a prevalence of 6.6%. Compliant prescribing was 77% for urinary tract infections (UTI), 79% for respiratory tract infections (RTI), and 76% for skin and soft tissue infections (SSTI). Ciprofloxacin was responsible for 63% of non-compliant prescribing. On the respite wards there was a higher rate of total prescribing, non-compliant prescribing, and prescribing by physicians employed at the local hospital.
Guidelines for antibiotic use must be implemented actively and efforts to improve antibiotic prescribing in nursing homes must be aimed at both nursing home and hospital physicians.
Cites: JAMA. 1999 Oct 20;282(15):1458-6510535437
Cites: Scand J Prim Health Care. 2009;27(4):208-1519929185
Cites: Br J Gen Pract. 1999 Jun;49(443):436-4010562741
Cites: Tidsskr Nor Laegeforen. 2001 Mar 10;121(7):827-3011301708
Cites: Tidsskr Nor Laegeforen. 2002 Oct 10;122(24):2376-812448254
Antibiotic resistance is a problem in nursing homes. Presumed urinary tract infections (UTI) are the most common infection. This study examines urine culture results from elderly patients to see if specific guidelines based on gender or whether the patient resides in a nursing home (NH) are warranted.
This is a cross sectional observation study comparing urine cultures from NH patients with urine cultures from patients in the same age group living in the community.
There were 232 positive urine cultures in the NH group and 3554 in the community group. Escherichia coli was isolated in 145 urines in the NH group (64%) and 2275 (64%) in the community group. There were no clinically significant differences in resistance. Combined, there were 3016 positive urine cultures from females and 770 from males. Escherichia coli was significantly more common in females 2120 (70%) than in males 303 (39%) (p?
Cites: Intern Med J. 2012 Jul;42(7):e157-6421241444
Little is known about anxiety and its associations among persons with dementia in nursing homes. This study aims to examine anxiety, anxiety symptoms, and their correlates in persons with dementia in Norwegian nursing homes.
In all, 298 participants with dementia =65 years old from 17 nursing homes were assessed with a validated Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Associations between anxiety (RAID-N score) and demographic and clinical characteristics were analyzed with linear regression models.
Anxiety, according to a cutoff of =12 on the RAID-N, was found in 34.2% (n = 102) of the participants. Irritability (59.7%) and restlessness (53.0%) were the most frequent anxiety symptoms. The participants' general physical health, a wide range of neuropsychiatric symptoms, and anxiolytic use were significant correlates of higher RAID-N scores.
Knowledge about anxiety, anxiety symptoms, and their correlates may enhance early detection of anxiety and planning of necessary treatment and proactive measures among this population residing in nursing homes.
Since the number of elderly people will rise in the years to come, knowledge about their health trends is important for social planning. The objective of this study was to investigate trends in health development among elderly people over 70 years in Nord-Trøndelag county.
In the Nord-Trøndelag Health Study (HUNT) we have collected health data over three rounds: HUNT1 (1984?–?86), HUNT2 (1995?–?97) and HUNT3 (2006?–?08). Using cross-sectional analyses, we have studied changes in self-reported health, level of functioning and the use of health services. The material includes 12 391 persons (85?% participation) in HUNT1, 11 069 (69.3?% participation) in HUNT2 and 8 194 in HUNT3 (54.7?% participation).
Subjective health and activities of daily living (ADL functions) were assessed as better in HUNT3 than in HUNT2. Self-reported physical activity increased from HUNT1 to HUNT3. The use of home-help services decreased from HUNT2 to HUNT3, while the use of nursing homes and home nursing services remained unchanged. The use of general practitioner services increased in all periods, while the use of outpatient services increased strongly from HUNT1 to HUNT2.
It appears that the elderly inhabitants of Nord-Trøndelag county feel that their health has improved and that they have become more self-reliant and more physically active in the period from 1984 to 2008, but the findings need to be interpreted with some caution due to the decline in the participation rate from HUNT1 to HUNT3.