Background: Aspiration pneumonia (AP) is a subset of pneumonia caused by the aspiration of food and fluids to the lungs and is highly prevalent in the older population. Oropharyngeal dysphagia (OD) is one of the risk factors for AP and it is also associated with malnutrition, dehydration and poor functional outcomes. As pneumonia is the second…

Background: Research suggests that people with intellectual disabilities have a higher risk for cardiovascular disease than the general population. The aim of this study was to identify barriers for the prevention, diagnosis, and treatment of cardiovascular disease for people with intellectual disabilities. Method: We conducted individual…

Community-based frail older adults, burdened with complex medical and social needs, are at great risk for preventable rapid rehospitalizations. Although federal and state regulations are in place to address the care transitions between the hospital and nursing home, no such guidelines exist for the much larger population of community-dwelling…

This study addresses the factors influencing decisions to send medicine-surgical (med-surg) patients home or to nursing facilities (NFs). The sample (n = 7,852) was taken from a large, urban, teaching, med-surg unit where discharges were documented and data collected over a two-and-a-half-year period. Using logistical regression, the factors found…

Context: Scope of practice is an important factor in both training and recruiting rural family physicians. Purpose: To assess rural Idaho family physicians' scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status. Methods: A survey instrument was developed based on a literature…

The Delta Society defines animal-assisted therapy as "a goal-directed intervention in which an animal is incorporated as an integral part of the clinical healthcare treatment process." Unlike other animal-assisted activities, animal-assisted therapy, or AAT, is led by a professional such as a physical therapist, occupational therapist,…

Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training…

Staff carers in pediatric skilled nursing facilities (PSNF) deal directly with dying residents, and are on the forefront of communication with families. These providers have expressed misunderstandings regarding the meaning of resuscitation status and redirection of care. This descriptive study evaluated perceptions and understanding of end of…

Surveyed nursing homes in New York in 1986 and 1988 concerning policies on decisions about life-sustaining treatment, patient decision-making capacity, prevalence of ethics committees to resolve disputes, and advance directives. Between 1986 and 1988, number of facilities with explicit policies and institutional vehicles to address issues…

A major demonstration and evaluation project was undertaken to study the consequences of using incentive payments to change admission, discharge, and outcome patterns for Medicaid patients in nursing homes. Thirty-six proprietary, Medicaid-certified, skilled nursing homes in San Diego County with a combined Medicaid inpatient census of…

With improvements in medical technology and an increase in life expectancy, there also has been a substantial increase in the number of individuals with chronic diseases. The chronically ill elderly, who absorb an ever-growing proportion of our public and private resources, are of particular concern. This study analyzes findings from a major…

Michigan physicians (N=930) were asked whether they made nursing home visits and if not, why not. A typology was developed to differentiate among various physician types based on reasons given. Six physician types were found, each identified with a different policy lever that could be used to encourage them to treat nursing home patients. (Author)

Assessed decision-making capability and preferences regarding advance directives of 39 nursing home residents and proxies. Most patients willingly stated preferences; over one-half opted to forego burdensome measures when death appeared imminent. Decisionally capable patients were more likely to forego life-sustaining measures than those of…

The purpose of this survey was to describe nursing home social services staff roles and perceptions related to end-of-life medical decision making for nursing home residents in endstage dementia. Using a self-designed questionnaire, 138 nursing home social services staff from across New York State answered questions about advance directives,…

Assesses the stability of nursing home residents' preferences for medical treatments. Nondemented, nondepressed residents (N=37) were surveyed serially over a six-month period. Subjects preferred more treatment for their current health concerns than for all hypothetical conditions. All preference changes were toward less intervention. Most…