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Nursing home resident use of care directives

JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 1999年第5期54卷 M225-M229页

作者： Suri, DN Egleston, BL Brody, JA Rudberg, MA Univ Illinois Sch Publ Hlth Chicago IL USA

Background. The Patient Self-Determination Act of 1991 requires that nursing homes reimbursed by Medicare or Medicaid inform all residents upon admission of their rights to enact care directives in the event of terminal illness. This study investigated the relationship between care directive use and resident functional status. Methods. We analyzed a version of the Minimum Data Set (MDS+) from a single state. We selected residents who were admitted to a nursing home in the first half of 1993 and followed them in the nursing home through the end of 1994. We created logistic models to examine independent correlates associated with having an advance directive or a do-not-resuscitate (DNR) order on admission. We then created similar logistic models to examine independent correlates associated with writing an advance directive or DNR order subsequent to admission. Results. Of the 2,780 residents, 11% (292) had advance directives and 17% (466) had DNR orders upon admission. Of those without care directives upon admission, 6% (143) subsequently had an advance directive and 15% (339) subsequently had a DNR order. Cross-sectionally, older individuals and whites were more likely to have a care directive. Having poor cognitive and physical function was associated with having a DNR order upon admission. Longitudinally, longer stayers and whites were more likely to have an advance directive. residents who lost physical function were more likely to have an advance directive and those who lost cognitive function were more likely to have a DNR order. Conclusions. Care directive use is influenced by a number of sociodemographic and functional characteristics.

关键词：日常生活活动预先指示非洲裔美国人年龄因素认知/生理学认知障碍/病理生理学队列研究横断面研究欧洲大陆世系人群住院时间 Logistic模型纵向研究多元分析医护疗养所/组织和管理病人入院病人辩护/立法和法学复苏医嘱临终病人老年人老年人 80以上人类

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Pressure ulcer development in the VA: Characteristics of nursing homes providing best care

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AMERICAN JOURNAL OF MEDICAL QUALITY 1999年第1期14卷 39-44页

作者： Berlowitz, DR Anderson, JJ Brandeis, GH Lehner, LA Brand, HK Ash, AS Moskowitz, MA Bedford VA Hosp HSR&D Field Program Ctr Hlth Qual Outcomes & Econ Res Bedford MA 01730 USA Bedford VA Hosp Grp Management Sci Bedford MA 01730 USA Boston Med Ctr Hlth Care Res Unit Boston MA USA Boston Univ Sch Med Boston MA 02118 USA Boston Univ Sch Publ Hlth Boston MA USA

This study identifies structural characteristics of VA nursing homes that are associated with the best patient outcomes. We evaluated risk adjusted rates of pressure ulcer development in VA nursing homes and related these rates to facility size, staffing patterns, teaching nursing home status, and rural versus urban locale. Higher rates of pressure ulcer development were seen among urban teaching nursing homes and among nursing homes associated with both larger and smaller VA hospitals. Staffing patterns had a complex association with pressure ulcer development, and smaller nursing home staffs were not clearly associated with higher rates. For multivariate modeling, only hospital size and staffing remained significant independent predictors of pressure ulcer develop ment. These results emphasize that while structural characteristics of VA nursing homes can provide insights about care, improving the quality of care in this setting will require a much greater understanding how nursing homes are organized to meet patient needs.

关键词：规范老人疗养院/组织和管理老人疗养院/标准线性模型多元分析医护疗养所/组织和管理医护疗养所/标准结果评价(卫生保健) 压力性溃疡/流行病学美国/流行病学美国退伍军人事务部老年人人类

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Dissonance in the dining room: A study of social interaction in a special care unit

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QUALITATIVE HEALTH RESEARCH 1999年第1期9卷 133-155页

作者： Moore, KD Univ Wisconsin Sch Architectural & Urban Planning Inst Aging & Environm Milwaukee WI 53201 USA

This study is a multi-method, intrinsic case study of social interaction in a special care unit (SCU) for cognitively impaired older persons. It is found that residents are capable of developing a range of social bonds even though the SCU in question is found to have several organizational and physical factors that unwittingly thwart its therapeutic potential. These limitations are illuminated by consideration of the congruence between the conceptualization of the dining areas held by staff and that held by residents as revealed throught the process of negotiation occurring in social interaction. The study adopts an enviornment-behavior perspective following the theoretical development of Lawton (1986) and merges it with the qualitative approach to place pursued by Goffman (1961) and Gubrium (1978). It is suggested that a focus on place as a unit of analysis offers potential for bridging Qualify of Life with the cognitively impaired.

关键词：日常生活活动痴呆摄食行为医护疗养所/组织和管理社会环境人类

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Community formation and community roles among persons with Alzheimer's disease: A comparative study of experiences in a residential Alzheimer's facility and a traditional nursing home

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QUALITATIVE HEALTH RESEARCH 1999年第1期9卷 65-85页

作者： McAllister, CL Silverman, MA Univ Pittsburgh Sch Publ Hlth Pittsburgh PA 15260 USA Univ Pittsburgh Med Ctr Hlth Syst Alzheimers Dis Res Ctr Training & Informat Core Pittsburgh PA 15260 USA

Based on an ethnographic study in a residential Alzheimer's facility and a traditional nursing home, this article discusses the process of community formation and the maintenance of community roles among individuals suffering from dementia ill institutional settings. These include: therapeutic programming that promotes resident independence and choice;flexible and person-centered staff roles;and a physical environment that facilitates social interaction, autonomy, and participation in the activities of daily living. In contrast, institutional programs that are regimented, that follow a medical rather than a social model of care, and that take place in physical environments that have limited options may discourage resident interaction and social bonding, thus inhibiting community formation. Although Alzheimer's disease and other forms of dementia may create difficulties for the realization of community and community roles among institutionalized people, more significant are the environmental conditions in which such individuals live and the programs designed for their care.

关键词：阿尔茨海默病/心理学设施的设计和建造卫生服务研究人际关系医护疗养所/组织和管理生活质量寄托医疗设施/组织和管理社会行为社会支持老年人老年人 80以上女(雌)性人类男(雄)性

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Making the best of it: Adapting to the ambivalence of a nursing home environment

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QUALITATIVE HEALTH RESEARCH 1999年第1期9卷 119-132页

作者： Kahn, DL Univ Texas Austin TX 78712 USA

This article is based on a 9-month ethnographic study of a nursing home for older Jewish people. In this article, the process that 21 key informants went through in adapting to the dual nature of the nursing home as institution and as home is examined. A widely used phrase, "making the best of it," was used by informants and other residents of the nursing home to describe this process. Interpretive analysis of this emic phrase revealed four dimensions: (a) recognizing the ambivalence of their living environment and situation, (b) downplaying negative aspects of it, (c) having no other options, and (d) using their will to transcend and create a home.

关键词：适应心理学卫生服务研究医护疗养所/组织和管理社会环境老年人老年人 80以上女(雌)性人类男(雄)性

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THE DETERMINANTS OF THE HOSPITALIZATION OF NURSING-HOME RESIDENTS

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JOURNAL OF HEALTH ECONOMICS 1993年第3期12卷 349-359页

作者： FREIMAN, MP MURTAUGH, CM AGCY HLTH CARE POLICY & RES CTR GEN HLTH SERV INTRAMURAL RES2101 E JEFFERSON STSUITE 500ROCKVILLEMD 20852 USA

A study analyzes the determinants of the probability that an elderly nursing home resident will be hospitalized over the course of a year. A multinomial logistic model is estimated with 4 possible outcomes for the year: 1. hospitalization, 2. dying in the nursing home prior to hospitalization, 3. leaving the nursing home alive prior to any hospitalization, and 4. remaining in the home for a full year without any hospitalization. The Institutional Population Component (IPC) of the 1987 National Medical Expenditure Survey sample of residents as of January 1, 1987, is analyzed. The overwhelming majority of residents (84%) either were hospitalized during their stay or spent the full year undisturbed in the nursing home. Two important results are found for the financial variables. The rate of payment to the home has a significant and negative effect on the probability of a resident being hospitalized, relative to remaining in the nursing home for the full year. For-profit nursing homes are more likely to hospitalize residents.

关键词：数据收集决策组织预测老人疗养院/经济学老人疗养院/组织和管理住院/经济学住院/统计学和数值数据 Logistic模型医护疗养所/经济学医护疗养所/组织和管理病人转诊/经济学病人转诊/统计学和数值数据偿还途径/经济学美国老年人人类

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EMPOWERING THE ELDERLY NURSING-HOME RESIDENT - THE RESIDENT RIGHTS CAMPAIGN

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SOCIAL WORK 1989年第2期34卷 155-157页

作者： MCDERMOTT, CJ CAMBRIDGE NURSING HOME SOCIAL SERV1 RUSSELL STCAMBRIDGEMA 02140 USA

Since feeling in control of one's life is essential to mental health, nursing homes often contain mentally unhealthy residents. Suggestions for empowering nursing home residents are presented.

关键词：日常生活活动适应心理学决策马萨诸塞医护疗养所/组织和管理病人辩护社会控制正式社会工作人类

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COMPLEMENTARY ROLES FOR FORMAL AND INFORMAL SUPPORT GROUPS - A STUDY OF NURSING-HOMES AND MORTALITY-RATES

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JOURNAL OF APPLIED BEHAVIORAL SCIENCE 1985年第4期21卷 407-425页

作者： LITWAK, E AUSTRALIAN NATL UNIV CANBERRA ACT 2600 AUSTRALIA

Organizational theorists have argued that formal and informal support systems cannot exist in strong form in the same society. In this article, the author argues that such theories fail to consider the complementary of these two systems and the necessity of both for the completion of most tasks. A study of tasks performed for nursing home residents found that the formal organization assumed those tasks that could be standardized and deemed legitimate for Medicaid funding, while the others were either maintained by informal support groups or lost altogether. A study of the influence of informal support groups on mortality rates found that such groups played an important role in reducing death in older persons resulting from causes associated with nontechnical matters. In conclusion, the author finds that formal groups can best manage tasks that require technical knowledge or that can be reduced to simpler, routine components, whereas informal groups can better manage tasks requiring everyday knowledge and characterized by many contingencies or unpredictability. The author stresses that both formal and informal support must be provided when serviing older people.

关键词：佛罗里达 Medicaid 死亡率纽约医护疗养所/组织和管理组织机构社会环境社会支持老年人人类

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The Four Wall Syndrome: An Analysis of the Elderly in Relation to Seniors' Day Care

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Canadian Journal of Occupational Therapy 1978年第4期45卷 163-170页

作者： Kennedy, Myra S. Former Program Co-ordinator of Seniors' Day Care Geriatric Unit Withington Hospital Manchester England United Kingdom

A description of a pilot project in daytime care for the elderly and its results will provide the background for the presentation of the theory named “The Four Wall Syndrome”. This phrase was coined by the author to assist in the evaluation of the Day Care candidates and in the projection of the number of interviews as well as the type of interview techniques used when assessing the candidates for admission to a Seniors' Day Care program. The project began in May 1976, under the auspices of the New Brunswick Provincial Department of Social Services. Statistical proof of the project's success ensured its continuance for a second year. When the grant funds for the second year had been used, the Social Service Department decided to perpetuate Seniors' Day Care in the new package deal of community based services for the elderly in three key areas of New Brunswick. The ability of the program co-ordinator to apply “The Four Wall Syndrome” theory to interviews of candidates would assist in the screening process for admission to the program. It is believed that such a theory could be applicable to other programs for the elderly. © 1978, Canadian Association of Occupational Therapists (CAOT). All rights reserved.

关键词：老年人日间住院医疗/组织和管理新不伦瑞克医护疗养所/组织和管理病人入院试点项目人类

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