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Sheryl Zimmerman

Publications and source records attributed to Sheryl Zimmerman.

At least 19 recordsLinked to original sources
PubMed2007

Dementia care mapping as a research tool.

INTRODUCTION: Dementia Care Mapping (DCM) was originally developed as a clinical tool but has attracted interest as a potential observational measure of quality of life (QOL) and well-being of long-term care residents with dementia. DCM coding involves continuous observation over a 6-h period, with observers recording a Behavior Category Code (BCC, a recording of activity/interaction) and a Well/Ill Being (WIB) score at 5 min intervals. METHOD: Descriptive data from several different research teams on the distribution and psychometric properties of DCM data were compiled and summarized. RESULTS: Issues and problems identified include: complex scoring algorithms, inter-rater reliability of the BCCs, limited variability of WIB values, associations between resident characteristics and DCM assessments, rater time burden, and comparability of results across study settings. CONCLUSIONS: Despite the identified limitations, DCM has promise as a research measure, as it may come closer to rating QOL from the perspective of persons with dementia than other available measures. Its utility will depend on the manner in which it is applied and an appreciation of the measure's strength and limitations. Possible changes that might improve the reliability, validity, and practicality of DCM as a research tool include coding the predominant event (rather than the 'best' event), shortening the observation period, and adding '0' as a neutral WIB coding option.

Activities of Daily Living↗
PubMed2006

The Lower Extremity Gain Scale: a performance-based measure to assess recovery after hip fracture.

OBJECTIVE: To develop and determine the reliability and validity of a sensitive observational measure to assess recovery in clinically meaningful areas of function after hip fracture. DESIGN: Used survey data to identify activities difficult to perform after fracture; conducted focus groups; interviewed patients; and developed a standardized protocol to prospectively test the highest ranking activities. SETTING: Evaluations conducted in 8 Baltimore hospitals or the patients' residence. PARTICIPANTS: Patients 2 to 24 months postfracture, 65 years and older, and community-dwelling. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Lower Extremity Gain Scale (LEGS). RESULTS: Nine performance-based activities were appropriate for administration in clinical and research settings: (1) walk 3m (10ft); put on a (2) sock and (3) shoe on the fractured side; (4) rise from an armless chair; step (5) up and (6) down 4 stairs; get (7) on and (8) off the toilet; and (9) reach for an item on the ground from a sitting position. Reproducibility is good and measures of internal consistency and content, concurrent, and construct validity are high. CONCLUSIONS: The LEGS can be easily administered by clinicians in a short time as part of care. Research and clinical scoring methods and performance norms can track recovery in activities that are most relevant in the lives of patients.

Activities of Daily Living↗
PubMed2006

Hospice attitudes among assisted living and nursing home administrators, and the long-term care hospice attitudes scale.

OBJECTIVES: To examine the attitudes of residential care/assisted living (RC/AL) and nursing home (NH) administrators toward hospice and to assess facility and administrator characteristics related to those attitudes. DESIGN: Two exploratory factor analyses of the Hospice Attitudes Questionnaire using principal factors with a promax (oblique) rotation were conducted. One was in a sample of 390 RC/AL and NH administrators from four states (Florida, Maryland, North Carolina, and New Jersey) and the other included NHs from this and a second sample (n = 244). Association between facility and administrator characteristics and administrator attitudes towards hospice were examined among the 146 RC/AL administrators. RESULTS: Exploratory factor analysis in the full sample resulted in the 12-item Long-Term Care Hospice Attitudes Scale (LTC-HAS) with four component subscales: (1) emotional and spiritual support (three items, alpha = 0.83); (2) quality of care (four items, alpha = 0.78); (3) rapidity of death (three items, alpha = 0.66) and (4) end-of-life care coordination (two items, alpha = 0.73). The overall alpha for the 12-item scale was 0.81. When exploratory factor analysis was conducted on the NH data only, a three-item subscale related to financing and billing (alpha = 0.66) also emerged. Four facility and three administrator characteristics that were significantly related to hospice attitudes included state, facility type, facility age, affiliation with another level of care; and age, race, and nurse training. CONCLUSION: Findings from this paper provide insight about RC/AL facility and NH administrators' attitudes towards Hospice using scale data, an area with limited research. They indicate positive attitudes toward Hospice care coordination, and that Hospice should supplement, as opposed to replace, the care provided by facilities. Findings also suggest areas where targeted outreach and further study may be recommended.

Administrative Personnel↗
PubMed2006

An empirical typology of residential care/assisted living based on a four-state study.

PURPOSE: Residential care/assisted living describes diverse facilities providing non-nursing home care to a heterogeneous group of primarily elderly residents. This article derives typologies of assisted living based on theoretically and practically grounded evidence. DESIGN AND METHODS: We obtained data from the Collaborative Studies of Long-Term Care, which examined 193 assisted living facilities in four states: Florida, Maryland, New Jersey, and North Carolina. By using mixture modeling, we derived typologies in five different ways, based on: structure; process; resident case-mix; structure and process; and structure, process, and resident case-mix. RESULTS: Although configurations of typologies varied as a function of criterion variables used, common themes emerged from different cluster solutions. A typology based on resident case-mix yielded a five-cluster solution, whereas a typology based on structure, process, and resident case-mix resulted in six distinct clusters. Medicaid case-mix/psychiatric illness and high resident impairment were two clusters identified by both strategies. IMPLICATIONS: Because of the wide variation in structure, residents, and services within assisted living facilities, typologies such as those described here may be useful in clinical practice, research, and policy. To the extent that public payment defines its own cluster, the potential for inequities in care merits careful attention.

Aged↗
PubMed2006

Is hospice associated with improved end-of-life care in nursing homes and assisted living facilities?

OBJECTIVES: To examine whether hospice enrollment for nursing home (NH) and residential care/assisted living (RC/AL) residents near the end of life is associated with symptoms and symptom management, personal care, spiritual support, and family satisfaction. DESIGN: Structured, retrospective telephone interviews with family and staff who attended to NH and RC/AL residents in the last month of life. SETTING: A stratified sample of 26 NH and 55 RC/AL facilities in four states. PARTICIPANTS: Family members (n=97) and long-term care (LTC) staff (n=104) identified as most involved in care of 124 residents who died over a 15-month period. MEASUREMENTS: A variety of reported measures of care and symptoms before death, including the Discomfort Scale for Dementia of the Alzheimer's Type. RESULTS: Of 124 decedents, 27 (22%) received hospice services. Dementia was less common in hospice enrollees than in decedents who did not receive hospice care. Hospice enrollees more often had moderate/severe pain and dyspnea and received pain treatment and were more likely to receive assistance with mouth care and eating and drinking. There were no differences related to unmet need, and observed differences were largely eliminated when comparisons were limited to residents whose deaths were expected. CONCLUSION: Rates of hospice use observed in this study (22%) were considerably higher than previously reported, although persons with dementia may continue to be underreferred. Hospice use is targeted to dying residents with higher levels of reported pain and dyspnea. Because difference in care largely disappears in cases when death was expected, LTC staff seem to be well positioned to provide end-of-life care for their residents and are advised to remain sensitive to instances in which death may be expected.

Aged, 80 and over↗
PubMed2006

Testing of the SEE and OEE post-hip fracture.

The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise (SEE) and the Outcome Expectations for Exercise (OEE) scales in a sample of 166 older women post-hip fracture. There was some evidence of validity of the SEE and OEE based on confirmatory factor analysis and Rasch model testing, criterion based and convergent validity, and evidence of internal consistency based on alpha coefficients and separation indices and reliability based on R2 estimates. Rasch model testing demonstrated that some items had high variability. Based on these findings suggestions are made for how items could be revised and the scales improved for future use.

Activities of Daily Living↗
PubMed2006

Work organization, economic inequality, and depression among nursing assistants: a multilevel modeling approach.

To investigate the relationships among the nursing home work environment, emotional strain, and depression in Nursing Assistants in Ohio and West Virginia, this cross-sectional study was conducted with 395 Nurse Assistants in 49 nursing homes in Ohio and West Virginia. Organizational attributes were measured independently at the individual and organizational levels. Multilevel modeling techniques were used to analyze the data. Our methods examined nursing home organizational structure (ownership type, managerial style), and work organization (emotional strain) was examined in relation to the prevalence of depression among nursing assistants. Our findings suggest workplace emotional strain and age are associated with increased odds of depression. Implications of our work include that work in nursing homes for the environment it fosters has a strong effect on emotional strain and depression among Nursing Assistants.

Adult↗
PubMed2006

Pilot testing of the Restorative Care Intervention: impact on residents.

The purpose of this pilot study was to test the feasibility and effectiveness of a two-tiered motivational intervention, the Res-Care Intervention, on nursing home residents. Twenty-one residents consented to participate in the study. The residents were 88.3 (+/- 4.9) years of age, had lived in the facility 1.6 (+/- 3.4) years, were women (93%), White (93%), and unmarried (85%). Although there were some positiv trends, there was not a statistically significant difference in any of the resident outcomes following implementation of the Res-Care Intervention. The findings have been used to revise the Res-Care Intervention to include additional education needs for the nursing assistants, revisions in the motivational intervention for the nursing assistants and nurses, clarification of documentation and motivational techniques to improve documentation, and implementation of a more comprehensive treatment fidelity plan.

Activities of Daily Living↗
PubMed2005

Potentially inappropriate prescribing before and after nursing home admission among patients with and without dementia.

OBJECTIVES: This study was designed to describe changes in the prevalence of potentially inappropriate medication prescribing before and after nursing home admission, and to compare prevalence among residents with and without dementia. This paper extends the research on inappropriate medication prescribing among residents entering a nursing home, with the added feature of comparison by dementia status. METHODS: This retrospective cohort study was conducted using data from 59 randomly selected nursing homes in Maryland. Dually eligible (Medicare/Medicaid) residents aged > or = 65 years who were admitted to one of these nursing homes from 1992 to 1995 were eligible for inclusion in the cohort. An expert panel of physicians determined dementia status at admission. Potentially inappropriate prescribing, as defined by the 1997 Beers criteria, was compared using Medicaid prescription claims for up to 12 months before and after admission to characterize monthly prescribing patterns. RESULTS: The study group included 546 dually eligible nursing home residents with > or = 1 paid prescription claim for the 12 months before or after their admission date. A total of 372 (68%) residents were white, 443 (81%) were unmarried, 408 (75%) were female, and 334 (61%) were diagnosed with dementia at admission. Before nursing home admission, the mean monthly prevalence of potentially inappropriate medications for residents with and without dementia was 20% and 23%, respectively. After admission, the mean monthly prevalence increased to 28% among residents without dementia and decreased to 19% among residents with dementia. After adjusting for the mean number of other prescriptions, sociodemographic factors, and number of comorbid conditions, residents with dementia were as likely as residents without dementia to receive a potentially inappropriate drug before admission (prevalence ratio, 0.97; 95% CI, 0.58-1.62). After admission, residents with dementia were 27% less likely than residents without dementia to receive a potentially inappropriate drug, although the difference did not reach statistical significance (prevalence ratio, 0.73; 95% CI, 0.53-1.01). CONCLUSIONS: Inappropriate medication prescribing was similar before nursing home admission among patients with and without dementia. After admission, the prevalence was lower among residents with dementia, but it did not reach statistical significance.

Aged↗
PubMed2005

How good is assisted living? Findings and implications from an outcomes study.

OBJECTIVES: The objective of this work was to determine 1-year medical outcomes, nursing home transfer, and functional change of assisted living (AL) residents and their relationship to care. METHODS: On-site interviews and observations regarding the status and care of 2,078 residents in 193 facilities across four states were conducted; follow-up was by telephone interview with care providers. RESULTS: Annual mortality and transfer rates were 14.4 and 21.3 per 100 residents. The probability of hospitalization and new/worsening morbidities over a standardized quarter per 100 residents was 12.7 and 22.7. Standardized change in function was notable among those who were transferred or died and small among others. Facility characteristics did not generally relate to medical outcomes and transfer, and those that related to functional change were small and occurred across multiple functions. Facilities that are affiliated with another level of care were more likely to transfer; nurse staffing was favorable for hospitalization but not transfer; and aide turnover was protective for mortality. DISCUSSION: No single component defines "good" AL care. Predictors and outcomes are inconsistent, and effect sizes are small. Therefore, practice and policy should not focus narrowly on any one area or restrict the type of care-this being welcome news that supports diversity to accommodate individual preferences.

Aged↗
PubMed2005

Medicare cost differences between nursing home patients admitted with and without dementia.

PURPOSE: Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings. DESIGN AND METHODS: An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures per-person month (PPM) were compared for 640 residents diagnosed with dementia and 636 with no dementia for 1 year preadmission and 2 years postadmission. Multivariate analysis with generalized estimating equations was used to identify the source of Medicare cost differentials between the two groups. RESULTS: Medicare expenditures peaked in the month immediately preceding admission and dropped to preadmission levels by the third month in a nursing home. Adjusted PPM costs postadmission for the dementia group as a whole were 79% (p < .001) of the Medicare costs of treating residents without dementia. For the subgroup of residents admitted without a Medicare qualified stay (MQS), those with dementia had Medicare costs of just 63% (p < .001) of those without dementia. Overall Medicare costs PPM were insignificantly different between the two groups admitted with a MQS. IMPLICATIONS: Whether nursing home residents are admitted with a MQS is the single most important factor in assessing treatment cost differentials between residents admitted with and without dementia. Failure to consider this factor may lead researchers and policy makers to misdirect their attention from the true source of the differential-dementia patients admitted without a qualifying stay.

Aged↗
PubMed2005

The Exercise Plus Program for older women post hip fracture: participant perspectives.

PURPOSE: The purpose of this study was to explore the experiences of older women post hip fracture who were exposed to a motivational intervention, the Exercise Plus Program, intended to increase adherence to exercise. DESIGN AND METHODS: This study used a naturalistic inquiry. We interviewed a total of 70 older women, 12 months post hip fracture, using an interview guide asking about issues related to willingness to exercise. All interviews were tape recorded and transcribed verbatim. RESULTS: Analysis of the semi-structured interviews revealed 44 codes that were categorized and reduced to 14 major themes. Eleven of these themes focused on components that facilitated participation in exercise and included: (a) real and expected benefits; (b) visual cues and knowing what to do; (c) simplicity; (d) individualized care; (e) verbal encouragement to exercise; (f) regular schedule; (g) confidence (i.e., self-efficacy); (h) determination; (i) social support; (j) reciprocity; and (k) goal identification. The remaining three themes reflected what decreased the participants' willingness to exercise: (a) unpleasant sensations; (b) constraints to exercise; and (c) getting back to baseline. IMPLICATIONS: The findings provide some support for the benefit of the Exercise Plus Program. Lessons learned in the Exercise Plus Program can be translated to the development of other motivational interventions to help engage older adults in exercise, particularly those individuals who recently experienced an acute event, such as a hip fracture.

Aged↗
PubMed2005

Factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care facilities.

PURPOSE: We identify resident, nursing assistant, and facility factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care. DESIGN AND METHODS: We used a cross-sectional survey of 143 nursing assistants providing care to 335 residents in 38 residential care/assisted living (RC/AL) facilities and nursing homes in four states. We assessed resident quality of life by using the Quality of Life-Alzheimer's Disease Scale (QOL-AD). RESULTS: Scores on the quality-of-life scale were most strongly associated with resident clinical conditions, including severity of cognitive and functional impairments, depression, and behavioral symptoms of dementia. There was also an independent positive association between nursing assistants' ratings of resident quality of life and their own attitudes regarding dementia-person-centered care as well as training. However, the results of hierarchical linear modeling suggest that some sources of nursing assistant variability in quality-of-life ratings remain unidentified. IMPLICATIONS: Quality-of-life ratings by nursing assistants may be influenced by their attitudes about dementia and their confidence in addressing residents' fundamental care needs.

Adult↗
PubMed2005

Sociocultural aspects of transitions from assisted living for residents with dementia.

PURPOSE: Negotiating transitions and residential relocation are especially difficult for residents with dementia and their families. This article examined the decision-making process regarding retention or transfer of persons with dementia in assisted living facilities. DESIGN AND METHODS: Using an ethnographic approach, this study observed residents and facility life, and interviewed residents, staff, and family members in three assisted living facilities. RESULTS: Facility managers and administrators are pivotal figures in determining the timing of transitions and transitional care. Operating within the context of care requirements of dementia, they, the facility culture, and the family members' involvement in resident care mediate interpretations of and responses to change and decline, and ultimately influence decision making regarding retention or transfer. IMPLICATIONS: Transfer or retention may occur differently depending on whether managers are on- or off-site, the assisted living culture is dementia-friendly, and families are involved in care. Sensitizing assisted living managers and educating potential residents and family members to the importance of these factors may affect the eventual likelihood and timing of discharge.

Aged, 80 and over↗
PubMed2005

Health and functional outcomes and health care utilization of persons with dementia in residential care and assisted living facilities: comparison with nursing homes.

PURPOSE: This study compares health and functional outcomes and health care utilization of persons with dementia residing in residential care/assisted living (RC/AL) facilities and nursing homes. DESIGN AND METHODS: The study uses data from a longitudinal cohort study of 1,252 residents with dementia in 106 RC/AL facilities and 40 nursing homes in four states. RESULTS: Rates of mortality; new or worsening morbidity; and change in activities of daily living, cognition, behavioral problems, depressive symptoms, social function, and withdrawal did not differ between the two settings. However, because of death or transfer, only about one half of the persons with mild dementia and one third of those with moderate to severe dementia remained in RC/AL facilities 1 year after enrollment. In addition, hospitalization rates were greater among individuals with mild dementia in RC/AL facilities, largely because of a medically unstable subgroup with high nursing-home-transfer rates. IMPLICATIONS: Many persons with dementia can be served equally well in either setting; however, those with major medical care needs may benefit from nursing home residence.

Aged, 80 and over↗
PubMed2005

Dementia care and quality of life in assisted living and nursing homes.

PURPOSE: There are few empirical studies relating components of long-term care to quality of life for residents with dementia. This study relates elements of dementia care in residential care/assisted living (RC/AL) facilities and nursing homes to resident quality of life and considers the guidance this information provides for practice and policy. DESIGN AND METHODS: We used a variety of report and observational measures of the structure and process of care and 11 standardized measures of quality of life to evaluate the care for and quality of life of 421 residents with dementia in 35 RC/AL facilities and 10 nursing homes in four states. Data were collected cross sectionally on-site, and we conducted a 6-month follow-up by telephone. RESULTS: Change in quality of life was better in facilities that used a specialized worker approach, trained more staff in more domains central to dementia care, and encouraged activity participation. Residents perceived their quality of life as better when staff was more involved in care planning and when staff attitudes were more favorable. Better resident-staff communication was related to higher quality of life as observed and reported by care providers. Also, more stable resident-staff assignment was related to care providers' lower quality-of-life ratings. IMPLICATIONS: Improvement in resident quality of life may be achieved by improved training and deployment of staff.

Aged, 80 and over↗
PubMed2005

Evaluating the quality of life of long-term care residents with dementia.

PURPOSE: This study's purpose was to better understand existing measures of quality of life in dementia residents of long-term care facilities. DESIGN AND METHODS: We gathered data from 421 residents in 45 facilities. Analyses determined the psychometric properties of each measure, estimated the relationship between measures, and identified the extent to which resident characteristics predicted scores. RESULTS: Most instruments had good to excellent dispersion and interrater reliability, and most scales had good to excellent internal consistency. Proxy measures tended to correlate best with each other, less well with observational measures, and least well with resident measures. Resident cognition and activities of daily living (ADLs) function were associated with most quality-of-life measures but predicted no more than a quarter of the observed variance in any measure. IMPLICATIONS: Various measures and sources of data provide different perspectives on quality of life. No "gold standard" exists; so a combination of methods and sources is likely to provide the most complete picture of quality of life.

Aged↗