Journal of the American Medical Directors Association
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Multicenter Study
Lack of early defibrillation capability and automated external defibrillators in nursing homes.
To determine the availability of early defibrillation and automated external defibrillators in nursing homes in selected cities. ⋯ Despite the fact that nursing homes have been identified as locations with multiple cardiac arrests, the early defibrillation capabilities and prevalence of AEDs in this setting remains low. AEDs may play a role in improving survival from cardiac arrest in nursing homes. The placement of AEDs in nursing homes needs further consideration and study.
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Multicenter Study
Psychometric properties of the German "Pain Assessment in Advanced Dementia Scale" (PAINAD-G) in nursing home residents.
The study aims to evaluate the psychometric properties of the German version of a scale for the assessment of pain in advanced dementia (PAINAD-G). ⋯ PAINAD-G is a 1-dimensional scale that demonstrates good reliability. The outcome supports the assumption that the scale actually measures pain.
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Multicenter Study
Advance directives at end-of-life: nursing home resident preferences for artificial nutrition.
Nursing homes are increasingly the place where many Americans die. Thus, advance directives are critical to the preservation of the autonomous wishes at end-of-life. The purpose of this paper is to determine if preferences for artificial nutrition, as stated in the advance directives of nursing home residents, are honored in the last 2 months of life. ⋯ In this nursing home sample, advance directives were significant documents guiding decisions on artificial nutrition, and feeding tubes were in fact uncommon at the end of life. The study suggests that advance care planning, quality palliative care training, and administrative support are necessary for the honoring of preferences. Future research is needed to examine more broadly tube-feeding practices and prevalence in nursing homes.
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Multicenter Study
Predictors of anticoagulation prescription in nursing home residents with atrial fibrillation.
To determine predictors of oral anticoagulation (OAC) for atrial fibrillation (AF) in long-term care (LTC). ⋯ Prior stroke was the primary predictor of OAC use. Our model suggests that physicians may also incorporate concerns of age, bleeding, cognitive and physical function, and ethnicity into the decision-making process. Further study is needed to explore the reasons why 21% of the residents receive neither OAC nor ATT, and why OAC may be less likely to be prescribed to non-Caucasian LTC residents.
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Multicenter Study
Characteristics of long-term care facilities associated with standing order programs to deliver influenza and pneumococcal vaccinations to residents in 13 states.
Standing order programs (SOPs) are effective evidence-based interventions in which nurses or pharmacists are authorized to vaccinate according to an approved protocol without a physician order or examination. National rates for influenza and pneumococcal vaccination in long-term care facilities (LTCF) are far below HP2010 goals of 90%. ⋯ Although LTCFs with certain characteristics used SOPs more often, overall few facilities (<10%) used SOPs to improve vaccination rates. SOP use varied by state indicating that state policies or other factors may promote or inhibit SOP use. More studies are needed to examine the causes of state-level variations in vaccination interventions and their relationships to health outcomes of residents in LTCFs. The federal government's resources to promote SOPs should focus on all LTCFs, but with a particular focus on those that are less likely to be using SOPs and that represent a large proportion of homes nationally (i.e., for-profit and chain facilities).