Better Nursing Homes

August 28, 2012 Written by JP    [Font too small?]

Improving the quality of care that seniors receive in nursing homes is a passion of mine. In my experience, I’ve found that the most practical way of accomplishing this goal is by forming a strategic partnership between the nursing home staff, residents (and their families) and treating physicians. Evidence-based solutions form the common link between each of the three integral parts of the aforementioned team.

There is absolutely no question in my mind that a holistic approach to senior care is the way of the future. As proof, here are several techniques from recent studies that can and should be implemented in nursing homes worldwide. For starters, short bouts of foot massage (10 minutes/daily) is a safe and simple approach that improves various indices of wellbeing in nursing home residents. Reductions in dementia related agitation, pain and stress hormones have been evidenced after the periodic application of reflexology, a form of foot massage involving the manipulation of acupressure points. The addition of scheduled leisure activities such as listening to enjoyable music and/or playing Mah-Jongg, a Chinese game of skill that is similar to Gin Rummy, are clinically documented as improving mood in seniors with depressive symptoms. And, last but not least, sleep quality in elderly residents can be significantly bolstered by offering access to thrice-weekly Tai Chi exercise classes.

Inadequate nutrition remains a major concern in nursing homes throughout the world. Even the most expensive senior care establishments often underestimate the value of optimal nutrient intake. The August 2012 edition of the journal Maturitas provides a topical example by revealing that many elderly patients possess insufficient levels of Vitamin D. When adequate Vitamin D status is established, via intramuscular injections or supplementation, improvements in muscle strength and physical performance were noted. Vitamin B12 is another nutrient which is frequently lacking in older men and women. What’s more, undetected B12 deficiency can mimic common symptoms associated with old age such as depression, lightheadedness and memory loss. Fortunately, providing seniors with high-potency multivitamins containing Vitamins B12 and D typically addresses overt deficiencies. For this reason, I recommend the use of specially tailored multivitamin/mineral supplements for those residing in assisted living or nursing home environments. In addition, I’m happy to assist any senior health care providers with guidance about formulating or selecting dietary supplements for their unique clientele.

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Reflexology Versus Swedish Massage to Reduce Physiologic Stress (link)

Study 2 – Exploring the Effect of Foot Massage on Agitated Behaviors in Older(link)

Study 3 – Leisure Activities Alleviate Depressive Symptoms in Nursing Home (link)

Study 4 – Effects of Music on Depression in Older People: A Randomised (link)

Study 5 – The Effect of Tai Chi Exercise on the Sleep Quality of the Elderly (link)

Study 6 – Efficacy and Safety of High Dose Intramuscular or Oral Cholecalciferol (link)

Study 7 – Vitamin B12 deficiency in Australian Residential Aged Care Facilities (link)

Multivitamins May Slow Biological Aging By Preserving Telomere Length

Source: Am J Clin Nutr. 2009 Jun;89(6):1857-63. (link)

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Posted in Alternative Therapies, Nutrition, Nutritional Supplements

6 Comments & Updates to “Better Nursing Homes”

  1. Nick Pahl Says:

    The British Acupuncture Council has just produced a toolkit for its members on working with care homes. Acupuncture provides a substantial contribution to the healthcare of the UK, with an estimated 4 million sessions provided annually.

    Acupuncture provides evidenced based care and support to care home residents that can improve their health and wellbeing for a variety of conditions, for example for residents suffering with musculoskeletal pain, NICE Guideline C88 supports the use of acupuncture for lower back pain. According to this guideline, acupuncture is significantly better than standard/best medical care.

    Some members of the British Acupuncture Council (BAcC) are already working within the care home environment and the BAcC’s 3000 members are keen to bridge the gap between traditional acupuncture and the care sector.

    We believe that combining our strengths can improve the quality of life for care home residents and provide a cost effective solution to driving up quality standards in the care home environment

  2. JP Says:

    Thank you, Nick.

    Anyone interested in learning more about the information referenced by Mr. Pahl can click on the following link:

    Be well!


  3. JP Says:

    Update 04/29/15:

    BMC Geriatr. 2014 Sep 19;14:103.

    Efficacy of daily 800 IU vitamin D supplementation in reaching vitamin D sufficiency in nursing home residents: cross-sectional patient file study.

    BACKGROUND: The Dutch Health Council advises a standard daily vitamin D supplementation of 800 IU (20 mcg) for persons aged ≥ 70 years, with a target 25(OH)D serum concentration of ≥ 50 nmol/l. This recommendation is in line with advice from the Institute of Medicine (IOM) (2011) and the Expert Working Group on vitamin D (2012). A target 25(OH)D serum concentration of ≥ 75 nmol/l is also recommended in the literature. It is unknown whether this advice, initially designed for healthy adults/elderly, will lead to vitamin D sufficiency in the large majority of nursing home residents, taking into account the frailty of this population.

    METHODS: Cross-sectional patient file study. Participants were 71 psychogeriatric nursing home residents (25 males, 46 females) with a mean age of 83 (SD 7) years using cholecalciferol capsules (5600 IU) once a week, or cholecalciferol drops (50,000 IU/ml) 3 drops a week (7500 IU), for at least 3 months. Main outcome measure was serum 25(OH)D level after supplementation.

    RESULTS: Of all participants, 19 used cholecaliferol drops and 52 used cholecaliferol capsules. In total, mean serum 25(OH)D was 77 (SD 30) nmol/L and 55 residents (78%) were vitamin D sufficient. Among capsule users, mean serum 25(OH)D was 90 (SD 22) nmol/L and 49 (94%) were vitamin D sufficient. Among users of drops, mean serum 25(OH)D was 41 (SD 8) nmol/L and 6 (32%) were vitamin D sufficient.

    CONCLUSION: In most of these residents, vitamin D supplementation once a week with cholecalciferol capsules containing 5600 IU (equivalent to 800 IU daily) resulted in vitamin D sufficiency (serum 25(OH)D ≥ 50 nmol/L). When choosing a vitamin D preparation for routine supplementation in nursing home residents it should be noted that major differences may exist in efficacy, even when the various preparations contain the same amount of vitamin D.

    Be well!


  4. JP Says:

    Update 04/29/15:

    BMC Complement Altern Med. 2014 Aug 23;14:311.

    A relaxation technique enhances psychological well-being and immune parameters in elderly people from a nursing home: a randomized controlled study.

    BACKGROUND: The aging process involves a decline in immune functioning that renders elderly people more vulnerable to disease. In residential programs for the aged, it is vital to diminish their risk of disease, promote their independence, and augment their psychological well-being and quality of life.

    METHODS: We performed a randomized controlled study, evaluating the ability of a relaxation technique based on Benson’s relaxation response to enhance psychological well-being and modulate the immune parameters of elderly people living in a geriatric residence when compared to a waitlist control group. The study included a 2-week intervention period and a 3-month follow-up period. The main outcome variables were psychological well-being and quality of life, biomedical variables, immune changes from the pre-treatment to post-treatment and follow-up periods.

    RESULTS: Our findings reveal significant differences between the experimental and control groups in CD19, CD71, CD97, CD134, and CD137 lymphocyte subpopulations at the end of treatment. Furthermore, there was a decrease in negative affect, psychological discomfort, and symptom perception in the treatment group, which increased participants’ quality of life scores at the three-month follow-up.

    CONCLUSIONS: This study represents a first approach to the application of a passive relaxation technique in residential programs for the elderly. The method appears to be effective in enhancing psychological well-being and modulating immune activity in a group of elderly people. This relaxation technique could be considered an option for achieving health benefits with a low cost for residential programs, but further studies using this technique in larger samples of older people are needed to confirm the trends observed in the present study.

    Be well!


  5. JP Says:

    Updated 12/16/18:

    Int J Environ Res Public Health. 2018 Dec 7;15(12).

    The Effects of Tai Chi on Heart Rate Variability in Older Chinese Individuals with Depression.

    Background: Very little research has been done to simultaneously investigate the effects of Tai Chi (TC) on depression and heart rate variability (HRV). This study, therefore, attempted to explore the effects of TC on depression and on HRV parameters.

    Methods: Sixty older individuals with depression score of 10 or above (the Geriatric Depression Scale, GDS) were randomly assigned into two groups: TC (n = 30) and control group (n = 30). Participants in the experimental group participated in a 24-week TC training program (three 60-min sessions per week), whereas individuals in the control group maintained their unaltered lifestyle. Depression and HRV were measured using the GDS and digital electrocardiogram at baseline and after the 24-week intervention.

    Results: The TC had produced significant positive chances in depression and some HRV parameters (mean heart rate, RMSSD, HF, LFnorm, and HFnorm) (p < 0.05), whereas these positive results were not observed in the control group. Conclusions: The results of this study indicated that TC may alleviate depression of the elderly through modulating autonomous nervous system or HRV parameters. This study adds to a growing body of research showing that TC may be effective in treating depression of the elderly. Tai Chi as a mild to moderate mind-body exercise is suitable for older individuals who suffer from depression. Be well! JP

  6. JP Says:

    Updated 01/12/19:

    Soc Work Health Care. 2019 Jan 10:1-15.

    Positive effects of art therapy on depression and self-esteem of older adults in nursing homes.

    Depression and self-esteem affects the health and quality of life of older adults who live in nursing homes. This study tested the effectiveness of art therapy activities on reducing the depression and improving the self-esteem of elderly living in long-term care institutes. This was a quasi-experimental study. A purposive sampling strategy was used to select 55 subjects who were aged 65 and above with intact mental functions and depression tendencies and currently residing in nursing homes in Kaohsiung, Taiwan. 29 subjects who participated in a selection of 12 artistic activities were assigned to the experimental group and 26 subjects who adhered to their ordinary activities were allocated to the control group. Structured questionnaires of the artistic group were used for data collection. The art therapy programs showed promising effects in improving the depression and self-esteem of older adults living in nursing homes. Art therapy activities benefit the mental health of older adults. Incorporating artistic activities into social work care may help develop long-term care into a more diverse, unique, and innovative direction.

    Be well!


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