The elderly population is growing in nursing homes (NHs), with an estimated 3 million seniors to be residing in NH facilities by year 2030. Many of these seniors are potentially at risk for falls or infections. NH residents with Alzheimer’s disease or other forms of dementia are also increasing, and they are vulnerable to the adverse effects of medications. Psychotropics are overused in NHs, with approximately half to two thirds of residents receiving one or more psychotropics. Many negative health outcomes, e.g. falls and infections, have been associated with their use. The usage of psychotropic medications among NH residents has been a concern and topic of scrutiny for nearly three decades. In 1986, the Institute of Medicine published a landmark report that identified the overuse of psychotropic medications in NHs. The following year, the federal government passed the Omnibus Budget Reconciliation Act that included reform legislation to address psychotropic drug overuse. Since then, additional policies and initiatives have endeavored to rectify the problem, and scientists have conducted research regarding psychotropics and negative health outcomes. However, newer research within the last decade and at a national level is lacking. Therefore, this dissertation explores the association of psychotropic medications with falls and infections among NH residents using a national dataset, and this document is organized into five chapters. The first chapter discusses the background, significance, and current challenges surrounding psychotropic medication use in NHs. The second chapter delineates the search of the literature and relevant findings. The third chapter describes the methodology upon which this analytics of this dissertation was conducted. The fourth chapter outlines the results from the analyses. Lastly, the fifth chapter provides a synthesis and discussion of the findings and recommendations for health policy, practice, and future research.

Graduation date: 2004

Thesis (Ph. D.)--Ohio State University, 1982. / Includes vita. Includes bibliographical references (leaves 124-126). Available online via OhioLINK's ETD Center.

Thesis (M.A.)--Trinity International University, 2000. / Abstract. Includes bibliographical references (leaves 123-128).

Det är vanligt att patienter som genomgår kirurgi får antingen lokal eller regional anestesi istället för att bli helt sövda. Denna anestesiform kräver mycket av patienten avseende samarbete. Den perioperativa omvårdnaden anpassas under varje operation efter den enskilde patientens behov. Denna studie har utförts som en litteraturstudie med syftet att beskriva patienters upplevelser under vaken kirurgi. Resultatet kategoriserades utefter tre teman; Upplevelser av smärta och obekvämlighet, Upplevelser av oro och ångest och Upplevelser av utsatthet eller delaktighet. Patienter som genomgår vaken kirurgi upplever smärta, känslor av obekvämlighet, oro, ångest och rädslor för att behöva höra, se och känna något av operationen. Känslan av att inte ha kontroll över sin egen kropp skapar känslor av utsatthet. Närvaro och kommunikation mellan anestesisjuksköterskan och patienten skapar upplevelser av delaktighet. Resultatet diskuteras utifrån Comfort Theory’s fyra kontexter; Fysisk, Psykospirituell, Sociokulturell och Miljömässig. Anestesisjuksköterskans uppgifter blir att hitta de omvårdnadsinterventioner som lindrar och underlättar patientens situation i den perioperativa miljön. Vidare finns det således behov av att undersöka vilka olika omvårdnadsinterventioner som påverkar patientens perioperativa nöjdhet och bekvämlighet. / A common procedure in surgery is local or regional anesthesia in contrast to general anesthesia. These forms of anesthesia demand a lot from the patient in terms of collaboration. During the surgical procedure, the perioperative nursing care needs to be adapted to each patient’s individual needs. Therefore, this study is a literature review with the aim to describe patients’ experiences during awake surgery. The results were categorised from three themes, experiences of pain and discomfort, experiences of anxiety and fear, experiences of vulnerability or participation. Patients undergoing awake surgery experience pain, discomfort, anxiety and fear of hearing, seeing and feeling anything during the surgical procedure. The feeling of not having control of your own body results in experiences of feeling vulnerable. To be close to the patient and have a good communication between the nurse anesthetist and the patient create experiences of participation. The role of the nurse anesthetist is to find nursing interventions which relieve and help the patient in these situations. The results are discussed according to the Comfort Theory’s context; physical, psychospiritual, sociocultural and environmental. The skills for the nurse anesthetist are to find nursing interventions which relief and ease the situation for the patient. Furthermore, there is a need to investigate effects of different nursing interventions on patients’ satisfaction and comfort in the perioperative setting.

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This thesis presents a study about the experience of becoming a nursing home resident as it affects the identity and self-esteem of very old persons. / In a qualitative study with six female residents of an English-speaking Centre d'Acceuil in Montreal, themes are explored in the light of theory about the effects of institutionalization. Consideration is given to the dynamics of relationships with family, friends, peers and staff. Loss of autonomy is singled out as the factor having the most impact on the individuals in the study. / As life draws to a close, each of the women interviewed struggles in her own way with conflict between the value of self-determination and the value of acceptance of dependence on others. The author suggests that the attempt to reconcile these two values may be a "life-task" for very old institutionalized persons. Questions are raised at the level of planning for institutional policy and a direction is indicated for the education of social workers planning to work with an elderly clientele.

The actual fluid intake of forty (40) residents of a nursing home was determined by an analysis of detailed three-day food and fluid intake records obtained by direct observation. Intake was compared to an established standard to determine the adequacy of fluid intake for this population. Subjects were grouped in two groups according to age (<85 years and >85 years) to determine whether age influenced fluid intake. In addition, data such as number and frequency of medications and dependency factors, such as ability to feed self, ability to communicate, ability to move and ability to make decisions, were collected and correlated.There was no significant difference between actual fluid intake and required fluid intake for the population a whole and for the two age groups. However, there were individuals who had very low fluid intakes suggesting other factors which influence fluid intake. There were positive correlations between fluid obtained from non meal feedings and frequency of medication delivery and number of medications delivered during a 24 hour period. In addition, there were positive correlations among the dependency factors. There was no correlation among any of the dependency factors and fluid intake for the group as a whole or for the two age groups.It was concluded from this study that this population of elderly nursing home residents obtained adequate fluid. Medication frequency and number appeared to influence the amount of fluid that a resident might obtain during non meal feedings. However, as a subject became more dependent, this factor did not affect the fluid intake of this population. / Department of Home Economics

Using an analysis of secondary data from the Health and Retirement Survey, this thesis provides the groundwork for understanding factors for nursing home placement using matching techniques to understand the differences between those persons with similar health characteristics who are not residents of nursing homes, and who are temporary residents or permanent residents of nursing homes. / Fisher Institute for Wellness and Gerontology