Delirium upon admission to Swiss nursing homes

QUESTIONS UNDER STUDY: We wished to investigate the prevalence of delirium in patients upon admission to nursing homes and whether or not the previous place of residence predicts delirium. METHODS: The Resident Assessment Instrument Minimum Data Set (RAI-MDS) and the Nursing Home Confusion Assessment Method (NHCAM) were used to determine whether the previous place of residence (community, nursing home, acute care, psychiatric, rehabilitation hospital) predicted the prevalence of sub-syndromal or full delirium in nursing home residents in three Swiss cantons (n = 11745). RESULTS: 39.7% had sub-syndromal and 6.5% had full delirium. Lower cognitive performance and increased depressive symptoms were significant predictors of higher NHCAM values independent of previous residence. Age, civil status, continence, newly introduced drugs, and basic activities of daily living were predictors in some resident groups. The variance of NHCAM scores explained varied between 25.1% and 32.3% depending on previous residence. CONCLUSIONS: Sub-syndromal and full delirium are common upon nursing home admission. Increased dependence and depression are consistently associated with higher NHCAM scores. Patients from psychiatric settings have an increased risk of delirium. Although factors associated with delirium depend on a patient's previous residence, all patients must be carefully screened for sub-syndromal and full delirium.

Diabetes-related knowledge among medical and nursing house staff

To assess the diabetes-related knowledge of medical and nursing house staff with particular focus on inpatient diabetes management and insulin therapy.

Hydraulic Conductivity of Model Soil-Bentonite Backfills Subjected to Wet-Dry Cycling

The potential for changes in hydraulic conductivity, k, of two model soil-bentonite (SB) backfills subjected to wet-dry cycling was investigated. The backfills were prepared with the same base soil (clean, fine sand) but different bentonite contents (2.7 and 5.6 dry wt %). Saturation (S), volume change, and k of consolidated backfill specimens (effective stress = 24 kPa) were evaluated over three to seven cycles in which the matric suction, Ym, in the drying stage ranged from 50 to 700 kPa. Both backfills exhibited susceptibility to degradation in k caused by wet-dry cycling. Mean values of k for specimens dried at Ym = 50 kPa (S = 30-60 % after drying) remained low after two cycles, but increased by 5- to 300-fold after three or more cycles. Specimens dried at Ym ≥ 150 kPa (S < 30 % after drying) were less resilient and exhibited 500- to 10 000-fold increases in k after three or more cycles. The greater increases in k for these specimens correlated with greater vertical shrinkage upon drying. The findings suggest that increases in hydraulic conductivity due to wet-dry cycling may be a concern for SB vertical barriers located within the zone of a fluctuating groundwater table.

Cardiometabolic effects in caregivers of nursing home placement and death of their spouse with Alzheimer's disease

To test the hypothesis that cardiometabolic risk is attenuated when caregivers are relieved of caregiving stress when the caregiving recipient transitions out of the home.

Psychotropic medication use in Swiss nursing homes

Psychotropic medication is commonly used in nursing homes, to treat behavioural and psychological symptoms of dementia (BPSD) for example. Treatment with antipsychotics may improve BPSD in some residents but can be associated with serious side effects, such as higher mortality, faster disease progression and cerebrovascular events. In the current study, psychotropic medication use was analysed in a representative sample of nursing home residents in the German-speaking part of Switzerland, at entry and during follow-up.

Nursing the fatherland? Hohenzollern statebuilding and the hidden transcript of political resistance in Hanoverian female charity during the Second German Empire

In summer 1866 the Austro-Prussian struggle for supremacy in Germany erupted into open conflict. King Georg V of Hanover sided with other governments loyal to the German Confederation against Prussia, but after initially defeating Prussian forces at Langensalza, he was forced to capitulate. Two days after the battle, on June 29, 1866, the widow of the Hanoverian general Sir Georg Julius von Hartmann told her daughter in no uncertain terms how she felt about the Prussian government and its allies. In her opinion they were nothing more than “robber states” that cloaked their disregard for the Ten Commandments in sanctimonious public displays of piety. “These Protestant Jesuits,” she continued, “offend me more than the Catholic ones. You know that I am German with all my heart and love my Germany, but I cannot consider them genuine Germans anymore because they only want to make Germany Prussian.”

A Job Diagnostic Survey of Nursing Home Caregivers: Implications of Job Redesign

Nursing home caregiving was analyzed as a job, subject to management intervention. Specifically examined was the usefulness of job redesign, a managerial intervention used to enhance worker motivation and effectiveness. Information from interviews with administrators was combined with survey data from aides and LPNs (n= 489) in 21 nursing homes to assess to need for, and feasibility of, redesign of caregiving work. Implementation principles and examples are included.

Nursing Homes as a Setting for Psychological Practice: Public Policy Perspectives.

Recent federal legislation has provided renewed interest in improving the quality of nursing home care. The lack of both funding and personnel are significant barriers that may keep psychology's disciplinary expertise from being fully used in nursing homes. Nursing homes may be forced to undertake mandated activities (e.g., preadmission screening, nurses aides' training, and evaluation) without psychologists' expertise, relying either on medical practitioners with little knowledge of mental health interventions or on minimally qualified, entry-level mental health workers. Advocates for improved nursing home care must see the links among basic disciplinary skills, interdisciplinary collaboration, and improved care for mentally impaired elderly individuals.

Assessing Nursing Assistants' Knowledge of Behavioral Approaches to Mental Health Problems

Nurse's aides are the primary caregivers in nursing homes, a major receiving site for elders with behavioral and psychiatric problems. We describe the development, psychometric properties, and utility of a brief instrument designed to assess aides' knowledge of three specific mental health problems (depression, agitation, and disorientation) and behavioral approaches to them. The instrument was administered to 191 nurse's aides and 21 clinicians with training in behavioral management and experience with older residents. The nurse's aides averaged 11 of 17 correct answers, and the clinicians averaged 15 of 17 correct answers. Implications for staff training and consultation activities in nursing homes are discussed.

The Relationship of Antipsychotic Drug Use, Resident Behavior, and Diagnoses Among Nursing Home Residents

Nursing homes have been criticized for frequent use and possible misuse of psycho-active agents. These issues are of clinical concern and policy relevance, especially since the passage of the Omnibus Budget Reconciliation Act (OBRA) of 1987. Using a sample of 419 residents, the authors examined the relationships among antipsychotic drug (AP) use, behavior, and mental health diagnoses. Only 23.2% of the residents were administered APs on a routine and/or "as-needed" basis. Based on the Multidimensional Observation Scale for Elderly Subjects (MOSES) ratings, AP users were more irritable, disoriented, and withdrawn than were nonusers. Also, AP users demonstrated agitated behaviors more frequently. Notably, AP users and nonusers differed significantly in terms of documented mental health diagnoses. Among AP users, 70.1% had documented dementia, 8.3% were psychotic or had other psychiatric disorders, and 21.6% had no mental health diagnoses. In contrast, the majority of nonusers had no mental health disorders. Logistic regression revealed that diagnostic factors, frequency of agitation, level of withdrawal, and marital status were significant predictors of AP use.

Improving Nursing Home Care Through Training amd Job Redesign

Nursing assistants have the primary contact with older residents of nursing homes. The Penn State Nursing Home Intervention Project's short-term longitudinal study assessed the single and combined effects of two interventions designed to affect nursing assistants' performance by increasing their knowledge and motivation: skills training and job redesign. Statistically significant differences in nursing assistants' knowledge were evident in comparisons between intervention and control sites, but performance was not improved. Implications for policy, practice, and research are discussed.