Medical Care of Nursing Home Residents

Evans, J. M.; Chutka, Darryl S.; Fleming, Kevin C.; Tangalos, Eric G.; Vittone, Janet L.; Heathman, Joanne H.

doi:10.4065/70.7.694

Cited by 51 publications

(24 citation statements)

References 49 publications

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“…Probably, many of these patients are chronically (and mildly) dehydrated, even without acute medical illness [2,4] . Considering the number of LTC patients, in the US alone more than 2 million [5] , the enormity of the problem is highlighted.…”

Section: Introductionmentioning

confidence: 99%

Dehydration among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia

et al. 2007

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Introduction: Long-term care (LTC) residents, especially the orally fed with dysphagia, are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly. However, combinations of these indices are more reliable. Objective: Assessment of hydration status among elderly LTC residents with oropharyngeal dysphagia. Methods: A total of 28 orally fed patients with grade-2 feeding difficulties on the functional outcome swallowing scale (FOSS) and 67 naso-gastric tube (NGT)-fed LTC residents entered the study. The common laboratory, serum and urinary tests were used as indices of hydration status. The results were considered as indicative of dehydration and used as ‘markers of dehydration’, if they were above the accepted normal values. Results: The mean number of dehydration markers was significantly higher in the FOSS-2 group (3.8 ± 1.3 vs. 2 ± 1.4, p = 0.000). About 75% of these FOSS-2 patients had ≧4 dehydration markers versus 18% of the NGT-fed group (p = 0.000). A low urine output (<800 ml/day) was significantly more common in the FOSS-2 group (39 vs. 12%, p = 0.002). Above normal values of blood urea nitrogen (BUN), BUN/serum creatinine ratio (BUN/S_Cr), urine/serum osmolality ratio (U/S_Osm), and urine osmolality U_Osm, were significantly more frequent in the dehydration-prone FOSS-2 group. This combination of 4 indices was present in 65% of low urine output patients. In contrast, it was present in only 36% of the higher urine output patients (p = 0.01). Patients with a ‘normal’ daily urine output (>800 ml/day) also had a significant number (2 ± 1.5) of positive indices of dehydration. Conclusions: Dehydration was found to be common among orally fed FOSS-2 LTC patients. Surprisingly, probable dehydration, although of a mild degree, was not a rarity among NGT-fed patients either. The combination of 4 parameters, BUN, BUN/S_Cr, U/S_Osm and U_Osm, offers reasonable reliability to be used as an indication of dehydration status in daily clinical practice.

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Section: Introductionmentioning

confidence: 99%

Dehydration among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia

et al. 2007

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“…Ein Großteil dieser Betreuungsplätze war allerdings in baulich überalterten Großheimen untergebracht. 1 Die rechtliche Betriebsform dieser Pflegeinstitutionen entsprach der einer "Pflegeanstalt für chronisch Kranke", welche von der Genehmigungs-und Betriebsform prinzipiell dem Krankenanstaltengesetz unterliegt. Hinsichtlich der Organisationsform waren "Abteilungen" mit etwa 200 betreuten Menschen strukturiert, welche in der Ablauforganisation im Wesentlichen wie Krankenanstalten organisiert waren.…”

Section: Die Spezielle Historische Entwicklung Im Bundesland Wienunclassified

“…Neben dem in Österreich praktizierten Modell, finden sich auch internationale Modelle der Implementierung von Heimärzten in Pflegeheimen [1,2]. Aufgrund des zunehmenden Anwachsens hochbetagter Menschen mit Multimorbidität und Pflegebedarf kam es in den Niederlanden in den 80-iger Jahren zu zunehmender Inanspruchnahme der Akutspitäler mit entsprechender Verlängerung der durchschnittlichen Verweildauer bzw.…”

Section: Ausblickunclassified

Der Heimarzt – Ein Modell zur Verbesserung der ärztlichen Betreuung in Pflegeheimen

Fasching

2007

Ethik Med

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“…The nursing home population in the United States is expected to reach 5 million Americans by 2030 at a cost of $700 billion annually (14). This Objective: To determine intensive care unit (ICU) admission characteristics predictive of mortality among older nursing home residents.…”

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confidence: 99%