When healthcare workers remotely monitor residents with dementia in nursing homes, it works, according to a new study. The team found that remote monitoring — with some on-site help — can help them avoid injuries. It’s a safe, feasible way to help people with dementia in long-term care communities avoid falls, the authors say.
The report was published in the Journal of the American Geriatrics Society.
Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls.
“Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study,” authors said. NH PRIDE stands for Nursing Home PRevention of Injury in DEmentia program.
The study included healthcare staff members and residents at five long-term care communities. Researchers identified which residents were at a high risk for falls that could cause injuries. In total, there were 46 people enrolled in the program (out of an initial 274 who were eligible). Of the residents studied, 73.9% were female, and 63% had dementia.
A remote team looked at electronic health records and gave recommendations for injury prevention plans, or IPPs. Staff completed IPPs for 45 residents. On-site, a research nurse coordinated care and engaged residents as well as educating them to facilitate shared decision-making. The team measured outcomes with surveys, medical records and interviews with staff members.
Upon examining the data, the nurse suggested 93 medications be prescribed in 36 of the residents. (A total of 80% of the residents had one or more deprescribing recommendation.) Of the 45 participants, the nurse recommended osteoporosis treatment for 20 of them.
Four months after the study started, most people adhered to the medication changes that were recommended, and adverse side effects were rare.
The deprescribing intervention was unique in that it was led by a nurse with interprofessional support. Medication reviews in a nursing home are usually led by pharmacists with shared decision-making left to busy providers; but in the NH PRIDE model, the nurse communicated with staff before making recommendations on medication, letting the staff participate in the decisions.
During the study, staff members found several ways to improve the program including communicating with psychiatrists and aligning suggestions into the provider workflow.
Though they want to see more research to see if this can reduce falls throughout nursing home chains, they say the program can help people with dementia avoid injuries.
