Research paper
Comparison of care dependency and related nursing care problems between Austrian nursing home residents with and without dementia

https://doi.org/10.1016/j.eurger.2014.04.015Get rights and content

Abstract

Objective

Demographic developments have led to increased chronic diseases, such as dementia, which result in care dependency and nursing care problems like incontinence. This study aims to compare the degree of care dependency and the prevalence of nursing care problems between Austrian nursing home residents with and without dementia.

Methods

Since 2009 a cross-sectional study has been conducted annually in Austrian nursing homes. Data from the standardized questionnaire sampling 2155 residents with and 1422 residents without dementia between 2009 and 2012 have been analysed.

Results

Seventy-two percent of residents with dementia compared to 45.5% of residents without dementia are completely or to a great extent care dependent, with the highest care dependency being in hygiene, continence, (un)dressing and avoiding danger. Residents with dementia have a significantly higher prevalence of urinary incontinence (87.9% vs. 69.5%), fecal incontinence (68.2% vs. 44.5%), double incontinence (64.8% vs. 36.1%), restraints (33.5% vs. 22.4%), malnutrition (27.9% vs. 18.4%) and falls (9.9% vs. 7.0%). No significant difference was found for pressure ulcers (5.2% vs. 6.5%).

Conclusion

Residents with dementia have a significantly higher degree of care dependency than residents without dementia and they also have, except for pressure ulcers, a significantly higher prevalence of nursing care problems. These results should increase awareness among health care professionals of areas requiring target-oriented dementia care. Further research should explore care dependency and nursing care problems in different stages of dementia and compare the development of care dependency and nursing care problems among residents with and without dementia.

Introduction

Demographic developments and improved health care have led to an increasingly aging population [1], [2]. By the year 2050, nearly 2 billion people worldwide will be 60 or older, with the fastest growing age group being 80+ [2]. These developments will lead to a higher demand for long-term care, e.g. in nursing homes [3], [4], [5], because (chronic) diseases, like dementia, increase with age [1], [6], [7]. In nursing homes internationally, more than 50% of residents suffer from dementia [7], [8], [9].

Fig. 1 shows the development and definition of care dependency and nursing care problems. Besides care dependency, this study focuses on the nursing care problems of malnutrition, incontinence, pressure ulcers, falls and restraints, because people with dementia are at risk of developing these problems [10], [11], [12] and the problems themselves are important quality indicators for nursing homes [8], [13], [14], [15]. Care dependency and nursing care problems can induce negative consequences like reduced quality of life, high health care costs and higher mortality [8], [16], [17], [18], [19]. Adequate care interventions can reduce, stabilize and perhaps even prevent (e.g. prevention of pressure ulcers in dementia residents) care dependency and/or nursing care problems [8], [20], [21]. This is why statistical data is integral to adequate care, as it provides institutions with an overview of the extent of care dependency and nursing care problems suffered by their residents. These data help health care professionals to consciously introduce changes into their daily practice that will improve quality of care [8], [22].

In the international literature, (care) dependency remains a rarely studied and highly neglected topic [15], [23]. From population-based studies, we know that the worldwide prevalence of dependency (professional and/or non-professional care) in people over 60 is 13% [15] and from a few studies, we know that the prevalence of care dependency in nursing home residents with dementia ranges from 28–83% [24]. However, we have very limited information regarding the comparison of the degree of care dependency between nursing home residents with and without dementia [24]. The same applies for studies comparing the prevalence of malnutrition, incontinence, pressure ulcers, falls and restraints between residents with and without dementia [24], because most studies tend to take all nursing home residents into account [14], [25], [26]. This is why the results from the studies conducted only insinuate that care dependency and nursing care problems may be higher in residents with dementia [24].

In general, we know from the literature that dementia leads to a gradual cognitive, functional and behavioural decline [12], [15] and that it is the strongest independent contributor to care dependency [15]. Therefore, it could follow that residents with dementia are more care dependent than those without and that they may have a higher prevalence of nursing care problems; but it is not enough to assume this, it must be confirmed and visualised with data. It is important to compare care dependency and nursing care problems between residents with and without dementia in order to better understand residents with dementia [24]. Their improved care also requires demonstrating the extent of these differences and consequently exploring which nursing care problems and human needs (e.g. eating and drinking, social contact) are most important for them [24]. Such information can improve target-oriented care and priority identification for intervention studies.

The International Prevalence Measurement of Care Problems survey has the potential to provide insight into the quality of nursing care on national and international levels. It does so by measuring the degree of care dependency and the prevalence, prevention and treatment of nursing care problems (pressure ulcers, incontinence, malnutrition, intertrigo, falls, restraints) as well as by measuring the availability of structural quality indicators (e.g. guidelines) using a standardized and comprehensive questionnaire [22]. The survey is conducted annually on one day in different healthcare settings (e.g. nursing homes, hospitals) in the Netherlands (since 1998), Austria, Germany, Switzerland and New Zealand [22]. The first survey in Austria was issued in 2009.

This study aims to show the results from the Austrian survey obtained by comparing the degree of care dependency and the prevalence of related nursing care problems between Austrian residents with and without dementia. The research questions are: (1) How care dependent are Austrian nursing home residents with dementia compared to residents without dementia? (2) How prevalent are the nursing care problems of pressure ulcers, incontinence, malnutrition, falls and restraints in Austrian nursing home residents with dementia compared to residents without dementia?

Section snippets

Design

The Austrian Prevalence Measurement of Care Problems survey [8] as part of the International Prevalence Measurement of Care Problems survey is a cross-sectional, multi-centre point prevalence study conducted annually in Austria [22]. This study analysed the data from Austrian nursing homes between 2009 and 2012 (4 measurement points).

Setting and sample

Of the 877 nursing homes in Austria, 467 have > 50 beds [27]. A convenience sampling was performed for this study. Every year (2009–2012) all Austrian nursing homes

Results

From 2009 to 2012, 24 of the 467 Austrian nursing homes with 50+ beds took part in the Austrian Prevalence Measurement of Care Problems survey. All in all 3577 (79.8%) residents participated in the study. Two thousands, one hundred and fifty-five (60.2%) of these residents had a medical diagnosis of dementia.

Table 1 shows the basic characteristics of the sample. Residents with dementia are older and they have more women in the sample than residents without dementia. The prevalence of

Discussion

This study conducted in Austrian nursing homes aimed to compare the degree of care dependency and the prevalence of related nursing care problems between residents with and without dementia. With respect to the first research question, results demonstrate that residents with dementia have a higher degree of care dependency than residents without dementia (more residents with dementia are completely care dependent: 37.4% vs. 15.8%), which confirmed study results by Guo et al. [32] and reported

Conclusion

Residents with dementia are more care dependent than residents without dementia and they have, except for pressure ulcers, a higher prevalence of nursing care problems. The high degree of care dependency and prevalence of the assessed nursing care problems, especially in residents with dementia, depict the fact that these quality indicators are still important issues in nursing homes and that there is room for improvement. On the basis of the results, maximizing the independence of residents

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Acknowledgements

Special thanks to all participating nursing homes, caregivers and residents.

Ethical statement: for this study ethical approval from the Medical University of Graz, Austria ethics committee was obtained. Written informed consent was acquired from each resident or their legal representatives. The authors guarantee that privacy has been strictly respected, and that no personal details are disclosed in the manuscript.

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