Conventional wastewater treatment systems are not designed to remove pharmaceutical compounds from wastewater. These compounds can be degraded into many other transformation products which are ...hardly, if at all, studied. In this context, we studied the occurrence and degradation of furosemide, a very frequently detected diuretic, along with its known degradation products in several types of wastewater. Influent and effluent from the Seine-Centre Wastewater Treatment Plant (WWTP) (Paris, France) as well as outlet of residential care homes (Dordogne, France) were analyzed by Ultra-Performance Liquid Chromatography-tandem Mass Spectrometry (UPLC-MS/MS) to quantify furosemide and its known degradation products, saluamine and pyridinium of furosemide. Oxidation experiments (chlorination, ozonation and UV photolysis with hydrogen peroxide) were then performed on furosemide solutions and on water from residential care facilities to study the degradation of furosemide by potential advanced processes, and also to identify unknown oxidation products by high-resolution mass spectrometry. Furosemide was well degraded in Seine-Centre WWTP (>75%) but did not increase the concentrations of its main degradation products. Saluamine and pyridinium of furosemide were already present at similar concentrations to furosemide in the raw wastewater (∼2.5–3.5 μg.L−1), and their removal in the WWTPs were very high (>80%). Despite their removal, the three compounds remained present in treated wastewater effluents at concentrations of hundreds of nanograms per liter. Chlorination degraded furosemide without pyridinium production unlike the other two processes. Chlorination and ozonation were also effective for the removal of furosemide and pyridinium in residential care home water, but they resulted in the production of saluamine. To our knowledge this is the first evidence of saluamine and pyridinium of furosemide in real water samples in either the particulate or dissolved phase.
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•Pyridinium of furosemide and saluamine were quantified for the first time in wastewater samples.•Seine-Centre WWTP shows a good removal of furosemide and its degradation products.•Ozonation and chlorination completely degrade furosemide but may produce saluamine.•New chlorination and UV/H2O2 degradation products of furosemide were identified.
The aim of this study was to contribute with knowledge about how a sense of home and belonging is enacted and can be supported in everyday life, with a particular focus on the relationships that ...connect everyday life and the environment in nursing home contexts. The concepts ‘a sense of home’ and ‘belonging’ were chosen with the ambition to grasp values grounded in experiences and everyday practices, with an openness for various aspects that can support an enjoyable life and comfort for nursing home residents. The study focused on communal areas, e.g. dining room, kitchen, corridors and gardens, that serve as arenas where nursing home residents’ everyday lives expand beyond the private room. Ethnographic methods were applied to identify and explore situations where a sense of home and belonging were enacted in nursing homes that had been acknowledged as good examples of nursing home environments. Through the analytic process, four qualities were identified: (a) a cornerstone for stability and everydayness, (b) the beating heart, (c) spatial dynamics, and (d) magnetic places. Following from the chosen methodology, the findings provide a situated understanding of how communal areas in nursing homes can invite a sense of home and belonging for the residents.
Carbapenemase-producing Enterobacteriaceae (CPE) are an important and increasing threat to public health. In hospitals and long-term care facilities, carriers should be identified to prevent ...transmission; however, guidelines for infection control are not applicable to all types of care homes.
To report the outbreak investigation of a VIM-metallo-β-lactamase-producing Escherichia coli in a Dutch residential care home, where residents lived in private apartments but also used shared facilities.
Contact and environmental screening rounds were performed to assess carriage and colonization rates. Due to the domestic characteristics of the home, customized infection control measures were needed. A bundle of interventions was implemented, including contact precautions, improved hygiene and education.
In total, eight CPE carriers, including the index case, were identified among 110 residents. VIM-CPE spread was associated with the use of shared toilets in communal areas. Seven months after the first finding, all carriers were found to be VIM-negative, and after 1 year, VIM CPE was no longer detectable in the environment.
A customized bundled approach was needed to control the outbreak successfully. Current guidelines should be adapted to be suitable for all types of residential care homes in order to combat the spread of multi-resistant pathogens effectively.
Background
While it is well established that frail older people have a higher risk of negative health outcomes, the prevalence of frailty and its associated factors in Italian older institutionalized ...population has never been investigated.
Aims
The aims of this study were to assess the prevalence of frailty and to identify its associated factors in an Italian residential care home population.
Methods
An observational cross-sectional study was designed to evaluate older people aged 70 or over of an Italian residential care home. A multidimensional assessment examining functional, geriatric, ophthalmic, and audiological domains was carried out to identify factors associated with frailty. Physical frailty was evaluated using Fried’s criteria.
Results
Data analysis uncovered a 51.1% prevalence of pre-frailty and a 40.4% prevalence of frailty in the 94 eligible participants (64 females) whose data were complete. The multivariable analysis showed that a low education level (OR = 5.12, 95% CI 1.22–21.49), a low physical quality of life score (OR = 13.25, 95% CI 3.51–50.08), a low mental quality of life score (OR = 9.22, 95% CI 2.38–35.69), visual impairment (OR = 7.65, 95% CI 1.77–33.14), and hearing impairment (OR = 4.62, 95% CI 1.03–20.66) were independently associated with frailty.
Conclusions
Frailty was found to be highly prevalent in the residential care home studied. Since frailty is a reversible condition, identifying the modifiable factors associated to it should be viewed as an important step in planning and implementing targeted, early prevention strategies.
Background:
A growing number of informal caregivers (IFCs) manage hospice patients’ anxiety by administering lorazepam (Ativan), yet little is known about prescribing practices in home care or the ...extent to which IFCs carry out regimens.
Design and Methods:
Data on hospice prescribed lorazepam was determined through a retrospective review of medication records from 216 deceased patients. The dose of lorazepam and type of regimen (i.e., scheduled, PRN, combination) as well as frequency with which it was administered by IFCs was calculated upon admission to a residential care home and on patients’ day of death.
Results:
The majority (63.1%) of patients were prescribed lorazepam on admission to the home, and more (79.5%) were prescribed lorazepam on the day of death. While higher doses of lorazepam were prescribed and administered on the day of death, the percentage of medication consumed was low on admission (17%) and day of death (27%). Nearly all (92.8%) prescribed lorazepam on the day of death were allowed PRN medication. For PRN only regimens, less than a quarter (24.4%) of patients were given lorazepam on admission with less than half (40.4%) given it while dying. Highest lorazepam administration rates (91.2%) occurred on the day of death when lorazepam was prescribed under a combined regimen.
Conclusion:
The high frequency of PRN regimens reveal that IFCs are frequently tasked with making decisions about if and when to administer lorazepam. Low overall lorazepam administration suggests a closer monitoring of lorazepam use and enhanced support of IFCs may be needed.
Background
Most prefer to die at home, but the Medicare Hospice Benefit does not cover custodial care, making it difficult for terminally ill patients with housing insecurity and/or caregiver ...instability to access hospice care at home.
Objectives
To examine the characteristics of patients who received end-of-life care in community-run, residential care homes (RCHs) operating under the social model hospice.
Methods
A retrospective chart review of 500 residents who were admitted to one of three RCHs in Upstate New York over a 15-year period (2004-2019).
Results
Patients served by the RCHs included 318 (63.6%) women and 182 (36.4%) men aged 34-101 (M = 77.8). The majority (94.9%) were Caucasian and most had cancer diagnoses (71.6%). Prior to admission, most (93%) patients resided in a private residence, and nearly half (47%) lived alone, but most (81.7%) had full- or part-time caregivers. Nearly all patients were admitted either directly from a hospital (47.5%) or private home (47.2%). Over half (52%) were admitted to RCHs within a month of hospice enrollment, and 20.1% enrolled concurrent with admission. While the average length of stay was 21 days, 50% died within 10 days of admission.
Conclusions
Community-run RCHs represent a unique approach for improving access to hospice home care for patients with home insecurity and/or caregiver instability, yet most patients had prior caregiver coverage and were admitted from a hospital or home setting, suggesting there is a need for community care settings for patients unable to remain at home in the final weeks or days prior to death.
Music is of vital importance for cognition, human care, and the formation of social communities throughout life. Dementia is a neurocognitive disorder that affects cognitive domains, and in ...late-stage dementia, care is needed in all aspects of daily living. Within residential care home contexts, carers play a significant role for the "caring culture" but often lack professional training in verbal and non-verbal communication skills. Thus, there is a need for training carers to respond to the multidimensional needs of persons with dementia. Music therapists use musical interactions but are not trained to train carers. Therefore, our aim was to explore person-attuned musical interactions (PAMI), and additionally, to develop and evaluate a training manual to be used by music therapists when supporting and training carers in non-verbal communication with persons with late-stage dementia in residential care home contexts.
With a realist perspective and systems thinking and within the framework for complex intervention research, the research group integrated several overlapping subprojects by applying a non-linear and iterative research process. Core elements related to person-centered dementia care as well as learning objectives were considered through the following four phases; Developing, Feasibility, Evaluation, and Implementation.
The result was a training manual for qualified music therapists to use when teaching and collaborating with carers about how to implement PAMI in dementia care. The manual included comprehensive resources, a clear structure for training, defined learning objectives, and integration of theory.
With increased knowledge about caring values and non-verbal communication, residential care home cultures may develop carer competencies and provide professional attuned care for persons with dementia. Further piloting and testing to examine the general effect on caring cultures is needed.
Systematic reviews have shown the effectiveness of music in reducing the behavioural and psychological symptoms of dementia (BPSD). Effects of active (i.e. singing) compared to receptive (including ...vibroacoustic therapy) individual music therapy methods for specific BPSD/dementia sub-types are unclear, for example, that receptive methods (i.e. vibroacoustic therapy) increase parasympathetic responses and active music therapy improves cognitive and emotional functioning.
A three-armed pragmatic randomised controlled trial will be conducted with German care home residents with dementia. Residents (N = 75) randomly assigned to the two intervention groups (individual active music therapy or individual vibroacoustic therapy) will receive two sessions/week for six weeks plus standard care. The control group will receive only standard care during data collection. The Neuropsychiatric Inventory-Nursing Home will assess BPSD; secondary outcomes include depression, quality of life, activities of daily living, health economy and musical engagement. Outcomes are measured at baseline, post-intervention (6 weeks), and 12-weeks post randomisation. MMSE is used as a screening measure. We hypothesise that individual active music therapy and individual vibroacoustic therapy will reduce BPSD significantly more than standard care. Secondary hypo-theses are increased quality of life and musical engagement and decreased depressivity and health resource usage.
A greater relaxation response is expected in the receptive arm due to the massage-like vibration. Increased cognitive clarity and reduced depression are expected in the active arm. The trial is registered with the German Clinical Trials Register (DRKS00023233).
This article comprises a sociological analysis of how architects imagine the ageing body when designing residential care homes for later life and the extent to which they engage empathetically with ...users. Drawing on interviews with architectural professionals based in the United Kingdom, we offer insight into the ways in which architects envisage the bodies of those who they anticipate will populate their buildings. Deploying the notions of ‘body work’ and ‘the body multiple’, our analysis reveals how architects imagined a variety of bodies in nuanced ways. These imagined bodies emerge as they talked through the practicalities of the design process. Moreover, their conceptions of bodies were also permeated by prevailing ideologies of caring: although we found that they sought to resist dominant discourses of ageing, they nevertheless reproduced these discourses. Architects’ constructions of bodies are complicated by the collaborative nature of the design process, where we find an incessant juggling between the competing demands of multiple stakeholders, each of whom anticipate other imagined bodies and seek to shape the design of buildings to meet their requirements. Our findings extend a nascent sociological literature on architecture and social care by revealing how architects participate in the shaping of care for later life as ‘body workers’, but also how their empathic aspirations can be muted by other imperatives driving the marketisation of care.
Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a ...service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.
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