The goal of Golden Living’s Organized Research Unit (ORU) is to support clinicians through conduct of health-related research, specifically Health-Services Research (HSR) using pragmatic methods and “real-world” data. An important distinction between HSR and other types of health-related research is its concentration on populations. The population of focus for Golden Living’s ORU is older adults with multiple chronic conditions that receive care across the continuum of post-acute settings. Because HSR is a multidisciplinary field of scientific investigation that requires many resources to conduct, our mission is made possible through collaboration and support from all departments/business lines in the Golden Living family, as well as partnerships with external institutions.
Collaborative Mission: To improve the well-being of the senior population by advancing clinical knowledge and practices in post-acute care through health-services research in the fields of medicine, pharmacy, nursing, rehabilitation, and wellness.
The Instrumented Test of Sensory Integration for Balance: A Validation Study
PI/PD: Freeman (Golden Living ORU); Oregon Health and Sciences University (OR)
Increased postural sway associated with aging and degenerative disease is a common indication of postural dysfunction and fall risk which makes objective testing in these areas important. Unfortunately, “gold standard” measures of sway such as SOT are importable and can be costly and complicated to use, thus are often unavailable in post-acute settings. In a study of community-dwelling older adults with known balance deficits, we compared sway measured with SOT to a novel system of portable body-worn movement monitors. We found that instrumenting the mCTSIB improved scale of measure from ordinal to ratio, thus test precision, which allowed clinicians’ to quantify sway with accuracy similar to SOT. We also found that compared to SOT, the instrumented mCTSIB may be better able to differentiate between fallers and non-fallers. READ MORE
Falls, balance, and health related quality of life in older adults
PI/PD: C. Henderson (Aegis DOR); Eastern Washington University (WA)
Role: PI/PD and Study Site
Health-Related Quality of Life is an important area for therapists to assess and may be indicative of poor balance and fall risk. Researchers found that all physical aspects of the SF-36 Health-Related Quality of Life survey were highly correlated with fall risk classification and balance performance on several outcome measures commonly used by physical therapists. Assessment of Health-Related Quality of Life is an important element of a comprehensive assessment of the older adult, and low scores may be representative of poor balance and greater fall risk. Study results based on data from Riverview Retirement Community in WA when under contract with Aegis Therapies. READ MORE
Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults
PI/PD: Insight Therapeutics, Brown University (RI) and (Western Reserve University (OH)
Role: Study Site
Sponsor: Sanofi Pasteur
Seasonal influenza has been shown to cause an average of 36,000 deaths and 226,000 hospitalizations per year in the USA. Compared with a standard-dose vaccine, a high-dose flu vaccine (IIV3-HD) improves antibody responses to influenza among older adults. In a study of 15,991 participants from the USA and Canada, research found that IIV3-HD induced significantly higher antibody responses and provided better protection against laboratory-confirmed influenza illness than did standard-dose vaccine. Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults
Analysis of pilot data show relationship between gains in rehab and self-performance/burden of care
L. Freeman and M. Yao (Golden Living ORU)
Measurement and reporting health outcomes is essential in the evolution of post-acute health care systems. Aggregate data from health assessment systems can be used to inform important decisions regarding service use and best practices. Both the ROM and the MDS are instruments designed to measure functional ability, and both have been used widely with older persons in post-acute care. Comparative information on their properties can help clinicians assess the potential applications of the two instruments. In 2014, we analyzed a data sample of ROM scores from Aegis Therapies’ and MDS data from Golden Living Centers to test relationships and evaluate institutional capacity and readiness to successfully conduct research using our own large datasets. READ MORE
Relationship between MDS 3.0 and rehab outcomes
L. Freeman and M. Yao (Golden Living ORU), University Texas Medical Branch Galveston (TX)
Sponsor: NIH- Center for Rehabilitation Research Using Large Datasets
To further evaluate the clinometric properties of the Rehabilitation Outcome Measure instrument and to explore the extent to which rehab gains are associated with functional performance and burden of care as measured by the Minimal Data Set 3.0.
Worldwide Clinical Trials, NIH – National Institute on Drug Abuse
Sponsor: US Worldwide, LLC
To investigate the efficacy, safety, and dose-response of lofexidine (2.4mg or 3.2 mg per day) in reducing withdrawal signs and symptoms and facilitating completion of detoxification/extending treatment retention in subjects undergoing detoxification from short-acting opiods in a double-blind inpatient setting (Days -17) followed by an open-label inpatient/outpatient setting (Days 8-14). The Investigator hypothesizes that subjects will achieve maximum treatment effect with tolerable side effects at the 3.2 mg total daily dose and that both the 3.2 mg and 2.4 total daily doses will show better efficacy over placebo in treating symptoms of acute opioid withdrawal.
Balancing a Model of Care with Rehabilitation and Prevention Services
L. Freeman and S. Ochoa (Aegis GPS), Galeon Retirement Community (MN)
Sponsor: Minnesota State, Community Service/Service Delivery grant
To expand rehab and wellness services for older adults that allow rural communities to rebalance their long-term service delivery system, support aging in place, and promote independence. With support from Aegis, Galeon proposed to implement and evaluate the impact of evidence-based specialty programs across post-acute care and community settings. Specifically, FTF for high intensity strength training, GEM for condition and recovery phase-specific electrophysical agents, bioDensity™ for high intensity osteogenic loading and Tai Chi for functional mobility. This sponsored project is led by Galeon of Osakis in MN, an Aegis Therapies customer.
▌Health-Service Related LITERATURE
Medicine and Pharmacy
Variations in the treatment culture of nursing homes and responses to regulations to reduce drug use
Efforts to reduce unnecessary use of antipsychotic drugs in nursing centers have been a regulatory focus for nearly 20 years that has resulted in many evidence-based practice strategies, as recently presented by Dr. Mary Evans Presents
. However, there is limited health-services research on the influence of organizational factors such as patient-care models or treatment cultures. In a large multicenter SNF trial, researchers proposed that reductions would be greater in centers with an organizational culture of managing dementia and mental illness which is compatible with regulations, such as resident-centered care models. They found that Organizational greater reductions in use of antipsychotic drugs were found in facilities with a resident-centered culture, a less severe case mix, and a higher nurse-to-resident staffing ratio. READ MORE
Effects of skilled nursing facility structure and process factors on medication errors during nursing home admission
Health Care Management Review
Medication errors contribute to 1.5 million adverse drug events annually, approximately half of which require hospitalization were for individuals 65 years or older. Researchers examined facility-reported medication errors and potential medication errors that occurred during the 7-day transition period for residents entering or reentering a SNF. “Chain affiliation was associated with a reduction in the volume of errors during the transition period” and may be related to processes and mechanisms such as training mandates, nurse staffing levels, standardized medication review systems, risk management reviews resulting in practice changes, and error reporting cultures. READ MORE
Palliative and Hospice
Geriatric rehabilitation for patients with advanced COPD
International Journal of Palliative Nursing
There are several peer-reviewed research studies that show rehabilitation can improve quality of life. Similarly, the importantance of improving quality of life in palliative and hospice care is well established. But is there evidence to support the role of rehab in palliative care? There is a growing need for disease-specific geriatric rehabilitation programs worldwide, including conditions associated with progressive organ failure such as chronic obstructive COPD. The authors developed and implemented a post-acute geriatric rehabilitation and palliative care program in a SNF for patients with advanced COPD that included interventions provided by PT, OT, and SLP. ‘These case studies show that a geriatric rehabilitation COPD programme can offer substantial benefits and can integrate aspects of rehabilitation and palliative care.’ READ MORE
Rehabilitation and Wellness
Intensive treatment of dysarthria secondary to stroke
Clinical Linguistics & Phonetics
Among the more than 5 million people in the USA who have survived a stroke, it is estimated that between 20% and 40% have some type of dysarthria that alters perceptual characteristics of speech and may interfere with speech intelligibility. In this phase I experimental study, authors examined the treatment effects, magnitude of change (if present), and treatment feasibility for people with dysarthria secondary to stroke. Four participants, ranging in age from 50 to 74 years that were 9 months or more post stroke and had dysarthria, completed the study. Using Lee Silverman Voice Treatment (LSVT® LOUD), the authors found statistically significant improvements in vocal decibels of sound pressure level (dB SPL) and phonatory stability as well as larger vowel space area. READ MORE
Abstracts of work submitted/pending/accepted for publication are provided. Full text of manuscripts (research) or white papers (analyses) are provided ONLY when made available from lead author and/or through open access by the journal.
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