Journal of the American Geriatrics Society
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Multicenter Study
Oral care provided by certified nursing assistants in nursing homes.
The purpose of this study was to describe the actual daily oral care provided by certified nursing assistants (CNAs) for dentate elderly nursing home (NH) residents who required assistance with oral care. The study was conducted in five nonrandomly selected NHs in upstate New York using real-time observations of CNAs providing morning care to residents, retrospective chart review, and CNA screening interviews. Oral care standards developed and validated by a panel of 10 experts (dentists, dental hygienists, registered nurses) to be appropriate for dentate NH residents were used to evaluate the oral care provided by 47 primary dayshift CNAs to a convenience sample of 67 residents. ⋯ Most residents (63%) who received oral care assistance were resistive to CNA approaches. For most observations, oral care supplies were not evident. Actual oral care provided to residents contrasts sharply with CNAs' self-reported practices in the literature and suggests that NH residents who need assistance receive inadequate oral health care.
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Multicenter Study Comparative Study
Prospective multicenter study of acute asthma in younger versus older adults presenting to the emergency department.
To describe acute asthma in younger versus older adults presenting to the emergency department (ED). ⋯ Older asthma patients were less responsive to emergency bronchodilation. This may reflect chronic undertreatment with inhaled corticosteroids.
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To assist facilities in identifying those evidence-based processes of poststroke care that enhance measurable patient outcomes. The guideline(s) should be used by facilities (hospitals, subacute-care units and providers of long-term care) to implement a structured approach to improve rehabilitative practices and by clinicians to determine best interventions to achieve improved patient outcomes. ⋯ The guideline was prepared under the auspices of the VA/DoD. No other source of support was identified in the document, or supporting documents.
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Comparative Study
Outcome of critically ill oldest-old patients (aged 90 and older) admitted to the intensive care unit.
To compare the outcomes of critically ill oldest-old patients (> or = 90) with those of younger patients. ⋯ All-cause in-hospital mortality was higher in the oldest-old group than in younger patients, but the mortality of this cohort of patients did not seem to reach a figure that would make physicians, relatives, and healthcare administrators decide against ICU care in this population.
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Multicenter Study Controlled Clinical Trial
A nonpharmacological intervention to improve sleep in nursing home patients: results of a controlled clinical trial.
To improve nighttime sleep in nursing home patients. ⋯ This multicomponent, nonpharmacological intervention conducted by trained research staff had no effect on nighttime sleep in this sample of nursing home patients. Enhanced nonpharmacological interventions should be developed and tested and combined with environmental interventions to mitigate noise when feasible. Adjunctive drug therapy may be needed to improve sleep in a substantial proportion of this population and should be tested in addition to nonpharmacological interventions in rigorous clinical trials.