Portland, Ore.

Oregon Health & Science University School of Nursing researchers hope to improve care for older adults in rural assisted-living facilities with two grants totaling $400,000.

This research is particularly important now because assisted living is the fastest growing group residential setting for frail, older people in the United States.

One grant will focus on medication safety for residents in eight rural assisted-living settings. Adverse drug reactions affect both quality of life and health care costs. Residents in assisted living are at risk for adverse drug events because of their advanced age, frailty and their use of high risk medications, said Heather Young, Ph.D., G.N.P., F.A.A.N, Grace Phelps Distinguished Professor, OHSU School of Nursing, Ashland, and the study’s principal investigator. The co-investigators are Juliana Cartwright, Ph.D., R.N., associate professor, OHSU School of Nursing, Ashland Campus, and Suzanne Sikma, Ph.D., R.N., associate professor and a postdoctoral fellow, OHSU School of Nursing, faculty member with the John A. Hartford Center for Geriatric Nursing Excellence and associate professor, University of Washington, Bothell. Young and Cartwright are also faculty members of the Hartford Center at OHSU.

The research will be conducted during the next two years in Ashland, Klamath Falls, Grants Pass and Bandon in Oregon; and in Lynden, Port Angeles, Poulsbo and Port Townsend in Washington. The specific aim of the study is to identify communication structures and processes in assisted-living facilities that potentially promote or impede medication safety with the goal of developing approaches to improve the quality of medication management for assisted-living residents.

The other two-year grant is designed to address end-of-life care for older people in assisted-living facilities.

“Older people prefer to die at home, and more than 95 percent of people moving into assisted-living facilities believe they will be able to remain in their assisted-living homes until they die. In two earlier studies, I observed and talked with residents and their families about their experiences, concerns and desires around being able to die ‘at home’ in their assisted-living apartment. This new study examines how hospice nurses and the nurses and caregivers in assisted-living facilities can work together to support 'good deaths' in these settings. Understanding how and why people die is as important as knowing why people die,” said Cartwright, principal investigator on this study. Lois Miller, Ph.D., R.N., associate professor and a member of the OHSU John A. Hartford Foundation Center for Geriatric Nursing Excellence, is co-investigator. Both are faculty members at the OHSU School of Nursing, Ashland Campus.

Up to 50 hospice nurses, assisted-living facility nurses, and assisted-living facility caregivers will be interviewed to learn about their experiences and perspectives in how end-of-life care happens in these settings, including what are the barriers to providing good care, and what could improve the quality of the care. Hospices and assisted-living facilities in Portland and Klamath Falls are participating in the study.

Both of these research studies are important to a growing number of people. The number of older adults living in ALFs more than doubled between 1998 and 2002 to 11,850, and more than half of assisted-living residents are in rural communities. More older Oregonians reside in assisted-living facilities than any other group residential setting, including nursing homes.

Oregon is an especially ideal state for conducting these studies. Oregon has the longest history of assisted-living facilities in the country and thus a longer history of their residents facing the challenges of dying in this setting. The concept of assisted-living facilities as a housing option for older adults was developed first in Oregon in 1981.

The National Institute of Nursing Research funded both grants.

 

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