Journal of the American Medical Directors Association
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There is a growing consensus on the relevance of a palliative care approach in end-stage dementia. The objective of this study was to assess the impact, in terms of family satisfaction with end-of-life care, of a nursing home (NH) pilot educational program for nursing staff and physicians on comfort care and advanced dementia. ⋯ The booklet, as support tool, and the educational program may have facilitated communication within the team, and between the team and family members. Replication of this intervention in a multicenter NH population is needed to adequately assess its effectiveness.
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Pain constitutes a constant challenge facing staff and residents of skilled nursing facilities (SNF) and nursing homes (NH). Many SNF and NH have not adopted a uniform plan to assess and treat pain for their residents despite published literature that demonstrates that the implementation of scales improves detection and treatment of pain. The objective of this study was to analyze the baseline pain level in the institutionalized elderly, and then implement a standard pain scale for its assessment and evaluation, while simultaneously identifying challenges in adopting this standardized method. ⋯ Pain evaluation and management is of paramount importance because of its high prevalence and demonstrated deleterious effects on both quality of life and long-term survival. Tools for verbal and nonverbal evaluation of pain are necessary in both NH and SCF. Also, regular cognitive and behavioral assessment may help evaluate pain by providing additional information to physicians, nurses, and other caregivers when treatment becomes more challenging and complex. The use of standard standing orders can easily help decrease the potential of toxicity related to the use of analgesics.
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Comparative Study
Cognitive screening for dementia and mild cognitive impairment in assisted living: comparison of 3 tests.
Compare diagnostic characteristics of brief cognitive screening tests in residential care/assisted living (RC/AL) residents. ⋯ Although the MMSE and Mini-Cog are both sensitive to dementia, modest specificity and positive predictive value may limit their utility as screening tools. Preliminary MMX data suggest it improves screening for MCI compared to the Mini-Cog or MMSE, while providing a similar level of screening for dementia. Further work is needed to identify suitable instruments for cognitive screening across the range of MCI and dementia.
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To describe the perceptions of physicians who care for nursing home residents regarding the etiology of behavior problems associated with dementia, their attitudes toward treatment, their knowledge of nonpharmacological interventions, and relationships among these issues and demographic variables and actual practice. ⋯ The frequency with which behavior problems in dementia are attributed to environmental and psychosocial causes suggests there are a large number of cases in which nonpharmacological interventions could be employed. Physicians are generally in favor of the use of these methods, but their knowledge varies. Increasing physicians' knowledge of nonpharmacological techniques would increase the likelihood of their use.
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To explore the relationship between nursing home patients with different stages of dementia and different dementia diagnoses and use of pain medication according to pain intensity. ⋯ Patients with severe dementia and mixed dementia are at high risk to suffer from severe pain. More research and quality improvement programs are needed to increase the knowledge in pain treatment by staff, which requires competence in both pain assessment and dementia.