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Category: Research & Innovation

Do Warmed Blankets Change Pain, Agitation, Mood or Analgesic Use Among Nursing Home Residents?

Overview:
Nursing home residents frequently experience pain, feeling too cold in the environment, and agitation. While warmed blankets are often used in hospital settings to promote thermal, physical, and psychological comfort, we conducted the first research on the use of warmed blankets in long-term care.

Results:
Approximately one fourth of our residents used warmed blankets during the study period. Warmed blankets were associated with decreased agitation, number of pain complaints, severity of pain, and use of analgesics. Warmed blankets are a low-cost intervention that can bring comfort to older adults. The full study was published: Kovach, C. R., Putz, M., Guslek, B., & McInnes, R. (2019). Do Warmed Blankets Change Pain, Agitation, Mood or Analgesic Use Among Nursing Home Residents? Pain Management Nursing, 20(6), 526-531.

Feasibility and Pilot Testing of a Mindfulness Intervention for Frail Older Adults and People with Dementia

Overview:
Mindfulness interventions have been beneficial for healthy adults and people dealing with a stressful medical or mental health diagnosis. We examined the feasibility of a mindfulness activity for older adults in long-term residential settings and examined differences in outcomes between a mindfulness and cognitive activity. The Present in the Now (PIN) intervention is a mindfulness intervention with three components: attentional skill exercises, body awareness activities, and compassion meditation.

Results:
This study demonstrated that mindfulness is feasible for older adults with multiple chronic conditions and cognitive impairment. Short-term positive changes in agitation, pleasure, anger, anxiety/fear, daytime wakefulness, and discomfort level were seen when participants were in the mindfulness arm of the study that were not present during participation in the cognitive activity. These findings are consistent with multiple studies showing a relationship between mindfulness activities, and decreased stress reactivity. Mindfulness focuses on using strengths within oneself to promote well-being, comfort, and compassion. The full study was published: Kovach, C. R., Evans, C. R., Sattell, L., Rosenau, K., & Gopalakrishnan, S. (2018). Feasibility and pilot testing of a mindfulness intervention for frail older adults and individuals with dementia. Research in gerontological nursing, 11(3), 137-150.

Shallow Restrictive Breathing: A Modifiable Problem for Better Health

Overview:
When frail older adults don’t breathe well, they can’t move well and are at increased risk for comorbid problems. We are the first group in the country to study restrictive ventilatory patterns (RVP) in frail older adults. RVP contributes to two prevalent problems in older adults: 1) the development of pneumonia and other lower respiratory infections; and 2) declining endurance for physical activity.

Results:
We found that an astounding 51% of people in residential long-term care had spirometry-confirmed moderate or severe RVP. People with RVP were more likely to have lower muscle strength, a stooped posture, difficult breathing, and dementia. People who had RVP were less likely to still be walking independently, with or without an assistive device such as a cane or walker. No approved therapies currently exist to treat RVP in frail older adults. Addressing the problems uncovered in our research has the potential to improve strength, decrease or delay functional decline, and prevent pneumonia. The full study was published: Kovach, C. R., Taani, M. H., Evans, C. R., Kelber, S., & Margolis, I. (2019). Restrictive Ventilatory Patterns in Residents of Continuing Care Retirement Communities. Western journal of nursing research, 41(3), 355-371. Based on the results of this study we developed the Breathing Room Intervention and are currently testing its effectiveness.

Pain and Sleep Quality

Overview:
Sleeping well is associated with positive health outcomes, less daytime sleepiness, and a greater sense of well-being and psychological functioning. While we know that people who have pain don’t sleep well, the sources of pain that predict poor sleep in older adults has not been previously studied.

Results:
This study found that in residential long-term care, having dementia, being male, and having respiratory distress or urinary retention were all associated with worse nighttime sleep. Comprehensive pain and sleep assessments need to be done so that treatments can be initiated that will promote sleep quality. The manuscript of this study is currently under review.

Proton Pump Inhibitors And The Prescribing Cascade

Overview:
We studied drugs commonly prescribed for indigestion, peptic ulcer disease, and gastro-esophageal reflux disease (GERD) in three nursing homes. People who were taking many oral drugs and vitamins were more likely to be taking these drugs. Many drugs have anticholinergic properties, but too many anticholinergics can be problematic. There were major differences in the prescribing of anticholinergics in the three nursing homes. The Jewish Home had the lowest anticholinergic use. Anticholinergics can open up the lower esophagus, allowing gastric acids up into the esophagus.

Results:
This study found that residents with higher anticholinergic drug use were more likely to be taking a proton pump inhibitor drug.

Patterns Of New Physical Problems Emerging In Long-Term Care Residents With Dementia

Overview:
People receiving skilled nursing care have multiple physical conditions that can affect their comfort and quality of life. This study provides a more comprehensive view of the overall burden from new physical problems and symptoms occurring in older adults with dementia residing in long-term care.

Results:
Findings suggest a higher intensity of physical needs than found in other studies. The differences in the patterns of how these problems emerged may have important implications for health care delivery.

Feasibility Testing Of A Protocol To Stop Ineffective Drug And Non-Drug Treatments

Overview:
Ineffective treatments continue to be given to nursing home residents with dementia, and many more treatments are started than stopped. The Track and Trigger Treatment (T3) Protocol, developed by Dr. Kovach, assists nurses to track responses to new treatments and get ineffective treatments stopped or altered. Use of the T3Protocol in this study was associated with significantly more treatments being stopped.

Results:
Treatments were most commonly stopped because of ineffectiveness (33%), followed by the problem being resolved (29%), side effects (18%), and a change in goals of care (20%). The protocol developed by Dr. Kovach is a novel and innovative tool that improved care and decreased costs.

Decreasing Infections: Testing A Protocol Utilizing Ultraviolet Irradiation To Decrease Nursing Home Infections

Overview
People residing in nursing homes are at increased risk for infection. We are the first in the world to test pulsed xenon ultraviolet light in addition to manual cleaning in nursing homes to reduce microbial burden, infection rates, and comorbid problems associated with infection. This study demonstrated that the pulsed-xenon ultraviolet disinfection device is superior to manual cleaning alone for decreasing microbes on environmental surfaces, as well as decreasing infection rates, and the rates of hospitalization for infection.

Results:
Suggest that placing a stronger emphasis on environmental surface disinfection in long-term care organizations may decrease facility acquired infections. Read more about this study on the BioMed Central website.