The role of a nursing home administrator's education in influencing quality of care in US nursing homes

Nursing home literature links poor management practices to poor quality of care and resident outcomes. Since Nursing Home Administrators (NHAs) require an array of skills to perform their role, it is important to explore what makes a NHA effective. This research fills a gap in the literature and provides a possible option to improve the quality of care in nursing homes. Purpose of the study. The study examines whether NHAs with advanced education (defined as a Masters degree or more) are associated with better quality of care in licensed nursing homes (NHs). Design and Methods. Data was derived from the CDC’s 2004 National Nursing Home Survey, which is a representative sample of NHs across the US. A Donabedian- inspired structure-process-outcomes study model was created to explain how education relates to quality of care. Quality of care was defined as onsite oral care, employee influenza vaccination rates and staff recognition programs. Statistical analyses included multivariate logistic regression; covariates included facility-level variables used in similar peer-reviewed research but also included select measures from the Area Resource File to control for county-level factors. Results. Descriptive and analytical analyses confirm that NHAs with a Bachelor’s degree, Associate degree or high school diploma perform less well than NHAs with a Masters degree or more. NHAs with advanced education are more likely to have onsite dental care and recognition programs for staff than NHAs with a Bachelor’s degree (or less). Also NHAs with less than graduate education are more likely to provide off-site dental care. Employee vaccination rates are not impacted by education. Adding certification, tenure or years of experience to a NHA with advanced education gives them an advantage. In fact, certification and experience alone do not have a positive relationship to care indicators; however adding these to advanced education produces a significant result. Implications. This research provides preliminary evidence that advanced education for the NHA is associated with better quality of care. If future research can confirm these findings, there is merit in revisiting the qualifications. Education can be a legitimate option to support quality improvement efforts in US nursing homes. ^

The prevalence of periodontal disease in Mexican American vs European American elderly in three distinct socio-economic communities in San Antonio, Texas

Purpose of the Study: This study evaluated the prevalence of periodontal disease between Mexican American elderly and European American elderly residing in three socio-economically distinct neighborhoods in San Antonio, Texas. ^ Study Group: Subjects for the original protocol were participants of the Oral Health: San Antonio Longitudinal Study of Aging (OH: SALSA), which began with National Institutes of Health (NIH) funding in 1993 (M.J. Saunders, PI). The cohort in the study was the individuals who had been enrolled in Phases I and III of the San Antonio Heart Study (SAHS). This SAHS/SALSA sample is a community-based probability sample of Mexican American and European American residents from three socio-economically distinct San Antonio neighborhoods: low-income barrio, middle-income transitional, and upper-income suburban. The OH: SALSA cohort was established between July 1993 and May 1998 by sampling two subsets of the San Antonio Heart Study (SAHS) cohort. These subsets included the San Antonio Longitudinal Study of Aging (SALSA) cohort, comprised of the oldest members of the SAHS (age 65+ yrs. old), and a younger set of controls (age 35-64 yrs. old) sampled from the remainder of the SAHS cohort. ^ Methods: The study used simple descriptive statistics to describe the sociodemographic characteristics and periodontal disease indicators of the OH: SALSA participants. Means and standard deviations were used to summarize continuous measures. Proportions were used to summarize categorical measures. Simple m x n chi square statistics was used to compare ethnic differences. A multivariable ordered logit regression was used to estimate the prevalence of periodontal disease and test ethnic group and neighborhood differences in the prevalence of periodontal disease. A multivariable model adjustment for socio-economic status (income and education), gender, and age (treated as confounders) was applied. ^ Summary: In the unadjusted and adjusted model, Mexican American elderly demonstrated the greatest prevalence for periodontitis, p < 0.05. Mexican American elderly in barrio neighborhoods demonstrated the greatest prevalence for severe periodontitis, with unadjusted prevalence rates of 31.7%, 22.3%, and 22.4% for Mexican American elderly barrio, transitional, and suburban neighborhoods, respectively. Also, Mexican American elderly had adjusted prevalence rates of 29.4%, 23.7%, and 20.4% for barrio, transitional, and suburban neighborhoods, respectively. ^ Conclusion: This study indicates that the prevalence of periodontal disease is an important oral health issue among the Mexican American elderly. The results suggest that the socioeconomic status of the residential neighborhood increased the risk for severe periodontal disease among the Mexican American elderly when compared to European American elderly. A viable approach to recognizing oral health disparities in our growing population of Mexican American elderly is imperative for the provision of special care programs that will help increase the quality of care in this minority population.^

Assessment of executive function before and after vitamin D replacement in vulnerable adults who self-neglect

Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to do self-care and to protect themselves. The specific aims were to (1) determine the feasibility of using multiple EF measures with community-dwelling elders with SN, (2) identify changes in EF between baseline and 5-months in community-dwelling elders with SN who receive 50,000 IU or 400 IU of oral vitamin D monthly and (2) explore changes in specific dimensions of EF between the groups. ^ Methods: Fifty adults, 65 years of age and older, were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following tests at baseline and five-months: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Demographic data was collected at baseline and serum 25-OHD levels were collected at baseline and five-months. ^ Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the MMSE, CLOX II, TMT A & B and the EXIT 25. At five-months, the only statistically significant difference between groups was in the TMT A & B test scores; the control group did better than the treatment group. There was a non-significant increase in serum vitamin D levels for both groups and no difference between groups. ^ Conclusions: Results from this study provide support that individuals who SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: 'concept generation', 'planning', 'inhibition', and 'spatial working memory'. Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN. ^ Key Words: Self-neglect, Executive Dysfunction, Executive Function, Adult Protective Services, Community-dwelling, Vitamin D ^

Mistreatment and self-neglect in community dwelling older adults: Studies of construct validity, measurement invariance and latent classes

Mistreatment and self-neglect significantly increase the risk of dying in older adults. It is estimated that 1 to 2 million older adults experience elder mistreatment and self-neglect every year in the United States. Currently, there are no elder mistreatment and self-neglect assessment tools with construct validity and measurement invariance testing and no studies have sought to identify underlying latent classes of elder self-neglect that may have differential mortality rates. Using data from 11,280 adults with Texas APS substantiated elder mistreatment and self-neglect 3 studies were conducted to: (1) test the construct validity and (2) the measurement invariance across gender and ethnicity of the Texas Adult Protective Services (APS) Client Assessment and Risk Evaluation (CARE) tool and (3) identify latent classes associated with elder self-neglect. Study 1 confirmed the construct validity of the CARE tool following adjustments to the initial hypothesized CARE tool. This resulted in the deletion of 14 assessment items and a final assessment with 5 original factors and 43 items. Cross-validation for this model was achieved. Study 2 provided empirical evidence for factor loading and item-threshold invariance of the CARE tool across gender and between African-Americans and Caucasians. The financial status domain of the CARE tool did not function properly for Hispanics and thus, had to be deleted. Subsequent analyses showed factor loading and item-threshold invariance across all 3 ethnic groups with the exception of some residual errors. Study 3 identified 4-latent classes associated with elder self-neglect behaviors which included individuals with evidence of problems in the areas of (1) their environment, (2) physical and medical status, (3) multiple domains and (4) finances. Overall, these studies provide evidence supporting the use of APS CARE tool for providing unbiased and valid investigations of mistreatment and neglect in older adults with different demographic characteristics. Furthermore, the findings support the underlying notion that elder self-neglect may not only occur along a continuum, but that differential types may exist. All of which, have very important potential implications for social and health services distributed to vulnerable mistreated and neglected older adults.^

El juego en la vejez, relatos de viejos marplatenses

En este texto se intenta problematizar la temática del juego en la vejez. Para ello la autora recurre a la descripción de una experiencia realizada en la ciudad de Mar del Plata en el contexto de la Formación Docente y que tiene como actores a personas adultas mayores y a estudiantes del cuarto año de estudios del Profesorado en Educación Física provincial. Se tiene en cuenta como marco teórico el material bibliográfico aportado por el Seminario Teoría de los Juegos cursado por la autora en su trayecto para lograr el postítulo de Magíster en Educación Corporal y se entrecruzan con otros estudios pertinentes a la temática gerontológica. Asimismo, los datos obtenidos por medio de la realización de entrevistas en un trabajo de campo allí descripto son los insumos necesarios para analizar, por un lado, tanto las conceptualizaciones que se tiene sobre la vejez y el envejecimiento como las ideas y preconceptos acerca del juego en los adultos mayores. Por otro lado, los juegos de hoy y ayer y la multiplicidad de sentidos que estos adquieren en la vejez, a partir de las voces de los propios protagonistas de la experiencia

Desafíos actuales del envejecer

Presentamos hallazgos sobre el envejecer en la actualidad y su entrecruzamiento con la participación en grupos. Señalamos la importancia de la educación permanente en la producción de subjetividad. Se destaca la contribución de las investigaciones referidas a la: docencia, extensión universitaria y formación de investigadores. Partimos del marco teórico de la psicología, se revisan los aportes interdisciplinarios que enriquecen el campo gerontológico. A partir de la longevidad se busca identificar las transformaciones del envejecer, el proceso de revisión identificatoria y el trabajo psíquico de revisar, cuestionar y transformar las significaciones simbólicas, a la par que hacer lugar a lo nuevo en relación con sus funciones: hombre/mujer; esposo/esposa; abuelo/abuela. Se emplea metodología cualitativa: entrevistas en profundidad, historias de vida, crónicas del funcionamiento grupal. Surge la preocupación constante y conciente de los mayores, por preservar su capacidad de desear, crear, producir y gozar, la búsqueda de realización personal y la interrelación con el medio, con los otros y con sus pares. Se observan lógicas propias que promueven la horizontalidad de los vínculos y presentan representaciones, sentidos y conductas que modifican el concepto tradicional del viejo. Se destaca la riqueza del encuentro intersubjetivo entre investigadores y entrevistados, en la elaboración de los cambios.

El juego en la vejez, relatos de viejos marplatenses

En este texto se intenta problematizar la temática del juego en la vejez. Para ello la autora recurre a la descripción de una experiencia realizada en la ciudad de Mar del Plata en el contexto de la Formación Docente y que tiene como actores a personas adultas mayores y a estudiantes del cuarto año de estudios del Profesorado en Educación Física provincial. Se tiene en cuenta como marco teórico el material bibliográfico aportado por el Seminario Teoría de los Juegos cursado por la autora en su trayecto para lograr el postítulo de Magíster en Educación Corporal y se entrecruzan con otros estudios pertinentes a la temática gerontológica. Asimismo, los datos obtenidos por medio de la realización de entrevistas en un trabajo de campo allí descripto son los insumos necesarios para analizar, por un lado, tanto las conceptualizaciones que se tiene sobre la vejez y el envejecimiento como las ideas y preconceptos acerca del juego en los adultos mayores. Por otro lado, los juegos de hoy y ayer y la multiplicidad de sentidos que estos adquieren en la vejez, a partir de las voces de los propios protagonistas de la experiencia

Desafíos actuales del envejecer

Presentamos hallazgos sobre el envejecer en la actualidad y su entrecruzamiento con la participación en grupos. Señalamos la importancia de la educación permanente en la producción de subjetividad. Se destaca la contribución de las investigaciones referidas a la: docencia, extensión universitaria y formación de investigadores. Partimos del marco teórico de la psicología, se revisan los aportes interdisciplinarios que enriquecen el campo gerontológico. A partir de la longevidad se busca identificar las transformaciones del envejecer, el proceso de revisión identificatoria y el trabajo psíquico de revisar, cuestionar y transformar las significaciones simbólicas, a la par que hacer lugar a lo nuevo en relación con sus funciones: hombre/mujer; esposo/esposa; abuelo/abuela. Se emplea metodología cualitativa: entrevistas en profundidad, historias de vida, crónicas del funcionamiento grupal. Surge la preocupación constante y conciente de los mayores, por preservar su capacidad de desear, crear, producir y gozar, la búsqueda de realización personal y la interrelación con el medio, con los otros y con sus pares. Se observan lógicas propias que promueven la horizontalidad de los vínculos y presentan representaciones, sentidos y conductas que modifican el concepto tradicional del viejo. Se destaca la riqueza del encuentro intersubjetivo entre investigadores y entrevistados, en la elaboración de los cambios.

Desafíos actuales del envejecer

Presentamos hallazgos sobre el envejecer en la actualidad y su entrecruzamiento con la participación en grupos. Señalamos la importancia de la educación permanente en la producción de subjetividad. Se destaca la contribución de las investigaciones referidas a la: docencia, extensión universitaria y formación de investigadores. Partimos del marco teórico de la psicología, se revisan los aportes interdisciplinarios que enriquecen el campo gerontológico. A partir de la longevidad se busca identificar las transformaciones del envejecer, el proceso de revisión identificatoria y el trabajo psíquico de revisar, cuestionar y transformar las significaciones simbólicas, a la par que hacer lugar a lo nuevo en relación con sus funciones: hombre/mujer; esposo/esposa; abuelo/abuela. Se emplea metodología cualitativa: entrevistas en profundidad, historias de vida, crónicas del funcionamiento grupal. Surge la preocupación constante y conciente de los mayores, por preservar su capacidad de desear, crear, producir y gozar, la búsqueda de realización personal y la interrelación con el medio, con los otros y con sus pares. Se observan lógicas propias que promueven la horizontalidad de los vínculos y presentan representaciones, sentidos y conductas que modifican el concepto tradicional del viejo. Se destaca la riqueza del encuentro intersubjetivo entre investigadores y entrevistados, en la elaboración de los cambios.

El juego en la vejez, relatos de viejos marplatenses

En este texto se intenta problematizar la temática del juego en la vejez. Para ello la autora recurre a la descripción de una experiencia realizada en la ciudad de Mar del Plata en el contexto de la Formación Docente y que tiene como actores a personas adultas mayores y a estudiantes del cuarto año de estudios del Profesorado en Educación Física provincial. Se tiene en cuenta como marco teórico el material bibliográfico aportado por el Seminario Teoría de los Juegos cursado por la autora en su trayecto para lograr el postítulo de Magíster en Educación Corporal y se entrecruzan con otros estudios pertinentes a la temática gerontológica. Asimismo, los datos obtenidos por medio de la realización de entrevistas en un trabajo de campo allí descripto son los insumos necesarios para analizar, por un lado, tanto las conceptualizaciones que se tiene sobre la vejez y el envejecimiento como las ideas y preconceptos acerca del juego en los adultos mayores. Por otro lado, los juegos de hoy y ayer y la multiplicidad de sentidos que estos adquieren en la vejez, a partir de las voces de los propios protagonistas de la experiencia

Age-Related Effects in Working Memory Recognition Modulated by Retroactive Interference

One of the main causes for age-related declines in working memory is a higher vulnerability to retroactive interference due to a reduced ability to suppress irrelevant information. However, the underlying neural correlates remain to be established. Magnetoencephalography was used to investigate differential neural patterns in young and older adults performing an interference-based memory task with two experimental conditions, interrupting and distracting, during successful recognition. Behaviorally, both types of retroactive interference significantly impaired accuracy at recognition more in older adults than in young adults with the latter exhibiting greater disruptions by interrupters. Magnetoencephalography revealed the presence of differential age-related neural patterns. Specifically, time-modulated activations in temporo-occipital and superior parietal regions were higher in young adults compared with older adults for the interrupting condition. These results suggest that age-related deficits in inhibitory mechanisms that increase vulnerability to retroactive interference may be associated with neural under-recruitments in a high-interference task.

Fast-Twitch Glycolytic Skeletal Muscle Is Predisposed to Age-Induced Impairments in Mitochondrial Function

funcion mitocondrial en fibras rápidas

Edna Chavis

As an advocate for the elderly, Edna Chavis has made many improvements for matured people. She worked for the Social Security Administration for eleven years, where she recognized that “older people are the same as anyone else with the same wants and desires.” Since then, she gained educational experience to assist her in understanding the self-concept of older people. She earned a Bachelor of Arts Degree in Social Science and a teaching certificate from Eastern Michigan University in 1972, a Master of Science Degree in Adult Education from Tuskegee Institute in 1975, and a PhD Degree in Social Gerontology and Adult Education from the University of Missouri in 1979. Some of her accomplishments include her position as the head of the Missouri Delegates to the White House Conference on Aging and her lobbying efforts toward Missouri’s first Governor’s Conference on Aging. She was also awarded the Lt. Governor’s Nursing Home Task Force Certificate of Appreciation. As an adjunct instructor at Lincoln University, Chavis emphasizes to her students that aging is a natural process. She has had a great impact on her students, several of whom have continued on related career paths. Following her own advice that “Aging successfully is to never sit down and do nothing,” Chavis continues to teach, work as a gerontologist, and serve on committees within the Department of Health and Senior Services.

Qualidade da Construção dos Vínculos entre Filhas Cuidadoras e Mães Idosas Dependentes

Este estudo teve por objetivos: - descrever as dificuldades nas relações entre as filhas-cuidadoras e suas mães idosas dependentes de cuidados, a partir de relatos das filhas; - investigar, a partir dos relatos da história familiar dessas filhas, a existência de conflitos prévios a necessidade de cuidar, relacionados à construção dos vínculos; identificar os principais desafios associados assistência ao cuidador familiar de idosos no que tange a resolução de conflitos com o idoso dependente. Método – tratou-se de um estudo qualitativo em que foram apresentados três casos clínicos de cuidadoras que haviam sido encaminhados para atendimento psicológico pela equipe multiprofissional de um Instituto de Geriatria e Gerontologia, unidade de atenção secundária da Secretaria de Estado da Saúde de S.P. Os resultados indicaram dificuldades relacionais entre ambas: cuidadoras filhas e mães idosas. As cuidadoras revelaram sobrecarga física e emocional e grande sofrimento. Todavia, a existência desses conflitos remontava às relações anteriores à atual situação de dependência; ficando bastante evidenciado, tanto pelas histórias de vida das cuidadoras, quanto pelo conteúdo trazido durante o processo terapêutico, a repetição das relações primeiras estabelecidas entre mãe-filha. O processo psicoterapêutico pôde permitir a essas cuidadoras a compreensão da necessidade em ter suas falhas ambientais supridas, na medida em que foi propiciado um ambiente favorável ao relacionamento humano. Assim, ao observarmos que ao longo do processo as pacientes apresentavam mudanças significativas, entendemos que a psicoterapia pode figurar como meio preventivo e preservação de equilíbrio psíquico.

Rede e apoio social entre idosos atendidos em um ambulatório de Geriatria

O objetivo geral deste estudo foi analisar a relação entre a rede e apoio social, satisfação com o apoio social recebido e as variáveis sociodemográficas, de saúde física e mental, dos idosos atendidos em um Ambulatório de Geriatria de um Hospital Geral Terciário do interior paulista. Trata-se de um estudo descritivo, transversal e exploratório, realizado com 98 idosos atendidos no referido ambulatório. Para a coleta de dados, utilizaram-se o Mini Exame do Estado Mental, um questionário de caracterização sociodemográfica e de saúde, a Escala de Depressão Geriátrica (EDG-15), o Índice de Katz, a Escala de Lawton e Brody, a Escala de medida da rede e apoio social do Medical Outcomes Study e a Escala de Satisfação com o Suporte Social. Os aspectos éticos foram respeitados conforme a Resolução 466/2012 do Conselho Nacional de Saúde. A média de idade dos idosos foi de 80,1 anos, 70,4% eram mulheres, 49,0% viúvos; a média de anos de estudo foi 2,3; 24,5% dos idosos residiam com o cônjuge e filhos ou somente com os filhos; a renda familiar média foi de R$1.773,70. Quanto à capacidade funcional, 80,6% eram independentes para as atividades básicas da vida diária e 88,8% eram parcialmente dependentes para as instrumentais. Os idosos possuíam, em média, 5,3 diagnósticos médicos e os sintomas depressivos estiveram presentes para 61,2% deles. Quanto à rede social, o escore total médio foi de 6,4 pessoas para contato na rede, sendo que 36,7% apresentavam médio contato e participação em atividades sociais. Em relação ao apoio social, o maior escore médio foi para a dimensão material (90,2) e o menor para a interação social positiva (81,8); já para a satisfação com o suporte social, 36,7% e 32,7% apresentaram alta e média satisfação, respectivamente. Foi encontrada correlação inversa entre os escores de todas as dimensões da escala de apoio social e os escores da EDG-15, indicando que quanto maior o apoio social em todas as dimensões, menor é a presença de sintomas depressivos e houve diferenças estatisticamente significativas para todas as dimensões, material (p=0,014), afetiva (p=0,026), interação (p=0,011), emocional (p=0,001) e informação (p=0,005); já a correlação entre os escores das dimensões da escala de apoio social e os escores na escala de Lawton e Brody, foi inversa e fraca para as dimensões material (r=-0,157) e informação (r=-0,027), sugerindo que quanto menor a independência para as AIVDs, maior o apoio social nas referidas dimensões, porém, não houve diferença estatisticamente significativa, material (p=0,121) e informação (p=0,789). A correlação entre os escores da EDG-15 e os escores da escala de satisfação com o apoio social, foi inversa e moderada (r=- 0,467), indicando que quanto maior a satisfação com o apoio social, menor a presença de sintomas depressivos, sendo estatisticamente significativa (p=0,000). Evidencia-se a importância de conhecer se os idosos estão inseridos em rede social e se percebem o apoio social para um melhor direcionamento da assistência prestada ao idoso e para o planejamento e formulação de políticas públicas, programas e projetos voltados a essa população