• Klíčová slova
• NURSING HOMES/statistics *,
• MeSH
• domovy pro seniory * MeSH
• hospitalizace * MeSH
• lidé MeSH
• pečovatelské domovy statistika a číselné údaje   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: The objectives of this study were to describe the prevalence of diabetes mellitus (DM) in European nursing homes (NHs), and the health and functional characteristics of diabetic residents (DMR) aged 60 years and older. DESIGN: Between 2009 and 2011, the Services and Health for Elderly in Long TERm care (SHELTER) project, a 12-month prospective cohort study, was conducted to assess NH residents across different health care systems in 7 European countries and Israel. METHODS: The study included 59 NHs in 8 countries with a total of 4037 residents living in or admitted to a NH during the 3-month enrollment period. The multidimensional InterRAI instrument for Long-Term Care Facilities (InterRAI-LTCF) was used to assess health and functional status among residents. Descriptive statistics and linear, ordinal, and logistic regression were used to perform the analyses. RESULTS: We found a 21.8% prevalence of DM among NH residents. Residents with DM (DMRs) were significantly younger compared with non-DMRs (82.3, SD ± 7.7; 84.6, SD ± 8.4; P < .001). DMRs were more frequently overweight or obese, and presented more often with ischemic heart disease, congestive heart failure, hypertension, and stroke than residents without DM. DMRs also took more drugs, had pressure ulcers (PU) or other wounds more often, and more frequently had urinary incontinence (UI); they also reported worse self-perceived health. DM independently of other factors increased risk of PU occurrence (odds ratio 1.38; 95% confidence interval [CI] 1.02-1.86; P = .036) and decreased probability of higher pain scores (B = -0.28; 95% CI -0.41 to -0.14; P < .001). DM was not associated with ADL dependency, cognitive impairment, and depression in NH residents. CONCLUSION: Prevalence of DM in European NH residents is comparable to US national NH surveys, and to UK and German NH data based on glucose-level testing. DMRs compared with non-DMRs have more comorbid conditions, and a particularly higher incidence of cardiovascular diseases and obesity, PU, and severe UI. DMRs should be regarded as a specific group of residents who require an interdisciplinary approach in medical and nursing care.

• Klíčová slova
• Diabetes mellitus, nursing home, older adults,
• MeSH
• diabetes mellitus diagnóza   epidemiologie   MeSH
• dlouhodobá péče MeSH
• domovy pro seniory * MeSH
• geriatrické hodnocení MeSH
• kohortové studie MeSH
• komplikace diabetu diagnóza   epidemiologie   MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lineární modely MeSH
• logistické modely MeSH
• míra přežití MeSH
• multivariační analýza MeSH
• neparametrická statistika MeSH
• pečovatelské domovy * MeSH
• prevalence MeSH
• prognóza MeSH
• prospektivní studie MeSH
• rozložení podle pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• věkové rozložení MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

OBJECTIVES: According to published reports from the WHO, health care is undergoing a transformation that reflects the increasing importance of community care based on social, group, and individual needs. Community health care is provided by multidisciplinary teams, with nurses occupying irreplaceable positions. Nurse competencies constitute significant potential in the area of community based preventive care as well as the more traditional roles in treatment and recovery. METHODS: Data was obtained from health care professionals and the public through a structured interview. The study population included 1,007 physicians, 1,005 nurses and 2,022 laypersons. Respondents were selected randomly with the aid of quotas. The parameters for the selection of health care workers (nurses and physicians) were constructed based on registration data from the Institute of Health Information and Statistics. Layperson selection was based on data from the Czech Statistical Office. The Statistical Analysis of Social Data program (version 1.4.4) was used to process the data, which was in the form of 1st and 2nd degree contingency tables. The dependence level was determined based on χ2 and other testing criteria (according to the character of the signs). RESULTS: The results show that respondents perceive the concept of a "community nurse" as a nurse working independently in local neighborhoods and communities. Results also showed that work in senior care, followed by home care, and care for chronically ill patients were the most preferred. A role for nurses in health care education centers was only supported by 13.1% of physicians, 13.8% of nurses, and 6.8% of laypersons. The results also reveal that community nursing is perceived by both health care professionals and laypersons as fieldwork (i.e. work not based in a hospital or clinic environment), yet, at the same time, it was perceived as work that dealt with people needing health care. The results also reflect the opinion that the establishment of an independent nurse in the workplace (in the form of preventive care) could lead to an increase in the quality of care for employees (65.7% of physicians and 70.8% of nurses), an improvement in workplace health education (33% of physicians and 34.7% of nurses) and would provide support for healthy work environments (31.4% of physicians and 30.4% of nurses). CONCLUSION: Our results lead us to conclude that the health care system in the Czech Republic needs to better utilize the potential of trained nurses in the field of community health care. Additionally, steps need to be taken to increase job opportunities and staffing for nurses wanting to work in community health and preventive care.

• MeSH
• dospělí MeSH
• komunitní lékařství metody   MeSH
• komunitní ošetřovatelská péče metody   MeSH
• lékaři MeSH
• lidé středního věku MeSH
• lidé MeSH
• personál sesterský MeSH
• preventivní lékařství metody   MeSH
• role ošetřovatelky * MeSH
• služby preventivní péče metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVE: To evaluate the effect of a dance-based therapy on depressive symptoms among institutionalized older adults. DESIGN: Randomized controlled trial. SETTING: Nursing homes. PARTICIPANTS: Older adults (60 years or older) permanently living in a nursing home. INTERVENTION: Exercise Dance for Seniors (EXDASE) Program designed for the use in long-term care settings performed once a week for 60 minutes for 3 months. MEASUREMENTS: Baseline measures included sociodemographic characteristics, ability to perform basic as well as instrumental activities of daily living, basic mobility, self-rated health, and cognitive status. Outcome measures were collected before and after the intervention and included assessment of depressive symptoms using the geriatric depression scale (GDS). RESULTS: Comparison of participants with MMSE of 15 or higher showed that GDS scores in the intervention group significantly improved (P = .005), whereas the control group had a trend of further worsening of depressive symptoms (P = .081). GLM analysis documented highly statistically significant effect of dance therapy (P = .001) that was not influenced by controlling for intake of antidepressants and nursing home location. Dance therapy may have decreased depressive symptoms even in participants with MMSE lower than 15 and resulted in more discontinuations and fewer prescriptions of antidepressants in the intervention group than in the control group. CONCLUSION: This study provides evidence that dance-based exercise can reduce the amount of depressive symptoms in nursing home residents. In general, this form of exercise seems to be very suitable and beneficial for this population.

• Klíčová slova
• Dance therapy, depressive symptoms, nursing home,
• MeSH
• deprese terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pečovatelské domovy * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• socioekonomické faktory MeSH
• tanec * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Fecal incontinence (FI) is a significant health problem among the elderly, with a devastating effect on their quality of life. The aim of the present study was to describe the prevalence and severity of FI among nursing home residents, and to investigate factors associated with FI. METHODS: This was a cross-sectional study conducted in nursing homes in Ostrava, Czech Republic. Demographics and comorbidities were extracted from medical records of nursing homes. Data regarding incontinence were obtained via face-to-face interviews with residents or extracted from registered nurses' accounts (regarding residents with severe cognitive impairment). RESULTS: In total, 588 nursing home residents were enrolled into the study. FI was noted in 336 (57.1%) participating residents. The majority of FI residents (57.8%) reported FI episodes several times a week; daily FI episodes were found in 22.9% of the FI residents. The mean Cleveland Clinic Incontinence Score in FI residents was 17.2±1.8 (mean±SD). Factors associated with FI (statistically significant) were poor general health status (≥4 comorbidities), urinary incontinence, cognitive-function impairment (dementia), decreased mobility, and length of nursing home residency. There was no association between FI and age, sex, body mass index, or living with/without a partner. CONCLUSIONS: Our data indicate that FI is still a serious health problem-FI currently affects more than half of the nursing home residents in Ostrava, Czech Republic. The study outcomes (revealed high prevalence and seriousness of FI) emphasize the importance of close monitoring and appropriately managing FI in nursing home residents.

• Klíčová slova
• Fecal incontinence *, Institutionalized persons *, Nursing home resident *, Prevalence *, Risk factors *,
• MeSH
• domovy pro seniory statistika a číselné údaje   MeSH
• fekální inkontinence epidemiologie   MeSH
• kognitivní poruchy epidemiologie   MeSH
• komorbidita MeSH
• kvalita života MeSH
• lidé MeSH
• pečovatelské domovy statistika a číselné údaje   MeSH
• prevalence MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zdravotní stav MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

OBJECTIVES: Drugs with anticholinergic properties are associated with an increased prevalence of delirium, especially in older persons. The aim of this study was to evaluate the association between the use of this class of drugs in nursing home (NH) patients and prevalence of delirium, particularly in people with dementia. DESIGN: Cross-sectional multicenter study. SETTING AND PARTICIPANTS: 3924 nursing home patients of 57 nursing homes in 7 European countries participating in the Services and Health for Elderly in Long TERmcare (SHELTER) project. METHODS: Descriptive statistics, calculation of percentage, and multivariable logistic analysis were applied to describe the relationship between anticholinergic drug use and prevalence of delirium in NH patients. The Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB) were used to calculate the anticholinergic load. RESULTS: 54% of patients with dementia and 60% without dementia received at least 1 anticholinergic drug according to the ACB. The prevalence of delirium was higher in the dementia group (21%) compared with the nondementia group (11%). Overall, anticholinergic burden according to the ACB and ARS was associated with delirium both in patients with and without dementia, with odds ratios ranging from 1.07 [95% confidence interval (CI) 0.94-1.21] to 1.26 (95% CI 1.11-1.44). These associations reached statistical significance only in the group of patients with dementia. Among patients with dementia, delirium prevalence increased only modestly with increasing anticholinergic burden according to the ACB, from 20% (with none or minimal anticholinergic burden) to 25% (with moderate burden) and 27% delirium (with strong burden scores). CONCLUSIONS AND IMPLICATIONS: The ACB scale is relatively capable to detect anticholinergic side effects, which are positively associated with prevalence of delirium in NH patients. Given the modest nature of this association, strong recommendations are currently not warranted, and more longitudinal studies are needed.

• Klíčová slova
• Delirium, anticholinergic medications, dementia, nursing home patients,
• MeSH
• cholinergní antagonisté škodlivé účinky   MeSH
• delirium * chemicky indukované   epidemiologie   MeSH
• demence * farmakoterapie   epidemiologie   MeSH
• hospitalizace MeSH
• léčivé přípravky * MeSH
• lidé MeSH
• pečovatelské domovy MeSH
• průřezové studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• cholinergní antagonisté MeSH
• léčivé přípravky * MeSH

The objective of our study was to examine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among residents of nursing homes for the elderly of selected institutions in two Slovak regions compared to non-institutionalized volunteers of the same age, as well as young volunteers (20-24 years old). Nasal swabs from all participants (n = 424) were processed using standard methods for the isolation and identification of S. aureus and MRSA. Statistically significant differences were found between nursing home residents and young volunteers (12% vs. 1.5%; OR 8.85; 95% CI 2.087-37.706; p = 0.0007), as well as between non-institutionalized seniors and young volunteers (11% vs. 1.5%; OR 8; 95% CI 1.888-33.901; p = 0.005) in the prevalence of MRSA. Our results suggest that nursing home residency and older age could be a risk factor for the occurrence of high-risk MRSA strains.

• Klíčová slova
• MRSA, S. aureus, elderly,
• MeSH
• dospělí MeSH
• lidé MeSH
• methicilin rezistentní Staphylococcus aureus * MeSH
• mladý dospělý MeSH
• pečovatelské domovy MeSH
• prevalence MeSH
• rizikové faktory MeSH
• senioři MeSH
• stafylokokové infekce * epidemiologie   MeSH
• Staphylococcus aureus MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika epidemiologie   MeSH

OBJECTIVE: The aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less. METHODS AND DEIGN: The study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment. RESULTS: Among the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions. CONCLUSIONS: This study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.

• Klíčová slova
• Adverse effects, Cognitive impairment, End-of-life, Nursing home residents, Potentially inappropriate medications,
• MeSH
• domovy pro seniory MeSH
• křehký senior MeSH
• lidé středního věku MeSH
• lidé MeSH
• nevhodné předepisování statistika a číselné údaje   MeSH
• pečovatelské domovy * MeSH
• prevalence MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• seznam potenciálně nevhodných léčiv * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Německo epidemiologie   MeSH

BACKGROUND: Benzodiazepines (BZDs) and Z-drugs have high potential for developing frequent adverse drug events in older adults (e.g., psychomotor sedation, drug-related dementia, deliria, drug dependence, etc.). Knowledge of the prevalence and patterns of the use of BZDs/Z-drugs in vulnerable older patients is important in order to prevent and reduce the burden caused by their drug-related complications. Our study focused on international comparisons of the prevalence, country-specific prescribing patterns and risk factors of regular BZD/Z-drug use in nursing home (NH) residents. METHODS: This cross-sectional study retrospectively analysed data of 4156 NH residents, prospectively assessed in the Services and Health in the Elderly in Long TERm care (SHELTER) project conducted from 2009 to 2014. Residents aged 65+ in 57 NHs in 7 European countries and Israel were assessed by the InterRAI Long-Term Care Facilities instrument. Descriptive statistics and multiple logistic regression models were used to describe the country-specific prevalence, patterns and risk factors of BZD/Z-drug use. RESULTS: The mean age of the participants was 83.4 ± 9.4 years, 73% were female and 27.7% used BZDs/Z-drugs. The prevalence of BZD/Z-drug use differed significantly across countries, ranging from 44.1% in Israel to 14.5% in Germany. The most frequently prescribed were zopiclone (17.8%), lorazepam (17.1%) and oxazepam (16.3%). Lorazepam, oxazepam and diazepam were used in most of the countries. Brotizolam, temazepam and zolpidem showed highest prevalence in Israel (99.4% of all regular users of this medication in the sample), the Netherlands (72.6%) and France (50.0%), respectively. Residing in Israel was the most significant factor associated with the use of BZDs/Z-drugs or BZDs only (odds ratio [OR] 6.7; 95% confidence interval [CI] 4.8-9.2 and OR 9.7, 95%CI 6.5-14.5, respectively). The use of Z-drugs only was most significantly associated with residing in France (OR 21.0, 95%CI 9.0-48.9). CONCLUSIONS: Despite global recommendations and warnings, the preference for and extent of use of individual BZDs and Z-drugs in vulnerable NH residents differ significantly across countries. The strong association with country of residence compared to clinical and functional factors denotes that prescribing habits, social, cultural, behavioural, and regulatory factors still play an important role in the current diverse use of these medications.

• Klíčová slova
• Aged, Benzodiazepines, Europe, Israel, Nursing homes, Z-drugs,
• MeSH
• benzodiazepiny * MeSH
• léčivé přípravky * MeSH
• lidé MeSH
• pečovatelské domovy MeSH
• prevalence MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Francie MeSH
• Izrael epidemiologie   MeSH
• Německo MeSH
• Nizozemsko MeSH
• Názvy látek
• benzodiazepiny * MeSH
• léčivé přípravky * MeSH

This study was conducted to examine differences between self- and proxy ratings of activities in daily living (ADL) in nursing home residents and to compare them with actual performance. An impact of cognitive status on these ratings was also determined. Data were obtained from 164 dyads of nursing home residents (self-ratings) and their professional care providers (proxy ratings). Statistical procedures included t tests, intraclass correlations, Pearson's correlations, analysis of variance (ANOVA) and ROC curves. Paired t test provided evidence that residents in general overestimated their abilities for all ADLs (p < .01 in all cases), but a substantial subset of 54 residents, with mean MMSE of 18, agreed with their care providers. The mean MMSE score of those who overestimated their abilities was 13 (N = 57). The ANOVA revealed that greater rating differences were associated with more severe cognitive impairment (MMSE, F = 9.93, p < .001). Proxy ratings of walking were not significantly different from actual performances (p = .145), while self-ratings overestimated it (p < .001). Although residents in general overestimated their ADL abilities and results of comparison with actual performance indicated that proxies may be closer to the actual status in this population, a considerable number of those with milder cognitive impairment were able to assess their ADLs with reasonable accuracy.

• Klíčová slova
• ADL, Agreement, Differences, Nursing home residents, Proxy reports, Self-reports,
• Publikační typ
• časopisecké články MeSH