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Little is known about physical activity (PA) and sedentary behavior (SB) among nursing home residents although PA is known as a health promoter. This study examined PA, SB, and their predictors among nursing home residents (n = 63). Dependent variables were accelerometry-based PA and SB. Predictor variables included in a path analysis were age, sex, body mass index, Barthel Index, cognitive status (Mini-Mental State Examination), physical performance (hand grip strength and habitual walking speed), and well-being (World Health Organization-5 well-being index). PA was very low (M steps per day = 2,433) and SB was high (M percentage of sedentary time = 89.4%). PA was significantly predicted by age (β = −0.27, p =.008), body mass index (β = −0.29, p =.002), Barthel Index (β = 0.24, p =.040), and hand grip strength (β = 0.30, p =.048). SB was significantly predicted by body mass index (β = 0.27, p =.008) and Barthel Index (β = −0.30, p =.012). Results might be helpful for everyday practice to identify individuals at high risk for low PA and high SB. [ABSTRACT FROM AUTHOR]

BackgroundMany long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment.ObjectiveThe purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress.DesignThis study was a descriptive, cross-sectional survey using targeted sampling.ParticipantsA total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting.MethodsThis study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses.ResultsThe mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001).ConclusionSince the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.Clinical relevanceOur study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Aim: This study investigated the levels of depression and anxiety in nurses and nursing assistants working in long‐term care facilities during the COVID‐19 pandemic. We also explored the potential causes of depression and anxiety in nurses and nursing assistants working in long‐term care facilities during the pandemic. Background: The COVID‐19 pandemic has had a considerable impact on long‐term care facilities. The high infection and mortality rates for COVID‐19 have resulted in an increased workload for caregivers. Introduction: The COVID‐19 pandemic exposed caregivers working in long‐term care facilities to higher risks of anxiety and depression. Additionally, the high risk of infection in the work environment and concerns about spreading COVID‐19 to family members and long‐term care facility residents led to various forms of stress among caregivers. Methods: The present study was a cross‐sectional study. Questionnaires were used to investigate depression and anxiety among regarding nurses and nursing assistants working in long‐term care facilities during the pandemic. Results: The depression and anxiety levels of the nurses were higher than nursing assistants, but had no statistically significant difference (p = 0.551). The factors influencing levels of depression and anxiety in nurses contained facility affiliation and experience working. In terms of nursing assistants, age, marital status, and facility affiliation were correlated with the levels of depression and anxiety. Discussion: The pandemic has severely impacted caregivers. In the process of implementing pandemic prevention measures and providing care for COVID‐19 patients, safeguarding the psychological health of caregivers is also essential. Conclusion: The levels of depression and anxiety in nurses were higher than in nursing assistants working in long‐term care facilities during the pandemic. Implication for nursing and health policy: Long‐term care facilities managers are recommended to enhance the education and training process for caregivers. Managers are also recommended to ensure provision of sufficient amounts of pandemic prevention equipment and resources. [ABSTRACT FROM AUTHOR]

Aim: To discover what long‐term care (LTC) staff working in self‐managing teams consider necessary to remain sustainably employable. Design: Qualitative study with semi‐structured interviews. Methods: In 2020, semi‐structured interviews were conducted one‐on‐one with 25 LTC workers from a medium‐large Dutch organization providing long‐term care. All interviews were audio‐recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti. Results: LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence. Conclusion: In order to remain willing and able to work, LTC workers in self‐managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs. Implications: It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs. Impact: A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self‐managing teams in LTC organizations, understanding what workers in self‐managing teams need in order to remain sustainably employable is crucial.For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs.The outcomes of this study primarily impact workers and management within LTC organizations with self‐managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector. Reporting Method: The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used. Patient or Public Contribution: Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study. [ABSTRACT FROM AUTHOR]

The COVID-19 outbreak, which most severely impacted older citizens, served as a stress test for residential eldercare facilities. The mortality rates of care home residents varied widely across countries in 2020 before vaccinations became available. Why have some countries been better (or less) able to protect their older citizens in care homes? This article examines the role of specific characteristics of national systems of residential care in enhancing or weakening the capacity of these systems to protect their residents from the pandemic and seeks to draw some lessons for the future. Because the mortality rate in care homes strongly correlates with the overall infection rate within the community, this article adopts an innovative approach to conceptualize and measure the protection capacity of national residential care systems more specifically – that is net of mortality rates within the community. The study makes important contributions to the care policy field. The traditional care regime typology fails to explain cross-national variations in the protective capacity of care homes. Governmental spending on long-term care systems certainly matters for protective capacity but we find that a factor previously neglected by care regime scholars also matters. More specifically, we show that the pattern of staff organization affects protective capacity. Our findings call for a rethinking of care systems in the face of future pandemics. [ABSTRACT FROM AUTHOR]

The way in which international actors formulate proposals for reforming or establishing public social policies not only varies between different organisations but is also dependent on the policy field in question. This article compares the positions of two international organisations (IOs), the Economic Commission for Latin America and the Caribbean (ECLAC) and the Pan American Health Organization (PAHO), on the two related social policy fields of health and long-term care in Latin America. We apply qualitative document analysis to reports and strategy articles published by ECLAC and PAHO between 2000 and 2015. The analysis finds that despite some similar proposals by both organisations, there are also clear differences between their positions depending on the policy areas. While both organisations see the need to establish healthcare and long-term care as a human right, they have different ideas on targeted and universal approaches. Moreover, with long-term care as a new and emerging policy field, there is still much more variation in how the IOs address the topic, while proposals on healthcare are shaped by previous debates at international and regional levels. [ABSTRACT FROM AUTHOR]

An increasing number of children with complex life-limiting and life-threatening conditions are being cared for at home by their parents. Negative impacts on maternal health are now being recognised. This study sought to voice parental experiences to determine what matters most; explore day-to-day decision making and Advance Care Planning; and to inform local service development. Seven mothers from one community nursing service were interviewed using a semi-structured qualitative approach during the Coronavirus disease 2019 pandemic. Seven data-driven themes were identified following six phase thematic analysis: cherishing normality; navigating the system; being proactive; meaningful connections; beginner to expert – and back; they're not any child – they're my child; and Coronavirus disease 2019 pandemic. Practice implications include early discussion of what matters most and benefits of written plans to ensure fair access to treatment for children with complex health. Mothers highlighted that sharing their story enhanced their sense of coping and purpose. Increased support at times of vulnerability and permission to explore decisions were highly valued. [ABSTRACT FROM AUTHOR]

Objectives: In older patients with mental and physical multimorbidity (MPM), personality assessment is highly complex. Our aim was to examine personality traits in this population using the Hetero-Anamnestic Personality questionnaire (HAP), and to compare the premorbid perspective of patients' relatives (HAP) with the present-time perspective of nursing staff (HAP-t). Design: Cross-sectional. Setting: Dutch gerontopsychiatric nursing home (GP-NH) units. Participants: Totally, 142 GP-NH residents with MPM (excluding dementia). Measurements: NH norm data of the HAP were used to identify clinically relevant premorbid traits. Linear mixed models estimated the differences between HAP and HAP-t trait scores (0–10). Agreement was quantified by intraclass correlation coefficients (ICCs). All HAP-HAP-t analyses were corrected for response tendency (RT) scores (−10–10). Results: 78.4% of the patients had at least one premorbid maladaptive trait, and 62.2% had two or more. Most prevalent were: "disorderly" (30.3%), "unpredictable/impulsive" (29.1%) and "vulnerable" (27.3%) behavior. The RT of relatives appeared significantly more positive than that of nursing staff (+1.8, 95% CI 0.6–2.9, p = 0.002). After RT correction, the traits "vulnerable", "perfectionist" and "unpredictable/impulsive" behavior scored higher on the HAP than HAP-t (respectively +1.2, 95% CI 0.6–1.7, p < 0.001; +2.1, 95% CI 1.3–2.8, p < 0.001; +0.6, 95% CI 0.1–1.1, p = 0.013), while "rigid" behavior scored lower (−0.7, 95% CI −1.3 to −0.03, p = 0.042). Adjusted ICCs ranged from 0.15 to 0.58. Conclusions: Our study shows high percentages of premorbid maladaptive personality traits, which calls for attention on personality assessment in MPM NH residents. Results also indicate that the HAP and HAP-t questionnaires should not be used interchangeably for this patient group in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to explore the relationship between intersectional inequities and moral distress among those working in Long-Term Care (LTC) in British Columbia, Canada. Methods: This was a cross-sectional and retrospective study. We assessed moral distress, of 1678 respondents, using a modified Moral Distress Scale, and an equivalent distress mitigation score, at the intersections of gender and racial/ethnic identity. Then, we explored which worker attributes were more predictive of intention to leave work. Results: We found notable difference in experiences of moral distress across intersecting identities, including high moral distress scores among Indigenous men and women, and white women. Significant differences in mitigation scores were also found by intersectional identities. Discussion: Moral distress was the most important predictor of intention to leave work. The differences across racial and gender identity groups suggest the need for tailored interventions to address moral distress among LTC providers. [ABSTRACT FROM AUTHOR]

This study investigates the impacts of health shocks among older individuals on the dynamics of their living arrangements in Europe and the United States. Exploiting unpredicted health shocks, we use an event‐study difference‐in‐differences approach to demonstrate that health shocks increase difficulties with activities of daily living and instrumental activities of daily living, thereby increasing the need for care. Our findings indicate that health shocks raise the probability of nursing home residency and co‐residence with adult children by 0.7 and 1.4 percentage points in Europe, and by 2.1 and 1.8 percentage points in the U.S., respectively. Further analyses reveal that more generous long‐term care public policies correlate with a higher probability of nursing home residency and a lower probability of co‐residing with adult children, highlighting the significant role of public policies in household responses to health shocks. Additionally, we find that health shocks negatively impact adult children's labor supply, particularly in the U.S. [ABSTRACT FROM AUTHOR]

Objective: Examination of the impact of the COVID-19 pandemic on rates of antipsychotic medication use, initiation and discontinuation, among newly admitted long-term care residents. Design: Repeated cross-sectional study. Settings and Participants: Long-term care home residents in Alberta, British Columbia and Ontario, Canada assessed with the Minimum Data Set (MDS) 2.0 assessment. The cohort was segmented according to admission during the pandemic (March 2020/2021) and 2 pre-pandemic (March 2018/2019 and March 2019/2020) periods. Methods: Multivariable logistic regression models were fit to characterize the association between long-term care admission during the COVID-19 pandemic and the use of antipsychotic medications. A second set of logistic regression models were fit among residents with follow-up assessments to characterize the association between long-term care admission and antipsychotic initiation/discontinuation at follow-up. All models were adjusted for resident characteristics including sex, age group, Aggressive Behaviour Scale score, Cognitive Performance Scale score, and diagnoses of Alzheimer's disease and related dementias, anxiety disorder, depression, and bipolar disorder. Results: 21 612 residents admitted during the pandemic and over 30 000 in each pre-pandemic period were included. Antipsychotic use increased during the pandemic period among newly admitted residents from both community (adjusted odds ratio [aOR] 1.20-1.29) and hospital settings (aOR 1.21-1.23). Residents admitted during the pandemic period were more likely to have antipsychotic medications initiated (aOR 1.25-1.26) and less likely to have had them discontinued (aOR 0.74-0.76) at the time of follow-up assessment. Conclusion and Implications: Multiple factors contributed to the observed increase in antipsychotic medication use among newly admitted long-term care home residents during the COVID-19 pandemic: increased medication use at the time of admission, increased medication initiation at follow-up, and decreased medication discontinuation at follow-up. A whole-systems approach that extends beyond long-term care into hospital and community settings is necessary to address this prevalent issue. [ABSTRACT FROM AUTHOR]

Background: Geriatric rehabilitation is a multidisciplinary intervention that promotes functional recovery in older adults. Our objective was to assess the efficacy of geriatric rehabilitation in inpatient and geriatric day hospital settings. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, PEDro and AgeLine from inception to September 30, 2022 for randomized controlled trials (RCTs) including older adults (age ≥ 65 years) undergoing geriatric rehabilitation (inpatient or day hospital) with a usual care comparator group. Primary outcome measures included mortality, long-term care home (LTCH) admission, and functional status. Secondary outcomes included discharge/remaining at home, functional improvement, length of stay, cognition, mood, and quality of life. Records were screened, abstracted and assessed for risk of bias (Cochrane Risk of Bias [RoB] 2) by two reviewers independently. We conducted a random effects meta-analysis to summarize risk ratios (RR, dichotomous outcomes) and standardized mean differences (SMD, continuous outcomes). Results: Of the 5304 records screened, 29 studies (7999 patients) met eligibility criteria. There were 23 RCTs of inpatient geriatric rehabilitation (6428 patients) and six of geriatric day hospital (1571 patients) reporting outcomes of mortality (26 studies), LTCH admission (22 studies), functional status (19 studies), length of stay (18 studies), cognition (5 studies), mood (5 studies) and quality of life (6 studies). The primary outcome of mortality at longest follow up was lower in the rehabilitation group (RR 0.84, 95% confidence interval [CI] 0.76 to 0.93, I2 = 0%). LTCH admission was lower in the rehabilitation group at longest follow up (RR 0.86, 95% CI 0.75 to 0.98, I2 = 8%). Functional status was better in the rehabilitation group at longest follow up (SMD 0.09, 95% CI 0.02 to 0.16, I2 = 24%). Cognition was improved in the rehabilitation group (mean difference of mini-mental status exam score 0.97, 95% CI 0.35 to 1.60, I2 = 0%). No difference was found for patient length of stay, mood, or quality of life. Conclusions: Geriatric rehabilitation in inpatient and day hospital settings reduced mortality, LTCH admission, and functional impairment. Future studies should explore implementation of this intervention for older adults. Review registration: PROSPERO: CRD42022345078. [ABSTRACT FROM AUTHOR]

Background: Older care receivers of long-term care at home or in residential care are in sustained and close contact with nurses. Consequently, nurses' attitudes towards older adults and their care influences the quality of the delivered care. There is a dearth of research on long-term care nurses' attitudes towards older adults. We aimed to investigate Austrian long-term care (residential care and home care) nurses' attitudes towards adults 80 + and towards geriatric care, as well as possible influencing factors like personal and professional contact with older adults. Methods: An online survey using a cross-sectional design was carried out in fall 2023 with a convenience sample of 875 Austrian nurses (qualified nurses, specialised nurses, nurses without diploma). The questionnaire included three scales: (1) The Aging Semantic Differential which measures general attitudes towards older adults, (2) the Perspectives on Caring for Older People Scale, and (3) the Positive/Negative Contact Scales. Results: Nurses were found to hold neutral to positive attitudes towards adults 80 + and their care. Attitudes towards older adults and their care were positively influenced by positive contact experiences and few negative experiences in their work environment. Nurses in home care had significantly more positive contact with care receivers and held more positive attitudes towards adults 80 + than residential care nurses. Conclusion: These results suggest that intergenerational contact can positively impact attitudes of nurses towards older care receivers. In order to further facilitate positive attitudes, it is recommended to create positive contact opportunities between nurses and care receivers by, for example, implementing intergenerational educational interventions. [ABSTRACT FROM AUTHOR]

Background: The quality of life (QoL) of long-term care residents with advanced dementia represents a critical concern. However, empirical data on this topic especially within Chinese society remains relatively scarce. Aims: This study aimed to investigate the QoL in this population and identify the key factors affecting it. Methods: A cross-sectional study employing cluster sampling methodology was carried out in three long-term care facilities in Macao, involving a sample of 81 residents. The participants were assessed using the Functional Assessment Staging Test (FAST) and the Quality of Life in Late-Stage Dementia (QUALID) scale. Other variables recorded included Behavioral and Psychological Symptoms of Dementia (BPSD), comorbidities, PAINAD scores, and Waterlow scores. Results: The majority of participants were female (65.4%), and 70.1% were classified at Stage 7 on the FAST scale. The mean score on the QUALID was 23.94 ± 7.58, suggesting a relatively lower QoL in Macao, particularly in items of smiling, interaction, and touch. Multiple linear regression analysis indicated that higher PAINAD scores, presence of BPSD, and higher FAST stage were significantly associated with lower quality of life among long-term care residents with advanced dementia, explaining 65.9% of the total variance (F = 36.639, p < 0.001). Conclusions: The findings indicated that residents with advanced dementia in Macao experience relatively lower quality of life, particularly in aspects such as smiling, interaction, and touch. Pain, BPSD, and advanced dementia stage are the three major associated factors of QoL among long-term care residents with advanced dementia. Comprehensive and individually tailored care strategies focusing on pain management and interventions targeting BPSD are suggested to enhance QoL in this population. [ABSTRACT FROM AUTHOR]

Background: Non-life-threatening cases treated by emergency services have been increasing in recent years, especially in older people. In a region in Germany with approximately 600,000 inhabitants, the role of a specially trained community paramedic (Gemeindenotfallsanitäter, G-NFS) was introduced in 2019. The G-NFS is dispatched to low-acuity requests, attends the assignment alone and is allowed to treat patients at home. Aim: The aim of this study was to analyse the assignments attended by the G-NFS relating to the suspected diagnoses, with a focus on older people (≥ 65 years) according to their care setting. Methods: In this descriptive, retrospective study, we analysed the anonymous assignment report forms 07/2023–12/2023 of cases where patients were aged ≥ 65 years. The suspected diagnoses (free text field) were categorised according to the International Classification of Primary Care 2nd Edition (ICPC-2) scheme. Furthermore, baseline characteristics, urgency of the assignment, provided measures, transport and further treatment were analysed, stratified by care setting. Results: Of the 1,643 included anonymous assignment report forms, 52.9% (n = 869) related to patients aged ≥ 65 years. In this population, the mean age was 80.7 years (SD 8.2), 49.6% were female and most were in long-term care, whether as home care recipients (34.8%) or as nursing home residents (26.9%). The most frequent diagnoses were categorised as urological (24.9%), general and unspecified (13.7%), circulatory (13.6%), digestive (12.8%), musculoskeletal (11.5%) and respiratory (10.3%). In 52.7% of the cases no transport was necessary, while 73.7% of urological cases did not need to be transported. Conclusion: The G-NFS was dispatched mainly to older people. Most of them were in long-term care and were not transported. The most common suspected diagnoses were categorised as urological, followed by general and unspecified, and circulatory, and differed by care setting. There is a strong need to strengthen outpatient healthcare structures for low-acuity health issues in older and immobile patients. [ABSTRACT FROM AUTHOR]

Unpaid eldercare provided by family comes with costs to caregivers, including the limitations eldercare responsibilities may place on labor force participation and work hours. This study examines the relationship between the frequency of unpaid eldercare and work behavior for previously full-time workers using multivariate regression and 2011–2018 American Time Use Survey data. High-frequency eldercare provision is associated with a decreased probability of being in the labor force for both men and women, and 5.5 fewer weekly hours worked for men ages 25–49, conditional on working full time 2–5 months prior. Policymakers should consider the relationship between work and unpaid caregiving for high-frequency caregivers in addressing growing care demand. [ABSTRACT FROM AUTHOR]

As the proportion of the population comprising the elderly cohort increases, so too does the demand for medical care for long-term conditions among this demographic. The advent of information technology and artificial intelligence has prompted a crucial examination of the potential of smart medical technology and equipment to enhance the quality of long-term care and the operational efficiency of long-term care facilities. The introduction of smart healthcare into long-term care is influenced by a few factors, and expert opinions often exhibit ambiguity and subjectivity in the evaluation process. As Z-numbers are capable of adequately expressing the ambiguity of expert assessments and the degree of certainty associated with them, they are employed in this study to convey the opinions of the experts. Furthermore, the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method is an effective approach to analyzing the relationships between factors. Consequently, this study integrates the Z-numbers and DEMATEL methods for empirical analysis. The present study focuses on two long-term care institutions with different natures as empirical subjects. The findings of the study indicate that Institution A identifies the "Internet of Things" as the most pivotal key factor, whereas Institution B deems "Smart clinics and urgent care centers" to be the most crucial key factor. The analysis demonstrates that three factors—global positioning systems, telemedicine, and electronic medical records—are all regarded as significant influencing factors for different long-term care institutions. Consequently, the analytical model of this study is not only theoretically sound but also effective in identifying the key factors and importance of introducing smart healthcare into long-term care institutions. [ABSTRACT FROM AUTHOR]

Housing conditions and quality are well-established structural or social determinants of health. Poor quality housing also has the potential to affect care needs, but there is much less research on the topic, particularly on nonspecialist housing. Based on analysis of in-depth interviews with 44 people aged 65 and older living in England, their unpaid carers (N = 22), or as a carer-care recipient dyad (N = 6), (total N = 72), this study sought to explore the perceived relationship between people’s housing conditions and characteristics and their care needs. Findings indicate three key themes within this relationship: condition of home (cold and damp; state of repair; cleanliness and clutter); space and design (space, access); and legal relationship with the home (ability to carry out remedial work; precarity). There was variation in how and whether housing affected care needs by housing tenure, financial resources, and the type and level of care need. Care needs can increase requirement for warmer, less damp homes and be a barrier to improving homes. In turn, housing has a role to play in preventing the occurrence or worsening of care needs. Improving housing through policy and practice actions could reduce care needs and improve the lives of older people now and in the future. [ABSTRACT FROM AUTHOR]

Background/Objectives: Inadequate fluid intake is prevalent among older adults living in care settings and can lead to dehydration-related events such as falls and hospitalization. Staff knowledge and confidence using diverse strategies is needed to provide adequate hydration to residents. PROMOTE is a multicomponent intervention designed to support staff to increase resident fluid intake between meals. This study evaluated the educational components of PROMOTE. Methods: Participants (n = 87) working in long-term care or retirement homes completed an online pre-/post-test evaluation of a 7 min educational video. Key informant participants (n = 13) reviewed all educational materials, evaluated their usefulness and feasibility, and were interviewed to identify how to improve the materials. Results: The educational video improved knowledge (e.g., self-rating of knowledge pre-test median 8, standard error of the mean (SEM) 0.18; post-test median 9, SEM 0.13) and confidence. Participants intended to use PROMOTE strategies in their work with residents (1 [very likely] to 10 [very unlikely] median 2.0 SEM 0.27). Key informants rated the hydration of residents as an organizational priority (median 9.0 SEM 0.42) and all indicated that they would use the educational video in their future training. Less feasible educational components as rated by key informants included huddle discussions and email pushes. Posters were seen as feasible (54%) but only somewhat useful (77%). Conclusions: Brief educational videos can improve staff knowledge and confidence regarding providing adequate hydration to residents. Having several educational components that can be used with this video was viewed positively. Recommendations were made to improve the materials. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study investigated the experiences of inpatient family caregivers who experienced restrictions in meeting their family members owing to the changed visitation guidelines of long-term care hospitals during the early stages of the coronavirus disease 2019 (COVID-19). We aimed to deepen our understanding of the nature of these caregivers' experiences. Methods: The participants were family caregivers of patients in long-term care hospitals during the early stages of the COVID-19 pandemic. We collected data from nine inpatient caregivers from April to July 2021. Individual interviews and data were analyzed using Colaizzi's phenomenological method. Results: Participants' experiences were classified into the following three themes: (1) a prison-like long-term care hospital bound by strict COVID-19 prevention rules; (2) growing affection for unreachable parents; and (3) adaptation to a new, safer daily life. Participants had difficulty communicating with their families living under quarantine conditions during COVID-19 due to non-face-to-face situations. However, amid the long-term COVID-19 situation, participants overcame these challenges through efforts to facilitate communication. Conclusions: The results of this study can be used as basic data to support the smooth communication between patients and caregivers in long-term care hospitals in the event of an infectious disease outbreak in the future, to alleviate emotional stress, and to minimize the weakening of families. [ABSTRACT FROM AUTHOR]

Background: Regular dental l check-ups and good oral hygiene are challenging for nursing home residents, resulting in poor oral health. The interRAI instrument for Long-Term Care Facilities (LTCF) enables caregivers to evaluate residents' health, including oral health, and to integrate oral care into general care planning. Because the current oral heal1th section in the interRAI instruments does not accurately identify residents who need help with daily oral care or dental referral, the interRAI Oral Health Section (OHS-interRAI) was developed. The OHS-interRAI differs from the current section by including more items, response options and guidelines, photographs, instruction videos, and Collaborative Action Points to alert caregivers when oral care is needed. This study describes and compares residents' oral health status assessed by caregivers using the current section and the OHS-interRAI. Methods: This cross-sectional study includes baseline data of adults aged 65 years or older in Flemish and Dutch nursing homes, collected by professional caregivers (e.g., nurses, nurse aids, therapists). Assessments with the current section dated from October 2016 to January 2023, and with the OHS-interRAI from October 2020 to January 2023. Results: InterRAI assessments of 12,476 residents from 158 nursing homes with the current section were compared with those of 1212 residents from 37 nursing homes with the OHS-interRAI. The OHS-interRAI assessments showed more missing data. A higher proportion of oral health problems was detected with the OHS-interRAI compared to the current section for chewing function (13.7% vs. 6.8%), dry mouth (9.8% vs. 7.6%), teeth (22.1% vs. 16.6%),and gums (7.8% vs. 3.1%). There was no significant difference in the proportion of residents with discomfort or pain in the mouth. Conclusions: More missing OHS-interRAI data may be attributed to regulatory decisions on using the interRAI LTCF instrument. Caregivers identified more oral health problems with the OHS-interRAI, which may be due to its additional features, such as photographs and extensive instructions. The Collaborative Action Points included in the OHS-interRAI support continuity of care and enable integration of oral care into general care. Further research is needed to evaluate whether the OHS-interRAI accurately identifies residents who need help with daily oral hygiene or dental referral. [ABSTRACT FROM AUTHOR]

Although long-term care is a substantial financial risk for elderly Americans, only about 10% purchase insurance, with many of the remainder relying on Medicaid. Faced with rising Medicaid expenditure on long-term care, states introduced long-term care partnership programmes in the hope of reducing Medicaid spending by encouraging the purchase of private insurance. Using numerical optimization techniques, we show theoretically that partnership programmes will only modestly increase long-term care insurance coverage. Most of the benefits will go to those who would have purchased non-partnership policies. Thus, the potential costs to Medicaid will exceed the savings. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is fundamental to nursing home residents' health. Likewise, physical capacity (PC) is essential to carry out activities of daily living. Although PC and PA are associated, misalignment has been reported in specific subgroups. Increased PC is oftentimes not linked to high PA (i.e., Can do - don't do) and vice versa (i.e., Can't do - do do). Therefore, identifying other contextual factors influencing PA in misaligned groups is important. This study aimed to identify contextual factors in nursing home residents with aligned or misaligned PA and PC. Methods: In total, 180 nursing home residents (≥ 65 years, 79.4% females) were divided into four quadrants (Q1: Can do - do do; Q2: Can do - don't do; Q3: Can't do - do do; Q4: Can't do - don't do) based on thresholds for PA (≥ or < 2,500 steps/day) and PC (≤ or > 0.5 m/s gait speed). Kruskal-Wallis H test and effect sizes (ES) were applied to analyze quadrants' differences regarding PA (steps per day), objective motor capacity, life-space mobility, activities of daily living (ADL), psychosocial well-being, cognition, subjective mobility-related concerns, and spatial orientation. Results: Specific contextual factors differed significantly between the groups. Compared to Q1, Q2 presents a significantly lower life-space mobility (ES: 0.35) and objective motor capacity (ES: 0-36-0.49); Q3 has a lower objective motor capacity (ES: 0.55–1.10); Q4 shows lower independence in ADL (ES: 0.57), life-space mobility (ES: 0.48), subjective mobility-related concerns (ES: 0.38) and objective motor capacity (ES: 0.99–1.08). No significant group differences were found for psychosocial well-being, cognition, and spatial orientation. Conclusions: This study provides new insights into PA behavior of nursing home residents. Key variables linked to PA are objective motor capacity, life-space mobility, ADL, and subjective mobility-related concerns. Surprisingly, some potentially impactful variables such as cognition, orientation, and psychosocial well-being did not differ between the groups. This may suggest that these variables may not represent key targets for interventions aiming to improve PA. This study builds the foundation for further research into the underlying mechanisms behind PA behaviors and supports future efforts to plan specific, targeted interventions for nursing home residents. Trial registration: The trial was prospectively registered at DRKS.de with registration number DRKS00021423 on April 16, 2020. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions In long‐term care (LTC), the incidence of hip or vertebral fractures are eight times that in the community. Despite the wide availability of osteoporosis therapy, LTC residents are omitted from pivotal trials and not treated. Denosumab is a relatively new, monoclonal antibody therapy for osteoporosis treatment. Via a randomized trial, we sought to determine the safety and efficacy of denosumab in LTC residents.We conducted a 2‐year, double‐blind, placebo‐controlled, randomized clinical trial in 201 osteoporotic men and women aged ≥ 65 years, living in LTC communities. Participants with multimorbidity, dysmobility, and cognitive impairment were not excluded. The intervention was denosumab 60 mg subcutaneous every 6 months or placebo. Our primary outcome measures were hip and spine bone mineral density (BMD) improvement at 24 months. Secondary outcomes included BMD at other skeletal sites, function, and safety.We included 123 women and 78 men with a mean ± standard error age of 81.5 ± 0.6. Overall, 83% and 71% completed 12 and 24 months, respectively. Compared with placebo, the women receiving denosumab had a greater 24‐month percent increase in spine (7.41 ± 0.93 vs. 2.15 + 0.56; p = 0.014), and total hip BMD (4.62 ± 0.62 vs. −0.19 ± 0.79; p = 0.007); and men in spine (7.91 ± 0.96 vs. 1.12 ± 1.13; p = 0.002) and total hip (3.74 ± 0.55 vs. 0.48 ± 0.74; p = 0.018). There were no significant differences in safety metrics.Denosumab was a safe and effective therapy for improving BMD in osteoporotic older men and women with multiple comorbidities in LTC. [ABSTRACT FROM AUTHOR]

Currently, over 5.7 million adults 65+ are projected to have a SUD, and the number of fatal overdose deaths among older adults is rising in both community and facility settings. This exploratory study involved surveys of 37 nursing facilities (NF) in Kentucky in order to identify current admission practices to screen, prevent, and/or address resident substance use. Respondents indicated that they were ill-equipped to address such problems and fail to offer specialized programs for residents or training for staff. Training and best practices for residents, their families, and staff should be established to address residents with substance use and SUD. [ABSTRACT FROM AUTHOR]

Health information technologies (HIT) provide opportunities to support staff as well as residents and their families in long-term care (LTC) homes. Yet, LTC homes lag behind other healthcare organizations in HIT adoption, and little is known about the factors that inform and shape LTC home managers’ decisions. We conducted an exploratory Delphi study with a panel of 19 Canadian LTC managers who were surveyed through three iterative rounds (brainstorming, narrowing down, and ranking) to solicit their input on the key factors that influence HIT adoption decisions. An authoritative list of 25 factors, described and ranked in importance, was produced. The top five identified factors were (in order of importance): availability of funding, impact on workload and efficiency, value proposition, ease of use, and impact on residents’ outcomes. The findings of this research may inform policies and interventions that provide training and workshop opportunities for managers in LTC and increase the awareness of the advocacy and leadership role that managers can play in advancing technology adoption in support of older adults’ care. The results can also be used to support funding from LTC home governing bodies, which is tied to the technology adoption portfolio, to institutionalize the commitment to technological transformation in LTC. [ABSTRACT FROM AUTHOR]

Background The Finnish multidomain lifestyle intervention study to prevent cognitive impairment and disability (FINGER, N = 1259), a randomised controlled trial had beneficial effects on morbidity in older people, but to what extent such a lifestyle intervention may affect the use of health care services and their costs especially in long term are unknown. Objective This study investigated the effect of a two-year FINGER multidomain intervention on health care service use during the 8-year follow-up. The costs of service use were also evaluated. Methods Health care service use obtained from national health care registers (days of inpatient hospital stay and long-term care, number of visits to emergency services, hospital as outpatient, home care, primary care physician and primary care nurse) was analysed among participants of the FINGER. Trial targeted community-dwelling people aged 60–77 years at risk for cognitive impairment, who were randomly allocated to the multidomain intervention or control group. Costs were evaluated as the mean costs of services used. Results There were no significant differences in total health care costs between the intervention and control groups. The participants in the intervention group, however, had a lower use of the hospital inpatient care (RR 0.73, 95% CI 0.54–1.00) and emergency services (RR 0.83, 95% CI 0.70–0.97) than those in the control group. Hospital inpatient care was lower especially among men. The use of other types of health care services did not differ between the groups. The costs of health care service use without including long-term care were lower in the intervention group (RR 0.81, 95% CI 0.68–0.99). Conclusions The FINGER intervention has a potential to reduce the need for the inpatient hospital care and emergency visits and associated costs, especially among men. [ABSTRACT FROM AUTHOR]

Background: Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time‐varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS). Methods: NHATS participants were included in this study if they: (1) resided in ALF from Round 1 (2011) through Round 8 (2018); (2) completed the sample person (SP) interview at baseline; (3) were admitted to ALF at age 65 years or older. We conducted Cox proportional hazards regression to examine candidate predictors (difficulty with basic activities of daily living (ADL), chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, self‐reported health, participation in social and physical activity, and sociodemographic) associated with transfer to a nursing home. Employing backward elimination, we built parsimonious final models for analysis. Results: The analytic sample included 970 participants of whom 143 transferred to nursing homes over 8 years. Those who had a better physical performance at baseline (HR = 0.83, 95% CI = 0.79–0.88) and were college educated (HR = 0.58, 95% CI = 0.36–0.92) demonstrated a significantly lower risk for transfer to a nursing home over 8 years. Residents who maintained physical activity (HR = 0.56, 95% CI = 0.37–0.86), better physical performance (HR = 0.87, 95% CI = 0.80–0.94), and difficulty with fewer basic ADLs (HR = 1.13, 95% CI = 1.02–1.26) were at lower risk for transfer to a nursing home over 8 years. Conclusions: Our findings can be used to identify older adults in ALFs at risk of transfer to a nursing home. Strategies to promote physical function and physical activity could avoid/delay the need to transfer. Helping older residents to age in place will have important health and economic benefits. [ABSTRACT FROM AUTHOR]

Background: Although many healthcare settings have since returned to pre‐pandemic levels of operation, long‐term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre‐pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid. Methods: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over‐dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non‐dually enrolled residents. Results: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre‐pandemic years for all examined subgroups. For example, compared with 2018–2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher. Conclusions: In 2022, emergency department and hospital utilization rates among long‐term residents were lower than pre‐pandemic levels and mortality rates were higher than pre‐pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents. [ABSTRACT FROM AUTHOR]

Aims: To analyse the concept of eating experiences in people living with dementia. Design: Rodgers' evolutionary method of concept analysis was used as a framework for the paper. Data Sources: The literature was searched using electronic databases PubMed, Google Scholar, CINHAL, PsycInfo, Web of Science, Embase and Elsevier databases. These databases cover a variety of disciplines, including but not limited to nursing, medicine and occupational therapy. The relevant literature published from 1989 to April 2023 was thoroughly examined. Any quantitative or qualitative studies published in English focused on eating or dining experiences in people with dementia were included. Review Methods: Rodgers' evolutionary method for concept analysis was used. The attributes, antecedents, consequences and case examples of the concept were identified. Results: Twenty‐two articles met the inclusion criteria, identifying key attributes of self‐connection, the special journey of life and self‐interpretation. Antecedents, as framed by the socio‐ecological model, were categorized to represent intrapersonal (personal preferences, individual culture, mealtime routines), interpersonal (social interaction) and environmental (dining room environment, policies) factors. Consequences were divided into external (nutritional health, physical health and quality of life) and internal (personhood, autonomy and independence, dignity and feeling valued and mental well‐being) domains. Conclusion: A theoretical definition and conceptual model of eating experiences in people living with dementia was developed. The identified attributes, antecedents and consequences can be utilized in nursing education, research and intervention approaches. Impact: This article allows nurses and other healthcare professionals to better understand people living with dementia through the relationship between eating and interpersonal, intrapersonal and environmental aspects to develop personalized interventions and care strategies to achieve an optimal quality of life. Patient or Public Contribution: Not applicable. [ABSTRACT FROM AUTHOR]

Aims: To assess visitors' perceptions of the benefits and challenges related to engaging in a remote visit intervention, which was designed to address the loneliness of people living with moderate to severe dementia in care homes. Design: A qualitative descriptive study. Methods: Twenty‐four people living with dementia in care homes in Canada and their family and friends (i.e., remote visitors) took part in facilitated remote visits in 2021. Each person living with dementia received scheduled visits for 30–60 min per week for 6 weeks. Participants chose to complete one longer visit, or multiple shorter visits, per week. Twenty remote visitors participated in semi‐structured interviews after six weeks to discuss their perspectives on the effectiveness, benefits and challenges of the program in relation to addressing experiences of loneliness of the person living with dementia. Conventional content analysis was used to analyze the data. Results: We describe three themes and several sub‐themes. Themes support the use of remote visits to enhance, rather than replace, in‐person visits; the benefits of remote visits for the person living with dementia and their remote visitors; and the conditions that lead to a successful remote visit. Conclusion: Remote visitors reported that facilitated visits had positive effects for both visitors and people living with dementia with respect to loneliness, communication, relationships, and social connection. Implications for Patient Care: Clinicians can consider the factors that contributed to positive experiences of remote visits. The factors include individualized, facilitated visits that were flexible, and the use of reliable technology in a supportive, distraction‐free environment. Impact: Loneliness and social isolation are growing health concerns. When experienced by people living with dementia residing in long‐term care homes, loneliness and social isolation can result in lower levels of quality of life and well‐being, and higher levels of anxiety and responsive behaviours.Remote visitors perceived that facilitated remote visits have the potential to address loneliness and improve quality of life for people living with dementia and also offer social support to remote visitors.The findings can impact clinician practice by guiding the use of remote visits in care homes, and inform future intervention research to evaluate the effectiveness of remote visits for people living with dementia and their remote visitors. Reporting Method: This manuscript adheres to the relevant EQUATOR guidelines (the Consolidated criteria for reporting qualitative research or COREQ). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Over the course of the last year and a half, the Coronavirus has swept across the world causing death and devastation to our geriatric population residing in long term care facilities, also known as nursing homes. This paper explores the complicated grief responses exhibited by individuals who were affected by nursing home resident COVID-19 deaths. Nursing home resident survivors, families of the deceased residents, and healthcare workers in this situation have experienced a wide variety of complicated grief responses that need to be addressed. To address this need, an application will follow regarding the usage of a garden memorial ritual and ceremony to help these grievers in their first steps of mourning. [ABSTRACT FROM AUTHOR]

To determine the frequency of physical therapy (PT) services and potential disparities in receiving PT among Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings. Secondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017-2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date. To identify potential disparities in access to PT services, we performed multivariable logistic regression to determine resident demographic, clinical, and community factors associated with receiving PT. Not applicable. Medicare fee-for-service LTC residents aged ≥65 years. Not applicable. Receiving PT services. Of the 999,495 LTC residents with a history of spine pain, 49.6% received PT. Only 12.1% of PT episodes specifically treated spine pain. The odds of receiving PT were higher for residents with pain in multiple spine regions or neuropathic pain (OR, 1.27; 95% confidence interval CI, 1.26-1.29) and for residents with inpatient admissions (OR, 1.76; 95% CI, 1.75-1.78). Odds of receiving PT were lower for residents from minoritized racial and ethnic groups, and for residents with dementia (OR, 0.89; 95% CI, 0.88-0.90), depression (OR, 0.95; 95% CI, 0.94-0.96), or who lived in urban or more socioeconomically deprived areas. Although nearly half of LTC residents with histories of spine pain received PT services, most PT was not for spine pain. There are potential disparities in access to PT for LTC residents from minoritized groups living in urban and more deprived areas. Further work should examine PT outcomes and remove barriers to PT for LTC residents with histories of spine pain. [ABSTRACT FROM AUTHOR]

Purpose: The importance of wound care as a part of end-of-life care is rising due to aging populations and increased chronic disease prevalence. This study developed a comprehensive competency framework on palliative wound care for nursing staff within long-term care facilities (LTCFs). Methods: The study utilized a three-phased exploratory methods approach involving topic modeling, expert interviews, and a Delphi survey. Results: Four key competencies emerged regarding nursing competency for palliative wound care in LTCFs: (1) building partnerships with patients and caregivers, (2) an individual approach to wound treatment based on understanding the patient's situation, (3) a holistic approach through shared information and cooperative decision-making, and (4) integration of wound management knowledge within end-of-life care. Conclusion: This framework supports developing targeted training programs for nurses to improve the quality of life for terminally ill patients in LTCFs. [ABSTRACT FROM AUTHOR]

Taiwan is currently an aging society and will be a super-aging society in the near future. The purpose of this research is to use two models of data envelopment analysis (DEA)—the slacks-based measurement (SBM) model and the dynamic slacks-based measurement (DSBM) model—to analyze the efficiency of long-term care (LTC) in Taiwan. This analysis aims to explore the current situation of LTC in Taiwan and provide policy recommendations for LTC. The computation empirical result on the LTC efficiency score presents that the DSBM model exhibits higher efficiency than the SBM model after considering the carry-over variable in the former model. The result from the SBM model indicates that Taiwan's outlying islands display the worst LTC efficiency, but this result does not appear in the DSBM model. Lastly, these two models both indicate that the number of elderly people being serviced in institutions exhibits higher efficiency and lower slack than those serviced in homes in 2017 and 2018. This paper concludes that the DEA approach is a viable method for examining the performance of the LTC services system as Taiwan approaches a super-aged society. [ABSTRACT FROM AUTHOR]

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Who is responsible for health care? Neoliberal policies since the 1970s seem to place this responsibility increasingly on the individual, in a process that is called responsibilization. The recent literature on neoliberalism, however, has questioned the preference of free-market liberalism for individual responsibility and shows how neoliberals often made common cause with communitarian conservatives on social policies. Melinda Cooper, for instance, has argued in her book Family Values that free-market liberals and social conservatives in the US both identified the family as a 'wholesale alternative to the 20-century welfare state'. This article investigates whether this coalition of neoliberals and social conservatives, who agree on the importance of familial solidarity in addition to market freedom, has also played a role in the making of Dutch health care policies. By tracing how responsibility for long-term care has been allocated in the postwar Netherlands in the specific case of children with (cognitive) disabilities, the author will show how 'the family' has increasingly been embraced by policymakers as the main responsible party. This is remarkable because the Dutch postwar welfare state sought to loosen family ties in favour of individual arrangements. However, attempts by different stakeholders to deinstitutionalize Dutch health care during the 1990s unintentionally moved the state's responsibility for long-term care not so much onto individuals as onto families. [ABSTRACT FROM AUTHOR]

Background and Objectives Oral health of older adults in nursing homes is poor, which can negatively affect general health and well-being. Most oral health problems are preventable with good oral hygiene and regular dental check-ups. Caregivers can help improve residents' oral health through regular oral health assessments. The interRAI instrument used in Long-Term Care Facilities to evaluate older adults' health and well-being, has the potential to integrate oral care into general care planning. The recently optimized Oral Health Section for inclusion in the interRAI instruments (OHS-interRAI) enables nondental caregivers to identify residents requiring help with oral hygiene and/or a dental referral. This study reports the first data obtained using the OHS-interRAI, describing the oral health situation of older adults in Flemish and Dutch nursing homes. Research Design and Methods In this cross-sectional study, interRAI Long-Term Care Facilities data, including OHS-interRAI data, were collected from October 2020 to January 2023 and analyzed from 417 and 795 persons aged 65 years or older in Flemish and Dutch nursing homes, respectively. Results Most common oral health problems were poor oral hygiene and compromised teeth. Differences in oral health were found between Flemish and Dutch residents. Flemish residents had significantly more problems with chewing, dry mouth, oral and denture hygiene, and tongue condition than their Dutch counterparts. They also had a higher need for help with oral hygiene (19.4% vs 14.0%), and a dental referral (36.8% vs 20.9%). Older adults in Flemish nursing homes (20.3%) had significantly fewer dental check-ups than those in Dutch nursing homes (73.5%). Discussion and Implications The use of the OHS-interRAI by nondental caregivers identified at least one-third of the residents requiring help with oral hygiene and/or a dental referral. By means of trigger algorithms (Collaborative Action Points), the OHS-interRAI enables the integration of oral care into general care planning. [ABSTRACT FROM AUTHOR]

Background: Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention "Learning to feel better... and help better" has shown positive results regarding family caregivers' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention. Methods: A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups. Findings: A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes. Conclusion: Findings suggest that psychoeducation, with active skills training based on caregivers' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Preventing functional disability benefits the quality of life of older adults and mitigates the economic burden of an aging society. However, the most effective physical performance tests and optimal cut points for identifying older adults at risk of functional disability remain unclear, and Japan lacks physical function‐based assessment tools. We aimed to identify the physical performance tests related to functional disability and to develop a predictive test battery for it.We included 975 older adults (mean 72.8 ± 5.2 years, 55.4% women) in Kasama City, Japan. Functional disability was defined as certification of care level 2 or above based on the long‐term care insurance system. Cox proportional hazards analysis examined the association between physical performance tests and incident functional disability.During a mean follow‐up of 8.6 years (maximum 14 years), 236 participants (24.2%) developed functional disability. After adjusting for covariates, higher performances in grip strength, single‐leg balance with eyes open (SLB), timed up‐and‐go (TUG), five‐repetition sit‐to‐stand (5‐STS), and 5‐m habitual walk were significantly associated with a lower risk of functional disability. In a stepwise model, SLB, TUG, and 5‐STS were key predictors of functional disability. Receiver operating characteristic analysis determined optimal cut points of 32.6/32.7 s for SLB, 6.5/6.6 s for TUG, and 7.8/7.9 s for 5‐STS. We developed a predictive battery combining these cut points (area under the curve = 0.78).The developed battery of physical performance tests predicts future functional disability and is useful for screening older adults at high risk. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsClinical implicationThis study aimed to assess the knowledge, attitude, and practice of the healthcare professionals and paid caregivers toward non-pharmacological interventions (NPIs) for managing behavioural and psychological symptoms of dementia (BPSD) in Australian residential aged care homes (RACHs).A cross-sectional, online survey was completed by RACH staff and physicians over the period 6 March-31 August 2023. Descriptive statistics were used to present the results.Ninety-six respondents participated (41.7% aged 35–54 years, 80.2% female, 38.5% nurses). While 50–65% of the respondents were extremely familiar with 15 of NPIs, only 22% believed there was a sufficient funding for their implementation, and 6% felt there were sufficient human resources. Although 66% of the respondents viewed NPIs as more useful than medications, only 46% expected consistent positive outcomes from NPIs. The most used NPIs were redirection, behaviour management, and validation therapy.The study highlights that barrier such as inadequate funding, limited human resources, skepticism about NPIs’ effectiveness, unfamiliarity with certain NPIs, and unfavourable attitude toward NPIs are likely to slow NPI adoption for BPSD management.To improve practice, it is essential to address these barriers through targeted education, and training, increased funding, and enhancement of the workforce. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Discussion Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community‐based rehabilitation model for care homes, namely Interdisciplinary Care Home‐bAsed Reablement Program (I‐CHARP), by examining whether (and, if so, how) I‐CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia.I‐CHARP is a 4‐month bio‐behavioural‐environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8–12 full individual sessions and additional eight brief follow‐ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi‐experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I‐CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi‐structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I‐CHARP processes and implementation issues.In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes.Trial Registration: Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088.Protocol version: 1.0 dated 20 July 2023 [ABSTRACT FROM AUTHOR]

The demand for home-based eldercare, especially for those with dementia, has been growing as societies age; in this context, the acute shortage of local care labor has resulted in the use of migrant workers in many countries. Taiwan, Singapore, and Austria, all emphasizing the family’s responsibility for eldercare, have long histories of recruiting migrant workers for home-based eldercare. However, cases of mistreatment of migrant caregivers and care recipients have aroused public concern regarding migrant workers’ care capabilities and working conditions. Migrant caregivers have also reported that their lack of care skills and sufficient rest hamper their work with care recipients who have dementia. This commentary provides a critical review of the laws and policies pertaining to live-in migrant care workers’ care capabilities and working conditions; the effects of such legal frameworks; and recent changes in Taiwan, Singapore, and Austria. This article enhances our cross-country understanding of the advantages and disadvantages of using foreign labor for eldercare in private homes. Governments should enact legislation that supports live-in migrant care workers’ care capabilities and welfare, thereby also improving the well-being of care recipients and their families. [ABSTRACT FROM AUTHOR]

Background: Appropriate use of medication is a key indicator of the quality of care provided in long-term care (LTC). The objective of this study was to determine whether resident-facility language concordance/discordance is associated with the odds of potentially inappropriate prescribing of antipsychotics (PIP-AP) in LTC. Methods: We conducted a population-based, retrospective cohort study of LTC residents in Ontario, Canada from 2010 to 2019. We obtained resident language from standardized resident assessments, and derived facility language by determining the proportion of residents belonging to each linguistic group within individual LTC homes. Using linked administrative databases, we identified all instances of PIP-AP during a 1-year follow-up period. PIP-AP was defined using the STOPP-START criteria, which have previously been shown to predict adverse clinical events such as emergency department (ED) visits and hospitalizations. The association between linguistic factors and PIP-AP was assessed using adjusted multivariable logistic regression analysis. Results: We identified 198,729 LTC residents consisting of 162,814 Anglophones (81.9%), 6,230 Francophones (3.1%), and 29,685 Allophones (14.9%). The odds of PIP-AP of were higher for both Francophones (aOR 1.15, 95% CI 1.08–1.23) and Allophones (aOR 1.11, 95% CI 1.08–1.15) when compared to Anglophones. When compared to English LTC homes, French LTC homes had greater odds of PIP-AP (aOR 1.12, 95% CI 1.05–1.20), while Allophone homes had lower odds of PIP-AP (aOR 0.82, 95% CI 0.77–0.86). Residents living in language-discordant LTC homes had higher odds of PIP-AP when compared to LTC residents living in language-concordant LTC homes (aOR 1.07, 95% CI 1.04–1.10). Conclusion: This study identified linguistic factors related to the odds of PIP-AP in LTC, suggesting that the linguistic environment may have an impact on the quality of care provided to residents. [ABSTRACT FROM AUTHOR]

Generating and translating high‐quality evidence is integral to providing safe and effective medication management for residents of aged care homes. Residents are often under‐represented in trials of medication effectiveness and safety. This paper reviews opportunities and challenges for generating and translating evidence for safe and effective medication management in aged care homes. There are an increasing number of randomized controlled trials (RCTs) being conducted in aged care homes. Observational studies can also help address the evidence‐practice gap arising from underrepresentation of residents in RCTs. Stepped‐wedge and helix counterbalanced designs may help overcome limitations of traditional RCTs for evaluating medication management interventions in the aged care setting. Strategies for generating evidence include building effective partnerships with aged care homes and organizations, using novel trial designs, leveraging existing data and knowledge sharing through international platforms. Strategies for translating evidence include using quality indicators for audit and feedback, provision of education and training, engaging internal and external stakeholders, and development of local action plans and guideline implementation tools. There is an emerging interest in the role of knowledge brokers to facilitate knowledge translation. Future directions for generating and translating evidence include strengthening international research collaboration, industry partnerships, standardizing aged care home data to support national and international comparisons, and optimizing the use of technology. Initiatives may include improving access to routinely collected administrative health and medication data for conducting high‐quality observational studies. Future studies should assess outcomes prioritized by residents to ensure that medication management strategies are tailored to their needs. [ABSTRACT FROM AUTHOR]

The most adverse outcomes of the COVID-19 pandemic include high post-infection mortality among long-term care (LTC) home residents. Research about mortality over a longer period after contracting COVID-19 and in different pandemic years is limited. In the current study, we examined outcomes for 1,596 LTC residents from the day of a positive COVID-19 test until January 31, 2023. We reported all-cause mortality 30 days after contracting COVID-19 and monthly throughout the follow-up, up to 35 months after the pandemic start. We also examined mortality among 2,724 residents residing in the same LTC homes, with no history of COVID-19 during the same period. The results underscored a large number of deaths in the first month post-infection, with 30-day mortality substantially decreasing over the years—from 28% (95% CI [24.3, 31.8]) among residents contracting COVID-19 in 2020, to 8.3% (95% CI [7.4, 9.2]) in the 2022 cohort. Observed over longer periods, monthly mortality among residents with a COVID-19 history was similar to mortality in the No-COVID residents, and no evidence was found of increased mortality risk in the COVID group beyond the first post-infection month. We discuss mortality in LTC during the pandemic and a continuing need to reduce mortality in the acute phase of COVID-19. [ABSTRACT FROM AUTHOR]

Objective Data Sources/Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To examine the association of Medicaid home‐ and community‐based services (HCBS) expenditures on the home care workforce.We use two national, secondary data sources from 2008 to 2019: state‐level Medicaid HCBS expenditures and the American Community Survey, in which we identify direct care workers in the home (i.e., home care workers), defined as nursing, psychiatric, and home health aides or personal care aides working in home health care services, individual and family services, and private households.Our key explanatory variable is HCBS expenditures per state per year. To estimate the association between changes in Medicaid HCBS expenditures and the workforce size, hourly wages and hours worked, we use negative binomial, linear, and generalized ordered logit regression, respectively. All models include demographic and socioeconomic characteristics, the number of potential HCBS beneficiaries (individuals with a disability and income under the federal maximum income eligibility limits), indicators for minimum wage and/or overtime protections for direct care workers, wage pass‐through policies, and state and year fixed effects.We exclude states with incomplete reporting of expenditures.States' HCBS expenditures increased between 2008 and 2019 after adjusting for inflation and the number of potential HCBS beneficiaries. Yet, home care workers' wages remained stagnant at $11–12/h. We find no association between changes in Medicaid HCBS expenditures and wages. For every additional $1 million in Medicaid HCBS expenditures, the expected number of workers increases by 1.2 and the probability of working overtime increased (0.0015% points; p < 0.05). Results are largely robust under multiple sensitivity analyses.We find no evidence of a statistically significant relationship between changes in state‐level changes in Medicaid HCBS expenditures and worker wages but do find a significant, but small, association with hours worked and workforce size. [ABSTRACT FROM AUTHOR]

Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21–1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02–1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03–1.33) and renal failure (OR = 1.63, 95% CI = 1.42–1.86), high fall risk (OR = 2.67, 95% CI = 2.30–3.10), and being bedridden (OR = 6.55, 95% CI = 5.48–7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15–2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally. [ABSTRACT FROM AUTHOR]

Background: Rehabilitation can help long-term care (LTC) residents with dementia maintain their independence. However, many residents do not receive rehabilitation. This study aimed to identify the barriers and facilitators to providing rehabilitation for LTC residents with dementia and propose practical interventions for overcoming them. Methods: Using a phenomenological research design, we conducted a qualitative study involving 17 privately owned LTC homes in Nova Scotia, Canada. Data were collected through individual interviews and a focus group with residents with dementia (n = 3), family members (n = 4), rehabilitation providers (n = 6), and other staff (n = 3). We analyzed the data using inductive thematic content analysis and mapped the results onto the socioecological framework and the Behaviour Change Wheel (BCW) to classify and analyze barriers and facilitators to rehabilitation. The APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) in the BCW were used to identify feasible interventions and policies linked to the identified barriers and facilitators. Results: Barriers at the intrapersonal level included communication difficulties, comorbidities, and lack of motivation among residents. Interpersonal factors encompassed the availability of family support and lack of interdisciplinary practice. Policy/environmental factors involved limited resources, complex admission processes, low staff ratios, and restrictive restraint policies. Enhancing communication, reducing the use of restraints, promoting interdisciplinary practice, and increasing accessibility to activity spaces and equipment will improve the provision of rehabilitation for the residents. Conclusion: Enhancing the capabilities, opportunities, and motivations of all actors in LTC homes can potentially minimize these barriers. Interventions such as staff training on effective communication and dementia care, promoting person-centred and meaningful activities, and improving interdisciplinary collaboration are crucial. Policy measures to improve hospital-to-LTC transitions, increase volunteer involvement, educate families and communities, and recruit more staff are recommended. Addressing these barriers through targeted interventions and policy changes can significantly improve rehabilitation provision for residents with dementia in LTC settings. [ABSTRACT FROM AUTHOR]