Biomedical subjects

Sheryl Zimmerman

Publications and source records attributed to Sheryl Zimmerman.

At least 55 records · Page 3Linked to original sources

PubMed2003

Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up.

OBJECTIVES: To examine the prevalence, incidence, persistence, predictors, and outcomes of cognitive impairment after hip fracture. DESIGN: Longitudinal cohort study. SETTING: Eight hospitals in Baltimore, Maryland. PARTICIPANTS: Six hundred seventy-four hip fracture patients aged 65 and older living in the community before fracture. MEASUREMENT: Delirium at admission and postsurgery, Mini-Mental State Examination (MMSE) scores postsurgery, and prefracture proxy ratings of MMSE and dementia. Follow-up measures at 2 and 12 months postfracture included mortality, MMSE, physical activities of daily living (PADLs), instrumental activities of daily living (IADLs), social functioning, and the Center for Epidemiologic Studies-Depression Scale. RESULTS: Overall, 28% had prefracture dementia or MMSE impairment, 8% had cognitive impairment first detected presurgery, 14% had impairment first detected postsurgery, and 50% were not impaired before or during hospitalization. Incident cognitive impairment was more likely in patients who were older, male, and less educated and had more prefracture PADL impairment, intertrochanteric fractures, and higher anesthesia risk ratings. Presurgery incident cases did not differ significantly from those detected postsurgery in functional outcomes or in persistence of cognitive impairment. Cognitive impairment first noted in the hospital persisted through 2 and 12 months in more than 40% of patients. Those with cognitive impairment persisting through 2 months had poorer 12-month PADLs and social functioning. CONCLUSION: Prefracture cognitive impairment and incident cognitive impairment during hospitalization are risk factors for poor functional outcomes. Many incident cognitive problems persisted over 2 to 12 months, and per-sistence predicted later functional and social impairment.

Activities of Daily Living↗

PubMed2003

End-of-life care in assisted living and related residential care settings: comparison with nursing homes.

OBJECTIVES: To define the current state of end-of-life care in residential care/assisted living (RC/AL) facilities and nursing homes (NHs) and to compare these two types of care settings. DESIGN: Interviews of staff and family informants about deaths that occurred during a longitudinal study. SETTING: Fifty-five RC/AL facilities and 26 NHs in Florida, Maryland, New Jersey, and North Carolina. PARTICIPANTS: Two hundred twenty-four staff and family informants that best knew the 73 RC/AL residents and 72 NH residents who died in or within 3 days after discharge from a study facility. MEASUREMENTS: Telephone interviews conducted with the facility staff member who knew the decedent best and the family member who was most involved in care during the last month of life of the decedent. Data were collected on circumstances of death, perceptions of dying process, cause of death, care during the last month of life, mood, discomfort, and family satisfaction. RESULTS: Most decedents died in the facility where they had resided, and more than half of the subjects were alone when they died. Greater proportions of staff and family in the NHs knew that the resident's death was only days or weeks away. Both RC/AL and NH residents experienced few highly negative moods, and even on their most uncomfortable day, the overall discomfort was low for residents in both facility types. Summary ratings of family satisfaction were significantly higher for the RC/AL (32.1) than the NH (41.2) group (P=.016). CONCLUSION: These data suggest that end-of-life care in RC/AL settings appears similar in process and outcomes to that provided in NHs. Thus, aging and dying-in-place can effectively occur in RC/AL.

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PubMed2003

Assisted living and nursing homes: apples and oranges?

PURPOSE: The goals of this study are to describe the current state of residential care/assisted living (RC/AL) care and residents in comparison with nursing home (NH) care and residents, identify different types of RC/AL care and residents, and consider how variation in RC/AL case-mix reflects differences in care provision and/or consumer preference. DESIGN AND METHODS: Data were derived from the Collaborative Studies of Long-Term Care, a four-state study of 193 RC/AL facilities and 40 NHs. Multivariate analyses examined differences in ten process of care measures between RC/AL facilities with less than 16 beds; traditional RC/AL with 16 or more beds; new-model RC/AL; and NHs. Generalized estimating equation models determined differences in resident case-mix across RC/AL facilities using data for 2,078 residents. RESULTS: NHs report provision of significantly more health services and have significantly more lenient admission policies than RC/AL facilities, but provide less privacy. They do not differ from larger RC/AL facilities in policy clarity or resident control. Differences within RC/AL types are evident, with smaller and for-profit facilities scoring lower than other facilities across multiple process measures, including those related to individual freedom and institutional order. Resident impairment is substantial in both NHs and RC/AL settings, but differs by RC/AL facility characteristics. IMPLICATIONS: Differences in process of care and resident characteristics by facility type highlight the importance of considering: (1) the adequacy of existing process measures for evaluating smaller facilities; (2) resident case-mix when comparing facility types and outcomes; and (3) the complexity of understanding the implication of the process of care, given the importance of person-environment fit. Work is continuing to clarify the role of RC/AL vis-à-vis NHs in our nation's system of residential long-term care.

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PubMed2003

Pressure ulcers and the transition to long-term care.

OBJECTIVE: To estimate the prevalence of pressure ulcers among newly admitted residents of long-term-care facilities and to determine whether patients admitted from hospitals had a higher prevalence than those admitted from home or other settings. DESIGN: Prospective cohort study conducted between 1992 and 1995. SETTING: 59 long-term-care facilities in Maryland. PARTICIPANTS: 2015 residents aged 65 years and older newly admitted to participating long-term-care facilities. MAIN OUTCOME MEASURE: Stage II, III, or IV pressure ulcer, first mentioned in the long-term-care facility's chart within 2 days of admission. MAIN RESULTS: Of the 2015 residents studied, 208 (10.3%) had 1 or more pressure ulcers on admission to a long-term-care facility. The proportion of patients with 1 or more pressure ulcers was 11.9% among those admitted from a hospital and 4.7% among those not admitted from a hospital (P<.001). In multivariable analysis, admission from a hospital was significantly associated with pressure ulcer prevalence on admission (odds ratio, 2.2; 95% confidence interval, 1.3-3.7). A lower prevalence of pressure ulcers on admission was significantly associated with being white; a higher prevalence was associated with being chairbound or bedridden, being underweight, and having fecal incontinence. CONCLUSION: Admission to a long-term-care facility from a hospital is an important marker for higher pressure ulcer risk. The identification of pressure ulcer risk factors is essential to the implementation of prevention activities, ensuring that appropriate interventions are targeted to the residents who are most likely to benefit.

Activities of Daily Living↗

PubMed2003

Association of depression with agitation in elderly nursing home residents.

Agitation is a serious problem for elderly individuals with dementia. It is often the major reason for admission to a restrictive environment such as a nursing home or hospital. The objectives of the current study were to (1) identify the components of agitation embedded in the Psychogeriatric Dependency Rating Scale (PGDRS) and (2) find race, gender, depression, and cognitive deficits associated with the factors extracted from the PGDRS in demographic variables and clinical variables. The study sample comprised 2285 subjects who were admitted to 59 nursing homes across Maryland. The factor analysis of the PGDRS confirmed that agitation is made up of a number of different elements ranging from physical and/or verbal aggression to wandering. Correlates of these elements varied, as did possible treatments. For example, physical and/or verbal aggression often accompanied severe depression, suggesting that treating the depression may alleviate this problem. However, wandering and psychotic behavior may be less amenable to existing treatments as these behaviors were associated with severe cognitive impairment.

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PubMed2002

Effect of fracture on the health care use of nursing home residents.

BACKGROUND: Osteoporotic fractures result in increased health care use. Care following fracture has been characterized for community dwellers but not for nursing home residents, whose fracture rates are as much as 11 times higher than those of age-matched community dwellers. Knowing the amount of care following fracture may help determine the effects of fracture prevention on use and costs in this population. METHODS: A prospective cohort study was conducted, with 18 months of follow-up, of 1427 randomly selected white, female nursing home residents 65 years and older from 47 randomly selected nursing homes in Maryland. RESULTS: After controlling for age, comorbidities, and mobility, nursing home residents who experienced a fracture were hospitalized more than 15 times as often as those who did not in the month following the fracture (relative rate, 15.35; 95% confidence interval, 12.27-19.21) and at a higher rate from 3 through 12 months postfracture. Rates in the first month were higher for persons with a hip fracture (relative rate, 31.01; 95% confidence interval, 26.52-36.24). Rates of emergency department use and contacts with physicians and therapists were increased, the latter two for 12 months following fracture. Also, before the fracture, patients who experienced a fracture visited the emergency department and had more physician contacts; for those with a hip fracture, there were fewer prefracture hospitalizations. CONCLUSIONS: Health care use remained elevated through 1 year postfracture. Comparisons with community patients suggest that this care may be less than what would be provided in other settings. For patients who fractured a hip, higher use decreased after 6 months, similar to community cohorts. Nursing home residents who visit the emergency department may warrant special screening for a fracture.

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PubMed2002

Inappropriate medication prescribing in residential care/assisted living facilities.

OBJECTIVES: To identify the extent to which inappropriately prescribed medications (IPMs) are administered to older patients in residential care/assisted living (RC/AL) facilities and to describe facility and resident factors associated with receipt of one or more IPMs. DESIGN: Cross-sectional study of a stratified, representative sample of 193 facilities in four states. SETTING: We identified representative geographic regions within Florida, New Jersey, North Carolina, and Maryland and drew from within them a stratified random sample of 193 RC/AL facilities. Three subtypes of facilities were included in the sample: small homes (<16 beds), larger "new-model" homes, and larger "traditional" homes. PARTICIPANTS: Within each larger home, a random sample of residents aged 65 and older was approached for consent; in smaller homes all residents were approached. The overall enrollment rate was 92%; 2,078 residents were enrolled. MEASUREMENTS: Questionnaires and on-site observations were used to gather data on facility administration and staffing and resident characteristics. All prescription and nonprescription medications taken at least 4 of the 7 days before data collection were taken from medication administration records and coded for analysis. IPM designation was based on modification of a list developed by Beers et al. and currently used by nursing home surveyors. RESULTS: The majority of RC/AL patients were taking five or more medications; 16.0% of these patients were receiving IPMs. The most common IPMs were oxybutynin, propoxyphene, diphenhydramine, ticlopidine, doxepin, and dipyridamole. In multivariate analyses, using generalized estimating equations, IPM use was associated with the number of medications received, smaller facility bed size, moderate licensed practical nurse turnover, absence of dementia, low monthly fees, and absence of weekly physician visits. CONCLUSIONS: IPMs remain a problem in long-term care, but rates in these RC/AL settings compare favorably with those reported for other frail older populations, suggesting that use of medications with severe adverse effects may be waning. Regular physician facility visits may improve prescribing, as will attention to high-risk groups such as individuals on multiple medications.

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PubMed2002

Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors.

OBJECTIVES: Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection. DESIGN: Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow-up. SETTING: A stratified random sample of 59 nursing homes across Maryland. PARTICIPANTS: Two thousand fifteen new admissions aged 65 and older. MEASUREMENTS: Facility-level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record abstraction; and direct observation. Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records). RESULTS: The 2-year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days. Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome. High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use. High rates of hospitalization for infection were associated with for-profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes. CONCLUSIONS: The association between RN turnover and both outcomes underscores the relationship between nursing leadership and quality of care in these settings. The relationship between hospitalization for infection and for-profit ownership and chain affiliation could reflect policies not to treat acute illnesses in house. The link between social factors of care (environmental quality, prioritizing staff satisfaction, resident privacy, and facility visitation) and hospitalization indicates that a nonmedical model of care may not jeopardize, and may in fact benefit, health-related outcomes. All of these facility characteristics may be modifiable, may affect healthcare costs, and may hold promise for other, less-medical, forms of residential long-term care.

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PubMed2002

The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia.

OBJECTIVE: To develop an observational instrument that describes the ability of physical environments of institutional settings to address therapeutic goals for persons with dementia. METHODS: A National Institute on Aging workgroup identified and subsequently revised items that evaluated exit control, maintenance, cleanliness, safety, orientation/cueing, privacy, unit autonomy, outdoor access, lighting, noise, visual/tactile stimulation, space/seating, and familiarity/homelikeness. The final instrument contains 84 discrete items and one global rating. A summary scale, the Special Care Unit Environmental Quality Scale (SCUEQS), consists of 18 items. Lighting items were validated using portable light meters. Concurrent criterion validation compared SCUEQS scores with the Professional Environmental Assessment Protocol (PEAP). RESULTS: Interrater kappa statistics for 74% of items were above.60. For another 10% of items, kappas could not be calculated due to empty cells, but interrater agreement was above 80%. The SCUEQS demonstrated an interrater reliability of.93, a test--retest reliability of.88, and an internal consistency of.81--.83. Light meter ratings correlated significantly with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) lighting items (r =.29--.38, p =.01--.04), and the SCUEQS correlated significantly with global PEAP ratings (r =.52, p <.01). DISCUSSION: The TESS-NH efficiently assesses discrete elements of the physical environment and has strong reliability and validity. The SCUEQS provides a quantitative measure of environmental quality in institutional settings.

Activities of Daily Living↗

PubMed2002

Evaluating the components of the Exercise Plus Program: rationale, theory and implementation.

Recovery following a hip fracture is facilitated by participation in regular exercise. Despite the benefits of exercise, it is difficult to get older adults to initiate and adhere to regular exercise programs. The Attribution Theory of Achievement Motivation suggests that an individual's future involvement in an activity is based on assessments of prior experience with the activity. Conversely, the Theory of Self-efficacy states that self-efficacy expectations and outcome expectations are not only influenced by behavior, but also by verbal encouragement, physiological sensations and exposure to role models or self-modeling. These expectations then determine the individual's willingness to initiate and engage in a given activity. Using a 2x2 factorial design, the primary aim of this study is to compare these two theories. The effectiveness of the Exercise Plus Program will be compared to the individual components of the program (Exercise Training and Plus components) on both self-efficacy and outcome expectations, exercise behavior, activity, and specific physical and psychological outcomes. A total of 240 older women post hip fracture will be recruited from five different acute care facilities. This study will add to current knowledge by examining the impact of a combined exercise training/social learning intervention approach versus either alone.

Exercise Therapy↗

PubMed2002

Distribution of African Americans in residential care/assisted living and nursing homes: more evidence of racial disparity?

OBJECTIVES: In this study, we examined racial separation in long-term care. METHODS: We used a survey of a stratified sample of 181 residential care/assisted living (RC/AL) facilities and 39 nursing homes in 4 states. RESULTS: Most African Americans resided in nursing homes and smaller RC/AL facilities and tended to be concentrated in a few predominantly African American facilities, whereas the vast majority of Whites resided in predominantly White facilities. Facilities housing African Americans tended to be located in rural, nonpoor, African American communities, to admit individuals with mental retardation and difficulty in ambulating, and to have lower ratings of cleanliness/maintenance and lighting. CONCLUSIONS: These racial disparities may result from economic factors, exclusionary practices, or resident choice. Whether separation relates to inequities in care is undetermined.

Adult↗

PubMed2001

The public health impact of Alzheimer's disease, 2000-2050: potential implication of treatment advances.

Recent developments in basic research suggest that therapeutic breakthroughs may occur in Alzheimer's disease treatment over the coming decades. To model the potential magnitude and nature of the effect of these advances, historical data from congestive heart failure and Parkinson's disease were used. Projections indicate that therapies which delay disease onset will markedly reduce overall disease prevalence, whereas therapies to treat existing disease will alter the proportion of cases that are mild as opposed to moderate/severe. The public health impact of such changes would likely involve both the amount and type of health services needed. Particularly likely to arise are new forms of outpatient services, such as disease-specific clinics and centers. None of our models predicts less than a threefold rise in the total number of persons with Alzheimer's disease between 2000 and 2050. Therefore, Alzheimer's care is likely to remain a major public health problem during the coming decades.

Alzheimer Disease↗

PubMedDate not supplied

Health-related quality of life: is it a good indicator of function post THR?

The purpose of this study was to explore the impact of health-related quality of life (HRQOL) measured with the Short Form Health Survey (SF-36) on Functional Recovery Status (physical and psychosocial recovery status) at base-line, 2 months, 6 months, and 12 months following total hip replacement (THR). A secondary analysis was performed using data gathered from a sample of 271 older adults post THR. Four empirically based hypothesized models were tested. None of the models fit the data, with each having significant chi2 values and chi2 /df ratios greater than 3. Different dimensions of HRQOL at baseline, 2, 6, and 12 months were related to physical recovery status, and none of the 8 dimensions of the SF-36 was significantly related to psychosocial recovery status. Overall, the results of this study do not support the hypothesis that HRQOL, as measured by the SF-36, comprehensively explains functional recovery status following THR. Clinically, these findings may be applicable to individuals at risk for poor recovery. They also may prompt practitioners to consider alternative factors that influence psychosocial recovery.

Age Distribution↗

PubMedDate not supplied

Making a difference: nursing assistants' perspectives of restorative care nursing.

This article explores the experiences of nursing assistants who participated in the Res-Care Pilot Intervention. A qualitative study used a focus group methodology. An interview guide was used and data from focus groups were audiotaped and transcribed verbatim. A purposive sample of 13 nursing assistants participated in the focus groups. A total of 35 different codes were identified, and these were reduced to the following four themes: resident barriers to restorative care, facility or system barriers to restorative care, nursing assistant strategies, and system facilitators of restorative care. The study supports and adds to previous work that suggests that in order to successfully implement changes in care in nursing home settings the following issues should be addressed: real or perceived workload issues, poor communication with nursing, insufficient knowledge or education, lack of appropriate supplies, and insufficient administrative support. The findings may be used to revise the Res-Care Pilot Intervention and direct future implementation of programs in nursing home settings.

Attitude of Health Personnel↗

PubMedDate not supplied

Testing of the Res-Care Pilot Intervention: Impact on nursing assistants.

The purpose of this study was to test the feasibility and effectiveness of a two-tiered motivational intervention--the Res-Care Pilot Intervention--on willingness of nursing assistants to participate in the Res-Care Intervention, the impact of the intervention on nursing assistants' self-efficacy, and outcome expectations related to restorative care, knowledge of restorative care, restorative care behaviors, and job satisfaction. A sample of 13 nursing assistants with an average age of 47.3 +/- 8.9 (range 29-56) years, the majority of whom were women (93%) and African American (77%), consented to participate in the study. There was a statistically significant increase in outcome expectations related to restorative care activities (F = 8.9, P <.05), a nonsignificant trend toward increased knowledge of restorative care (F = 1.4, P > .05) and documented time doing restorative care activities (F = -.56, P > .05), and no difference in self-efficacy expectations (F = .58, P > .05) or job satisfaction (F = .48, P > .05). The findings provide useful information for future research in restorative care.

Activities of Daily Living↗

PubMedDate not supplied

Physician care in assisted living: a qualitative study.

OBJECTIVES: To identify patterns and emerging concepts used by assisted living (AL) residents, their families, and the facility staff to describe the care provided by physicians to the AL residents. DESIGN: Qualitative research and analysis based on audio-taped and transcribed ethnographic interviews with residents, family members, and staff of AL facilities. SETTING: Three AL facilities representing small and traditional AL facilities. PARTICIPANTS: Forty-three in-depth interviews including 16 AL residents, 13 family members, three facility managers, and 11 staff members. MEASUREMENTS: Ethnographic, audio-taped interviews coded by consensus by a doctoral-level analysis team. Coding focused broadly on any references to physicians or doctors in the interviews. RESULTS: Emergent themes included four major physician-related themes in AL including: magnification of physician authority; disagreements with physician care; physician communication; and continuity/discontinuity of physician care. CONCLUSION: Physicians caring for residents of AL facilities should consider how residents, families, and staff stakeholders may influence their patient care for AL residents in terms of their authority, decision-making, communication, and continuity of care.

Aged↗

PubMedDate not supplied

Measuring the frequency of contact between nursing home residents and their family and friends.

BACKGROUND: The involvement of family and friends in nursing home care represents an important resource for an overburdened long-term care system. However, little guidance exists for researchers interested in measuring family involvement. OBJECTIVES: This methodological report provides an overview of approaches to measuring family involvement in nursing home care and examines agreement between family and staff on the frequency of visits and telephone calls to a resident by family and friends. Agreement is also assessed for subgroups of the sample based on characteristics of the family, staff, facility, and resident. METHODS: From a large and representative sample of nursing home residents, 823 pairs of significant others and staff were interviewed. Primary variables were reports of visitation and telephone contact received by the resident in the preceding 2 weeks according to the significant other and staff person. RESULTS: Significant other reports of visitation and telephone contact were significantly higher than staff reports (p <.001 and p <.01). Agreement (via intraclass correlation) between significant others and staff was moderate for reports of visit and telephone call frequency. With one exception, no significant differences in agreement were found between subgroups defined by characteristics of the family, staff, facility, or resident. For visits, agreement between nurse's aides and significant others was lower than between other staff persons (e.g., LPNs and RNs) and significant others (p <.05). DISCUSSION: Due to the complexity of nursing home settings as well as of the social support system of residents, researchers need to carefully consider their approach to the measurement of the involvement of family and friends in the nursing home.

Adult↗

PubMedDate not supplied

Treatment fidelity in behavior change research: a case example.

BACKGROUND: Treatment fidelity refers to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Assuring optimal treatment fidelity also may decrease the costs of a study and help the research team explain findings. APPROACH: The Behavioral Change Consortium developed a comprehensive model of treatment fidelity that incorporates 5 areas: (a) study design, (b) training providers, (c) delivery of treatment, (d) receipt of treatment, and (e) enactment of treatment skills. The definitions of these areas and a case example (Testing the Effectiveness of the Exercise Plus Program) are provided. RESULTS: There was evidence of treatment fidelity related to delivery based on careful monitoring of the study implementation. A comprehensive plan for training of the interventionists was provided, although evidence of treatment fidelity to training was not quantified. There were evidence based on observations of treatment sessions of delivery and receipt of the intervention and evidence of enactments based on evaluation of exercise calendars. DISCUSSION: The development and implementation of a treatment fidelity plan requires a careful conceptualization of what is relevant to treatment fidelity in any given study. Monitoring of treatment fidelity ideally requires direct or indirect observations of sessions, which can be built into the study design so that costs are minimal in terms of time and resources. Monitoring treatment fidelity allows research teams to truly test interventions and to develop and implement interventions that ultimately improve the overall health and well-being of individuals.

Models, Nursing↗