Journal of the American Medical Directors Association
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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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Anticachexic or antisarcopenic medications are prescribed worldwide for geriatric patients with poor appetite and associated weight loss. They represent a valuable treatment option for managing cachexia. However, the well-publicized adverse reports about these medications in acquired immunodeficiency syndrome (AIDS) and in the cancer population has led to some concern and much subsequent discussion over the safety of these medications being used in geriatric population. This review looks at the evidence in relation to the benefits and risks of these medications and discusses what we know about their use in the geriatric population.
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Comparative Study
Predictors of rehabilitation outcomes: a comparison of Israeli and Italian geriatric post-acute care (PAC) facilities using the minimum data set (MDS).
To understand the relative contribution of sociodemographic, clinical, and health care features to rehabilitation outcomes in Israel and in Italy in post-acute care (PAC) facilities. ⋯ We found support for the hypothesis that differences in sociodemographic and clinical factors cannot account for all differences in ADL improvement, and that the organization of care and constraints of the health system also influence functional outcomes. Policymakers should examine the policy-amenable features of the Italian and Israeli systems so that optimal ADL recovery can be encouraged. Any reduction in disability will help both patients and the health care system; slightly higher short-term PAC treatment costs may have large long-term future benefits, if they result in the reduction of ADL disability. This study is one of the first to examine outcomes of PAC in 2 countries, and can provide an initial assessment of how rehabilitation can be enhanced or limited by health policies and staffing patterns.
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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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To evaluate the prevalence of substantial daily pain among nursing home residents aged 65 and older. ⋯ This study highlights within-state variation in MDS reporting by nursing home as well as resident-specific factors associated with daily substantial pain. Rural, for-profit, and low-occupancy nursing homes had less documented pain. Communication ability and not having cognitive impairment were important factors in having such pain reported.