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Journal of the American Geriatrics Society v.65 no.1, 2017년, pp.59 - 65   SCI SCIE SSCI
본 등재정보는 저널의 등재정보를 참고하여 보여주는 베타서비스로 정확한 논문의 등재여부는 등재기관에 확인하시기 바랍니다.

Informed Family Member Involvement to Improve the Quality of Dementia Care in Nursing Homes

Tjia, Jennifer (Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts ); Lemay, Celeste A. ( School of Nursing, Northeastern University, Boston, Massachusetts ); Bonner, Alice ( Healthcare Management Solutions, LLC, La Vergne, Tennessee ); Compher, Christina ( Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts ); Paice, Kelli ( Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts ); Field, Terry ( Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts ); Mazor, Kathleen ( Division of Epidemiology, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts ); Hunnicutt, Jacob N. ( Division of Epidemiology, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts ); Lapane, Kate L. ( Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts ); Gurwitz, Jerry ( );
  • 초록  

    Objectives To describe the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. Design Mixed‐methods study based on semistructured interviews. Setting U.S. nursing homes (N = 20) from five CMS regions (III, IV, VI, VIII, IX). Participants Family members of nursing home residents (N = 41). Measurements Family member responses to closed‐ and open‐ended questions regarding involvement in resident care and antipsychotic initiation. Two researchers used a content analytical approach to code open responses to themes of family involvement in behavior management, decision‐making, knowledge of risks and benefits, and informed consent. Results Fifty‐four percent of family members felt highly involved in decisions about behavior management. Forty‐two percent recalled being asked how to manage resident behavior without medication, and 17% recalled receipt of information about antipsychotic risks and benefits. Sixty‐six percent felt highly involved in the process of initiating antipsychotic medication; 24% reported being asked for input into the antipsychotic initiation decision and knowing before the antipsychotic was started. Conclusion Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40% of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process. Interventions that standardize family engagement and promote adherence to existing federal regulations are needed. This discussion builds on these findings to weigh the policy options of greater enforcement of existing regulations versus enactment of new legislation to address this challenging issue.


  • 주제어

    nursing home .   dementia .   antipsychotics .   family involvement .   off‐label.  

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