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Background: Older people with diabetes who live at home and receive home care services (HCS) are vulnerable, which may result in a need for more care than the HCS can provide. In this study we aimed to explore associations between pharmacologically treated diabetes and the risk of short-term and long-term nursing home stays (NHS) among older people receiving HCS. Methods: This nationwide registry study included older people ≥ 65 years receiving HCS, as registered in the Norwegian Information System for the Nursing and Care Sector (IPLOS) (2010–2014). Data from IPLOS were merged with data from the Norwegian Prescription Database and the Norwegian Patient Registry. Pharmacologically treated diabetes (hereafter referred to as diabetes) was defined based on prescriptions of glucose-lowering drugs (GLD) (≥ 1 prescription in the current or previous year). Persons not prescribed GLD were defined as not having diabetes. Based on Anatomical Therapeutic Chemical (ATC) codes we identified the following subgroups: persons without diabetes, persons using "non-insulin GLD only", "insulin and non-insulin GLD" and "insulin only". An NHS was defined as at least one stay during a given calendar year, where a short-term NHS is temporary, and a long-term NHS is permanent. Log-binomial regression was used to test for differences in NHS and results are reported as risk ratios (RR) with 95% CIs. Results: Both insulin-treated subgroups had a higher risk of a short-term NHS ("insulin only" users RR 1.06 (CI 1.03–1.09) and "insulin and non-insulin GLD" users RR 1.04 (CI 1.02–1.06)) compared to those without diabetes. In general, persons with diabetes had a lower risk of a long-term NHS than those without diabetes (RR 0.92 (CI 0.89–0.94)). The subgroup using "insulin and non-insulin GLD" had the lowest risk of a long-term NHS (RR 0.86 (CI 0.81–0.91)). Conclusion: Despite a lower risk of a long-term NHS among older people with diabetes, we found an increased risk of a short-term NHS among persons with insulin-treated diabetes who live at home and receive HCS. This calls for attention when planning health care, in order to provide coordinated and individualized care to prevent short-term NHS's. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic presented unprecedented challenges for residential care homes for older people. However, the obstacles they faced and their resilience strategies have received insufficient research attention. This study, focusing on 13 residential care homes in Southeast China, addressed this research gap. The homes were visited between February and March 2023; 38 staff members (managers, nurses, social workers, and care workers) were interviewed. Thematic analysis revealed that the homes faced multidimensional challenges, including infection risks, declining mental health among residents, heavy workloads, and financial difficulties. Despite these challenges, they exhibited organizational resilience, primarily in their ability to cope with immediate issues during the pandemic, although their capacity to anticipate and adapt was weak. Factors influencing organizational resilience included their knowledge base, critical resources, a stable team with high morale and motivation, better integration of healthcare services, and government anti-COVID policies. This research highlights valuable insights for improving the quality of care in residential care homes in the post-pandemic era and in aiding policymakers and administrators in strengthening the organizational resilience of residential care homes in future crises. [ABSTRACT FROM AUTHOR]

Background: There is little knowledge about home care services personnel competencies and beliefs concerning oral healthcare for home-dwelling, dependent older adults. This study aims to map oral healthcare beliefs among home care services personnel, and have the following question: How do the education level, years of work experience and training in oral health have impact on home care services personnel oral healthcare beliefs? Methods: A cross-sectional study among home care services personnel working with older people receiving home care services was conducted across four municipalities in south-eastern Norway. The questionnaire consisted of background information (gender, education level, years of work experience, training in oral healthcare, employment status) and the nursing Dental Coping Beliefs scale. Ethics approval for this study was obtained from the Norwegian Centre for Research Data. Results: Two hundred and sixty-two homecare services personnel responded to the questionnaire, 16.5% males and 83.5% females; 40.5% had had training in oral healthcare. Home care services personnel believed that gum diseases and cavities can be prevented by dental flossing (61.4%) and toothbrushing (98.4%). 59% disagreed that preventing sickness and medicines from destroying teeth is impossible. However, the majority of the home care services personnel were uncertain about how oral mucosal disorders can be treated. Having more than three years of higher education was positively associated with being in higher quartiles of oral healthcare beliefs, and external locus of control, and having training in oral healthcare was positively associated with being in the lower quartiles of internal locus of control and self-efficacy dimensions. Males were more likely to be in the lower quartile of oral healthcare beliefs, which wasn't positive. Conclusion: In the population studied, the home care services personnel beliefs about oral healthcare improved with an increasing level of education and having had training in oral healthcare. This suggests that home care services personnel need more education and training in oral healthcare. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To explore the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality for frail compared with non‐frail individuals following their first assessment by an aged care assessment team (ACAT) for a government‐funded home care package.The study involved people aged 65 years and over who completed their first ACAT assessment in 2013 and were followed for up to 36 months. Frail and non‐frail study participants were matched through caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression estimated the impact of frailty on PRAC admission and mortality rates. Healthcare costs, encompassing hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use, from ACAT assessment to end of follow‐up, PRAC entry or death were summarized monthly by frailty status.13 315 non‐frail controls were matched with up to three frail individuals (52 678 total). Frail individuals experienced higher mortality (incidence rate ratio [IRR] = 1.76; 95% confidence interval [CI] 1.70–1.83) and greater likelihood of entering PRAC (IRR = 1.73; 95% CI 1.67–1.79) compared with non‐frail individuals. Total healthcare costs over the 3‐year post‐assessment period for 39 363 frail individuals were $1 277 659 900, compared with expected costs of $885 322 522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual (mean = $457, SD = 3192) was hospital admissions ($345; 75%).Frailty is associated with higher rates of mortality and of entering PRAC, and excess costs of frailty are substantial and sustained over time. These findings emphasize the potential economic value of providing home care for older people before they become frail. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

The state plays an increasingly crucial role in providing home care as an aging population leads to mounting care needs. The public care system in the United States delivers home care and compensation for care work through an increasingly bureaucratic mode of governance featuring task-list enumeration, documentation, professional supervision, and exacting surveillance. The process adopts a rigid functional approach to define, measure, and regulate care that creates tension with home care's relational, fluid, and person-centered dimensions. Through the concept of "care bureaucracy," this Article describes the status quo disciplinary bureaucracy governing public home care, analyzes its political economy context, including its origin in poverty law, and lays out its benefits and profound costs. The care bureaucracy not only burdens care workers and families needing care with unpaid, invasive, and bureaucratic work, but also deters participation and stifles the provision of home care, threatening the state's capacity to adequately deliver the promised quality care. The Article also proposes an alternative way to govern public home care by drawing from the Department of Veterans Affairs' caregiver programs for veterans with service-related disabilities. This Article makes two contributions to legal scholarship on care and the state. First, this Article explores the tension between public responsibility and the autonomy of families and workers in a mundane form of family regulation--a disciplinary bureaucracy--in the public home care system. The care bureaucracy imposes a not-so-punitive and yet highly omnipresent regulation of the users' family, workplace, and bodily autonomy by micro-managing their physical movements inside homes. Second, it establishes the political-economy connection between the bureaucratization and fragmentation of public home care. In analyzing the status quo political economy of the care bureaucracy, this Article provides a roadmap to reform the public care system into one more responsive to the growing care needs. [ABSTRACT FROM AUTHOR]

Background: Respiratory tract infections are readily transmitted in care homes. Airborne transmission of pathogens causing respiratory tract illness is largely unmitigated. Portable high-efficiency-particulate-air (HEPA) filtration units capture microbial particles from the air, but it is unclear whether this is sufficient to reduce infections in care home residents. The Air Filtration to prevent symptomatic winter Respiratory Infections (including COVID-19) in care homes (AFRI-c) randomized controlled trial will determine whether using HEPA filtration units reduces respiratory infection episodes in care home residents. Methods: AFRI-c is a cluster randomized controlled trial that will be delivered in residential care homes for older people in England. Ninety-one care homes will be randomised to take part for one winter period. The intervention care homes will receive HEPA filtration units for use in communal areas and private bedrooms. Normal infection control measures will continue in all care homes. Anonymised daily data on symptoms will be collected for up to 30 residents. Ten to 12 of these residents will be invited to consent to a primary care medical notes review and (in intervention homes) to having an air filter switched on in their private room. The primary outcome will be number of symptomatic winter respiratory infection episodes. Secondary outcomes include specific clinical measures of infection, number of falls / near falls, number of laboratory confirmed infections, hospitalisations, staff sickness and cost-effectiveness. A mixed methods process evaluation will assess intervention acceptability and implementation. Discussion: The results of AFRI-c will provide vital information about whether portable HEPA filtration units reduce symptomatic winter respiratory infections in older care home residents. Findings about effectiveness, fidelity, acceptability and cost-effectiveness will support stakeholders to determine the use of HEPA filtration units as part of infection control policies. [ABSTRACT FROM AUTHOR]

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Purpose: Support of social contact and a sense of belonging may be essential for older persons who need help, to take care of their wellbeing and reduce the feeling of loneliness. The aim of this qualitative study was to explore the features that influence social contact and belonging among older persons who received home care nursing. Patients and Methods: The study involved nine individual in-depth interviews with older persons residing in Norway. The interviews were analyzed in accordance with a model of content analysis. Findings: Social contact and belonging among the older persons depended on the availability of necessary resources that foster social activity, contact with family and friends, and housing quality. Interaction with helpers and accommodation of their needs as necessary were important for these persons. Reflecting on the past and considering life in context may be essential as a basis for their present and future life. Conclusion: The results of the present study indicated that a sense of being cared for and supported are important for social contact and belonging. Social activity, engagement in family and contact with friends and neighbors are valued. However, a proportion of older persons are not engaged in such activities. Volunteer help may be a key factor for improving social contact. Moreover, contact and communication with home care nurses are important for recognition as valued persons and as a link to the community. Plain Language Summary: This study gave older persons who are dependent on help in their daily life at home the opportunity to express the experiences regarding their social contact and belonging.Social contact and belonging depended on the availability of necessary resources and support, relationships with family and friends, and the quality of their homes. Furthermore, personal contact with helpers and accommodation of their needs were important for those older persons. Reflecting on the past and considering life in context was also important as a basis for their present and future life.Volunteer help may be important for improving social contact. Good communication with home care nurses may be essential for recognition as valued persons and as a connection to the healthcare system in the community. To enhance the sense of belonging, the healthcare system and community must manage the dependencies of older persons in a manner that recognizes their value. [ABSTRACT FROM AUTHOR]

Background: Medication management has a key role in the daily tasks of home care professionals delivered to older clients in home care. The aim of this study was to examine the effect of using a robot for medication management on home care professionals´ use of working time. Methods: A pragmatic non-randomized controlled clinical trial was conducted. The participants were home care professionals who carried out home care clients' medication management. Home care clients were allocated into intervention groups (IG) and control groups (CG) (n = 64 and 46, respectively) based on whether or not they received the robot. Data were collected using the Working Time Tracking Form prior to and 1 and 2 months after introducing the intervention. The t-test was used to compare the groups at each three timepoints. Analysis of Covariance was used to examine the groups' differences for the total time for medications as the number of visits per day as the covariate. Results: With robot use, the total amount of home visits decreased by 89.4% and 92.4% after 1 and 2 months of intervention use, respectively, compared to pre-intervention (p < 0.001). The total working time used for medication management considering the number of visits per day decreased from 54.2 min (95% CI 37.4–44.3) to 34.9 min (31.4–38.3), i.e., by slightly over 19 min (p < 0.001) in the IG group. During the follow-up, the total working time used for medication management considering the number of visits per day remained the same in the CG group. Conclusion: Using a robot for medication management had a notable effect on decreasing the use of working time of home care professionals. For health services, decreased use of working time for medication management means that the time saved can be assigned to services that cannot be replaced otherwise. More digital solutions should be developed based on home care clients' and professionals' needs to meet the challenge of the growing number of older people in need of home care and ensure their safety. Trial registration: ClinicalTrials.gov Identifier: NCT05908604 retrospectively registered (18/06/2023). [ABSTRACT FROM AUTHOR]

Aging is an important problem. Nowadays life conditions have become more sophisticated. Homecare services include people with old age, disabilities, chronic illnesses, or individuals in recovery. We all have to support our elderly people’s life feel more comfortable but should not forget the difficulties of caregivers in life. In this study, we aimed to evaluate that may occur in our elderly population as well as their relatives. This is a descriptive cross-sectional study. The sociodemographic characteristics of the participants, the General Health Questionnaire – 28 (GHQ-28), Maslach Burnout Inventory (MBI), and Zarit Caregiver Burden Scale (ZCBS) were analyzed. SPSS 24.0 program was used for the analysis. Of the 150 caregiving people included in the study, 67.3% of the caregivers were first-degree relatives. The main disease of 65.3% of the patients who were cared for was neurological. Caregivers who performed care over two years had higher scores on the ZCBS and MBI, but it was only ZCBS that was statistically significant in this group (p=0.16). It may be a support method for both parts to reduce the burden of care of individuals who care for their patients at home and to contribute to their social lives. [ABSTRACT FROM AUTHOR]

The focus of Finnish craft teacher education is on educating craft teachers in formal basic education. In this study, the aim was to research craft student teachers' experiences of teaching practices that were arranged in out-of-school contexts. The data comprised craft student teachers' (n = 18) written reflections included in their course portfolios. Their teaching practice took place in adult education centres, basic education in arts, older peoples' care homes, youth work centres, centres for people with disabilities, social work centres, museums, craft cafés and clubs and a vocational training institution. The written reflections concerned the students' expectations at the beginning and those at the end of the teaching practice and were analysed according to the principles of qualitative data analysis. The students found both similarities and differences in craft pedagogy in different contexts. The out-of-school teaching practice broadened their future career perspectives and equipped them with new pedagogical skills. [ABSTRACT FROM AUTHOR]

Background: The connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people. Methods: This cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture—norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff's professions and years of work experience. Results: The most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience. Conclusions: This study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety. [ABSTRACT FROM AUTHOR]

This article explores the nature of paid caring labor, based on a study of paid care assistants in care homes for older people in England. Drawing from critical studies of work as well as perspectives on gender, care, and family, the aim is to see how the workers deliver care in their employment settings and consider the implications. The findings indicate that, in jobs which typically underpay and where the conditions of work are demanding, these workers are driven by ideals of "good care," "good caring," and "good carers." Such ideals, which are as much personal as professional, sometimes force them to trade-off loyalty to residents and their own interests. One cannot understand the nature of paid care without understanding the workers who do it, and understanding the workers means reaching deep into familial, economic, and social structures that reproduce paid care as a commodified form of unpaid care. [ABSTRACT FROM AUTHOR]

Background: With an ageing population, older adults will have more complex health and social care needs and many of these older adults will be living in care homes. Despite the growth in care home populations, care home residents are often excluded from research that could potentially benefit their care. The purpose of this scoping review is to explore resident-related barriers and facilitators to including older people living in UK care homes in research and to identify potential approaches to modify such barriers. Method: The 6-stage scoping review methodology framework proposed by Arksey and O'Malley guided this review. Five electronic databases (MedLine, PsychINFO, Scopus, Web of Science, CINAHL) and grey literature were searched. Identified articles went through two levels of screening, and those deemed relevant were collated, summarised and reported using a thematic analysis approach. Results: 90 reports were eligible for inclusion and were synthesised into 7 themes and related subthemes: (1) research design; (2) understanding and beliefs about research (resident and care home staff); (3) communication; (4) relationships; (5) eligibility criteria (resident and care home); (6) preference-based decisions; and (7) care home staff and environment. Given the complex interplay of the factors identified, both direct and indirect factors were included. Conclusions: A number of recurring barriers and facilitators to the inclusion of care home residents in research are reported. However, isolating resident-related barriers was complex as both direct and indirect factors must be considered as influential. Understanding the barriers and facilitators to inclusion will enable these factors to be addressed and increase the evidence-base for care provided to older people living in care homes. [ABSTRACT FROM AUTHOR]

Employee wellbeing has in many cases weakened and peer support has lessened. Nurses' exhaustion and decisions to change jobs are major challenges to the social and health care field. The purpose of this study was to chart home care employees' experiences of collegial peer support during the pandemic. The study questions were what is employees' collegial peer support like? And how could collegial peer support be developed? This study is part of a national project. The data were collected through themed group interviews conducted via the Teams platform. The participants were 15 nurses who work in the Pirkanmaa region. The data were analyzed through inductive content analysis. The home care nurses' collegial peer support is based on trust and is visible as peer support that reinforces employee agency, multichannel communication and a customer-focused, organization-based approach. The respondents wished for supervisors' support, official permission and training in experimenting with different forms of peer support. Through this study, collegial peer support in nursing has been made visible and modelled on a new conceptual level. The organization-based peer support that rose as part of the results offers an important perspective on the growing labor shortage in the social and health care field. The opportunities offered by collegial peer support between social and health care professionals require further study. [ABSTRACT FROM AUTHOR]

Background: Acute deterioration describes a rapid change in physical and/or mental health resulting from an acute illness – e.g., heart attack or infection. Older people in care homes are some of the frailest and vulnerable in society. They have complex health needs, experience multiple long-term conditions (MLTC) and have weakened immune systems due to the ageing process. They are more susceptible to acute deterioration and delayed recognition and response, is linked to poorer health outcomes, adverse events and death. Over the past five years, the need to manage acute deterioration in care homes and prevent hospital admissions has led to development and implementation of improvement projects, including the use of hospital derived practices and tools to identify and manage this condition. This is potentially problematic as care homes are different from hospitals—options to escalate care vary throughout the UK. Further, hospital tools have not been validated for use in care homes and have shown to be less sensitive in older adults living with frailty. Objectives: To collate the available evidence on how care home workers recognise and respond to acute deterioration in residents using published primary research, non-indexed and grey literature, policies, guidelines and protocols. Methods: A systematic scoping review was conducted following Joanna Briggs Institute (JBI) scoping review methodology. Searches were conducted using: CINAHL (EBSCOhost), EMCARE (OVID), MEDLINE (OVID) and HMIC (OVID). Snowball searches of included studies' reference lists were conducted. Studies that featured care homes with or without nursing and provided 24/7 care to residents were included. Results: Three hundred and ninety-nine studies were identified. After reviewing all studies against inclusion criteria, n = 11 were included in the review. All studies used qualitative methods and were conducted in Australia, UK, South Korea, USA and Singapore. Four themes were generated from the review: identifying residents with acute deterioration; managing acute deterioration, care home policies and procedures, and factors affecting recognition and response to acute deterioration. Findings: Recognition and response to acute deterioration in residents is determined by multiple factors and is context sensitive. There are several interrelated factors within and external to the care home that contribute to how acute deterioration is recognised and managed. Conclusions and Implications: The available literature on how care home workers recognise and respond to acute deterioration is limited and often subtends other areas of interest. Recognising and responding to acute deterioration in care home residents is reliant on a complex and open system encompassing multiple interrelated components. The phenomenon of acute deterioration remains underexplored and further research is required to examine contextual factors that accompany identification and management of this condition in care home residents. [ABSTRACT FROM AUTHOR]

China entered an aging society in 1999 based on the United Nations' definition that an aging society is one where the population aged sixty and above accounts for more than 10 percent of the total population. Accordingly, community-based home care for older people has become a social trend and the main policy orientation of the urban elderly care service system. How to meet older people's needs for living and caring services in urban residential areas is a major challenge for China to conduct urban redevelopment. This paper analyzes the supply-demand match of age-friendly public service facilities in communities based on the daily needs for public service facilities and the living circle characteristics of older people. Then it conducts an empirical study on typical residential communities in Suzhou and puts forward a hierarchical allocation strategy and improvement suggestions for age-friendly public service facilities in the self-sufficient community living circle, the near neighborhood living circle, and the urban expansion living circle. In addition, it proposes measures for improving the allocation of public service facilities in case communities in Suzhou through urban renewal. [ABSTRACT FROM AUTHOR]

SUMMARY: What was it like to care for older residents in a care home during the COVID‐19 pandemic? Care work was in crisis before the pandemic, which brought the fragility of the UK's healthcare system and those who work in it to the fore. I recount my experiences in a care home with isolated older people during the early months of the COVID‐19 global pandemic. In this autoethnography, I consider my attempt to prioritize isolated older care home residents' personhood alongside the complexities of caring during an inordinately physically and emotionally precarious time. While neglecting some aspects of my own needs, I describe how care work, while rewarding, can reproduce the already ingrained inequalities that characterize it. I argue that sensing absence as experienced by older people can be a means to help reduce some of their isolation and loneliness. During my time caring during the pandemic, time to care was corroded, further frustrating what care should be. Through my autoethnographic account of caring during the pandemic, I argue that the well‐being needs of caregivers alongside care receivers should be acknowledged as an integral aspect of care. [caring, COVID‐19, absence, care home, isolation]. [ABSTRACT FROM AUTHOR]

Objective: The UK National Institute of Clinical Excellence (NICE) guidelines recommend that care staff who provide daily personal care to residents: "Understand the importance of residents' oral health and the potential effect on their general health, well‐being and dignity." The aim of this study was to explore residents' views and perspectives of dental care in care homes in order to understand how to deliver this care. Method: Care homes were identified using care home inspection reports for Wales, the UK. Care homes for older people with residents having mental capacity to consent were invited to participate. Data were collected using semi‐structured one‐to‐one interviews with care home residents, care home managers and oral healthcare leads. Interviews were audio recorded, transcribed and analysed using a thematic approach to data. Analysis was assisted by NVivo 10 software. Data collection was completed when no new themes emerged. Results: This analysis presents findings from 26 interviews with residents, across five care homes. Going into care was associated with a loss of identity. Having teeth and looking after teeth (natural teeth or dentures) was part of keeping that identity. All prioritised privacy, pride and independence above effective oral hygiene. Oral hygiene was viewed as a very private event. Carers adapted oral care, to balance time constraints, care, privacy and dignity. Teeth were a part of personal pride to the extent that two residents said they did not want to die without dentures in their mouths. Conclusion: Whilst oral care is important to residents, dignity and privacy are often more important; care routines and practices are adapted around this. Carers need to adopt an individualised, pragmatic and sensitive approach to oral care to account for personal dignity when looking after residents to be able to provide appropriate oral care in accordance with guidance. Members of the dental team need to support carers to provide effective oral care, which allows dignified and effective care. [ABSTRACT FROM AUTHOR]

This article draws upon an ethnography of two differently-priced UK residential care homes for older people. Informed by recent scholarship on the materialities of care, together with separate theoretical contributions by Mary Douglas and Émile Durkheim, I examine the spatial and material organisation of care work. I sketch out care workers' attitudes and practices concerning hygiene and bodily waste, and how these are established and reaffirmed through the marking out of boundaries between materials, spaces and persons. Central to understanding care workers' erecting of, or inattention to, these boundaries is an awareness of the material, temporal and cultural conditions of work. Variances in the availability of resources, the formal organisation of work and the layout of residential homes affect the care provided to residents. In examining these variances, I identify how care workers' use of space functions to maintain or undercut not only hygiene and infection control standards but, also, more interpersonal virtues, such as dignity and respect for older people receiving care. I conclude by highlighting how the (mis)treatment of older people is a story of both a deeply inequitable market for care provision and a broader context of oppression, devaluation and dehumanisation. [ABSTRACT FROM AUTHOR]

Background: In Sweden, 72% of people with dementia live in ordinary housing. Of these, 50% receive home care services. Older people with dementia may benefit from developments in decision-making support which aim to facilitate their ability to communicate their personal needs and preferences with care managers and staff in home care services. In this study, we will test and evaluate the use of TalkingMats in Swedish municipal home care services for older people with mild to moderate dementia. TalkingMats is a low-technology communication tool, to help people with communication difficulties express their views. It uses a simple system of picture symbols which are placed on a textured mat. This study will provide insight into the extent to which TalkingMats benefits older people with dementia to feel more involved in decisions related to home care services. In addition, this study will assess the extent to which the use of TalkingMats promotes service providers' efforts to involve service recipients in decision making. The implementation of TalkingMats in home care services will also be studied. Methods: A parallel group, two-armed randomized controlled trial design in which TalkingMats and Usual Conversation Method will be compared. Two specific situations where older people with dementia must make decisions about home care services will be studied. First, a follow-up needs-assessment conversation between study participants and care managers will be studied. Second, a conversation between participants and home care staff regarding the delivery of the decided home care services will be studied. In addition, a qualitative approach will be used to gain an understanding of study participant and service provider experiences of the impact and implementation of TalkingMats. Discussion: The combined exploratory, descriptive, and experimental study design is considered an important strength which will facilitate multi-facetted knowledge production concerning the involvement and communication needs of older people with dementia generally and within the context of home care services specifically. Combining qualitative and quantitative methods will maximize our ability to assess the effects of TalkingMats. Trial registration: ClinicalTrials.gov ID: NCT05561998. Registered in September 28, 2022. [ABSTRACT FROM AUTHOR]

Background: Many older people with dementia currently prefer home care; however, homes are neither professionally designed nor regulated like health care facilities, and home care is more prone to safety incidents. Many studies have examined home care safety for older people with dementia. However, factors contributing to safety incidents in home care have not been adequately considered. This study explored the risk factors for home care safety for older people with dementia based on the perspective of family caregivers. Methods: This study used a qualitative research approach; a total of 24 family caregivers were interviewed face-to-face and semi-structured from February 2022 to May 2022, and the Colaizzi seven-step phenomenological research method was used to analyze the data and refine the themes. Results: Safety risks in home care for older people with dementia stem from five areas: poor health of older people with dementia, dementia symptoms, unsafe home environment, the insufficient caring ability of family caregivers, and lack of safety awareness of family caregivers. Conclusion: The risk factors for home care safety for older people with dementia are complex. And as the primary caregivers of older people with dementia, the caregiving ability and safety awareness of family caregivers primarily determine the safety of home care for older people with dementia. Therefore, when addressing home care safety for older people with dementia, the focus should be on providing targeted education programs and support services for family caregivers of older people with dementia. [ABSTRACT FROM AUTHOR]

Objective: To analyze the socio-demographic profile and caregiving situation of dependent older adults and their family caregivers in Brazil and Colombia. Method: This mixed comparative and exploratory study follows the comparative study stages proposed by Bereday, namely: Description, interpretation, juxtaposition, and comparison. A semi-structured interview was used. National and international ethical principles were followed in the study, with the ethics committee’s approval in each country. Results: A total of 250 participants were interviewed: 52 dependent older adults in Brazil and 56 in Colombia, along with 70 family caregivers in Brazil and 72 in Colombia. A total of 68.5 % of the elderly and 83.8 % of the caregivers were women. Twelve categories were created based on the participants’ statements, six in the dependent older people and six in the caregivers. Conclusion: Women and daughters were the primary family caregivers, and the Catholic religion was prevalent in both countries. Regarding the caregiving situation in both countries, it stands out that dependent older people and family caregivers feel the presence of a superior being assisting them in overcoming the challenges of caregiving activities. [ABSTRACT FROM AUTHOR]

Introduction: Constipation can be one of the biggest health problems for the older people that has negative effects on their quality of life. Some studies have reported that new non-pharmacological interventions such auricular acupressure have promising results in the management of constipation. This study was performed to investigate the effect of auricular acupressure on constipation and health-related quality of life in the older people living in the residential care home. Methods: Sample of this randomized clinical trial consisted of 53 older people with chronic constipation living in a residential care home in the southeast of Iran (Kerman city). The participants were randomly assigned to intervention (n = 27) and control (n = 26) groups. Auricular acupressure was applied to seven auricular acupoints (large intestine, rectum, San Jiao, spleen, lung, sympathetic, and subcortex) using Vaccaria seeds for the intervention group and for the control group, seedless auricular plasters were used at the seven auricular acupoints for 10 days. Data were collected before the intervention, end of the intervention, and 10-day follow-up using demographic and clinical, Patient Assessment of Constipation-Symptom, and Patient Assessment of Constipation-Quality of Life questionnaires. The SPSS-22 software was used for data analysis. Results: The difference between groups and times was significant in constipation and related quality of life and scores. The mean score of constipation at the end of intervention was 0.41 less in the intervention group than the control group (P < 0.0001). This mean score, in the intervention group also on the 10-day follow-up was 0.09 less than the control group (P = 0.004), which indicates a decrease in the severity of constipation symptoms. In the intervention group, mean score of quality of life related to constipation at the end of intervention and the 10-day follow-up was 0.56 and 0.19 less than the control group (Decrease in the mean score of quality of life related to constipation indicates an improvement in the quality of life) (P < 0.0001). Conclusion: The results showed the positive effect of auricular acupressure on reducing the severity of constipation symptoms and improving the quality of life in old patients living in the residential care home. This non-pharmaceutical practice can be used by nurses as an inexpensive, safe, acceptable, and non-invasive nursing care for older people with constipation in homes, medical centers, or nursing homes. [ABSTRACT FROM AUTHOR]

COVID-19 has rapidly impacted societies on a global scale, with older people among the most affected. To care for older people living in their own homes, female family caregivers play a pivotal role. The current study aimed to explore the actions of female family caregivers and the challenges they faced in taking care of older people living at homes during the COVID-19 pandemic in Belu district, Indonesia. This qualitative study involved twenty female family caregivers, who were recruited using a combination of purposive and snowball sampling techniques. Findings were grouped into two main categories: (i) actions of female family caregivers in taking care of older adults during the COVID-19 pandemic. These included limiting both visitations of extended family members and older adults' activities outside homes; explaining the virus to older adults and controlling their access to news, social media and smartphones; providing nutrition, supplement and maintaining daily diets; and (ii) challenges they faced in taking care of older adults included excessive fear of contracting COVID-19 and possibility of transmitting it to older people; feeling stressed; tired and overburdened. The study highlights the significant role family caregivers played to protect older people living at home. The findings can inform government to develop intervention programs that address and support the needs of both family caregivers and older people living at home. [ABSTRACT FROM AUTHOR]

Background: Low physical activity in care home residents brings about negative mental health consequences, such as higher levels of depression and loneliness. With advancements in communication technology, particularly during the COVID-19 pandemic, the feasibility and effectiveness of a randomised controlled trial (RCT) of a digital Physical Activity (PA) resource in care homes deserve more research attention. A realist evaluation was used to uncover influencing factors of a feasibility study implementation to inform how a digital music and movement programme would work and under what circumstances this would be most effective. Methods: Participants were 49 older adults (aged 65 years +) recruited across ten care homes in Scotland. Surveys were administered at baseline and post-intervention comprising psychometric questionnaires on multidimensional health markers validated in older adults with possible cognitive impairment. The intervention comprised 12 weeks of four prescribed digitally delivered movement (n = 3) and music-only (n = 1) sessions per week. An activity coordinator delivered these online resources in the care home. Post-intervention focus groups with staff and interviews with a sub-sample of participants were conducted to gain qualitative data on the acceptability of the intervention. Results: Thirty three care home residents started the intervention, but only 18 residents (84% female) completed both pre- and post-intervention assessments. Activity coordinators (AC) offered 57% of the prescribed sessions, with an average residents' adherence of 60%. Delivery of the intervention did not go as planned due to Covid restrictions in care homes and delivery challenges, including (1) motivation and engagement, (2) changes in cognitive impairment and disabilities of the participants, (3) death or hospitalisation of the participants and (4) limited staffing and technology resources to deliver the programme as intended. Despite this, group participation and encouragement of residents supported the delivery and acceptance of the intervention, with ACs and residents reporting improved mood, physical health, job satisfaction and social support. Improvements with large effect sizes were found for anxiety, depression, loneliness, perceived stress and sleep satisfaction, but no changes in fear of falling, domains of general health or appetite. Conclusion: This realist evaluation suggested that this digitally delivered movement and music intervention is feasible. From the findings, the initial programme theory was refined for future implementation of an RCT in other care homes but future research exploring how to tailor the intervention to those with cognitive impairment and/or lacking capacity to consent is needed. Trial registration: Retrospectively registered at ClinicalTrials.gov NCT05559203. [ABSTRACT FROM AUTHOR]

Background: The United Kingdom (UK) has a well‐developed health and social care system, and strong research governance. However, there is limited evidence to guide best research practice among vulnerable older people in care homes and there is no consensus on clinical trial methodology that is deliverable in this setting. Objectives: To review the literature on trials conducted among older adults residing in care homes within the UK and collate evidence on their methodological characteristics and outcomes. Methods: A systematic rapid review methodology was employed. MEDLINE, EMBASE and CENTRAL were searched in two incremental stages: stage 1 searched for oral health‐related trials conducted within the UK care homes up to July 2021, whereas stage 2 sought for general health‐related trials in the same setting from 2011 to 2021. The quality of included studies was assessed using Cochrane's RoB 2 and ROBINS‐I tools. Findings were summarised descriptively. Results: Five oral health and 33 general health‐related trials involving care home residents were included for analysis. The most common trial design was parallel group with two arms (n = 25) involving individual randomisation (n = 21). Consent was mainly obtained from residents and/or their proxies (n = 24), followed by residents only (n = 13) and care homes only (n = 1). Based on available data, the number needed to screen to recruit one participant ranged from 2 to 40 (median: 3; Q1‐Q3: 2‐9). Attrition rates ranged from 0% to 73% (median: 21%; Q1‐Q3: 13%‐32%) for follow‐up periods between 1 and 52 weeks. The studies were of mixed methodological quality. Conclusion: This rapid review outlines the methodological characteristics and outcomes of trials conducted among older adults in UK care homes. The findings of this review provide valuable information to assist in navigating and designing future research in this complex setting. [ABSTRACT FROM AUTHOR]

Objectives: (1) Explore the challenges of providing daily oral care in care homes; (2) understand oral care practices provided by care home staff; (3) co‐design practical resources supporting care home staff in these activities. Methods: Three Sheffield care homes were identified via the "ENRICH Research Ready Care Home Network," and three to six staff per site were recruited as co‐design partners. Design researchers led three co‐design workshops exploring care home staff's experiences of providing daily oral care, including challenges, coping strategies and the role of current guidelines. New resources were prototyped to support the use of guidelines in practice. The design researchers developed final resources to enable the use of these guidelines in‐practice‐in‐context. Findings: Care home staff operate under time and resource constraints. The proportion of residents with dementia and other neurodegenerative conditions is rapidly increasing. Care home staff face challenges when residents adopt "refusal behaviours" and balancing daily oral care needs with resident and carer safety becomes complex. Care home staff have developed many coping strategies to navigate "refusal behaviours." Supporting resources need to "fit" within the complexities of practice‐in‐context. Conclusions: The provision of daily oral care practices in care homes is complex and challenging. The co‐design process revealed care home staff have a "library" of context‐specific practical knowledge and coping strategies. This study offers insights into the process of making guidelines usable for professionals in their contexts of practice, exploring the agenda of implementing evidence‐based guidelines. [ABSTRACT FROM AUTHOR]

The percentage of older Americans increases each year, with a corresponding percentage increase of those considered the older old. Many older persons will develop chronic conditions, decreasing their ability to manage the activities of daily living and requiring many to move into assisted living facilities or group homes. When surveyed, a majority of people expressed that they wish to age in their own homes, and government programs are increasingly supportive of this option. This is a viable option for many if they have the assistance of private caregivers-who provide a vast array of support services-and essential person-to-person human contact during the last years of life. Not all caregivers are family; many are friends, partners, and former colleagues. Whether family or nonfamily, private caregivers often provide a recipient with selfsufficiency for many years, and for some until death. This Article discusses the statistics of aging and the obstacles faced by private caregivers who suffer economic deprivation as a result of the time and expense expended on behalf of an elder recipient. Presumptions, statutes, and the process of estate devolution work against compensation for a private caregiver. There is far too little recognition of what is contributed when a person feeds, bathes, administers medications, provides companionship, and confronts the bureaucracy meant to help the old. The common sentiment of all caregivers would be that they do it because they feel they must. But upon the death of the recipient, one person should not walk away with the benefits of the decedent's estate and the other with nothing except the recognition of what they must do and did. To better provide for the equal treatment of private caretakers, this Article posits the creation of a private caretaker presumption in favor of elder caregivers. This presumption would apply to any person who dedicates himself or herself another's care for a period of time sufficient to engender economic benefit to the recipient's estate and a concomitant loss to the caregiver. Then, based upon the estate assets available, the parameters of the claim, and defined mitigating factors, a presumption is raised that the caregiver may file a creditor claim against the estate in an amount that would make the caregiver equal to the other objects of the decedent's bounty. Existing remedies are insufficient; more is needed to promote equity. [ABSTRACT FROM AUTHOR]

Death has always been feared, dreaded and misunderstood due to the complex emotions emanating from it. Various scientific studies and literary works have been written on this concern, and although most people choose not to discuss nor think about death, it remains inevitable. The objective of the study was to explore thoughts about death, dying, and end-of-life among the elderly living in a home care facility. Interpretative Phenomenological Analysis was used to explore the respondents' experiences on their own terms. The selections of the key informants started by using a focused group discussion (FGD) in a large group of older people in the home care facility with the help of a gatekeeper. The research utilized a self-made semi-structured research instrument subjected to content validation by three qualified composed of two registered psychologists and a social worker. The findings revealed four pillars at the end of the tunnel based on the lived experience of the aged individual residing in a home care facility as follows: (1) personal concerns, (2) reluctance and unwillingness, (3) religiosity and spirituality, and (4) faith and good deeds. Based on the integration of the qualitative analysis, the Wheel of Life at the End of the Tunnel, an eidetic model about the end of life, was proposed that may serve as a basis for mental health programs for future studies. [ABSTRACT FROM AUTHOR]

Background: Research on eldercare has been dominated by a provider-oriented perspective, concerned with the conditions and views of care providers. There are striking differences compared with the field of disability studies, where help is framed as part of a larger project of having a daily life and being included in society. Pilot interviews indicate that older people develop active strategies to make care work. These include practical preparations, emotional activities such as showing an interest in staff members' lives, or rhetorical skills in asking for help. Objective: The aim of this project is to develop empirical and theoretical knowledge of eldercare as a relational practice, accomplished by older people in their daily lives. This perspective will also offer an alternative to ongoing attempts to reduce the user perspective to an issue about older people acting as customers in a market. Methods: The project will map, investigate, and follow up on care use from the perspective of care users. The project has an ethnographic 2-year longitudinal approach. Data consist of interviews and participant observations with 35 persons (home care users and cohabitating partners) and a diary study with additional 10 care users. Inclusion criteria are people 65 years or older with home care provided by needs assessors. It is preferred that they have had home care between 6 months and 2 years in order to follow a progression in roles, identities, and strategies within home care use. Results: Between May and October 2022, 25 interviews with home care users were conducted. Data collection with follow-up interviews and observations, analysis, and reporting of findings will be completed by December 2024. Conclusions: By studying care use in the context of older people's lives the project will add important knowledge about the strategies and adjustments older people apply to make care arrangements work. A user-oriented perspective will further the understanding of how power relations play out in home care over time in relation to the formal rights, categorical belongings, and established norm systems that place the user in superior or subordinate positions. [ABSTRACT FROM AUTHOR]

Background: Demographic, economic and organisational changes challenge home care services. Increased use of welfare technology and involvement of family members as co-producers of care are political initiatives to meet these challenges. However, these initiatives also involve ethical aspects. Method: The aim of this qualitative study was to explore family caregivers' experience of involvement and possible ethical aspects of caring for frail older family members receiving home care services supported by welfare technology. This study used a qualitative explorative and descriptive design within a phenomenological-hermeneutical approach. Sixteen interviews with eighteen family caregivers were conducted. The participants were sons, daughters, siblings and spouses of frail older people receiving home care services with the support of welfare technology. Data were analysed using reflexive thematic analysis. The COREQ checklist was used. Results: The analysis led to five main themes. First, the family caregivers' experienced caring as meaningful but increasingly demanding concerning the changes in home care services. Second, they experienced a change in relationships, roles, tasks, and responsibilities related to more family involvement and the use of welfare technology. This also challenged their sense of autonomy. However, welfare technology helped them deal with responsibilities, especially safety. The family caregivers requested early involvement, dialogue for care decisions, more cooperation and support from health professionals. Third, the participants experienced that health professionals decided the conditions for co-production without discussion. Their need for information and knowledge about welfare technology were not met. Fourth, the family caregivers felt that the health professionals did not adequately recognise their unique knowledge of the care receiver and did not use this knowledge for customising the welfare technology to the care receiver and their families. Fifth, the family caregivers expressed concern about service and welfare technology inequality in home care services. Conclusions: Co-production in the involvement of family caregivers in care is still not an integral part of home care service. Welfare technology was appreciated, but the family caregivers called for early involvement to ensure successful and safe implementation and use. More attention needs to be given to ethical concerns about the change in relations, transfer of tasks and responsibility, and risk of inequality. [ABSTRACT FROM AUTHOR]

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care. [ABSTRACT FROM AUTHOR]

Problems experienced in homes for older people in Tanzania highlighted the need for a situation analysis of healthcare standards to identify the baseline of care provided to residents in these homes. This study conducted a situation analysis of structure healthcare standards and associated criteria with the aim of contributing to improved quality of care for residents in homes for older people in Tanzania. Thirty-two homes for older people in Tanzania were audited using an audit instrument that included seven fields, 26 structure standards, and 262 associated criteria. The analysis showed that overall, the homes were non-compliant with healthcare structure standards and associated criteria. The Tanzanian Government should urgently introduce measures to address the missing standards and associated criteria. [ABSTRACT FROM AUTHOR]

Trial literature on falls management in care homes may provide limited detail on current practice and instead this information may be found in grey literature. This scoping review aimed to identify the key characteristics of current falls management programmes for UK care homes identified from the grey literature. A scoping review was conducted and evidence sources were included if they were targeted at UK care homes for older people and included any component of falls management (assessment, intervention, training). Search activities included searches of electronic databases, professional websites and contacting care homes for current examples. The principles of intervention component analysis were conducted to describe the features of falls management. Fortyeight evidence sources were included (17 online resources, 10 online articles, 9 policies and standards and 12 examples provided by individual care homes). 67 themes were identified under eight domains. The core domains detailed the characteristics of Assessment, Interventions and Training. The approach taken to managing falls was an overarching domain, with supporting domains including how to report and monitor falls, when to complete assessments and interventions, governance and accountability, and involvement of the wider healthcare system. [ABSTRACT FROM AUTHOR]

Background: Currently, population aging has been an obstacle and the spotlight for all countries. Compared with developed countries, problems caused by China's aging population are more prominent. Beijing, as a typical example, is characterized by advanced age and high disability rate, making this capital city scramble to take control of this severe problem. The main types of care for the disabled elderly are classified as home care, institutional care, and community care. With the obvious shortage of senior care institutions, most disabled elderly people are prone to choose home care. This kind of elderly care model is in line with the traditional Chinese concept and it can save the social cost of the disabled elderly to the greatest extent. However, home care for the disabled elderly is facing bumps from the whole society, such as lack of professional medical care, social support and humanistic care, and the care resources provided by a single subject cannot meet the needs of the disabled elderly. Objective: Based on the demands of the disabled elderly and their families, this study aims to explore the current status of home care service, look for what kind of care is more suitable for the disabled elderly, and try to find an appropriate elderly care mechanism which could meet the diverse needs of the disabled elderly. Methods: A total of 118 disabled elderly people and their primary caregivers were selected from four districts of Beijing by using multi-stage stratified proportional sampling method. A one-to-one and semi-structured in-depth qualitative interview were conducted in the study to find out the health status of the disabled elderly, the relationship between the disabled elderly and their primary caregivers, and utilization of elderly care resources, etc. The views of the interviewees were analyzed through the thematic framework method. All the methods were carried out in accordance with relevant guidelines and regulations. Results: The results showed that the average age of 118 disabled elderly is 81.38 ± 9.82 years; 86 (72.9%) are severe disability; 105 (89.0%)are plagued by chronic diseases; the average duration of disability is 5.63 ± 5.25 years; most of disabled elderly have 2 children, but the primary caregiver are their own partner (42, 35.6%), and there is an uneven sharing of responsibilities among the disabled elderly's offspring in the process of home care. The disabled elderly enjoy medical care services, rehabilitation training, daily health care, psychological and other demands. However, the disabled elderly and their families in Beijing face a significant financial burden, as well as physical and psychological issues. The care services provided by the government, family doctors, family members and social organizations fall far short of satisfying the diverse care needs of the disabled elderly. Conclusions: In order to effectively provide home care services for the disabled elderly, it is therefore necessary to establish a coordination mechanism of multiple subjects and give full play to the responsibilities of each subject. This study proposes a strengthening path for the common cooperation of multiple subjects, which taking specific responsibilities and participating in the home care for the disabled elderly: (1) The government should give full play to the top-level leading responsibilities and effectively implement people-oriented measures to the disabled elderly. (2) Family doctors strengthen their responsibilities as health gatekeepers and promote continuous health management of the disabled elderly. (3) Family members assume the main responsibility and provide a full range of basic care services. (4) Social forces promote supplementary responsibilities of public welfare and expand the connotation of personalized care services. (5) The disabled elderly should shoulder appropriate personal responsibility and actively cooperate with other subjects. [ABSTRACT FROM AUTHOR]

Background: The provision of independent prescribing rights for United Kingdom (UK) pharmacists has enabled them to prescribe within their area of competence. The aim of this study was to evaluate an evidence-based training programme designed to prepare Pharmacist Independent Prescribers (PIPs) to safely and effectively assume responsibility for pharmaceutical care of older people in care homes in the UK, within a randomised controlled trial. Methods: The training and competency assessment process included two training days, professional development planning against a bespoke competency framework, mentor support, and a viva with an independent General Practitioner (GP). Data on the PIPs' perceptions of the training were collected through evaluation forms immediately after the training days and through online questionnaires and interviews after delivery of the 6-month intervention. Using a mixed method approach each data set was analysed separately then triangulated providing a detailed evaluation of the process. Kaufman's Model of Learning Evaluation guided interpretations. Results: All 25 PIPs who received the training completed an evaluation form (N = 25). Post-intervention questionnaires were completed by 16 PIPs and 14 PIPs took part in interviews. PIPs reported the training days and mentorship enabled them to develop a personalised portfolio of competence in preparation for discussion during a viva with an independent GP. Contact with the mentor reduced as PIPs gained confidence in their role. PIPs applied their new learning throughout the delivery of the intervention leading to perceived improvements in residents' quality of life and medicines management. A few PIPs reported that developing a portfolio of competence was time intensive, and that further training on leadership skills would have been beneficial. Conclusions: The bespoke training programme was fit for purpose. Mentorship and competency assessment were resource intensive but appropriate. An additional benefit was that many PIPs reported professional growth beyond the requirement of the study. Trial registration: The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17,847,169). [ABSTRACT FROM AUTHOR]

Background: Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams. Objective: We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making. Methods: We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis. Results: A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI -5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults' perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI -0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI -16.5% to 1.6%, P=.10). Conclusions: Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making. [ABSTRACT FROM AUTHOR]

The problems facing English care homes for older people have largely been defined in terms of funding. This paper starts from the position that it is vitally important also to address the big issue of the social care system, especially the changing nature of private provision since the introduction of a quasi-market almost three decades ago, such that large corporations have become increasingly dominant. The paper focuses on the implications of a fragmented, for-profit system of provision for financial sustainability and care quality, particularly in terms of workforce issues. It argues that heavy reliance on regulation via the market and operating through competition and choice is misplaced and that state regulation can play a crucial part in securing improvement in these fields. It concludes that the Government's recent (2021) proposals, which are mainly confined to funding and designed to prop up the current system, are unlikely to provide the 'long-term fix' that social care needs. [ABSTRACT FROM AUTHOR]

It is well accepted that the preferred place of care for many people is in their own homes and that home care services have the potential to allow people to remain in their own homes for as long as possible. This narrative review aimed to summarize the existing literature on person-centered practices in home care and develop a conceptual framework, based on The Health Information and Quality Authority’s (HIQA) standards development principles, to achieve high-quality person-centered home care. A narrative review was conducted using the academic databases Embase, APA PsychInfo, Social Services Abstracts and CINAH. A qualitative content analysis was used to analyze and synthesize the findings. In total 39 studies were included in this narrative review. This review emphasizes four key principles for person-centered home care. A human-rights based approach ensures care is delivered with dignity, respect, and non-discrimination, guaranteeing equitable access for all. The safety and wellbeing principle focuses on preventing health decline and harm, while promoting the overall well-being of the care recipient. Responsiveness centers on how staff identify and address individual needs, with their skills and competencies playing a crucial role. Finally, the accountability principle underlines the importance of strong leadership, clear governance, and effective collaboration between home care and other services. The approach of using principles as a framework to underpin this study can inform policymakers, home care providers and others in good practice in upholding person-centered care during the development of home care policy and care delivery. [ABSTRACT FROM AUTHOR]

Background: With ageing, food intake may decrease and lead to an insufficient nutrient intake causing protein-energy malnutrition (PEM) which is associated with adverse health effects and increased mortality. The aim of this study was to investigate the effects of individually tailored dietary counseling focused on protein intake among home care clients with PEM or at risk of developing PEM. The secondary aim was to study the intake of energy and other nutrients.Methods: This intervention study is part of the non-randomised population-based multidisciplinary Nutrition, Oral Health and Medication study (NutOrMed study). The intervention group comprised 112 and the control group 87 home care clients (≥75 years) with PEM or risk of PEM. PEM was defined by Mini Nutritional Assessment score < 24 and/or plasma albumin < 35 g/L. The nutrients intake was assessed from 24-hour dietary recall at the baseline and after the six-month intervention. The intervention consisted of an individually tailored dietary counseling; the persons were instructed to increase their food intake with protein and energy dense food items, the number of meals and consumption of protein-, energy- and nutrient-rich snacks for six months.Results: After the six-month nutritional intervention, the mean change in protein intake increased 0.04 g/kgBW (95% CI 0.05 to 0.2), fibre 0.8 g (95% CI 0.2 to 4.3), vitamin D 8.5 μg (95% CI 0.7 to 4.4), E 0.6 mg (95% CI 0.4 to 2.2), B12 0.7 μg (95% CI 0.02 to 2.6), folate 8.7 μg (95% CI 1.5 to 46.5), iron 0.4 mg 95% CI 0.6 to 2.4), and zinc 0.5 mg (95% CI 0.6 to 2.2) in the intervention group compared with the control group. The proportion of those receiving less than 1.0 g/kg/BW protein decreased from 67 to 51% in the intervention group and from 84 to 76% in the control group. Among home care clients with a cognitive decline (MMSE< 18), protein intake increased in the intervention group by 0.2 g/kg/BW (p = 0.048) but there was no change in the control group.Conclusion: An individual tailored nutritional intervention improves the intake of protein and other nutrients among vulnerable home care clients with PEM or its risk and in persons with cognitive decline.Trial Registration: ClinicalTrials.gov : NCT02214758. Date of trial registration: 12/08/2014. [ABSTRACT FROM AUTHOR]

Care homes for older people attract human rights discourse. This has intensified during the Covid-19 pandemic, which disproportionately affected care home communities with various human rights ramifications. Activist scholarship in human rights can contribute to the protection and realisation of the rights of people living, working in and visiting care homes through high-quality research. This article reports the findings of an analysis of pre-pandemic scholarship that explored the ways authors approached the topic of human rights of older people in care homes. The aim was to produce a typology of approaches to the topic as a basis for critical reflection and as a starting point for future activist scholarship in gerontology, social policy and law. Reflexive thematic analysis of 23 international English-language peer-reviewed articles published between 1998 and March 2019 was undertaken. Analysis was framed in the context of the health and social care setting of England. The article reports the pertinent and common assumptions that care homes are 'inherently risky' places for the protection of the human rights of 'vulnerable' care home residents. The article highlights five types of approaches: the anti-institutional, the legalistic, the care quality, the equality approach, and the issue-based approach. [ABSTRACT FROM AUTHOR]

Background: Homebound status is associated with an increased risk of morbidity and mortality in older adults, yet little is known about homebound older adults in Canada. Our objectives were to describe time trends in the prevalence of homebound status among community‐dwelling long‐term home care recipients and the characteristics associated with homebound status. Methods: This was a retrospective cross‐sectional and cohort study using linked health administrative data in Canada's most populous province, Ontario. We included adults aged 65 years and older who received at least one long‐term home care assessment from 2006 to 2017 (N = 666,514). Homebound individuals were those who exited the home an average of 0–1 days/week over the previous 30 days; not homebound comparators exited the home 2–7 days per week. We compared baseline characteristics between groups and estimated the association between these characteristics and homebound status at baseline and over time. Results: From 2006 to 2017, the annual proportion of long‐term home care recipients who were homebound increased from 48% to 65%. At first assessment, 50% of the cohort (331,836 of 666,514) were homebound. Among those with a 4–12 month repeat assessment, homebound status persisted over time for 80%, and developed anew in 24%. Dependency on others for locomotion, use of an assistive device, poor access to dwelling, older age, and female sex were most strongly associated with homebound status at baseline, as well as its development and persistence over time. Conclusions: We found that half of Ontario older adult long‐stay home care clients were homebound at the time of their first assessment, and that the prevalence of homebound status among home care recipients rose steadily from 2006 to 2017. This informs further research and policy development to ensure the adequacy of supports for older homebound persons. [ABSTRACT FROM AUTHOR]

Care homes for older people may become places of deprivation of liberty due to their residents' lack of capacity to consent to their stay. The Optional Protocol to the Convention Against Torture requires States Parties to establish National Preventive Mechanisms to undertake visits to all places of deprivation of liberty to prevent torture and other ill treatment. This paper discusses the ways in which National Preventive Mechanisms report on human rights concerns in older people's care homes across 26 Council of Europe states. A framework established by the European Committee for the Prevention of Torture provides a starting point for this analysis. Common themes around restraint, ill treatment, safeguards for involuntary placements, and resourcing issues emerge. Against a backdrop of concerns heightened by the Covid-19 pandemic, the paper concludes that a narrow focus on individual human rights needs to be supplemented by addressing the structural issues on which the more broadly conceived rights of residents of care homes for older people depend. [ABSTRACT FROM AUTHOR]

"Context" is a multi-layered concept, and while it is thus possible that narrators make relevant a multiplicity of contextual layers in the stories they tell, often the exploration of the relation between narratives and "only" one or two contextual layers is capitalized on. Harrington argues that the organisation's values are made tangible in the narrative practices during these collection encounters, in which the collector affords indebted individuals interactive space and agency to tell their stories. The papers in this special issue explore a wide range of story types - both I big i and I small i - and they range across various genres ([11]), which implies that the stories may sometimes deviate significantly from the canonical narrative of personal experience as proposed in the seminal work by [9]. Organizational studies, as a discipline, has displayed a strong interest in the use of narrative analysis to investigate issues of concern to scholars, such as those around sense-making, communication, politics and power, learning and change, as well as identity and identification ([10]). [Extracted from the article]

The study investigates story-telling in naturally-occurring interactions in a care home for older people with dementia in England. Stories were told by a range of discourse participants and varied from more relationally-oriented anecdotes occurring as part of small talk to more transactionally-oriented narratives embedded into work routines. The main aim of the study was to explore narratives as social practice in the interactions of the care staff and to discover what functions they perform in their workplace practice and more generally in that of the care home. The analysis focused principally on two primarily work-oriented narrative types: "working stories" and "narratives of professional practice". The findings were that such stories performed a range of key functions in the professional practice of the care givers, in particular problem-solving, knowledge-sharing and critical evaluation. [ABSTRACT FROM AUTHOR]