Abstract:
OBJECTIVES:Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection. DESIGN:Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow-up. SETTING:A stratified random sample of 59 nursing homes across Maryland. PARTICIPANTS:Two thousand fifteen new admissions aged 65 and older. MEASUREMENTS:Facility-level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record abstraction; and direct observation. Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records). RESULTS:The 2-year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days. Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome. High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use. High rates of hospitalization for infection were associated with for-profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes. CONCLUSIONS:The association between RN turnover and both outcomes underscores the relationship between nursing leadership and quality of care in these settings. The relationship between hospitalization for infection and for-profit ownership and chain affiliation could reflect policies not to treat acute illnesses in house. The link between social factors of care (environmental quality, prioritizing staff satisfaction, resident privacy, and facility visitation) and hospitalization indicates that a nonmedical model of care may not jeopardize, and may in fact benefit, health-related outcomes. All of these facility characteristics may be modifiable, may affect healthcare costs, and may hold promise for other, less-medical, forms of residential long-term care.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Zimmerman S,Gruber-Baldini AL,Hebel JR,Sloane PD,Magaziner Jdoi
10.1046/j.1532-5415.2002.50610.xsubject
Has Abstractpub_date
2002-12-01 00:00:00pages
1987-95issue
12eissn
0002-8614issn
1532-5415pii
jgs50610journal_volume
50pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVES:To estimate population norms for use in assessment of individuals in relation to their age-matched peers using true longitudinal patterns of decline. DESIGN:Longitudinal study of 10 years of follow-up data from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) on the most commonly ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1532-5415.2007.01216.x
更新日期:2007-07-01 00:00:00
abstract:OBJECTIVES:To investigate whether midlife and older women who reported prior-year physical abuse, verbal abuse, or both abuse types had higher mortality risk than peers who did not report prior-year abuse. DESIGN:Retrospective analysis. SETTING:Community. PARTICIPANTS:One hundred sixty-thousand six hundred seventy-s...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2009.02429.x
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVES:To evaluate a new alcohol-related risk score for research use. DESIGN:Using data from a previously reported trial of a screening and education system for older adults (Computerized Alcohol-Related Problems Survey), secondary analyses were conducted comparing the ability of two different measures of risk to ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2007.01072.x
更新日期:2007-03-01 00:00:00
abstract:OBJECTIVES:To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans. DESIGN:Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physic...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,随机对照试验
doi:10.1111/jgs.14567
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVES:To examine current utilization patterns of cholinesterase inhibitor (ChEI) therapy for dementia to determine treatment duration, use in long-term care, how often patients receive these drugs until death, and frequency of switching between the available ChEIs. DESIGN:A population-based healthcare administrat...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1532-5415.2007.01377.x
更新日期:2007-10-01 00:00:00
abstract::It has long been thought that demographic aging and its attendant implications for health and social services is primarily a problem for industrialized wealthy countries. Nothing could be further from the truth since most older persons (and an increasingly higher number) reside in low-income countries. Through a descr...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/jgs.16191
更新日期:2019-11-01 00:00:00
abstract::As nursing homes become increasingly important sites for biomedical and behavioral research, researchers must address the ethical problems of increased vulnerability and the high prevalence of mental and physical disorders in the nursing home population. Obtaining valid informed consent is but one of the many difficul...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.1993.tb07470.x
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVES:To evaluate the prevalence of silent stroke and its associated consequences on physical, cognitive, and emotional functioning in an elderly population. DESIGN:Population-based cross-sectional survey. SETTING:The Memory and Morbidity in Augsburg Elderly project in the Augsburg region of southern Germany. P...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1532-5415.2004.52300.x
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVES:To assess the feasibility of a vitamin D intervention delivered through a Meals-on-Wheels (MOW) program to improve 25-hydroxyvitamin D (25(OH)D) concentrations and reduce falls in homebound older adults. DESIGN:Single-blind, cluster randomized trial. SETTING:MOW, Forsyth County, North Carolina. PARTICIPAN...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,随机对照试验
doi:10.1111/jgs.13610
更新日期:2015-09-01 00:00:00
abstract::The current literature on suicide by medicinal overdose among the elderly population of the United States and Britain is discussed. The older white male is a high risk in this regard. Physical and mental illnesses contribute to the problem of suicide among the aged, and some of the drugs prescribed for treatment (e.g....
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1975.tb00218.x
更新日期:1975-07-01 00:00:00
abstract:OBJECTIVE:The impact of cognitive function and decline on political ideology is unknown. We studied the relationship between cognition and both political orientation and political policy choices in a population of older persons. DESIGN:Longitudinal investigation. SETTING:A retirement community and its surroundings in...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16935
更新日期:2020-10-31 00:00:00
abstract:OBJECTIVES:To determine whether function-related indicators (FRIs), derived from preadmission claims data, help explain the frequent practice of forgoing secondary prevention medications observed in Medicare. DESIGN:Retrospective cohort. SETTING:National Medicare data. PARTICIPANTS:Elderly Medicare beneficiaries dis...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13953
更新日期:2016-03-01 00:00:00
abstract::To prevent falls effectively, one must first understand the underlying reasons. Although environmental factors are sometimes to blame, the fundamental cause is a decline in postural control which is partly age-related and partly due to pathologic changes in the central nervous system. Dizziness is a common complaint a...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1980.tb01125.x
更新日期:1980-11-01 00:00:00
abstract::Cognitive impairment in old age is one of the most important topics in modern geriatrics. This article discusses the historical dimensions of this phenomenon. To this end, a number of primary sources ranging from antiquity to the modern era are evaluated. Although a physiology and pathology of old age were conceptuali...
journal_title:Journal of the American Geriatrics Society
pub_type: 历史文章,杂志文章
doi:10.1111/j.1532-5415.2005.53558.x
更新日期:2005-11-01 00:00:00
abstract::Ninety-three consecutive outpatients receiving tricyclic antidepressants for at least one month were asked about medication side effects, including excessive appetite and craving for sweets. Prevalence of these side effects and their relationship (Pearson r) to type of medication, dosage, patient characteristics, diag...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1985.tb01777.x
更新日期:1985-10-01 00:00:00
abstract::An operational definition of frailty is important for clinical care, research, and policy planning. The literature on the clinical definitions, screening tools, and severity measures of frailty were systematically reviewed as part of the Canadian Initiative on Frailty and Aging. Searches of MEDLINE from 1997 to 2009 w...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.2011.03597.x
更新日期:2011-11-01 00:00:00
abstract::The objective of this study was to use performance-based measurements to identify, in a population of community-dwelling American Indians aged 55 and older, the prevalence and correlates of lower body functioning. Data were collected as part of a cross-sectional study of disability from members of a tribe in the south...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2011.03869.x
更新日期:2012-03-01 00:00:00
abstract::Thirty-two demented, elderly residents of a nursing home were admitted to a specially designed dementia unit. Each patient was assessed three times: prior to admission, and at four and 12 months after admission to the unit. Patients were evaluated using a modified version of a previously published assessment scale as ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1987.tb04638.x
更新日期:1987-04-01 00:00:00
abstract::The effect of age on glucose tolerance, insulin secretion, and in vivo insulin action (insulin clamp) was studied in 48 nonobese subjects, all of whom were fully ambulatory and in good general health. The observed age-related increase in fasting plasma glucose (r = 0.35, P less than 0.01) was not due to an increase in...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1982.tb05662.x
更新日期:1982-09-01 00:00:00
abstract:UNLABELLED:This longitudinal study of glucose tolerance in the residents of a Jewish home for the aged (JHA) is now in its 25th year. Of 1,177 supposedly nondiabetic persons screened on admission from 1965 to 1986, 22.5% had impaired glucose tolerance (IGT), reflecting its undiagnosed prevalence among the Jewish elderl...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1989.tb06676.x
更新日期:1989-12-01 00:00:00
abstract:OBJECTIVES:To evaluate the association between regular antiepileptic drug (AED) use and incident dementia. DESIGN:Case-control analysis. SETTING:Finnish public health register and German health insurance data. PARTICIPANTS:Individuals with dementia of any type (German data, N=20,325) and Alzheimer's disease (AD; Fin...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15358
更新日期:2018-07-01 00:00:00
abstract::Although the field of frailty research has expanded rapidly, it is still a nascent concept within the clinical specialties. Frailty, conceptualized as greater vulnerability to stressors because of significant depletion of physiological reserves, predicts poorer outcomes in several medical specialties, including cardio...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.14902
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVES:Strong feelings about patient autonomy as expressed in living wills, polls, and legislative referenda have been challenging the medical establishment to increase nontreatment, defined as foregoing a life-prolonging treatment, and even to provide treatments having life-shortening potential to selected patient...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1998.tb02717.x
更新日期:1998-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine physical activity and the predictors of physical activity and exercise among nursing home residents. DESIGN:Population study. PARTICIPANTS:The sample (n = 190) was obtained by selecting every man and every second women from the entire nursing home population (n = 346...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1994.tb06593.x
更新日期:1994-09-01 00:00:00
abstract::Nursing homes have become "ground zero" for the coronavirus disease 2019 (COVID-19) epidemic in North America, with homes experiencing widespread outbreaks, resulting in severe morbidity and mortality among their residents. This article describes a 371-bed acute-care hospital's emergency response to a 126-bed nursing ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16625
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVES:To determine whether slow gait represents a compensatory strategy to reduce the energetic cost of walking with age. DESIGN:Cross-sectional analysis. SETTING:Community-dwelling volunteers from the Baltimore Longitudinal Study of Aging (BLSA). PARTICIPANTS:Four hundred twenty community-dwelling persons aged...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2012.04153.x
更新日期:2012-10-01 00:00:00
abstract::The relation of serum albumin concentration to age was assessed in a series of hospitalized medical patients. Those with disease states (e.g., dysproteinemia, renal insufficiency, hepatic dysfunction, malnutrition) potentially associated with abnormal serum albumin levels were excluded, leaving a study population of 1...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1979.tb01715.x
更新日期:1979-01-01 00:00:00
abstract:OBJECTIVE:Prior reports on Hodgkin's disease have suggested a biologic behavior difference between young and old patients. A study of 35,033 patients could confirm that older patients do not do as well as young patients regardless of age. METHODS:The National Cancer Data Base provided data from U.S. tumor registries o...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2000.tb02653.x
更新日期:2000-03-01 00:00:00
abstract::Capitated or salaried managed care systems offer an important opportunity to provide high quality, cost-effective end-of-life care. However, capitated healthcare delivery systems have strong incentives to avoid patient populations in need of such care. Care currently provided at the end of life in fee-for-service prac...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1998.tb01047.x
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVES:To identify fracture types in a series of older adults with pelvic fractures and to determine whether the type of pelvic fracture affected short-term outcomes and morbidity. DESIGN:Retrospective chart review. SETTING:Teaching hospital. PARTICIPANTS:One hundred eighty-one individuals aged 65 and older with...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2011.03455.x
更新日期:2011-07-01 00:00:00