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The efficacy of two nonpharmacological techniques in reducing agitation, aggression and discomfort in nursing home residents with dementia is evaluated. Person-centered showering and the towel bath constitute safe, effective methods of reducing the problems.

Nighttime sleep improved and daytime agitation decreased, but no physical function measures changed significantly in a randomized trial of a combined physical activty and environmental intervention strategy carried out in 29 incontinent nursing home residents with the goal of finding out whether sleep would improve and whether agitation would be less intense. Sleep impairment is very widespread for such patients, and more prevalent and more severe than would be predicted based on age. Incontinent patients find nighttime care for this condition to be disruptive to sleep, so residents were not awakened on rounds unless four hourly rounds had passed since toileting or changing was offered.

Reports of research ethics in published nursing home research may be inconsistent unless specifically requested by the publisher's instructions to authors. An analysis of 45 research publications on nursing home residents showed a common lack of basic ethical standards, particularly missing committee or board reviews. In journals with explicit author instructions and the certainty of editing or peer review, however, much more care was taken with including detailed research ethics.

A study has been carried out to describe/compare experiences, priorities, needs, and concerns reported by white and black nursing home residents in the living-dying interval, the time between acquiring knowledge of impending death and death itself. Both groups concentrated on the quality of living, not on dying. Black subjects may have been undertreated for pain, but important care needs for pain and religion are not routinely addressed by the Resident Assessment Protocol and Minimum Data Set triggers.

The quality of care at a nursing home is often measured by the survival rates of the residents. A mathematical model was developed to predict the survival of residents and further improve the quality of care. The study showed that among 1145 residents, predictors of decreased survival were male gender, increased age, impairment of cardiac, neurological, cardiac, endocrine, and metabolic systems.

A program was designed to communicate resident/surrogate treatment preferences in the form of medical orders and to assess statewide nursing facility use of the physician orders for life-sustaining treatment (POLST) and to identify the patterns of orders documented on residents POLST forms. The POLST program is widely used in Oregon nursing facilities.

A study is undertaken to examine the prevalence of an excruciating daily pain and to identify the characteristics and outcomes of persons with this level of pain. Findings indicate that nursing home (NH) residents with daily pain that was excruciating were younger and seriously ill with functional decline and weight loss.

Client assessments have been reviewed retrospectively for clinical, functional, and cognitive information, and especially for the presence of dementia-related problem behaviors (D RPBs) and for the time during enrollment at which they occurred to find out about the incremental effect of DRPBs on the risk of and time to nursing home placement in frail, poor , demented older people . Findings show that DRPBs in demented older people shorten the time to nursing home placement and that study of effective interventions is called for. Cost of long-term care is a major issue for state Medicaid agencies. Home and community-based services programs, which primarily support performance of activities of daily living (ADLs), are discussed. African Americans in the stud y were close to half as likely to be institionalized as others.

In a n ursing home study it was found that having a full-time speech therapist on staff, more licensed nurses and fewer nursing assistants were independently associated with greater use of tube feeding in severely cognitively impaired nursing home residents. P otentially modifiable factors in nursing homes that may influence the practice of tube feeding in advanced cognitive impairment include advance directives, staffing ratio s, assessment by a speech therapist, specialized dementia units, and fiscal considerations. It seems limited resources and fiscal incentives motivate use of the intervention, which is inc reasingly shown to be not beneficial. Better terminal care may be given in a unit dedicated to this population.

It has been found that family members prefer that other nutrition interventions be tried before oral supplements are used or pharmacological approaches are put into place to improve oral food and fluid intake for nursing home residents. Preferences were investigated in a cross-sectional descriptive study. Family members feel there is a need for intervention if a resident consumes, on average, half of the food and fluid offered at mealtime.

Re sults of a survey involving 75 c ommunicative nursing home residents who reported some pain or discomfort every day or almost every day, 75 nursing home nurses, and 75 certified nursing assistants (CNAs) has shown that it is likely that if residents' fears about addiction, great dependency, and the persistent pain were to be quelled, and if C NAs felt adequa te time was available for pain assessment, pain management might be improved in nursing homes.

Nursing home facility risk factors for infection and hospitalization are discussed with focus on findings related to the importance of registered nurse turnover, administration, and social factors. A stratified random sample of 59 nursing homes across Maryland was carried out for this study. The positive relationship between hospitalization for infection and for-profit ownership and chain affiliation could indicate policies not to treat acute illnesses inhouse exist.

A study of the treatment of excess disability among cognitively impaired nursing home residents is discussed. An abilities-oriented care program was studied. The study can be questioned from a research point of view based on risk of obtaining findings that are difficult to interpret. Changes in the ward residents might be attributable to attention paid by researchers to caregivers or additional training of caregivers. In subsequent studies similar amounts to interaction should exist between investigators and staff on both control and experimental wards. Three dilemmas that investigators of such a situation face relate to implementation of intervention by research staff vs indigenous staff; strengthening intervention intensity; choice of the appropriate unit of randomization.