Apathy Is a Risk Factor for Mortality in Nursing Home Patients

MedicalResearch.com Interview with:
Johanna MH Nijsten, Msc
Clinical Neuropsychologist
Archipel Landrijt, Knowledge Center for Specialized Care
Eindhoven, the Netherlands
Department of Primary and Community Care, Radboudumc Alzheimer Center
Radboud University Medical Center
Nijmegen, the Netherlands 

MedicalResearch.com: What is the background for this study?

Response: Apathy is common in nursing home (NH) patients with dementia and is repeatedly found to be the most prevalent neuropsychiatric symptom. Apathy is defined by diminished or lack of motivational, goal-directed behavior, and a lack of cognition and emotional affect. Apathy leads to reduced interest and participation in the main activities of daily living, diminished initiative, early withdrawal from initiated activities, indifference, and flattening of affect.

Over the last two decades, more scientific knowledge has become available about specific fronto-subcortical systems in the brain that may be highly involved in apathy. Disruptions in these systems are found in patients with frontal lobe damage resulting from, for instance, (early-onset) dementia, traumatic brain injury, stroke, or multiple sclerosis. Fronto-subcortical circuits also play an important role in neurological disorders involving the basal ganglia such as Parkinson’s disease and Huntington’s disease. The neurodegenerative diseases and acquired brain injuries mentioned here are highly prevalent in patients receiving long-term NH care and the widespread clinical manifestation of apathy in NH-patients is thought to be related.

Since apathy is very common in nursing home-patients and may lead to a poor prognosis, clear insight into its risk for mortality is needed and NH-staff need to understand this risk.

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Patient Proxies Increasingly Important As Health Care Fragments

MedicalResearch.com Interview with:

Dr. Joan Teno, MD MD Cambia Palliative Care Center of Excellence Seattle, WA

Dr. Teno

Dr. Joan Teno, MD MD
Cambia Palliative Care Center of Excellence
Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our interest is understanding how continuity of care has changed with the eventual goal of understanding the impact on quality of care.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Make sure you have a proxy. Choose your proxy carefully.  In this era of health silos and multiple heath care professionals  involved in your care at each silo, it is important to have an advocate make sure that you get your care that you need and want.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Is this changing patterns of care that frail, older persons with multiple chronic illness care is in the hands of multiple health care professionals that practice in silos of health care providing high quality of care?

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MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Teno JM, Gozalo PL, Trivedi AN, Mitchell SL, Bunker JN, Mor V. Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014. JAMA Intern Med. Published online July 10, 2017. doi:10.1001/jamainternmed.2017.2136

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

Antipsychotic Medications Linked To Higher Mortality In Dementia Patients

Donovan Maust, MD, MS Assistant Professor of Psychiatry University of Michigan Research Scientist, Center for Clinical Management Research VA Ann Arbor Healthcare SystemMedicalResearch.com Interview with:
Donovan Maust, MD, MS
Assistant Professor of Psychiatry
University of Michigan
Research Scientist, Center for Clinical Management Research
VA Ann Arbor Healthcare System

Medical Research: What is the background for this study? What are the main findings?

Dr. Maust: From a recent government report, we known that about 1/3 of older adults with dementia in nursing homes and about 14% of those in the community have been prescribed an antipsychotic. While providers focus on what benefit the treatment they offer, it is important to also be aware of the potential harms, particularly when it is death. Prior estimates came from relatively short studies and showed a 1% increase. This paper finds that, over 180 days, the increased mortality comparing antipsychotic users to matched non-users is about 2 to 5 times higher.

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Nursing Home Culture Change Reduced Hospitalizations, Feeding Tubes and Bedsores

dr_susan_millerMedicalResearch.com Interview with:
Susan Miller, PhD
Professor of Health Services, Practice and Policy (Research) at the Center for Gerontology and Health Care Research
The Warren Alpert Medical School of Brown University

Medical Research: What are the main findings of the study?

Prof. Miller:  Upon introduction of culture change, the nursing homes that implemented culture change most extensively produced statistically significant improvements in the percent of residents on bladder training programs, the percent of residents who required restraints, the proportion of residents with feeding tubes, and the percent with pressure ulcers. They also showed a nearly significant reduction in resident hospitalizations. No quality indicator became significantly worse.

Among homes that implemented less culture change, the only significant improvement occurred in the number of Medicare/Medicaid health-related and quality of life survey deficiencies. Urinary tract infections and hospitalizations got slightly worse.

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MRSA and Nursing Home Admission Denials

Courtney Reynolds, PhD Medical Scientist Training Program University of California Irvine, School of MedicineMedicalResearch.com Interview with:
Courtney Reynolds, PhD
Medical Scientist Training Program
University of California Irvine, School of Medicine


MedicalResearch.com: What are the main findings of the study?

Dr. Reynolds: Our survey of factors influencing admission to 13 nursing homes in Orange County, California showed that MRSA carriers are denied admission more often than non-carriers, even after accounting for other important factors such as insurance status, required level of care and previous experience at the facility. In 80% of cases where MRSA carriage was responsible for denial of admission, nursing home administrators cited a lack of available single or cohort (MRSA only) rooms to accommodate these potential residents.
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