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| 2. |
- Joling, Karlijn J., et al.
(författare)
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Quality indicators for community care for older people : A systematic review
- 2018
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:1
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Forskningsöversikt (refereegranskat)abstract
- Background Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality.Methods Relevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality. Results Searches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain 'Additional evidence, formulation and usage' (51%), followed by 'Scientific evidence' (39%) and 'Stakeholder involvement' (28%).Conclusion A substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes.
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| 3. |
- Giovannini, Silvia, et al.
(författare)
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Polypharmacy in Home Care in Europe : Cross-Sectional Data from the IBenC Study
- 2018
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Ingår i: Drugs & Aging. - : Springer Science and Business Media LLC. - 1170-229X .- 1179-1969. ; 35:2, s. 145-152
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Tidskriftsartikel (refereegranskat)abstract
- Background Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. Methods We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs), and excessive polypharmacy (C10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy. Results Polypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17-2.13), pain (OR 1.51; 95% CI 1.15-1.98), dyspnea (OR 1.37; 95% CI 1.01-1.89), and falls (OR 1.55; 95% CI 1.01-2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56-0.83). Conclusions Polypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.
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- Morris, John N., et al.
(författare)
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Cognitive Change Among Nursing Home Residents : CogRisk-NH Scale Development to Predict Decline
- 2023
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Ingår i: Journal of the American Medical Directors Association. - 1525-8610 .- 1538-9375. ; 24:9, s. 1405-1411
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Examine cognitive changes over time among nursing home residents and develop a risk model for identifying predictors of cognitive decline. Design: Using secondary analysis design with Minimum Data Set data, cognitive status was based on the Cognitive Performance Scale (CPS).Setting and Participants: Baseline and 7 quarterly follow-up analyses of US and Canadian interRAI data (N = 1,257,832) were completed. Methods: Logistic regression analyses identified predictors of decline to form the CogRisk-NH scale.Results: At baseline, about 15% of residents were cognitively intact (CPS = 0), and 11.2% borderline intact (CPS = 1). The remaining more intact, with mild impairment (CPS = 2), included 15.0%. Approximately 59% residents fell into CPS categories 3 to 6 (moderate to severe impairment). Over time, increasing proportions of residents declined: 17.1% at 6 months, 21.6% at 9 months, and 34.0% at 21 months. Baseline CPS score was a strong predictor of decline. Categories 0 to 2 had 3-month decline rates in midteens, and categories 3 to 5 had an average decline rate about 9%. Consequently, a 2-submodel construction was employeddone for CPS categories 0 to 2 and the other for categories 3 to 5. Both models were integrated into a 6-category risk scale (CogRisk-NH). CogRisk-NH scale score distribution had 15.9% in category 1, 26.84% in category 2, and 36.7% in category 3. Three higher-risk categories (ie, 4-6) represented 20.6% of residents. Mean decline rates at the 3-month assessment ranged from 4.4% to 28.3%. Over time, differentiation among risk categories continued: 6.9% to 38.4.% at 6 months, 11.0% to 51.0% at 1 year, and 16.2% to 61.4% at 21 months, providing internal validation of the prediction model.Conclusions and Implications: Cognitive decline rates were higher among residents in less-impaired CPS categories. CogRisk-NH scale differentiates those with low likelihood of decline from those with mod-
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| 5. |
- Petrazzuoli, Ferdinando, et al.
(författare)
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Editorial : Dementia in Primary Care
- 2022
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Ingår i: Frontiers in Medicine. - : Frontiers Media SA. - 2296-858X. ; 9
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Tidskriftsartikel (refereegranskat)
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| 6. |
- Vetrano, Davide L., et al.
(författare)
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Multimorbidity Patterns and 5-Year Mortality in Institutionalized Older Adults
- 2022
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 23:8, s. 1389-1395, 1395.e1-1395.e4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to characterize multimorbidity patterns in a large sample of older individuals living in nursing homes (NHs) and to investigate their association with mortality, also considering the effect of functional status.Design: Observational and retrospective study.Setting and Participants: We analyzed data on 4131 NH residents in Italy, aged 60 years and older, assessed through the interRAI long-term care facility instrument. Entry date was between 2014 and 2018, and participants were followed until 2019.Methods: Multimorbidity patterns were identified through principal component analysis; for the identified components, subjects were stratified in quintiles (Q) with respect to their loading values, with the higher quantiles indicating greater expression of the component's pattern. Their association [hazard ratio (HR) and 95% CI] with mortality was tested in Cox regression models. Analyses were stratified by disability status.Results: Four patterns of multimorbidity were identified: (1) heart diseases; (2) dementia and sensory impairments; (3) heart, respiratory, and psychiatric diseases; and (4) diabetes, musculoskeletal, and vascular diseases. For the heart diseases pattern [HR Q5 vs Q1 = 1.83 (1.53–2.20)] and the dementia and sensory impairments pattern [HR Q5 vs Q1 = 1.23 (1.06–1.42)], as the specific multimorbidity expression increases, the risk of mortality increases. On stratifying by disability status, the association between the multimorbidity patterns and mortality was not always present.Conclusions and Implications: Different multimorbidity patterns are differentially associated with mortality in older residents of NHs, confirming that multimorbidity's prognosis is strictly dependent on the underlying disease combinations. This knowledge may be useful to implement personalized preventive and therapeutic care pathways for institutionalized older adults, which respond to individuals’ health needs.
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