Class of 2006 Abstract / Objectives: To determine the economic impact of controlled substance destruction in multiple long term care facilities in Southern Arizona and to identify related demographic characteristics of the patients and facilities. Methods: Subjects had controlled substance prescriptions destroyed at nursing homes serviced by a pharmacy nursing home provider in Tucson, Arizona. Controlled substances destruction records and existing prescription records were reviewed and data was collected on the name, strength, number of units destroyed, date of destruction and schedule of each controlled medication that was destroyed for a particular patient over the course of a year. Demographic data was collected on patient gender, age, type of insurance coverage and the size of the nursing home facilities. Results: A total of 1095 controlled substance prescriptions were destroyed during the time period of the study and the total cost of destroyed medication was $26,886.37. The average cost of destroyed medication per prescription was $24.55 ± 60.38 (mean ± SD). Schedule II controlled substances accounted for the highest total cost per prescription destroyed and destruction of unused controlled substances cost indigent insurance programs more than any of the other payers studied. There was no difference in mean cost per prescription destroyed by facility, therapeutic class or between women and men. Conclusions: The value of controlled substance destruction in long term care facilities is sizeable. To reduce waste, prescribers and pharmacy providers should initially dispense moderate quantities of controlled substances until it is apparent that the medication is tolerable and efficacious for the patient.

The purpose of the study was to design a reliable and valid assessment instrument that would provide a multidimensional profile of the elderly resident of a long term care facility. Use of this instrument would be a method of collecting and corrmunicating information concerning the full range of problems experienced by this group, in a form that is suitable for use at different levels of decisionmaking. The instrument consists of 31 unweighted items measuring functioning in 5 essential areas - cognitive, physical, emotional, social, and instrumental. Ratings were based on the observations of long term care staff who were in close contact with the individual over extended periods. Reliability and validity were tested using a non random sample of 76 elderly residents of one extended care unit. Both test-retest and interjudge reliability proved to be high and item analysis indicated that, with the exception of 2 items, the instrument provides levels of functioning appropriate to the sample population. The instrument also showed a high degree of internal consistency with the 3 major components identified as - cognitive behaviour, independence in daily living, and physical functioning. The validity of the instrument and its subsections was demonstrated through significant relationships with external criteria, namely - the number of problems listed on the multidisciplinary problem-oriented record, a health index measure, and a mental status rating. Further evidence of the instrument's validity was its ability to predict, retrospectively, 72 percent of the sample deaths in the first year following admission. Although only a preliminary form of analysis, this showed that a high level of mental functioning, combined with a low level of independence in daily living, was predictive of death within 3 to 9 months in the sample population. The implications of these results are discussed along with suggestions for further research in the area. Finally, potential uses for the assessment instrument in the field of long term care are provided. / Applied Science, Faculty of / Nursing, School of / Graduate

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Pain prevalence in nursing home (NH) residents is high. Studies report up to 85.0% of NH residents experience pain and up to 58.0% experience persistent pain. Pain in NH residents can lead to decreased happiness, quality of life, and life satisfaction. Traditionally, pain has been studied in relation to specific comorbid conditions or pain subtypes (nociceptive, neuropathic) with little consideration for the dynamic (temporal) nature of pain. Current pain subtypes are clinically linked to recommended pain treatments and provide insight into underlying mechanisms. However, current pain subtypes are limited by their focus on pain origin, do not include severity or duration of the pain experience, and do not illustrate how the course or trajectory of pain changes over time. Understanding the trajectory of pain experience can provide opportunities to alter the course of pain experience, improve residents’ quality of life and prevent adverse outcomes. This dissertation provides the first evidence of four distinct pain trajectories among NH residents including persistent pain which was associated with several resident characteristics and clinically relevant diagnosis. Using residents’ characteristics associated with persistent pain, such as a history of fracture or contracture, may improve care planning based on early identification or risk stratification and can improve mitigation of persistent pain. To identify and characterize pain trajectories in NH residents, the following activities were completed (1) systematic review of the literature related to prevalence of pain and associated factors in NH residents, (2) cross-sectional analysis of secondary data to examine prevalence of pain, persistent pain, and factors associated with pain in NH residents, and (3) a longitudinal retrospective analysis of secondary data using group-based trajectory modeling to identify, quantify, and characterize NH pain trajectories. The findings from this study highlight the prevalence and complexity of pain in NH residents.

In Ontario, the population of older adults is increasing. While the provincial government is taking action to address increasing demand on health systems, older adults are still suffering the consequences of a health system that is not able to meet their complex care needs. Older adults face barriers to continuity of care including difficulties with memory, reliance on informal caregivers, frailty, and difficulties scheduling appointments. These barriers also exist within the long-term care setting. Long-term care facilities are making efforts to provide more effective care, including designing care approaches aimed to meet the complex care needs of older adults. Aspects of a goal-oriented approach suggest that it has the potential to reduce fragmentation and positively impacting continuity of care. However, the impact of goal-oriented care on continuity of care in a long-term care setting has yet to be explored. This thesis uses an exploratory case study methodology to describe how a goal-oriented care approach influenced continuity of care in a long-term care setting, as perceived by residents, staff, and administrators. The case study setting is the Perley & Rideau Veterans Health Centre in Ottawa, Ontario, where the SeeMe program, a frailty-informed approach with a goal-oriented component, was recently introduced. Factors associated with the SeeMe program and other organizational factors perceived to facilitate and inhibit informational, relational and management continuity were identified. Aspects of the SeeMe program that facilitated informational continuity were: goals-of-care meetings with residents, their care team and family; care conferences that helped residents understand their care options; and, procedures that ensured consistency in where resident’s goal information is stored. Aspects that facilitated relational continuity were: understanding residents’ values and preferences; staff increasing awareness of the program for families; and, integration of the family perspective into a resident’s care. Program aspects that facilitated management continuity were: discussions that led to informed decision-making; use of assessments as a reference tool in the case of an acute health event; discussions that empowered residents to talk to external care providers; and, creation of a structure that facilitated consistencies in care. These factors can be targeted when designing care approaches aimed to improve continuity in long-term care settings.

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Thesis advisor: Karen S. Lyons / OBJECTIVES: Individuals with severe persistent mental illness (SPMI), also referred to as serious mental illness (SMI), experience significant inequities in health care access and outcomes. These inequities may span the lifetime of an individual living with SPMI, and include poorer cancer outcomes, shorter lifespans, barriers to having their needs met in long-term care, and a decreased likelihood of receiving hospice care when indicated. The purpose of this dissertation was to explore the causes of the disproportionately poor health outcomes for individuals living with SPMI and describe current facilitators and barriers to providing care to this vulnerable population. METHODS: A qualitative descriptive study was carried out to explore health care professionals’ perception of the needs of long-term care residents with SPMI and chronic medical conditions. and barriers and facilitators to meeting the needs of this population. A narrative review was performed to identify what is currently known about cancer symptom clusters in individuals with schizophrenia. Lastly, an integrated review was conducted to identity factors associated with hospice use by individuals with SPMI and potential barriers to use of hospice services. RESULTS: Ten health care professionals were interviewed for the qualitative study. The themes that emerged were: coming to know the individual and their unique needs takes time; being flexible and adapting approaches facilitates trust; respecting the inherent worth of each person contributes to caring. Participants described the importance of a person-centered approach when caring for long-term care residents with SPMI and chronic medical conditions. The narrative review of current literature pertaining to cancer symptom clusters in individuals with schizophrenia revealed that this phenomenon has been sparsely represented in research. No data directly pertaining to cancer symptom clusters in this population were identified. Data describing the related phenomena of health conditions that may influence cancer risk and outcomes, physical experiences of cancer, and emotional and behavioral symptoms which may impact ability to tolerate cancer treatments were identified. The integrated review of literature describing factors associated with hospice use among individuals with SPMI found that hospice and palliative care services may not be utilized by individuals with SPMI due to system-level barriers such as inadequate patient-provider communication, fragmented care, and absence of discussions around end-of-life care. CONCLUSIONS: Systemic problems such as miscommunication, fragmentation of care, and stigma contribute to the health inequities experienced by individuals living with SPMI. Nurses and other health care providers can work to ameliorate these systemic problems by promoting and participating in collaborative care models and utilizing assessment techniques appropriate to individuals who may have difficulty communicating about their health-related symptoms. Individuals with SPMI should be offered opportunities to participate in research when appropriate so that they may benefit from newer treatments for disease, and health care providers may improve their understanding of how to address the medical needs of this population. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

<p>The project explores decision making in the context of end-of-life (EOL) care choices among adults with few social and economic resources. Although most American adults believe that planning for EOL is important, only about 30% report making formal EOL plans such as Advance Directives, wills, trusts, or any other formal documentation. Using qualitative methodology, 25, participants who were all living at the same long term care facility, were interviewed during two different waves of data collection. The transcribed interviews were analyzed using thematic analysis and guided by Normative Rhetorical Theory framework. Remarkable conclusions were that without social and economic resources, participants reported they did not make choices about EOL and care, but rather their decisions were made by default.</p>

The population of elderly people in the United States is predicted to increase in large numbers within the next few decades. Many of them will be admitted to long-term-care centers in the waning years of their lives. Health care professionals will need to be prepared for this influx of the elderly into these institutions and for their demands of improved quality of life in these centers. Unplanned weight loss has become one of the major predictors of mortality in long-term-care residents. The purpose of the study was to compare the use of liberalized diets with the traditional therapeutic diets long advocated in long-term-care facilities in the United States. The objectives were to conduct a randomized clinical trial with a treatment group (subjects who consumed liberalized diets) and a control group (subjects who continued with their usual therapeutic diets), and to compare outcomes between the two groups. The randomized clinical trial was conducted for 18 weeks from April to August 2009 at a long-term-care facility in rural North Mississippi. Twenty-two persons ranging in age from 54 to 100 years were approved by their physicians for participation in the trial. All of these persons participated and completed the trial. Eleven of the participants received their prescribed therapeutic diet and 11 participants received a liberalized diet for the length of the trial study. At the end of the study, there were no significant differences (p>0.05) in mean body weights and laboratory values between the two groups. However, there was a trend of weight loss in the therapeutic diet group (mean weight loss of 2% (1.4 kg) during the 18-week trial), and although it was not significant (p>0.05), this supports the growing belief of those who advocate liberalized geriatric diets to improve quality of life and prevent unintentional weight loss. Participants in the liberalized diet group did not experience weight loss and gained 0.5 kg by the end of the study.

No description available.