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Objectives. We examined racial disparities in receipt and documentation of influenza and pneumococcus vaccinations among nursing-home residents. Methods. We performed secondary analyses of data from a nationally representative survey of White (n=11448) and Black (n=1174) nursing-home residents in 2004. Bivariate and multivariate analyses determined racial disparities in receipt of influenza vaccination in 2003 and 2004, receipt of pneumococcus vaccination ever, and having a documented history for each vaccination. Results. The overall vaccination rate was 76.2% for influenza and 48.5% for pneumococcus infection. Compared with Whites, Blacks showed a 13% lower vaccination rate and a 5% higher undocumentation rate for influenza, and a 15% lower vaccination rate and a 7% higher undocumentation rate for pneumococcus. For influenza, the odds ratio (OR) for Blacks being unvaccinated was 1.84 (P [less than or equal to]. 001), and the OR for Blacks having undocumented vaccination was 1.85 (P = .001). For pneumococcus infection, the OR for Blacks being unvaccinated was 1.70 (P [less than or equal to] .001), and the OR for Blacks having undocumented vaccination was 1.95 (P [less than or equal to] .001). Stratified analyses confirmed persistent racial disparities among subpopulations. Conclusions. Racial disparities exist in vaccination coverage among US nursing-home residents. Targeted interventions to improve vaccination coverage for minority nursing-home residents are warranted. (Am J Public Health. 2010;100:S256-S262. doi: 10.2105/AJPH.2009.173468)

The study aims to evaluate whether there is any change in the functional status of elderly patients suffering from end-stage renal disease (ESRD) before and after undergoing dialysis. The results indicate that dialysis was associated with a substantial decline in functional status.

Objective: To determine whether there is a difference in the incidence of pressure ulcers (PU) between African American (AA) and White nursing home (NH) residents in the Southeastern United States. Methods: Data from the Centers for Medicare and Medicaid Services Minimum Data Set were examined for 113,869 residents who were free of PU at NH admission during 1999-2002. Facility and neighborhood characteristics were abstracted from the Online Survey Certification and Reporting database and the 2000 U.S. Census respectively. Results: The incidence of PU in NH among AAs and Whites was 4. 7% (95% CL. 4.4-5.0) and 3.4 % (95% CI: 3.3-3.5) respectively. The association between race and PU development varied between males and females. Differences were noted between AA and White males who were dependent in mobility and between AA and White females who were bedfast and resided in facilities with less than 200 beds. Unlike for females, facility and neighborhood characteristics were not significant confounders in risk for PU incidence among males. Conclusion: PU occurred more frequently in AAs than in Whites. Results suggest that racial differences are marked among males and females with specific characteristics. Interventions for reducing this disparity should target these at-risk groups. KEYWORDS pressure ulcer, decubitus ulcer, nursing homes, African Americans, racial disparity DOI: 10.1080/089528/i0903284594

Objective: (1) To determine whether nutritional supplementation (energy and micronutrients) in institutionalised elderly has a positive effect on dietary intake and nutritional status. (2) To investigate whether individuals tend to compensate for the energy content of the intervention product by decreasing their habitual food consumption. Methods: A 24-week, randomised, double-blind, placebo-controlled, intervention trial in homes for the elderly (n=3), in nursing homes (n=3) and 'mixed' homes (n=3) in The Netherlands. Institutionalised elderly people (n=176) older than 60 years of age, with a body mass index S 30 kg /M2 and a Mini-Mental State Examination score of 10 points or higher, randomly received a nutrient-enriched drink or a placebo drink twice a day during 24 weeks in addition to their usual diet. Allocation to treatment took into account of sex, the Mini-Mental State Examination score and the plasma homocysteine level. Body weight and several nutrition-related analyses in fasting blood samples were measured in all participants. Data on dietary intake were collected in a subsample (n=66). Results: A significantly favourable effect (P Conclusions: This group of institutionalised elderly people does not compensate for the energy content of a concentrated nutritional supplement. Therefore, this supplement is effective for counteracting the development of malnutrition in this population. doi:10.1038/ejcn.2009.28; published online 20 May 2009 Keywords: aged; diet; nutritional status; micronutrients; dietary supplements; randomised controlled trial, Introduction Malnutrition is a common and serious problem in elderly people. Thirty-seven percent of the European institutionalised elderly are malnourished (Guigoz et al., 2002). Malnutrition or inadequate nutritional intake may [...]

ABSTRACT Malathion is an under-recognized and under-utilized therapy for head lice and scabies largely due to misperceptions about its safety profile. Specifically, its pure form as it exists in pharmaceutical [...]

Background. The purpose of this prospective cohort study was to describe the clinimetric evaluation of tour fall risk assessment tools (FRATs) recommended in best practice guidelines for use in residential aged care (RAC). Methods. Eighty-seven residents, mean age 81.59 years (SD [+ or -] 10.69), participated. The Falls Assessment Risk and Management Tool (FARAM), Peninsula Health Fall Risk Assessment Tool (PHFRAT), Queensland Fall Risk Assessment Tool (QFRAT), and Melbourne Fall Risk Assessment Tool (MFRAT) were completed at baseline, and 2 and 4 months, and falls occurring in the 6 months after the baseline assessment were recorded. Interrater agreement (kappa), predictive accuracy (survival analysis and Youden Index), and fit to the Rasch model were examined. Twelve-month fall history formed the predictive accuracy reference. Results. Interrater risk classification agreement was high for the PHFRAT ([kappa] = .84) and FARAM ([kappa] = .81), and low for the QFRAT ([kappa] = .51) and MFRAT ([kappa] = .21). Survival analysis identified that 43%-66% of risk factors on each tool had no (p >. 10) association with falls. No tool had higher predictive accuracy (Youden index) than the question, 'has the resident fallen in past 12 months?' (p > .05). All tools did not exhibit fit to the Rasch model, invalidating summing of risk factor scores to provide an overall risk score. Conclusion. The studied tools have poor clinimetric properties, casting doubt about their usefulness for identifying fall risk factors for those most at risk for falling and measuring fall risk in RAC. Key Words: Fall risk--Prognostic validity--Sensitivity--Specificity Elderly persons--Nursing home.

Purpose: In an attempt to more thoroughly describe aggressive behavior in nursing home residents with dementia, we examined background and proximal factors as guided by the Need-Driven Dementia-Compromised Behavior model. Design and Methods: We used a multivariate cross-sectional survey with repeated measures; participants resided in nine randomly selected nursing homes within four midwestern counties. The Minimum Data Set (with verification by caregivers) identified participants. We used a disproportionate probability sample of 107 participants (51% with a history of aggressive behavior) to ensure variability. Videotaped care events included four of direct care (shower baths, meals, dressing, and undressing) and two of non-direct care (two randomly selected 20-minute time periods in the afternoon and evening). The majority of participants (75%) received three shower baths, for a total of 282 videotaped baths. Results: Because the shower bath was the only care event significantly related to aggressive behavior (F = 6.9, p < .001), only those data are presented. Multilevel statistical modeling identified background factors (gender, mental status score, and lifelong history of less agreeableness) and a proximal factor (amount of nighttime sleep) as significant predictors (p < .05) of aggressive behavior during the shower bath. We found significant correlations between aggressive behavior and negative subject affect (r = .27) during the bath, and aggressive behavior and lifetime agreeableness level (r = - .192). We also found significant correlations between mental status and the amount of education (r = .212), and between negative caregiver affect and negative participant affect (r = .321). Implications: We identified three background and one proximal factor as significant risk factors for aggressive behavior in dementia. Data identify not only those persons most at risk for aggressive behavior during care, but also the care event most associated with aggressive behavior. Together these data inform both caregiving for persons with dementia as well as the design of intervention studies for aggressive behavior in dementia. Key Words: Aggression in dementia, Need-Driven Dementia-Compromised Behavior (NDB) model of dementia care, Nursing home care

Purpose: Previous research on nursing home resident quality of life (QOL) has mainly been cross-sectional. This study examined the association between changes in QOL and changes in resident clinical factors. Design and Methods: A longitudinal study of resident QOL was conducted in two nursing homes. Self-report interviews using a multidimensional measure of QOL were linked with clinical data from the Minimum Data Set. Five waves of interviews were conducted at 6-month intervals. Results: Residents with one or more Stage II or higher pressure ulcers for two consecutive 6-month periods reported declines in autonomy, security, and spiritual well-being QOL domains; those with declines in physical disability reported declines in the dignity domain. Increases in depressive symptoms were associated with decreases in comfort, meaningful activities, and food enjoyment domains, and increases in pain were associated with decreases in functional competence and dignity domains. Implications: There is evidence of an association between physical health and self-reported QOL. However, not every dimension of QOL exhibited the same pattern. Further research is needed on the link between specific clinical factors and aspects of QOL. Key Words: Health status, Nursing homes, Quality of life

Background. We examined whether questions addressing the effect of pain on day-to-day function add unique information to the standardized verbal descriptor scale for pain severity in nursing homes (NHs). Methods. Interviews were conducted with 123 residents in two Veterans Affairs NHs. All participants were asked about pain presence. Residents reporting pain were asked about severity of worst pain (mild, moderate, severe, very severe/horrible), degree of bother (not at all, a little, a moderate amount, a great deal), and the effect of pain on daily function (whether pain made it hard to 'sleep,' 'get out of bed,' or 'spend time with other people' and whether activities were limited because of pain). Results. Fifty-one percent of participants reported pain. The correlation between pain severity report and overall count of activity interference was significant (Spearman's rho = .449, p = .001). In general, for each activity, the proportion reporting interference increased as severity increased. Fischer's exact test showed significant association only for 'hard to get out of bed' (p = .0175) and 'hard to sleep' (p = .0211). As expected, residents reporting 'mild' pain reported less activity interference than those reporting 'very severe' pain. The association between pain and activity interference was more variable and less predictable among residents with 'moderate' or 'severe' pain. Conclusion. Questions addressing the effect of pain on day-to-day functions are an important addition to standardized pain assessments, particularly for persons who report intermediate levels of pain severity because the perceived effect on daily function may vary most among individuals at these levels. Key Words: Pain--Nursing home--Activity limitation.

Physical activity has been positively associated with cognition and the rest-activity rhythm. In the present study, nursing staff classified ambulatory nursing home residents with moderate dementia either as active (n = 42) or as sedentary (n = 34). We assessed the rest-activity rhythm by means of actigraphy, and we administered neuropsychological tests to assess cognitive functioning. Compared with the group that was considered sedentary, the group that was considered active had a significantly better rest-activity rhythm, indicating agreement between nursing staff classifications and data gathered by the actigraph. Cognitive function was related neither to active-sedentary classification nor to actigraph measures. Similar ambulatory nursing home residents with dementia may show considerable differences in their level of daily physical activity and in their rest-activity rhythm, but the precise relationship among all variables requires further investigation. Key Words: Cognition--Rest-activity rhythm--Sedentary.

Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental health. Design and Methods: We used all nursing homes (N = 740) in Pennsylvania in 2001, with 12,820 residents. We used the Minimum Data Set data; Online Survey, Certification and Reporting data; and the Area Resource File as data sources. We restricted our sample to newly admitted nursing home residents who were not restrained in the first two quarters of their residency. We examined which facility and individual characteristics during those first two quarters were associated with restraint initiation during the third quarter. We then examined the association of third-quarter restraint initiation with fourth-quarter health outcomes, using regressions that controlled for first- and second-quarter health status as well as other resident, facility, and market characteristics. The physical health outcomes examined consisted of falls, walking dependence, activities of daily living (ADLs), pressure ulcers, and contractures. Mental health outcomes examined consisted of cognitive performance, depression, and behavior problems. Results: The initiation of restraint use was associated with a previous fall (p < .01 ), psychoactive medication use (p < .05), low cognition (p < .01), ADL scores (p < .01 ), and the absence of pressure ulcers (p < .10), as well as a variety of facility characteristics. Subsequent to restraint initiation, we found an association with lower cognitive performance (p < .01), lower ADL performance (p < .01), and higher walking dependence (p < .01). Implications: We found that an association between restraint initiation and subsequent adverse health consequences exists and is substantial. Moreover, these results would appear to have practical as well as statistical significance. Key Words: Physical restraint, Outcomes, Health, Nursing homes

Nursing home residents are at high risk for invasive group A streptococcal (GAS) disease, and clusters of cases in nursing homes are common. To characterize the epidemiologic features of invasive [...]