Association Between Organizational Context and Resident Pain in Assisted Living: A Repeated Cross-Sectional Study

IF 3.6 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Matthias Hoben, Shovana Shrestha, Hana Dampf, David B. Hogan, Kimberlyn McGrail, Jennifer Knopp-Sihota, Colleen J. Maxwell
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引用次数: 0

Abstract

Objectives

Resident pain has been a common quality challenge in congregate care for older adults, and organizational context may explain variations in resident pain beyond resident-level factors. Most studies have focused on nursing homes (NHs), largely neglecting assisted living (AL). AL residents are at similar risk for pain as NH resident, but with AL providing fewer services and staffing resources. Our objective was to examine whether organizational context in AL was associated with resident pain during the first two waves of the COVID-19 pandemic.

Methods

This repeated cross-sectional study linked AL home surveys, collected in COVID-19 waves 1 (March–June 2020) and 2 (October 2020–February 2021) from a key contact, to administrative Resident Assessment Instrument-Home Care (RAI-HC) records in these homes. Surveys assessed preparedness for COVID-19 outbreaks, availability of a registered nurse or nurse practitioner, direct care staff shortages, decreased staff morale, COVID-19 outbreaks, confinement of residents to their rooms, supporting video calls with physicians, facilitating caregiver involvement. The dependent variable (moderate daily pain or pain of a severe intensity) and resident covariates came from the RAI-HC. Using general estimating equations, adjusted for repeated resident assessments and covariates, we assessed whether AL organizational context was associated with resident pain during the pandemic.

Results

We included 985 residents in 41 facilities (wave 1), and 1134 residents in 42 facilities (wave 2). Pain prevalence [95% confidence interval] decreased non-significantly from 20.6% [18.6%–23.2%] (March–June 2019) to 19.1% [16.9%–21.6%] (October 2020–February 2021). Better preparedness (odds ratio = 1.383 [1.025–1.866]), confinement of residents to their rooms (OR = 1.616 [1.212–2.155]), availability of a nurse practitioner (OR = 0.761 [0.591–0.981]), and staff shortages (OR = 0.684 [0.527–0.888]) were associated with resident pain.

Conclusions

AL organizational context factors were associated with resident pain. Policy and management interventions can and must address such factors, providing potentially powerful levers for improving AL resident quality of care.

Abstract Image

辅助生活设施中组织环境与居民疼痛之间的关系:重复横断面研究。
目的:居民疼痛一直是老年人集中护理中常见的质量问题,而组织环境可能是居民疼痛变化的原因,而非居民层面的因素。大多数研究都集中在养老院(NHs),而忽略了生活辅助设施(AL)。辅助生活区居民的疼痛风险与 NH 居民相似,但辅助生活区提供的服务和人力资源较少。我们的目的是研究在 COVID-19 大流行的前两波中,AL 的组织环境是否与居民疼痛有关:这项重复性横断面研究将在 COVID-19 第 1 波(2020 年 3 月至 6 月)和第 2 波(2020 年 10 月至 2021 年 2 月)从关键联系人处收集的 AL 家庭调查与这些家庭的居民评估工具-家庭护理(RAI-HC)行政记录联系起来。调查评估了 COVID-19 爆发的准备情况、注册护士或执业护士的可用性、直接护理人员短缺、员工士气下降、COVID-19 爆发、将居民限制在房间内、支持与医生视频通话、促进护理人员参与。因变量(中度日常疼痛或重度疼痛)和居民协变量来自 RAI-HC。通过使用一般估计方程,并对重复居民评估和协变量进行调整,我们评估了大流行期间 AL 组织环境是否与居民疼痛相关:我们纳入了 41 家机构的 985 名住院患者(第一阶段)和 42 家机构的 1134 名住院患者(第二阶段)。疼痛发生率[95%置信区间]从20.6%[18.6%-23.2%](2019年3月-6月)下降到19.1%[16.9%-21.6%](2020年10月-2021年2月),降幅不显著。更好的准备工作(几率比=1.383 [1.025-1.866])、将住院患者限制在房间内(OR=1.616 [1.212-2.155])、是否有执业护士(OR=0.761 [0.591-0.981])以及人员短缺(OR=0.684 [0.527-0.888])与住院患者的疼痛有关:AL 组织环境因素与住院患者疼痛有关。政策和管理干预措施可以而且必须解决这些因素,从而为改善 AL 居民的护理质量提供潜在的有力杠杆。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.10
自引率
2.50%
发文量
168
审稿时长
4-8 weeks
期刊介绍: The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.
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