Showing papers in "Journal of the American Medical Directors Association in 2007"

TL;DR: Frailty is a robust concept and however defined, elderly people who are frail have worse outcomes than those who are not frail and Random combinations of 15 variables used to make up alternate 5-item Frail-CHS definitions showed any stratification based on 5 variables allowed tertiles of risk to be discriminated.

TL;DR: There was an independent association between nutritional deficit and depression in this population of elderly people, which emphasizes the importance of early identification of depression among individuals with nutritional disorders.

TL;DR: Managers play a critical role in the satisfaction, loyalty and commitment of their staff; managers construct a person-centered workplace that deepens staff engagement; and engaged staff promote the well-being of the residents.

TL;DR: During a recent national meeting of an ad hoc VA Delirium Working Group, strategies for facilitating recognition of delirium were discussed, and the potential utility of introducing mental status as a vital sign was considered.

TL;DR: The results obtained from a representative sample of very old and frail elderly subjects living in a nursing home expand the knowledge that high levels of hemoglobin are associated with better survival.

TL;DR: Findings suggest a potentially important link between anemia and the risk of falls during hospitalization in ambulatory older patients and further studies are needed to determine if therisk of falls can be modified by correction of anemia.

TL;DR: Light is emerging that sheds light on the scope of the problem and the challenges to timely prevention, identification, and management of elder mistreatment, and practitioners may use this information to recognize and change factors associated with a higher likelihood of nursing home mistreatment.

TL;DR: The outcome supports the assumption that the PAINAD-G scale actually measures pain, and shows that residents rated to suffer from pain showed more pain behavior with increased cognitive deterioration.

TL;DR: A variety of medications are available with varying degrees of clinical research to support their use in ameliorating BPSD and the literature supporting various nonpharmacologic and pharmacologic treatments is reviewed.

TL;DR: Falls and fear of falling are more common in new LTC enrollees than in previously described community dwelling and SNF cohorts, and attention to associated characteristics like depression, arthritis, low back pain and lower extremity weakness may identify opportunities to reduce fear and improve patient safety during this transitional period.

TL;DR: The findings of this study support the need to improve recognition for nursing, improve staffing, and provide competitive compensation in nursing homes.

TL;DR: The “lessons learned” by Louisiana Nursing Home administrative directors (ADs) forced to make decisions relating to resident evacuation before Hurricanes Katrina and Rita are evaluated to determine how emergency planning has changed in those NHs.

TL;DR: The study results provide a broad-based perspective of the barriers to medication error reporting in the nursing home setting and suggest efforts to improve medication errorReporting frequency should focus on organizational-level rather than individual-level interventions.

TL;DR: Agitation was present in a significant number of residents who were borderline intact, was most common in subjects with moderate cognitive impairment, and decreased thereafter, while resistiveness to care was relatively rare in borderline intact and mildly impaired residents and increased gradually, with the highest prevalence in those with very severe cognitive impairment.

TL;DR: Significant disparities exist both in diagnosis and treatment of depression among elderly residents, and disadvantaged groups such as African Americans and residents with physical and cognitive impairments are less likely to be diagnosed and treated.

TL;DR: This national study in one of the largest managed healthcare systems in the United States has empirically confirmed the relative importance of certain risk factors for falls in long-term care settings.

TL;DR: Lower odds of substantial daily pain were associated with older age, rural locale, dementia, and thyroid, neurological, pulmonary, and sensory disorders, and rural, for-profit, and low-occupancy nursing homes had less documented pain.

TL;DR: While a physiological anorexia of aging occurs in all older persons, as a result of alterations in smell and taste, altered gastric emptying, increased satiating hormones such as cholecystokinin and leptin, and alterations in central nervous system function, it is usually underlying diseases that result in the loss of weight.

TL;DR: A new drug, lubiprostone, is a type 2-chloride channel activator and is shown to be effective, safe, and well tolerated in older adults treated for chronic constipation in studies up to a year.

TL;DR: Rational, evidence-based use of tube feeding in advanced dementia will depend fundamentally on improved education, and realigning incentives in these ways could improve the quality of care, quality of life, and safety of these vulnerable individuals, likely with reduced costs of care.

TL;DR: Improving the initial evaluation of infections, the use of antimicrobial agents, and the implementation of hand hygiene and infection control precautions should be key focus areas for medical directors in order to prevent infections and control antibiotic resistance.

TL;DR: The results suggest that better identification and treatment of depression reduce the risk of nursing home admission, and it is possible that the individual's quality of life could be significantly enhanced by better diagnosis and treatment.

TL;DR: The amount of light in the nursing homes was seldom sufficient to meet the visual needs of older people, and this lack of illumination may induce a higher risk of accidental falls for dementia patients as well as for other residents.

TL;DR: Despite clear benefit, nursing home residents were not supplemented adequately with calcium and vitamin D, and low levels of Vitamin D 25 (OH) D were identified in 49.4% of residents.

TL;DR: Nursing home residents should receive at least 800-1000 IU of D(3) per day in an effort to maintain optimal vitamin D levels, as well as ambulatory status (a surrogate for sun exposure), to determine the effect of various doses of vitamin D(2) and D (3) on 25-OH-D levels.

TL;DR: A review of the evidence in relation to the benefits and risks of anticachexic or antisarcopenic medications in geriatric patients with poor appetite and associated weight loss discusses what the authors know about their use in the geriatric population.

TL;DR: In this issue of the Journal, two studies show that levels of 25(OH) vitamin D below the acceptable level of 30 ng/mL were present in large numbers of residents, even when they were receiving vitamin D supplements.

TL;DR: Osteoporosis prevention needs to be a priority of the director of nursing as well as consultant pharmacists and physicians, and vitamin D levels should be measured in all residents and aggressive vitamin D replacement used in those residents with levels below 30ng/ ml.

TL;DR: Newly admitted nursing facility residents infrequently received an indicated osteoporosis treatment, including calcium with vitamin D, despite the expected high prevalence of osteoporeosis in this setting.

TL;DR: The study by Meyers et al, in this issue, is representative of the prevalence of diabetes in long-term facilities, while the review article by Haas addresses some of the difficulties that exist and treatment modalities available today.