INTRODUCTION: Hospitalisations can pose hazards and may not be an appropriate care setting for frail nursing home (NH) residents. Few studies have quantified the extent of NH resident hospitalisations in Singapore, hence we aimed to address this knowledge gap by studying characteristics of unplanned hospitalisations over a 1-year period. METHOD: This was a retrospective cohort study of 9922 subsidised residents across 59 NHs in Singapore, with analysis using administrative healthcare data. Key measures included inpatient admission and emergency department visit rates, final discharge diagnoses and estimated costs. We examined correlates of inpatient admissions with a multivariable zero-inflated negative binomial regression model incorporating demogra-phics, institutional characteristics and Charlson Comorbidity Index. RESULTS: There were 6620 inpatient admissions in 2015, equivalent to 2.23 admissions per 1000 resident days, and the majority were repeat admissions (4504 admissions or 68.0%). Male sex (incidence rate ratio [IRR] 1.23), approaching end-of-life (IRR 2.14), hospitalisations in the past year (IRR 2.73) and recent NH admission within the last 6 months (IRR 1.31-1.99) were significantly associated with inpatient admission rate. Top 5 discharge diagnoses were lower respiratory tract infections (27.3%), urinary tract infection (9.3%), sepsis (3.1%), cellulitis (1.9%) and gastroenteritis (1.1%). We estimated the total system cost of admissions of subsidised residents to be SGD40.2 million (USD29.1 million) in 2015. CONCLUSION We anticipate that unplanned hospitali-sation rate will increase over time, especially with an increasing number of residents who will be cared for in NHs. Our findings provide a baseline to inform stakeholders and develop strategies to address this growing problem.
Humans ; Singapore ; Nursing Homes/economics* ; Retrospective Studies ; Male ; Female ; Hospitalization/statistics & numerical data* ; Aged ; Aged, 80 and over ; Emergency Service, Hospital/statistics & numerical data* ; Information Storage and Retrieval ; Homes for the Aged/economics* ; Frail Elderly/statistics & numerical data*

OBJECTIVES: This study aims to investigate awareness of oral health care and health status among elderly people in nursing homes in Taiyuan. Strategies for preventing and treating oral diseases and improving the quality of life of the elderly in nursing homes were formulated on the basis of analyzed data. METHODS: A total of 359 participants from 48 nursing homes in six districts were selected randomly. Awareness, attitude, and behavior with regard to oral health care among the elderly were investigated through a survey using questionnaires and oral health examinations. Data were statistically analyzed with SPSS 20.0. RESULTS: Among the elderly in the nursing homes in Taiyuan, awareness and behavior with regard to oral health care were deficient and inappropriate, and thus professional guidance was needed. In addition to method and time of brushing teeth and bad oral habits, the oral health status of the elderly was statistically affected by age and education. Compared with the data of the Fourth National Oral Epidemiological Investigation, the number of elderly people aged 55-64 or 65-74 years who brush their teeth every day and accept oral diagnosis and treatment was lower. However, the ratios of edentulous and missing teeth without treatment were higher than the national average level for the same age groups. CONCLUSIONS The awareness and attitude of the elderly in nursing homes with regard to oral health care are unsatisfactory, and their oral health status is poor. Education on oral health care, development of good oral care habits, and regular oral health examination are essential to the maintenance of oral health in elderly people.
Aged ; Health Status ; Humans ; Middle Aged ; Mouth, Edentulous ; Nursing Homes ; Oral Health ; Quality of Life ; Toothbrushing

BACKGROUND: Predicting adverse health events and implementing preventative measures are a necessary challenge. It is important for healthcare planners and policymakers to allocate the limited resource to high-risk persons. Prediction is also important for older individuals, their family members, and clinicians to prepare mentally and financially. The aim of this study is to develop a prediction model for within 11-year dependent status requiring long-term nursing care or death in older adults for each sex. METHODS: We carried out age-specified cohort study of community dwellers in Nisshin City, Japan. The older adults aged 64 years who underwent medical check-up between 1996 and 2000 were included in the study. The primary outcome was the incidence of the psychophysically dependent status or death or by the end of the year of age 75 years. Univariable logistic regression analyses were performed to assess the associations between candidate predictors and the outcome. Using the variables with p-values less than 0.1, multivariable logistic regression analyses were then performed with backward stepwise elimination to determine the final predictors for the model. RESULTS: Of the 1525 female participants at baseline, 105 had an incidence of the study outcome. The final prediction model consisted of 15 variables, and the c-statistics for predicting the outcome was 0.763 (95% confidence interval [CI] 0.714-0.813). Of the 1548 male participants at baseline, 211 had incidence of the study outcome. The final prediction model consisted of 16 variables, and the c-statistics for predicting the outcome was 0.735 (95% CI 0.699-0.771). CONCLUSIONS We developed a prediction model for older adults to forecast 11-year incidence of dependent status requiring nursing care or death in each sex. The predictability was fair, but we could not evaluate the external validity of this model. It could be of some help for healthcare planners, policy makers, clinicians, older individuals, and their family members to weigh the priority of support.
Aged ; Cohort Studies ; Female ; Geriatric Assessment/statistics & numerical data* ; Humans ; Independent Living/statistics & numerical data* ; Japan ; Male ; Middle Aged ; Nursing Homes/statistics & numerical data* ; Risk Assessment ; Risk Factors

BACKGROUND: Dementia is a condition in which a person who has been living a normal life suffers from various cognitive impairments in memory, words, and judgment that considerably disrupt daily life. The oral care ability and subjective oral status of elderly individuals with dementia are lower than those of a healthy person. The oral health care of individuals admitted to nursing homes inevitably falls to nursing assistants and nursing care staff. This study aimed to investigate the need for oral health management items of and to provide basic direction for the future of the Dementia National Responsibility System. METHODS: Elders aged 65 years and over were selected from a comprehensive welfare center. A total of 155 questionnaires were analyzed. The questionnaire consisted of 15 items about general status, 9 items about recognition of the Dementia National Responsibility System, 5 items of the subjective recognition of oral health, and 6 items of the correlation between oral health and dementia. RESULTS: Among our subjects, 71.0% answered that they did not know about the Dementia National Responsibility System, 78.7% answered that they think they need the system, and 81.9% think that they should add dental health items to the Dementia National Responsibility System. The response to the need for dementia national responsibility, oral health items in the Dementia National Responsibility System, and oral specialists all showed scores of >4 points. The need for the Dementia National Responsibility System, oral health items, and specialists were found. CONCLUSION: It is necessary to include oral health care items in the Dementia National Responsibility System so that elderly individuals with dementia can receive the needed oral health care.
Accidental Falls ; Aged ; Cognition Disorders ; Dementia ; Dental Care ; Humans ; Judgment ; Memory ; Nursing ; Nursing Care ; Nursing Homes ; Oral Health ; Specialization

PURPOSE: In Korea, the prevalence of dementia patients has increased, which makes the care burden of nurses important. The purpose of this study is to identify factors affecting the care burden of nurses caring elderly patients with dementia. METHODS: A cross-sectional design was conducted using a convenience sample of 127 nurses from two hospitals and a nursing home in Korea. Participants completed questionnaires on knowledge of and attitudes toward dementia, social support, self-esteem, dementia problematic behavior (DPB), and professional caregiver burden index. The data were analyzed by using the t-test, ANOVA, Pearson correlation, and multiple regression with the SPSS/windows version 21.0 program. RESULTS: The influencing factors for nurse burden include day shift, DPB, self-esteem, social support, which explain 28.0% of care burden of nurses. CONCLUSION: To reduce the burden of the nurses, there needs to be an administrative system that focuses on enhancing their self-esteem and social support. Active institutional support may be necessary for the nurses taking care of elderly patients with dementia.
Aged ; Caregivers ; Dementia ; Humans ; Korea ; Nursing Homes ; Prevalence

PURPOSE: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. METHODS: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. RESULTS: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=−3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=−2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=−3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. CONCLUSION: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.
Advance Care Planning ; Advance Directives ; Aged ; Health Care Costs ; Humans ; Long-Term Care ; Nursing Homes ; Terminal Care

PURPOSE: The purpose of this study was to identify patient safety awareness and emergency response ability and affecting factors perceived by nursing homes and home visiting caregivers. METHODS: This study was a descriptive study that conveniently extracts nursing caregivers who care for elderly patients in S and G provinces, Korea. Data collection was done by structural questionnaires from April to May 2018. A total of 204 responses consisting of 103 nursing homes and 101 home visiting caregivers were used for data analysis in SPSS Win 22.0. RESULTS: Patient safety awareness and emergency response ability of nursing homes caregivers with each 4.24±0.50, 74.26±09.57 was each higher than that of the home visiting caregivers with 3.68±0.49, 68.02±12.12 (p < .001). The affecting factors of the patient safety awareness were working place, safety education, and daily average working hours with 12 or more (F = 27.30, p < .001) and that of emergency response ability were number of patients per personnel with 9 or more and emergency situation experience (F=14.00, p < .001). CONCLUSION: These results suggest that it is necessary to develop a safety education program that can share indirectly experience emergency situations that occur on the job site.
Aged ; Caregivers* ; Data Collection ; Education ; Emergencies* ; House Calls* ; Humans ; Korea ; Nursing Homes* ; Nursing* ; Patient Safety* ; Statistics as Topic ; Workplace

PURPOSE: This study aims to investigate the effects of intervention using the therapeutic robot, PARO, on the cognition, emotion, problem behavior, and social interaction of elderly people with dementia. METHODS: A nonequivalent control group pretest-posttest design was used. A total of 33 elderly people with dementia living in a nursing home facility participated in the study, with 17 in the experimental group and 16 in the control group. The intervention program with PARO was administered twice a week for 6 weeks, for a total of 12 sessions. Data were collected before and after intervention, using a questionnaire, direct observation, and video recording. RESULTS: There were statistically significant differences in positive emotions and problem behaviors between the groups. The experimental group demonstrated a significant improvement in social interaction. CONCLUSION: PARO intervention can be utilized as an effective nursing intervention to increase positive emotions and social interaction, as well as decrease problem behaviors, in elderly people with dementia living in nursing home facilities.
Aged ; Cognition ; Dementia ; Humans ; Interpersonal Relations ; Nursing ; Nursing Homes ; Problem Behavior ; Robotics ; Social Behavior ; Video Recording

PURPOSE: The purpose of this study was to investigate the expected family involvement of family members of elderly residents in nursing homes. METHODS: This study utilized a descriptive design with a survey research method. Data were collected using the Expect Family Involvement Questionnaire Scale, which was completed by 112 family caregivers of older adults in nursing homes in Seoul and Gyeong-gi Province. The collected data were analyzed using descriptive statistics. RESULTS: Responses to the questionnaire indicated the highest value was recorded for the item, ‘use of a room for family privacy’ with 2.41±0.43 points, followed by the item, ‘staff calling family for advice with resident problems’ with 2.38±0.38 points and ‘education about nursing home programs’ with 2.32±0.42 points. CONCLUSION: In order to promote family involvement in long-term care facilities, various approaches, interventions, and government supports with the respective of the family are required. The nursing home placement process should include understanding discuss on the importance of the role of family, and should help promote positive relationships between the elderly residents and their families. Staffs and administrators of nursing home are to consider the family as a partner rather than visitor.
Administrative Personnel ; Adult ; Aged ; Caregivers ; Humans ; Long-Term Care ; Methods ; Nursing Homes ; Nursing ; Seoul

OBJECTIVES: Sarcopenia and osteoporosis affects activities of daily living and quality of elderly people. However, little is known about its impact on elderly locomotor diseases, such as osteoporotic vertebral fracture (OVF). There is no report investigating the influence of both sarcopenia and osteoporosis on outcomes of OVF. This study aimed to evaluate the clinical outcomes of OVF in elderly patients from sarcopenic perspectives. METHODS: This prospective study was conducted with 396 patients, aged 65 years or more, hospitalized for the treatment of OVF (mean age, 81.9 ± 7.1 years; 111 males, 285 females). The primary outcome was the Japanese Orthopaedic Association (JOA) score for lumbar disease (at first visit, hospital discharge, and 1 year after treatment) and Barthel index (at the same time and before hospitalization). The second outcome was living place after discharge. Susceptibility to sarcopenia and osteoporosis were evaluated and clinical results of conservative treatment were compared. RESULTS: Sarcopenia significantly affected Barthel index at first visit and discharge. Sarcopenia patients had significantly higher rate for discharge to nursing home and living in nursing home after 1 year than patients without sarcopenia. Osteoporosis significantly affected the JOA score at the first visit and the Barthel index before hospitalization, at the first visit, discharge, and after 1 year. Osteoporosis did not affect the living place at discharge and after 1 year. CONCLUSIONS: Sarcopenia and osteoporosis affected outcomes of conservative treatment for OVF; moreover, sarcopenia affected the living place of OVF patients at discharge and after 1 year.
Activities of Daily Living ; Aged ; Asian Continental Ancestry Group ; Hospitalization ; Humans ; Male ; Nursing Homes ; Osteoporosis ; Prospective Studies ; Sarcopenia