Chunfeng Huang

Analyses of nursing home residents in hospice care using the Minimum Data Set

Objective: To present comprehensive profiles of residents in hospice care at admission to the nursing home using the Minimum Data Set (MDS). Design and Setting: We analysed 40,622 MDS admission assessments for nursing home residents in hospice care. The MDS contains resident-focused data on pain, cognitive patterns, physical function, disease diagnoses, medications, nutrition, and specific treatments received. Results: About four in five recently admitted hospice residents had ‘do not resuscitate’ orders and only 27% had a living will. Over 70% of recently admitted hospice residents experienced pain, with almost one half experiencing daily pain. Over one half of those hospice residents in pain experienced moderate pain and almost one third experienced horrible or excruciating pain. About 57% of recently admitted hospice patients had cancer, 21% had congestive heart failure, 20% had emphysema/chronic obstructive pulmonary disease, and 18% had depression. About one in two recently admitted hospice residents exhibited at least moderate impairment in cognitive function. Conclusions: There is a need to improve pain management, advanced directives, and mental health services for residents dying in nursing homes.

Profiles of nursing home residents with multiple sclerosis using the minimum data set

This paper profiles nursing home residents with multiple sclerosis (MS) at the time of admission, including sociodemographic characteristics, health status measures, and treatments received. Admission assessments from the Minimum Data Set are used to create these profiles of residents with MS. There are 9013 admission assessments in the MDS for residents with MS between June 22, 1998 and January 17, 2000 analyzed for this study. Residents with MS are distinctly younger at admission than most nursing home residents, averaging 57.98 years of age. Recently admitted residents with MS are more physically dependent than other nursing home residents and tend to have limited range of motion and loss of voluntary movement. About one in three newly admitted residents with MS had some degree of impaired cognitive function. Over one third of residents with MS were depressed at admission, yet only 11.7% of recently admitted residents with MS were evaluated by a licensed mental health specialist. This prompts concern about the psychosocial well-being of MS residents in nursing homes.

Caregiver burden among informal caregivers assisting people with multiple sclerosis.

Multiple sclerosis (MS) burdens not only patients but also their informal or family caregivers. This study was conducted to identify characteristics of caregivers, caregiving, and MS patients receiving informal care that are associated with caregiving burden. Data were collected through a national survey of informal MS caregivers and analyzed using an ordered logistic regression model to identify factors associated with burden. Burden was found to be significantly greater among male caregivers than among female caregivers. Moreover, greater burden was associated with more frequent patient bladder dysfunction, more hours per week spent providing assistance, and greater restriction on the caregivers ability to perform daily activities because of caregiving responsibilities. A strong association was found between the mental health status of the caregiver and burden. Health professionals should be sensitive to the impact of caregiving on the mental health of MS caregivers. The results of this study suggest that treating patient bladder dysfunction and facilitating respite care may reduce burden and improve the mental health of informal caregivers of people with MS. Future research should identify programs and services designed specifically to reduce burden experienced by male caregivers.

Profiles of nursing home residents with HIV.

Nursing homes are part of the long-term care continuum available to people with advanced HIV disease. The objective of this paper is to profile nursing home residents with HIV at fa time of admission, using the Minimum Data Set (MDS). These resident profiles contain sociodemographic characteristics, health status measures, and special treatments and procedures. There are 5,115 admission assessments in the MDS for residents with HIV between June 22, 1998, and January 17, 2000, analyzed for this study. Newly admitted nursing residents with HIV are predominantly male (69.4 percent) and minority (75.4 percent black and Hispanic), relatively young (44.45 years), and heavily Medicaid dependent (70.5 percent). These residents are typically clinically complex and receive a range of special treatments, procedures, and programs. Nursing home residents with HIV are a distinct subset of nursing home residents, largely dependent on the state Medicaid programs to pay for their care.

Caregiver perceptions of accomplishment from assisting people with multiple sclerosis

Objectives: Identify factors of informal caregivers, caregiving, and people with multiple sclerosis (MS) receiving assistance that are associated with perceptions of caregiver accomplishment. Methods: National data were collected in a telephone interview survey of 530 informal caregivers and analyzed using an ordered logistic regression model to identify factors associated with perceptions of caregiver accomplishment among 442 of these informal caregivers (caregivers providing all data in their survey responses needed for the regression model). Results: We found that age of the person with MS and duration of caregiving measured by the number of hours per week the caregiver assisted the person with MS were significantly linked to positive perceptions of accomplishment. Conversely, the caregiver’s perception that assisting the person with MS was emotionally draining, a spousal relationship, and caregiver education levels were significantly associated with negative perceptions of accomplishment. Conclusions: Health professionals treating people with MS and their caregivers should be sensitive to the impact caregiving has on the emotional needs of caregivers and to the unique support needs of spousal caregivers. Health practitioners also should be sensitive to the variety of benefit-finding themes expressed by caregivers to facilitate the caregivers’ efforts to discover gains in their experiences assisting people with MS, such as perceptions that caregiving provides a sense of accomplishment. Implications for Rehabilitation Assistance from informal caregivers enables people with multiple sclerosis to remain in their homes as their functional dependence becomes more permanent and their need for personal assistance increases. Caregiver perceptions that assisting the person with multiple sclerosis was emotionally draining and a spousal relationship were significantly associated with negative perceptions of accomplishment. Health professionals who treat informal caregivers, as well as health professionals treating people with multiple sclerosis, should be sensitive to the impact care giving has on the emotional health of caregivers, especially spousal caregivers.

Health-Related Quality of Life Among Young Adults with Multiple Sclerosis

Multiple sclerosis (MS) is an unpredictable disease that can have physical, psychological, and social impacts, reducing health-related quality of life (HRQOL). The objective of this study was to identify factors associated with HRQOL among young adults with MS. Survey data were collected from 100 people with MS aged 18 to 31 years, with 93 participants providing all data needed for analyses of our regression models. The survey cohort was recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry (now the NARCOMS/Global Patient Registry). Multiple linear regression models were used to analyze the data, with the Physical Component Summary and the Mental Component Summary of the 8-item Short Form Health Status Survey serving as dependent variables. Independent variables were other survey responses, including demographic, disease, and treatment characteristics. The results indicated that full-time employment, relapsing-remitting course of MS, and satisfaction with access to ...

Informal Caregivers Assisting People with Multiple Sclerosis: Factors Associated with the Strength of the Caregiver/Care Recipient Relationship

The objective of this study was to identify characteristics of informal caregivers, caregiving, and people with multiple sclerosis (MS) receiving this assistance that are associated with the strength of the care-giver/care recipient relationship. Data were collected in a national survey of informal caregivers and analyzed using an ordered logistic regression model to identify factors associated with caregiver perceptions of the strength of the relationship with the person with MS. The overall health of the person with MS was significantly associated with caregiver perceptions that providing assistance strengthened the caregiver/care recipient relationship, with poor health having a negative impact on the relationship. A spousal relationship between the caregiver and the person with MS was associated with significantly lower perceptions of a strengthened relationship. Conversely, caregiver perceptions that MS symptoms interfered with the independence of the person with MS in daily life were associated with caregiver perceptions of a strengthened relationship. Longer duration of caregiving and more hours per week spent providing assistance also were associated with a stronger relationship. In contrast, we found a significant negative association between caregiver perceptions that assisting the person with MS was burdensome and the strength of the relationship. Similarly, higher levels of education among caregivers tended to have a significantly negative impact on the caregiver/care recipient relationship. Our findings highlight the importance of addressing the needs and concerns of spousal caregivers. Health professionals who treat informal caregivers, as well as those treating people with MS, should be sensitive to the impact caregiving has on caregivers, especially spouses providing assistance.

Factors Affecting Employment Among Informal Caregivers Assisting People with Multiple Sclerosis

The objective of this study was to identify characteristics of informal caregivers, caregiving, and the people with multiple sclerosis (MS) receiving assistance that are associated with reduced caregiver employment. Data were collected during telephone interviews with 530 MS caregivers, including 215 employed caregivers, with these survey data analyzed using logistic regression. Poorer cognitive ability by the care recipient to make decisions about daily tasks and more caregiving hours per week predicted reduced caregiver employment. Better physical health domains of caregiver quality of life were associated with significantly lower odds of reduced employment. Health professionals treating informal caregivers, as well as those treating people with MS, need to be aware of respite, support, and intervention programs available to MS caregivers and refer them to these programs, which could reduce the negative impact of caregiving on employment.

Analyses of nursing home residents with HIV and dementia using the minimum data set.

Objective: The objective of this paper is to profile nursing home residents with HIV who also have dementia at the time of admission, using the Minimum Data Set (MDS). In addition, this paper compares HIV residents with dementia with other residents with HIV. These resident profiles contain sociodemographic characteristics, health status measures, treatments, and procedures. Study subjects: There are 1,074 admission assessments for HIV residents with dementia and 4,040 admission assessments for other residents with HIV in the MDS between June 22, 1998 and January 17, 2000; these were analyzed for this study. Results: Other residents with HIV were twice as likely to be physically independent as HIV residents with dementia. Only 1 of 5 HIV residents with dementia was independent in cognitive skills for daily decision making compared with 3 of 5 other residents with HIV who were independent in these skills. Significantly greater percentages of HIV residents with dementia also had anemia, depression, schizophrenia, cognitive and memory problems, hepatitis, renal failure, and cancer than other residents with HIV. Conclusions: These analyses demonstrate that HIV residents with dementia were significantly more likely to have other diseases, infections, and health care conditions than other residents with HIV.

Nursing Home Residents with HIV and Anemia

This research profiles nursing home residents who have human immunodeficiency virus (HIV) and anemia at the time of admission, utilizing the minimum data set (MDS). In addition, this article compares residents with HIV and anemia to other nursing home residents with HIV. These resident profiles include sociodemographic characteristics, health status measures, and special treatments and procedures received. This study analyzed 1,281 admission assessments for HIV residents with anemia and 3,832 admission assessments for other residents with HIV in the MDS between June 22, 1998 and January 17, 2000. A significantly greater percentage of HIV residents with anemia were female (38.6%) compared to other residents with HIV (27.9% female). Almost two-thirds of HIV residents with anemia and three-quarters of other residents with HIV received Medicaid coverage at the time of their admission to the nursing home. Approximately 3 of every 4 residents with HIV and anemia and other residents with HIV were from racial/ethnic minority groups. Significantly greater percentages of residents with HIV and anemia also had dementia, depression, pneumonia, hepatitis, renal failure, anxiety disorder, and cancer than other residents with HIV. These analyses demonstrate that at the time of admission to the nursing home, those residents with HIV and anemia were significantly more likely to have other diseases, infections, and health care conditions than other residents with HIV. In addition, HIV residents with anemia were significantly more likely to receive special treatments and procedures in the nursing home than other residents with HIV.