Biomedical subjects

Sheryl Zimmerman

Publications and source records attributed to Sheryl Zimmerman.

57 records · Page 4Linked to original sources

PubMedDate not supplied

Staff perceptions of end-of-life care in long-term care.

OBJECTIVE: Although residential care/assisted living facilities and nursing homes have increasingly become a significant site of death for older Americans, little is known about staff perceptions of end-of-life care, perceived need for improvement in care, and differences by type of setting. DESIGN, SETTING, AND PARTICIPANTS: Ninety-nine staff provided their perceptions of end-of-life care for 99 decedents from 74 residential care/assisted living facilities and nursing homes in four states as part of a larger cohort study. Staff were interviewed retrospectively regarding care provided during residents' last month of life. MEASUREMENTS: Staff reported on 11 areas of end-of-life care, describing the importance of each area and the level of improvement they felt was indicated. Weighted "need for change" scores were calculated as the product of perceived importance and need for improvement. RESULTS: Both residential care/assisted living and nursing home staff reported a need for more staff education and nursing assistant time, as well as more use of volunteers. The two lowest ranked items for both facility types were involvement of hospice and encouragement for staff to attend funeral services. Nursing home staff perceived a greater need for improvement than residential care/assisted living staff in all 11 areas. CONCLUSION: Results underscore the staffing demands of end-of-life care across facility types, and staff desires to be able to provide quality care throughout the dying process.

Assisted Living Facilities↗

PubMedDate not supplied

Depression in assisted living: results from a four-state study.

OBJECTIVE: Assisted living is a rapidly-growing sector of long-term care, but little research has been done on depression in this setting. Using data from a large sample of assisted-living residents, the authors sought to 1) describe the prevalence of depression and depressive symptoms; 2) identify resident characteristics associated with depression; and 3) examine the relationship between depression and the rate of nursing home placement and mortality. METHODS: A group of 2,078 residents age 65 and older were enrolled from 193 assisted-living facilities across four states (Florida, Maryland, New Jersey, and North Carolina). Residents were classified as depressed if their score on the Cornell Scale for Depression in Dementia (CSDD) exceeded 7. RESULTS: Using this criterion, 13% were depressed, and only 18% of those were on antidepressants. Over one-third of residents had symptoms of depression, such as anxious expression, rumination, or worrying, and 25% displayed sad voice, sad expression, or tearfulness. Depression was significantly associated with medical comorbidity, social withdrawal, psychosis, agitation, and length of residence in the facility. Depressed residents were discharged to nursing homes at 1.5 times the rate of nondepressed residents. Rates of mortality were also higher for depressed residents, but only those with severe depression (CSDD >12) had a statistically significant increased rate of death. CONCLUSION: The mission of assisted living is to help older adults retain autonomy, privacy, and quality of life in a personalized environment. Greater effort should be made to detect and treat depression in this setting, both to reduce suffering and prolong the resident's ability to remain in their preferred environment.

Aged↗

PubMedDate not supplied

Some predictors of psychiatric consultation in nursing home residents.

OBJECTIVE: Despite the high rate of psychiatric disorders in nursing homes, research indicates that psychiatric consultation is requested infrequently. The authors sought to determine the rate of psychiatric consultation in a nursing home population and to assess what factors were related to a consultation request. METHODS: Subjects were recruited from a stratified random sample of 59 nursing homes across Maryland. All new admissions age 65 years and older from September 1992 through March 1995 were eligible for the study. A total of 2,285 subjects were included in the study. Variables examined were factor scores from the Cornell Scale for Depression in Dementia and the Psychogeriatric Dependency Rating Scale (Behavioral Subscale), nursing home characteristics, and whether the resident had a psychiatric consultation within 90 days of admission. RESULTS: Twenty percent of the residents (N=404) had a psychiatric consultation. There was no significant association with demographic variables. Behaviors that triggered a psychiatric consultation included agitation, physical/verbal abuse, wandering, and manic/destructive acts. A psychiatric consultation was also requested when residents displayed anxiety. Surprisingly, depression in retarded and psychotic residents did not trigger a psychiatric consult. CONCLUSION: As expected, behavioral problems and agitation are common reasons for a psychiatric consultation. However, the resident who is depressed, particularly the quiet or retarded depressed resident, may be overlooked. In this context, it is important for the nursing staff to recognize that lethargy and social withdrawal may be signs of depression, and a referral to a psychiatrist may be in order.

Aged↗