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Background: The health issues experienced by older people can often be severe and complex, and an increasing number are using residential aged care services to meet their care needs. High-quality nursing care is fundamental to the health and safety of aged care residents and is contingent on nurses' accurate assessment, informed decision-making, and delivery of timely interventions. However, the role of the aged care nurse is often challenging, impeded by factors such as understaffing, high workloads, and a lack of access to clinical infrastructure and resources. When these challenges mount, residents are put at greater risk of adverse outcomes, such as avoidable clinical deterioration and hospital transfers. This study describes the adaptation and implementation of the emergency nursing framework, HIRAID® (History including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment, communication and plan)—a tool to assist nurses' assessment, decision-making and care in residential aged care. Methods: The HIRAID® framework will be adapted for residential aged care using a real-time Delphi and panel of aged care and nursing experts. The co-designed HIRAID® Aged Care framework will be trialled in 23 residential aged care homes in Sydney, Australia, in a modified stepped-wedge cluster randomised controlled trial design. All homes will be randomised into one of four clusters. Outcomes of interest include the rate of clinical deterioration events resulting from nurses' actions, the rate of hospital transfers determined to be inappropriate, performance against the national mandatory aged care quality indicators, resident satisfaction with care, nurse and medical staff satisfaction with communication, and the quality of nursing documentation. These outcomes will be evaluated using a combination of qualitative and quantitative analysis of routinely collected resident data, expert assessments of facility documentation events against validated criteria, and pre- and post-intervention surveys of residents, family carers, nurses, and medical staff. Discussion: This protocol describes a pragmatic trial that aims to translate an evidence-based framework from the emergency care context into residential aged care. The adapted HIRAID® Aged Care framework will be the first of its kind to standardise and guide holistic nursing assessment, decision-making, and documentation in residential aged care in Australia. Ethics and dissemination: This research has been approved by the Western Sydney Local Health District Human Research Ethics Committee: 2023/ETH00523. A waiver of consent has been approved to access resident health data and nursing documentation at each participating site. Trial registration: Australian and New Zealand Clinical Trial Registry, ACTRN12623000481673. Registered 12 May 2023. Protocol version: Version 1.0 6 February 2024. [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]

As compared to adult populations, there is a significant dearth of studies examining official misconduct among juveniles, leaving important gaps in our knowledge. Utilizing a sample of youth completing juvenile justice residential placement in Florida across four fiscal years (n = 5739), the current study seeks to examine the joint effects of facility environment and individual characteristics on institutional misconduct, represented by aggression and academic misconduct in facilities. Academic Youths' severity of criminal involvement, adverse childhood experiences (ACEs), emotional and communication skills, and history of violence or drugs all contributed to explaining their aggression and academic misconduct in facilities. The level of institutional security consistently emerged as a significant predictor for academic misconduct and aggression. Aggression in facilities was more sensitive to the severity of ACEs. Policy implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease contribute significantly to societal and individual impact globally. High‐quality management of these long‐term health conditions is important to prevent deterioration of health, although potentially more complex for patients with intellectual disabilities in residential care. Disease management in this context particularly benefits from complete and accurate recording of disease management. Without complete records, long‐term health conditions are more difficult to track due to the level of uncertainty regarding which clinical examinations have and have not been performed. This study therefore aims to examine the recording routines of quality indicators for disease monitoring for chronically ill patients with intellectual disabilities in Dutch residential care. Methods: This retrospective study utilised medical record data from a large Dutch long‐term care provider. We assessed the occurrence of cardiovascular disease (ICPC‐2 codes K74, K75, K76, K89 and K90), type 2 diabetes mellitus (T90, T90.02) and/or COPD (R91, R95). For adults with intellectual disabilities and long‐term condition, we analysed data entries in an 18‐month period (between July 2020 and December 2021). Observed consultation rates were calculated and presented in median with interquartile range and contrasted against the baseline number of consultations in primary care. Information on recorded quality indicators was presented in frequencies and percentages. Findings: Of the three long‐term conditions investigated, the most common was type 2 diabetes mellitus (8.6%; n = 287), followed by cardiovascular disease (5.8%; n = 195) and COPD (3.0%; n = 101). Of those who received management for their long‐term condition from their contracted GP, patients with type 2 diabetes mellitus, cardiovascular disease, or COPD had fewer consultations in 2021 than the Dutch baseline. Discussion of lifestyle was often not recorded. Disease monitoring quality indicators were recorded more often but at a lower frequency than expected. Conclusions: Because of the infrequent recording of quality indicators, recording of management of long‐term conditions for patients with intellectual disabilities in long‐term care appears suboptimal. Although this may not directly harm individual patients, it may jeopardise the quality of management of long‐term conditions, as suboptimal recording limits opportunities for evaluation and improvement. Within a broader trend towards data‐driven work methods in healthcare, recording of quality indicators requires attention from practice, research and policy. We should watch over long‐term diseases to help people stay healthy. We run tests, like checking blood pressure. The results are written in their medical records. These tests are like quality checks.We wanted to see if and how these quality checks were used, mostly for people with a learning disability living in care homes who also have heart disease, diabetes, or lung problems.We looked at their medical papers to see if these checks were there. We also looked at how often they saw the doctor.We found that chronically ill people with a learning disability went to the doctor quite often. But not as often as we expected. Also, the checks were not always written down. The talks about their lifestyle with the doctors were not noted very often.This can impact how well doctors care for the health issues of people with learning disability. [ABSTRACT FROM AUTHOR]

Objectives: Among residents who had a residential medication management review (RMMR), there is a lack of studies assessing exposure to polypharmacy and potentially inappropriate medications (PIMs) in people with dementia. This study compared the exposure to polypharmacy and PIMs in residents with dementia and without dementia receiving RMMR. Methods: A retrospective analysis was performed using data of 16,261 residents living in 343 Australian residential aged care facilities who had an RMMR in 2019. Medication use was assessed as polypharmacy (defined as ≥9 medications) and use of ≥1 PIMs using the 2019 updated Beers criteria. Dementia diagnosis was determined with ICD‐10 coding from medical records. Descriptive analyses reported resident demographics and patterns of medication use. Pearson's χ2 tests and logistic regression analysis were conducted to compare medication exposure between residents with and without dementia. Results: Among 16,261 residents, 6781 (42%) had dementia. Residents with dementia were significantly more likely to be exposed to polypharmacy and PIMs, compared to those without dementia (74% vs. 70% and 83% vs. 73%, p <.001 respectively). Residents with dementia had 1.31 times the odds of exposure to polypharmacy (adjusted OR: 1.31, 95% CI: 1.22–1.41, p <.001) and 1.88 times the odds of being prescribed ≥1 PIMs than people without dementia (adjusted OR: 1.88, 95% CI: 1.73–2.04, p <.001). Conclusions: In a study of residents receiving RMMR, polypharmacy and PIMs were highly common, and those with dementia were more likely to be exposed to inappropriate polypharmacy. There is a need for targeted deprescribing strategies to immediately address inappropriate prescribing in residents, particularly those living with dementia. [ABSTRACT FROM AUTHOR]

Objectives: Inclusion of consumer perspectives is a key component to person‐centred health‐care approaches. While current residential aged care systems focus on recording adverse events to meet the requirements of regulatory reporting, little is known about the views of residents. The aim of this research was to explore residents' responses on the types of incidents that have an adverse impact on them and how they are affected by these incidents. Methods: The study used a qualitative, inductive approach to derive themes from interviews with 20 permanent residents of aged care facilities in New South Wales and the Australian Capital Territory. Results: Four main themes surrounding adverse incidents emerged: (i) social relationships and the adverse impacts of lack of meaningful interactions, (ii) adjustment to life in the residential aged care facility and the loss of residents' former life and self‐determination, (iii) the impact of COVID‐19 lockdowns which meant that residents were not able to go out or interact with others and (iv) acceptance, resignation and resilience in coping with adverse incidents. Conclusions: This research highlights the difference between health‐care definition, used for incident management reporting and quality indicators, and the way residents respond when asked to describe an incident that has affected them. Resident responses discuss situations having an adverse effect on them in contrast to the way adverse events and incidents are reported and monitored. The findings suggest that within adverse event and incident management systems and resident governance systems, there is scope for incorporating periods of transitions and well‐being measures that capture elements that matter to older people. [ABSTRACT FROM AUTHOR]

Care partners (CP) of people with dementia (PWD) report that decisions about care setting are aided by the support of healthcare providers. However, providers are often underprepared to offer adequate counseling. This qualitative study aimed to identify what support from providers will assist CPs in making decisions related to care setting throughout the dementia journey. We conducted semi-structured interviews with current CPs of PWD and former CPs of decedents. We utilized the constant comparative method to identify themes regarding preferences around care setting as the PWD progressed from diagnosis to end-of-life. Participants were 31 CPs, including 16 current and 15 former CPs. CPs had a mean age of 67 and were primarily white (n = 23/31), female (n = 21/31), and spouses (n = 24/31). Theme 1: Current CPs discussed overwhelming uncertainty pertaining to care setting, expressing I dont know when I need to plan on more care, and a desire to understand what stage we are at. Theme 2: Later in the disease, former CPs wanted guidance from healthcare providers on institutional placement (I sure wouldve loved some help finding better places) or support to stay in the home (a doctor had to come to the house). CPs want early, specific guidance from healthcare providers related to transitions between home and long-term care. Early in the disease course, counseling geared toward prognosis and expected disease course helps CPs make plans. Later, caregivers want help identifying locations or institutionalization or finding home care resources.

Abstract Background The health issues experienced by older people can often be severe and complex, and an increasing number are using residential aged care services to meet their care needs. High-quality nursing care is fundamental to the health and safety of aged care residents and is contingent on nurses’ accurate assessment, informed decision-making, and delivery of timely interventions. However, the role of the aged care nurse is often challenging, impeded by factors such as understaffing, high workloads, and a lack of access to clinical infrastructure and resources. When these challenges mount, residents are put at greater risk of adverse outcomes, such as avoidable clinical deterioration and hospital transfers. This study describes the adaptation and implementation of the emergency nursing framework, HIRAID® (History including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment, communication and plan)—a tool to assist nurses’ assessment, decision-making and care in residential aged care. Methods The HIRAID® framework will be adapted for residential aged care using a real-time Delphi and panel of aged care and nursing experts. The co-designed HIRAID® Aged Care framework will be trialled in 23 residential aged care homes in Sydney, Australia, in a modified stepped-wedge cluster randomised controlled trial design. All homes will be randomised into one of four clusters. Outcomes of interest include the rate of clinical deterioration events resulting from nurses’ actions, the rate of hospital transfers determined to be inappropriate, performance against the national mandatory aged care quality indicators, resident satisfaction with care, nurse and medical staff satisfaction with communication, and the quality of nursing documentation. These outcomes will be evaluated using a combination of qualitative and quantitative analysis of routinely collected resident data, expert assessments of facility documentation events against validated criteria, and pre- and post-intervention surveys of residents, family carers, nurses, and medical staff. Discussion This protocol describes a pragmatic trial that aims to translate an evidence-based framework from the emergency care context into residential aged care. The adapted HIRAID® Aged Care framework will be the first of its kind to standardise and guide holistic nursing assessment, decision-making, and documentation in residential aged care in Australia. Ethics and dissemination This research has been approved by the Western Sydney Local Health District Human Research Ethics Committee: 2023/ETH00523. A waiver of consent has been approved to access resident health data and nursing documentation at each participating site. Trial registration Australian and New Zealand Clinical Trial Registry, ACTRN12623000481673. Registered 12 May 2023. Protocol version Version 1.0 6 February 2024.

Abstract Background The increasing care complexity of nursing home residents living with dementia requires new care models that strengthen professional collaboration. To contribute to the sustainable implementation of new care models, it is important that they are linked to the care reality. However, little is known about intra- and interprofessional organization and provision of care in German nursing homes. Therefore, the aim of this study was to explore the current care situation, problems and strengths regarding intra- and interprofessional collaboration in the care of residents living with dementia. Methods We conducted a holistic multiple case study. The individual care units in which residents living with dementia are cared for were defined as cases. The context was built by the respective nursing homes and their regional affiliation to the federal state of North Rhine-Westphalia. We used qualitative face-to-face interviews, documents and context questionnaires for data collection. The different sources of evidence served to capture complementary perspectives and to validate the findings. First, the collected qualitative data were analyzed using deductive-inductive content analysis. Second, similarities and differences between the cases were identified to elaborate case-specific and cross-case patterns and themes. The reporting followed the EQUATOR reporting guideline for organizational case studies. Results We included four care units comprising 21 professionals (nurses, physicians, social worker, physiotherapist, pharmacist) and 14 relatives of residents living with dementia. The analysis revealed four categories to describe current intra- and interprofessional collaboration in all cases: actors and their roles, service delivery, coordination and governance, and communication channel. Moreover, we identified three categories that relate to the strengths and problems of intra- and interprofessional collaboration in all cases: role understanding, teamwork, and communication and exchange. Although we examined similar care units, we found differences in the realization of professional collaboration and resulting problems and strengths that are connected to the organizational contexts and strategies used. Conclusions Even though professional collaboration follows given patterns; these patterns do differ context-specifically and are perceived as problematic and fragmentary. Therefore, the identified differences and problems in collaboration need to be addressed in future research to develop and successfully implement tailored innovative care models.

Introduction: Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross‐sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. Methods: Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self‐report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. Results: A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. Conclusion: This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model. [ABSTRACT FROM AUTHOR]

Background: The increasing care complexity of nursing home residents living with dementia requires new care models that strengthen professional collaboration. To contribute to the sustainable implementation of new care models, it is important that they are linked to the care reality. However, little is known about intra- and interprofessional organization and provision of care in German nursing homes. Therefore, the aim of this study was to explore the current care situation, problems and strengths regarding intra- and interprofessional collaboration in the care of residents living with dementia. Methods: We conducted a holistic multiple case study. The individual care units in which residents living with dementia are cared for were defined as cases. The context was built by the respective nursing homes and their regional affiliation to the federal state of North Rhine-Westphalia. We used qualitative face-to-face interviews, documents and context questionnaires for data collection. The different sources of evidence served to capture complementary perspectives and to validate the findings. First, the collected qualitative data were analyzed using deductive-inductive content analysis. Second, similarities and differences between the cases were identified to elaborate case-specific and cross-case patterns and themes. The reporting followed the EQUATOR reporting guideline for organizational case studies. Results: We included four care units comprising 21 professionals (nurses, physicians, social worker, physiotherapist, pharmacist) and 14 relatives of residents living with dementia. The analysis revealed four categories to describe current intra- and interprofessional collaboration in all cases: actors and their roles, service delivery, coordination and governance, and communication channel. Moreover, we identified three categories that relate to the strengths and problems of intra- and interprofessional collaboration in all cases: role understanding, teamwork, and communication and exchange. Although we examined similar care units, we found differences in the realization of professional collaboration and resulting problems and strengths that are connected to the organizational contexts and strategies used. Conclusions: Even though professional collaboration follows given patterns; these patterns do differ context-specifically and are perceived as problematic and fragmentary. Therefore, the identified differences and problems in collaboration need to be addressed in future research to develop and successfully implement tailored innovative care models. [ABSTRACT FROM AUTHOR]

Objectives: Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies. Methods: Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAIP) and staff members (WAI- T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning. Results: Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI- P and WAI- T ratings. Linear regression showed that patients with higher education reported lower WAI- P ratings (β = -.50, p = .044), while not being engaged in work or study was associated with lower WAI- T scores (β = -4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI- P ratings (β = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI- T (β = -.10, p = .002) and WAI- P ratings (β = -.19, p < .001). Better functioning level positively foresaw WAI- T (β = .14, p < .001) and WAI- P ratings (β = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy. Conclusions: This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Person-centred medicine is recommended in the care of older patients. Yet, involvement of care home residents and relatives in medication processes remains limited in routine care. Therefore, we aimed to develop a complex intervention focusing on resident and relative involvement and interprofessional communication to support person-centred medicine in the care home setting. Methods The development took place from October 2021 to March 2022 in the Municipality of Aarhus, Denmark. The study followed the Medical Research Council guidance on complex intervention development using a combination of theoretical, evidence-based, and partnership approaches. The patient involvement tool, the PREparation of Patients for Active Involvement in medication Review (PREPAIR), was included in a preliminary intervention model. Study activities included developing programme theory, engaging stakeholders, and exploring key uncertainties through interviews, co-producing workshops, and testing with end-users to develop the intervention and an implementation strategy. The Consolidated Framework for Implementation Research and the Interprofessional Shared Decision Making Model were used. Data were analysed using a rapid analysis approach. Results Before the workshops, six residents and four relatives were interviewed. Based on their feedback, PREPAIR was modified to the PREPAIR care home to fit the care home population. In total, ten persons participated in the co-producing workshops, including health care professionals and municipal managerial and quality improvement staff. The developed intervention prototype was tested for three residents and subsequently refined to the final intervention, including two fixed components (PREPAIR care home and an interprofessional medication communication template) delivered in a flexible three-stage workflow. Additionally, a multi-component implementation strategy was formed. In line with the developed programme theory, the intervention supported health care professionals´ awareness about resident and relative involvement. It provided a structure for involvement, empowered the residents to speak, and brought new insights through dialogue, thereby supporting involvement in medication-related decisions. The final intervention was perceived to be relevant, acceptable, and feasible in the care home setting. Conclusion Our results indicate that the final intervention may be a viable approach to facilitate person-centred medicine through resident and relative involvement. This will be further explored in a planned feasibility study.

Abstract Introduction Clinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia’s new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care. Methods and analysis The Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial is a helix-counterbalanced randomised controlled trial. The 12-month trial will be conducted in up to 19 RACFs operated by four Australian aged care provider organisations in Victoria, New South Wales, Western Australia and Queensland. RACFs will be randomised to receive three levels of implementation strategies (knowledge broker service, pharmacist-led quality use of medications education activities and distribution of the Guidelines and supporting materials) across three medication contexts (antipsychotics, benzodiazepines and antidepressants). Implementation strategies will be delivered by an embedded on-site aged care pharmacist working at a system level across each participating RACF. All RACFs will receive all implementation strategies simultaneously but for different medication contexts. The primary outcome will be a composite dichotomous measure of 6-month RACF-level concordance with Guideline recommendations and good practice statements among people using antipsychotics, benzodiazepines and antidepressants for changed behaviours. Secondary outcomes will include proportion of residents with Guideline concordant use of antipsychotics, benzodiazepines and antidepressants measured at the RACF-level and proportion of residents with psychotropic medication use, hospitalisation, falls, falls with injury, polypharmacy, quality of life, activities of daily living, medication incidents and behavioural incidents measured at the RACF-level. Discussion The EMBRACE trial investigates a novel guideline implementation strategy to improve the safe and effective use of psychotropic medications in RACFs. We anticipate that the findings will provide new information on the potential role of knowledge brokers for successful and cost-effective guideline implementation. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 — retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx .

Background: Person-centred medicine is recommended in the care of older patients. Yet, involvement of care home residents and relatives in medication processes remains limited in routine care. Therefore, we aimed to develop a complex intervention focusing on resident and relative involvement and interprofessional communication to support person-centred medicine in the care home setting. Methods: The development took place from October 2021 to March 2022 in the Municipality of Aarhus, Denmark. The study followed the Medical Research Council guidance on complex intervention development using a combination of theoretical, evidence-based, and partnership approaches. The patient involvement tool, the PREparation of Patients for Active Involvement in medication Review (PREPAIR), was included in a preliminary intervention model. Study activities included developing programme theory, engaging stakeholders, and exploring key uncertainties through interviews, co-producing workshops, and testing with end-users to develop the intervention and an implementation strategy. The Consolidated Framework for Implementation Research and the Interprofessional Shared Decision Making Model were used. Data were analysed using a rapid analysis approach. Results: Before the workshops, six residents and four relatives were interviewed. Based on their feedback, PREPAIR was modified to the PREPAIR care home to fit the care home population. In total, ten persons participated in the co-producing workshops, including health care professionals and municipal managerial and quality improvement staff. The developed intervention prototype was tested for three residents and subsequently refined to the final intervention, including two fixed components (PREPAIR care home and an interprofessional medication communication template) delivered in a flexible three-stage workflow. Additionally, a multi-component implementation strategy was formed. In line with the developed programme theory, the intervention supported health care professionals´ awareness about resident and relative involvement. It provided a structure for involvement, empowered the residents to speak, and brought new insights through dialogue, thereby supporting involvement in medication-related decisions. The final intervention was perceived to be relevant, acceptable, and feasible in the care home setting. Conclusion: Our results indicate that the final intervention may be a viable approach to facilitate person-centred medicine through resident and relative involvement. This will be further explored in a planned feasibility study. [ABSTRACT FROM AUTHOR]

Policymakers increasingly emphasize the importance of achieving meaningful participation of children living in residential care. To achieve the goal of participation, children must be adequately informed, have opportunities to express themselves freely and to be heard, and be given the opportunity to influence decisions about their lives. This study investigated the views and experiences of both children and staff with respect to children's participation in residential facilities in Norway. We conducted both focus‐group and individual interviews with 6 children and 18 staff members at different facilities. Qualitative interview data were analysed using the dimensions of meaningful participation: informing, hearing and involving. The study offers three main findings. First, children's initiatives determine if staff inform them of their rights, with two exceptions: children are presented with information by staff when they arrive at a facility and/or after staff use coercion that requires protocols. Second, staff members expressed the importance of listening to children's opinions in a standardized way, following bureaucratic guidelines and structures. Third, several children stated that, no matter what they say, they cannot change the minds of staff members. These findings reveal that the dimensions of meaningful participation (informing, hearing and involving) are not all fully present at these facilities. Further research is needed to determine how to achieve in practice the policy goal of participation of children in residential care. [ABSTRACT FROM AUTHOR]

Aim: To examine the experiences of internationally qualified nurses, including those from culturally and linguistically diverse backgrounds, transitioning to and working in the aged care sector of high-income countries. Design: A scoping review. Data Sources: CINAHL, MEDLINE and PSychINFO databases were searched to find eligible literature published from January 2010 onwards. Review Methods: This scoping review was based on the framework by Arksey and O'Malley and the PRISMA-ScR guidelines. The literature search was conducted by the first author, and all three authors reviewed the retrieved studies for eligibility and inclusion. Results: Fourteen articles were eligible. Data was categorized into three broad themes: stress of migration and transition; miscommunication, racism and discrimination; and aged care specific challenges which included two sub-themes ‘shock of aged care’ and ‘bottom care’. Conclusion: Internationally qualified nurses, particularly if they are culturally and linguistically diverse, face unique stresses and challenges in aged care and face barriers in the recognition of skills and qualifications. The under-utilization of skills is not only a loss in terms of patient care but is linked to fears of de-skilling, losing professional development and opportunities for career progression. Impact: Internationally qualified nurses are positioned as a solution to aged care shortages in high-income countries; however, there is a scarcity of research exploring their experiences. In the context of the global aged care staffing crisis, an understanding of the stresses and challenges faced by internationally qualified nurses will further strengthen efforts to recruit, support and retain skilled nurses in aged care. [ABSTRACT FROM AUTHOR]

Introduction: Clinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia's new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care. Methods and analysis: The Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial is a helix-counterbalanced randomised controlled trial. The 12-month trial will be conducted in up to 19 RACFs operated by four Australian aged care provider organisations in Victoria, New South Wales, Western Australia and Queensland. RACFs will be randomised to receive three levels of implementation strategies (knowledge broker service, pharmacist-led quality use of medications education activities and distribution of the Guidelines and supporting materials) across three medication contexts (antipsychotics, benzodiazepines and antidepressants). Implementation strategies will be delivered by an embedded on-site aged care pharmacist working at a system level across each participating RACF. All RACFs will receive all implementation strategies simultaneously but for different medication contexts. The primary outcome will be a composite dichotomous measure of 6-month RACF-level concordance with Guideline recommendations and good practice statements among people using antipsychotics, benzodiazepines and antidepressants for changed behaviours. Secondary outcomes will include proportion of residents with Guideline concordant use of antipsychotics, benzodiazepines and antidepressants measured at the RACF-level and proportion of residents with psychotropic medication use, hospitalisation, falls, falls with injury, polypharmacy, quality of life, activities of daily living, medication incidents and behavioural incidents measured at the RACF-level. Discussion: The EMBRACE trial investigates a novel guideline implementation strategy to improve the safe and effective use of psychotropic medications in RACFs. We anticipate that the findings will provide new information on the potential role of knowledge brokers for successful and cost-effective guideline implementation. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 — retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx. [ABSTRACT FROM AUTHOR]

Long-term care facilities are increasingly important places for palliative and end-of-life care provision in Japan. While the importance of culture has been noted for palliative and end-of-life care, an exploration of its influence on care provision in long-term care settings has received little direct attention in Japan. Exploring staff views and beliefs in palliative and end-of-life care in these settings can potentially enhance our understanding of culturally oriented care and facilitate the development of tailored and more effective support practices. This study aimed to explore the cultural views and beliefs regarding palliative and end-of-life care among the staff in Japanese long-term care facilities. A qualitative exploratory study was conducted using focus groups with facility staff (N = 71) and semi-structured interviews with facility managers (N = 10) in the Kanto region of Japan. Thematic analysis was conducted according to Braun and Clarke's approach. The findings are presented in five key themes: 'Changes in society's and family's end-of-life perspectives', 'Values and beliefs regarding death and dying', 'Anxiety and regret', 'Tensions in doing the right thing' and 'Ways of alleviating pressure'. The findings indicate that the provision of palliative and end-of-life care is underpinned by cultural nuances that influence care providers' approach and delivery. Recognising and understanding the cultural beliefs of staff around death, dying and end-of-life care are important in meeting the needs of residents. Palliative care education for staff in these settings should include cultural considerations that reflect changing societal views on death and dying. [ABSTRACT FROM AUTHOR]

Objectives: To address the following research questions: (i) What is the current situation and future vision on oral healthcare service in nursing homes (NHs) in Singapore? (ii) What are the enablers to achieve the future vision? (iii) How do views differ between dentists with and without clinical experiences in NHs? Background: Oral healthcare services in NHs need to reflect the perspectives of a diverse range of stakeholders and establish shared goals, however there is scarce evidence of in‐depth dentists' insights. Material and methods: Dentists were purposively recruited. Focus group discussions with 4–5 participants each were conducted via teleconferencing. Data were analysed thematically. Results: The participants (n = 19, median 36.0 years) recognised the need of comprehensive reform of the oral healthcare paradigm in NHs: symptomatic care to preventive care, disease‐oriented care to person‐centred care and more active collaborative care. Overall, five domains of enabling factors emerged: (1) to improve general system of oral healthcare in NHs, (2) to increase the number of dentists engaging in NHs, (3) to improve the quality of dental practice, (4) to improve the quality of daily oral care and (5) to promote seniors' cooperative attitude to oral healthcare. There was a noticeable difference in the perception on how to encourage dentists to serve in NHs. Conclusion: There is a need for a comprehensive reform of the oral healthcare paradigm for seniors in NHs in Singapore. A multi‐tiered strategy using both top‐down and bottom‐up approaches is required. [ABSTRACT FROM AUTHOR]

Abstract Bakground Worldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives. Methodology The study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis. Results The results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before. Conclusions The pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed.

Bakground: Worldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives. Methodology: The study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis. Results: The results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before. Conclusions: The pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed. [ABSTRACT FROM AUTHOR]

The shift towards community-based care in Japan has led to increased medication assistance for older people by non-medical care staff. These staff members help take pre-packaged medications, apply patches, and administer eye drops. This study assessed the risks associated with such assistance by reviewing medication-related incidents across 106 residential care facilities between April 1, 2015, and March 31, 2016. An analysis of incident reports showed that all incidents were minor, with no serious outcomes. The incidents were categorized into four types: dropped drugs, misdelivery/misuse of medicines, forgetting to take medicines, and loss of medicines, with dropped drugs being the most frequent. Most incidents occurred in the morning and primarily involved residents with intermediate nursing care needs. These findings indicate a low risk of serious incidents because of medication assistance from non-medical staff. However, the frequency and nature of the incidents were influenced by the timing of medication administration and the care needs of the residents. These insights highlight the need for customized approaches to medication assistance, considering the residents' care levels and potentially optimizing medication administration times to improve safety in residential care settings. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Research & Development in Nursing / Hemşirelikte Araştırma Geliştirme Dergisi is the property of Association for Research & Development in Nursing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives. Industry reports suggest that routine and essential care in Australian residential aged care (RAC), including allied health (AH) services, were disrupted during the coronavirus diseas 2019 (COVID-19) pandemic. This study aimed to explore whether AH services in RAC were paused during the pandemic, factors associated with a pause in care delivery, and qualitative details on how COVID-19 impacted AH service delivery. Methods. A 26-question survey was distributed via social media, health service providers, and AH networks between February and April 2022. Participation was restricted to AH professionals and assistants with experience in RAC during the pandemic. A mix of closed and open-ended response questions was used to collect demographic data and experiences of delivering care during the pandemic. Quantitative responses were analysed with descriptive statistics and a probit model. Content analysis was performed on open-ended questions. Results. One hundred and four AH professionals and assistants responded to the survey. Fifty-five percent of participants (n = 51) were contractually or casually employed. AH services were negatively impacted by the pandemic with 52% of respondents experiencing a pause in service delivery and 78% reporting poorer AH care quality. In a probit model, contracted/casually employed respondents were more likely to experience a pause in care delivery (1.03, P < 0.05) compared to permanently employed AH professionals. Conclusion. Insecure work arrangements may have exacerbated inconsistent care during the pandemic (impacting residents) and may have negative implications on the RAC AH workforce. In the future, an AH inclusive workforce policy including data collection and research is required to monitor and plan the RAC workforce. [ABSTRACT FROM AUTHOR]

Objective: To examine factors that may influence the risk of discharge to a residential aged care facility (RACF) in a population of frail older inpatients. Methods: We analysed data from 5846 inpatients aged over 60 years from 27 hospitals in Queensland, Australia, admitted from independent living and referred for geriatric consultation. Patients underwent an interRAI Acute Care Comprehensive Geriatric Assessment by trained nurses. Frailty was assessed using a 52‐item frailty index (FI). Risk/protective factors were determined a priori. Logistic regression assessed the relationship between factors and discharge destination, adjusted for FI, age, sex and hospital. Frailty × risk/protective factor interactions were performed. Results: Patients had a mean (SD) age of 79.7 (8.2) years and a mean (SD) FI of 0.44 (0.14). Twenty‐nine per cent (n = 1678) of patients were discharged to an RACF. Each 0.1 increment in FI increased the risk of discharge to an RACF by 54% (OR 1.54, 95% CI 1.40–1.68, p < 0.01). Being married or in a de facto relationship had protective effects up to an FI of 0.7, whereas behavioural and psychological symptoms of dementia (BPSD) increased the risk of RACF discharge up to an FI of 0.7. Female sex, faecal incontinence and living alone did not influence the relationship between frailty and discharge destination. Conclusions: The association between frailty and discharge to RACF has previously been recognised but here we found that risk and protective factors can influence this association. Whether early identification and management of mutable factors can reduce discharge to RACF should be addressed in future studies. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of a pharmacist‐led medication review on deprescribing medications in a Residential In‐Reach (RIR) service which provides acute care substitution to residential aged care residents. Methods: A pre‐post observational study was conducted. Patient characteristics and admission and discharge medications were collected over two 3‐month phases before (prephase) and after (postphase) the introduction of a pharmacist who performed a comprehensive medication review and provided deprescribing recommendations. The Screening Tool of Older Persons' Prescriptions (STOPP) version 2 was used to identify potentially inappropriate medications (PIMs). The Drug Burden Index (DBI) was used to measure cumulative anticholinergic and sedative medication burden. Outcome of deprescribing was measured by the reduction in the number of PIMs, DBI scores and proportion of polypharmacy from admission to discharge. Results: The prephase included 59 patients (mean age 87.3 years, 63% female), and the postphase included 88 patients (mean age 87.3 years, 63% female). There was a significant reduction in the mean number of PIMs (pre +0.05 ± 2.59 vs. post −0.78 ± 2.32, p = 0.04) and median DBI (pre −0.004 ± 0.17 vs. post −0.07 ± 0.2, p = 0.03) in postphase compared to prephase. The proportion of polypharmacy at discharge was reduced in the postphase (pre‐100% vs. post‐90%, p = 0.01). The most deprescribed PIMs as measured by STOPP in postphase were drugs without indication, cardiovascular system drugs and gastrointestinal system drugs. Conclusions: The introduction of a pharmacist‐led medication review in RIR service was associated with a significant reduction in the mean number of PIMs, median DBI and polypharmacy. Future studies are needed to determine whether deprescription is sustained to examine correlations to long‐term patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate retrospectively an analgesic stewardship role of a non‐dispensing pharmacist as part of a general practice team providing primary care services to residential aged care facilities (RACF). Methods: Our general practice implemented an analgesic stewardship program to optimise and monitor opioid usage for our patients located across 12 RACF in Canberra from March 2019 to September 2020. The primary objective was the development of a multidisciplinary chronic pain care plan to document treatment and monitoring strategies for optimising pain control. The pharmacist reviewed and documented existing pain management strategies in a care plan for each patient and discussed recommendations for optimisation with the general practitioner. The general practitioner implemented accepted recommendations and distributed finalised care plans to the RACF. A retrospective audit of care plans was undertaken to assess the outcomes: mean daily oral morphine equivalence to monitor opioid usage, and pain scores to monitor for any potential harm associated with analgesic stewardship. Results: One hundred and sixty‐seven residents received an initial care plan. Residents were scheduled for a follow‐up care plan after 6 months, which was achieved for 100 residents (60%). Scope for optimising opioid therapy was identified for 47 residents (28%) at baseline and 23 residents (23%) at follow‐up. Mean opioid usage and pain scores were reduced at follow‐up; 19.4 mg (SD 40.8) versus 13.4 mg (SD 22.8), and 4.2 (SD 2.3) versus 3.9 (SD 2.0), respectively. Conclusions: A systematic, multidisciplinary analgesic stewardship approach may optimise pain management plans and reduce opioid usage in RACF residents. [ABSTRACT FROM AUTHOR]

Background. Older adults in residential care homes in Hong Kong usually have multiple co-morbidities and need end-of-life (EOL) care. Repeated hospitalisations before death are common. The Hospital Admission Risk Reduction Program for the Elderly (HARRPE) score is correlated with mortality. We compared older adults identified by clinical referral with older adults identified by HARRPE score ≥0.4 in terms of EOL programme enrolment rate and mortality rates at 180 and 365 days. Methods. This retrospective cohort study included older adults aged ≥80 years residing in care homes from 1 July 2018 to 30 June 2019. We compared older adults identified by clinical referral with older adults identified by HARRPE score ≥0.4 in terms of EOL programme enrolment rate and mortality rates at 180 and 365 days. Results. Of 113 clinical referral patients and 735 patients with HARRPE score ≥0.4, 102 and 96, respectively, fulfilled EOL programme criteria. Their mean age was 92 years, with female predominance (71%). Enrolment rates were similar (57% and 51%, respectively). Survival probability was higher among enrolled patients than among nonenrolled patients (p<0.001). The two groups were comparable in terms of the 180-day mortality rate and 365-day mortality rate. In both groups, survival probabilities were higher in patients who enrolled in the EOL programme, compared with patients who did not enrol (p<0.001). The median survival was longer in the HARRPE group (191 vs 155 days). Conclusions. Older adults in residential care homes requiring EOL care according to HARRPE score ≥0.4 have similar enrolment and mortality rates, compared with clinical referral. The HARRPE score is a feasible tool to supplement clinical referral for timely EOL care. [ABSTRACT FROM AUTHOR]

Abstract Background In Sweden, older people in residential care had the highest mortality rates, followed by those who received home care, during the coronavirus disease 2019 (COVID-19) pandemic. Staff working in the care of older people assumed responsibility for preventing the spread of the virus despite lacking the prerequisites and training. This study aimed to investigate the psychosocial work environment during the COVID-19 pandemic among staff in the care of older people and examine the factors associated with staff’s perceptions of the clarity of instructions and the ability to follow them. Methods A cross-sectional study design was employed using a web survey. The staff’s perceptions of their psychosocial environment were analysed using descriptive statistics. The association between organisational and individual factors, as well as the degree of clarity of the instructions and the staff’s ability to follow them, were assessed using multivariate (ordinal) regression analysis. Results The main findings show that perceptions of the clarity and adaptability of the instructions were primarily correlated with organisational factors, as higher responses (positive) for the subscales focusing on role clarity, support and encouragement in leadership at work were associated with the belief that the instructions were clear. Similarly, those indicating high job demands and high individual learning demands were less likely to report that the instructions were clear. Regarding adaptability, high scores for demands on learning and psychological demands were correlated with lower adaptability, while high scores for role clarity, encouraging leadership and social support, were associated with higher adaptability. Conclusions High job demands and individual learning demands were demonstrated to decrease the staff’s understanding and adoption of instructions. These findings are significant on an organisational level since the work environment must be prepared for potential future pandemics to promote quality improvement and generally increase patient safety and staff health.

BackgroundResidential youth care (RYC) institutions aim to provide care and stability for vulnerable adolescents with several previous and present challenges, such as disrupted attachments, wide-ranging adverse childhood experiences, mental health problems, and poor quality of life (QoL). To the best of our knowledge, the present study is the first to provide knowledge of the associations between perceived social support and QoL and to explore the potential moderating effect of perceived social support on QoL for adolescents who have experienced maltreatment and polyvictimization.MethodsAll RYC institutions with adolescents between the ages 12-23 in Norway were asked to participate in the study. A total of 86 institutions housing 601 adolescents accepted the invitation, from which 400 adolescents volunteered to participate. The Child and Adolescent Psychiatric Interview was used to gather information on maltreatment histories and degree of victimization; the Kinder Lebensqualität Fragebogen was used to measure QoL through several domains (overall QoL, physical well-being, emotional well-being, and self-esteem); and the Social Support Questionnaire was used to measure perceived social support. Linear regression and independent samples t-test were used to study the associations between perceived social support and QoL as well as the potential moderating effect of perceived social support in the association between maltreatment history and QoL.ResultsPerceived social support was positively associated with QoL for both girls and boys, with domain-specific findings. A higher number of different types of support persons was associated with overall QoL, emotional well-being, and self-esteem for boys, but only with self-esteem for girls. Individual social support from RYC staff and friends was associated with higher QoL for girls. However, perceived social support did not moderate the association between maltreatment history and reduced QoL for either sex.ConclusionsThis study emphasizes the importance of maintaining social support networks for adolescents living in RYC, the crucial contribution of RYC staff in facilitating social support, and the potential value of social skills training for these vulnerable adolescents. Furthermore, a wider range of initiatives beyond social support must be carried out to increase QoL among adolescents with major maltreatment and polyvictimization experiences.

Background: Support workers are central to the delivery of residential aged care, but the workforce is facing increasing work demands and widespread shortages. This contributes to high rates of burnout, decreased job satisfaction and high staff turnover. Peer-led interventions are reported to be effective but it is necessary to use evidence-based interventions to support this key workforce group. Objective: This study aimed to evaluate the scientific evidence on effectiveness of strategies improving psychosocial and turnover-related outcomes for support workers in aged care that could be incorporated into a peer-led intervention. Design: Systematic review and meta-analyses of experimental and quasi-experimental studies. Setting: Residential aged care. Methods: A systematic literature review was conducted using MEDLINE (via PubMed), EMBASE (via Scopus), and CINAHL (via EBSCO). We included studies examining the effectiveness of workplace interventions aiming to reduce aged care support workers' turnover rates and/or improve their work-related psychosocial outcomes (such as work stress, job satisfaction, self-esteem, and other). A number of meta-analyses using a mixed-effects model were performed to calculate standardized mean differences and odds ratios. Results: Fifty-one studies were included: 15 randomised controlled trials (RCTs), 19 non-RCTs and 17 Pre-Post studies. Most of the studies were rated as having ‘high’ or ‘very high risk of bias’. The studies were clustered by intervention type: 1) knowledge-based, 2) interpersonal skills-based, 3) team-building, and 4) self-care. Knowledge-based interventions were the most used approach, with 26 studies in this category, and frequently reported improvements in stress- and satisfaction-related outcomes. There were twelve interpersonal skills-based and nine team-building interventions, which often reported decreased work stress, staff turnover, and intention to quit. There were four self-care interventions of which only one reported improvements in stress-related outcomes. Meta-analyses showed that only knowledge-based interventions resulted in statistically significant improvements: lower staff turnover rates (OR 0.47, 95 %CI: 0.37, 060), and higher scores for job/life satisfaction (SMD 0.26, 95 % CI: 0.05, 0.46) and staff attitude (SMD 0.23, 95 % CI: 0.05, 0.45). Conclusion: This review found numerous strategies that have been trialled to improve support workers’ psychosocial- and turnover-related outcomes. Most studies reported improvements in outcomes. However, our meta-analyses suggest that the effect sizes were small and mostly non-significant, with the evidence being of low certainty. The evidence for effectiveness of knowledge-based interventions appears the most convincing, with statistically significant improvements reported for turnover rates, job/life satisfaction and staff attitude. More high-quality studies are needed to consolidate the existing evidence. PROSPERO registration number: CRD42017059007; 02 June 2017.Tweetable abstract: Knowledge-based interventions most promising in improving support workers’ outcomes in aged care. #agedcare #staffturnover

Background: In Sweden, older people in residential care had the highest mortality rates, followed by those who received home care, during the coronavirus disease 2019 (COVID-19) pandemic. Staff working in the care of older people assumed responsibility for preventing the spread of the virus despite lacking the prerequisites and training. This study aimed to investigate the psychosocial work environment during the COVID-19 pandemic among staff in the care of older people and examine the factors associated with staff's perceptions of the clarity of instructions and the ability to follow them. Methods: A cross-sectional study design was employed using a web survey. The staff's perceptions of their psychosocial environment were analysed using descriptive statistics. The association between organisational and individual factors, as well as the degree of clarity of the instructions and the staff's ability to follow them, were assessed using multivariate (ordinal) regression analysis. Results: The main findings show that perceptions of the clarity and adaptability of the instructions were primarily correlated with organisational factors, as higher responses (positive) for the subscales focusing on role clarity, support and encouragement in leadership at work were associated with the belief that the instructions were clear. Similarly, those indicating high job demands and high individual learning demands were less likely to report that the instructions were clear. Regarding adaptability, high scores for demands on learning and psychological demands were correlated with lower adaptability, while high scores for role clarity, encouraging leadership and social support, were associated with higher adaptability. Conclusions: High job demands and individual learning demands were demonstrated to decrease the staff's understanding and adoption of instructions. These findings are significant on an organisational level since the work environment must be prepared for potential future pandemics to promote quality improvement and generally increase patient safety and staff health. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives Dementia-specific care units vary in their organizational characteristics and are difficult to compare in empirical studies. Based on a representative sample of care units in German nursing homes, we present a typology of organizational characteristics focusing on dementia-specific care structures. We also examine the relationships between organizational types and the provision of nonpharmacological interventions for people with dementia. Research Design and Methods Data were collected in a Germany-wide survey of a stratified randomized sample of 134 care units using a standardized questionnaire administered during telephone interviews with nursing home administrators or their representatives. The typology was developed based on a factor analysis of mixed data and a hierarchical cluster analysis. Results We identified 4 types of care units: Dementia Care Units (DCUs; n = 40), Dementia Special Care Units (DSCUs; n = 17), Usual Separated Care Units (n = 58), and Usual Incorporated Care Units (n = 19). All care unit types clearly differed in their organizational characteristics. The specialization of DSCUs was agreed upon with cost bearers and included admission criteria, higher costs, and better staff conditions. Dementia Care Units without specialization did not have these characteristics. Three of seven nonpharmacological interventions were associated with the DSCUs and two with DCUs, but not with the other care unit types. Discussion and Implications Researchers can use the typology to define and describe care units in empirical studies and improve the understanding and comparability of the context. A clear definition of care units also improves international comparisons. [ABSTRACT FROM AUTHOR]

Background: Cataract surgery improves quality of life and reduces cognitive deterioration. Objectives: This paper discusses the health implications of low vision, commonly related to cataracts, in older adults. A recent publication reported that cataract surgery reduces the risk of dementia by 30% over 10 years. Methods: We searched Medline from inception to January 2023. We also conducted backward and forward citation searches of included studies and set up alerts to identify studies published after the search date. We performed discussion groups with multidisciplinary experts. Results: This article provides a broad description of the importance of vision for cognitive function. We discuss access to public‐funded cataract surgery in Australia and New Zealand and how this impacts population benefits. Conclusions: We have evidence that cataract surgery can decrease the risk of dementia. This is an important topic that deserves recognition as part of an overall ageing response by policymakers and health professionals. [ABSTRACT FROM AUTHOR]

Objectives: To examine the incidence and trends in primary care, allied health, geriatric, pain and palliative care service use by permanent residential aged care (PRAC) residents and the older Australian population. Methods: Repeated cross‐sectional analyses on PRAC residents (N = 318,484) and the older (≥65 years) Australian population (N ~ 3.5 million). Outcomes were Medicare Benefits Schedule (MBS) subsidised primary care, allied health, geriatric, pain and palliative services between 2012–13 and 2016–17. GEE Poisson models estimated incidence rates and incidence rate ratios (IRR). Results: In 2016–17, PRAC residents had a median of 13 (interquartile range [IQR] 5–19) regular general medical practitioner (GP) attendances, 3 (IQR 1–6) after‐hours attendances and 5% saw a geriatrician. Highlights of utilisation changes from 2012–13 to 2016–17 include the following: GP attendances increased by 5%/year (IRR = 1.05, 95% confidence interval [CI] 1.05–1.05) for residents compared to 1%/year (IRR = 1.01, 95%CI 1.01–1.01) for the general population. GP after‐hours attendances increased by 15%/year (IRR = 1.15, 95%CI 1.14–1.15) for residents and 9%/year (IRR = 1.08, 95%CI 1.07–1.20) for the general population. GP management plans increased by 12%/year (IRR = 1.12, 95%CI 1.11–1.12) for residents and 10%/year (IRR = 1.10, 95%CI 1.09–1.11) for the general population. Geriatrician consultations increased by 28%/year (IRR = 1.28, 95%CI 1.27–1.29) for residents compared to 14%/year (IRR = 1.14, 95%CI 1.14–1.15) in the general population. Conclusions: The utilisation of most examined services increased in both cohorts over time. Preventive and management care, by primary care and allied health care providers, was low and likely influences the utilisation of other attendances. PRAC residents' access to pain, palliative and geriatric medicine services is low and may not address the residents' needs. [ABSTRACT FROM AUTHOR]

Abstract Background The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation of visitors, affecting the quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults’ daily life, were also interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these institutions. In this context, this study aims to evaluate the impact of the return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers. Methods This study used a pre-test and post-test design within the same group. The first round of data collection was conducted before volunteer-led activities returned and the second round after 1 month of return. The instrument used to assess QoL was the EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in Brazil. Volunteer-led activities were part of residents’ daily life before the COVID-19 pandemic, when these activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29 residents, 27 volunteers, and 23 employees of the long-term care institution. Results Using a Wilcoxon signed-rank test, the analyses indicated improvements after the 1 month return in different QoL aspects for the three groups. Volunteers improved their personal relationships (Z − 2.332, p

To describe acute seizure treatment for the long-term care setting, emphasizing rescue (acute abortive) medications for on-site management of acute unexpected seizures and seizure clusters. Narrative review. People with seizures in long-term care, including group residences. PubMed was searched using keywords that pertained to rescue medications, seizure emergencies/epilepsy, seizure action plans, and long-term care. Seizure disorder, including epilepsy, is prevalent in long-term care residences, and rescue medications can be used for on-site treatment. Diazepam rectal gel, intranasal midazolam, and diazepam nasal spray are US Food and Drug Administration (FDA)–approved seizure-cluster rescue medications, and intravenous diazepam and lorazepam are approved for status epilepticus. Benzodiazepines differ by formulation, route of administration, absorption, and metabolism. Intranasal formulations are easy and ideal for public use and when rectal treatment is challenging (eg, wheelchair). Intranasal, intrabuccal, and rectal formulations do not require specialized training to administer and are easier for staff at all levels of training compared with intravenous treatment. Off-label rescue medications may have anecdotal support; however, potential disadvantages include variable absorption and onset of action as well as potential risks to patients and caregivers or care partners. Delivery of intravenous-administered rescue medications is delayed by the time needed to set up and deliver the medication and is subject to dosing errors. Seizure action plans that include management of acute seizures can optimize the quality and timing of treatment, which may reduce emergency service needs and prevent progression to status epilepticus. Seizure disorder is prevalent across all ages but is increased in older adults and in those with intellectual and developmental disabilities. Prompt intervention may reduce negative outcomes associated with acute unexpected seizures and seizure clusters. Seizure action plans that include acute seizures can improve the treatment response by detailing the necessary information for staff to provide immediate treatment. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents in residential care have more adverse childhood experiences (ACEs) than those living in any other type of care. However, there is scant research on risk factors accounting for this accumulation. Objective: To establish the prevalence of ACEs in child residential care and to explore predictors of accumulation and clustering patterns. Method: A cluster-randomized sample of 1275 children ages 5–18 years was drawn from 78 residential care facilities across Romania. Clinical psychologists from Child Protective Services (CPS) aided in the collection of ACEs, family, health and history data. Network analysis was used to explore ACE clustering patterns, while a Zero-Inflated Negative Binomial regression provided insights into covariate risk factors. Results: Within the network, influential ACEs were found to be consistent with previous research. However, using expanded ACEs on a high exposure sample, two new clusters emerged: (1) ACEs reported by children at the highest mean ages (abused by a romantic partner, arrested or incarcerated, sexually abused), (2) ACEs pertaining to social exclusion (seriously medically ill, discriminated, bullied). Several risk factors significantly predicted ACE accumulation: craniocerebral trauma, prenatal exposure to drugs, cognitive delay, conduct disorder and frequent change of homes. Institutional placement and special education were found as protective factors. Conclusions: A child in residential care that was institutionalized for reasons other than neglect or abuse had 80% probability of not being ever exposed to any ACEs. Nevertheless, CPS can utilize important risk factors and influential past ACEs to detect children at higher risks of further adversity. [ABSTRACT FROM AUTHOR]

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Objectives: Organisational culture is increasingly recognised as influencing the quality of care provided to patients and residents of aged care, both in research and in policy. For example, investigations into quality and safety issues in health care frequently highlight cultural problems, but often without adequate theorisation of culture. This study aimed at identifying how cultures of care delivery are considered in the final report of the Royal Commission into Aged Care Quality and Safety, and its subsequent implications. Methods: A documentary analysis was performed on the five volumes of the final report using qualitative content analysis. Results: Of 211 references to culture, the majority focussed on organisational culture (n = 155), followed by the sector's culture (n = 26), the culture of the agencies involved in managing aged care (n = 21) and the national culture relating to the treatment of older people (n = 8). These cultures were discussed in five ways: (1) highlighting poor culture as a problem (n = 56); (2) showcasing the style of culture that should be aspired to (n = 45); (3) reinforcing the importance of culture (n = 38); (4) making attributions about factors contributing to culture (n = 33); and (5) discussing the need for culture change (n = 30). Conclusions: The Royal Commission's findings emphasise the importance of care culture and the need for change but provided limited guidance on how this should be achieved, or culture conceptualised. [ABSTRACT FROM AUTHOR]

ObjectiveTargeted testing and treatment of persons with latent tuberculosis infection (LTBI) is a critical component of the US tuberculosis (TB) elimination strategy. In January 2016, the California Department of Public Health issued a tool and user guide for TB risk assessment (California tool) and guidance for LTBI testing, and in September 2016, the US Preventive Services Task Force (USPSTF) issued recommendations for LTBI testing in primary care settings. We estimated the epidemiologic effect of adherence to both recommendations in California.MethodsWe used an individual-based Markov micro-simulation model to estimate the number of cases of TB disease expected through 2026 with baseline LTBI strategies compared with implementation of the USPSTF or California tool guidance. We estimated the risk of LTBI by age and country of origin, the probability of being in a targeted population, and the probability of presenting for primary care based on available data. We assumed 100% adherence to testing guidance but imperfect adherence to treatment.ResultsImplementation of USPSTF and California tool guidance would result in nearly identical numbers of tests administered and cases of TB disease prevented. Perfect adherence to either recommendation would result in approximately 7000 cases of TB disease averted (40% reduction compared with baseline) by 2026. Almost all of this decline would be driven by a reduction in the number of cases among non-US-born persons.ConclusionsBy focusing on the non-US-born population, adherence to LTBI testing strategies recommended by the USPSTF and the California tool could substantially reduce the burden of TB disease in California in the next decade.

Smoke-free laws and policies have contributed significantly to the decline in smoking in the U.S, but are not often applied in high-prevalence smoking populations where they are most needed. Smoking among clients in publicly funded substance use disorder (SUD) treatment is 3-4 times higher than the general population, and little is known about tobacco policies programs have adopted. To identify the prevalence of tobacco-free grounds and other smoking policies in California's publicly funded, adult, residential SUD programs. Using a California DHCS contact list of 1,921 publicly funded, non-medical, SUD programs, 362 were eligible to participate in a brief semi-structured phone survey concerning indoor and outdoor smoking for staff and clients and other tobacco policies. Of 259 programs that completed the survey, 28 (10.8%) reported tobacco-free grounds. 91 (35.1%) expressed interest in implementing tobacco-free policies and 23 have plans to do so. Nearly all programs (n = 253, 97.7%) had some policy restricting e-cigarette use, and 110 (43.5%) of these reported a complete ban on e-cigarette use. 124 (47.9%) had policies prohibiting staff and clients smoking together. Most California residential SUD programs allow outdoor smoking for staff and clients and few have adopted tobacco-free grounds policies. Given the reported interest in adopting tobacco-free policies, the high density of smokers in the SUD population, and the association of tobacco-free policies with lower client and staff smoking rates, state licensing and regulatory agencies, as well as county health departments, should work with SUD programs to adopt tobacco-free policies.

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a difficult to treat infection, particularly in residents of elderly care centers (ECCs). Despite the substantial burden of MRSA, an inadequate number of studies have analyzed MRSA prevalence in ECCs. Objectives We conducted a worldwide systematic review and meta-analysis on the prevalence and risk factors of MRSA in ECCs. Methods We searched MEDLINE/PubMed, EMBASE, Web of Science, and Scopus databases and the gray literature sources for all studies published between January 1980 and December 2022 on the prevalence of MRSA in ECCs. A random-effects model was utilized to estimate pooled prevalence rates at 95% confidence intervals (CI). Moreover, the data were analyzed based on World Health Organization-defined regions, income, and human development index levels. Results In total, 119 studies, including 164,717 participants from 29 countries, were found eligible for meta-analysis. The pooled global prevalence of MRSA was 14.69% (95% CI 12.39–17.15%; 16,793/164,717). Male gender [prevalence ratio (PR) = 1.55; 95% CI 1.47–1.64], previous MRSA infection (PR = 3.71; 95% CI 3.44–4.01), prior use of antibiotics (PR = 1.97; 95% CI 1.83–2.12), hospitalized within the previous year (PR = 1.32; 95% CI 1.20–1.45), have had any wound (PR = 2.38; 95% CI 2.23–2.55), have used urinary catheter (PR = 2.24; 95% CI 2.06–2.43), have used any medical device (PR = 1.78; 95% CI 1.66–1.91), and those with diabetes (PR = 1.55; CI 1.43–1.67) were more likely to be colonized by MRSA than other patients. Conclusion Screening programs and preventive measures should target MRSA in ECCs due to the high global prevalence rates.

Abstract Background Being a general practitioner for residents in many care homes may challenge communication with residents, relatives, and care home staff, and potentially lead to lower quality of care. Several countries have therefore introduced different solutions to reduce the number of general practitioners at each care home. In 2017, the designated general practitioner model was introduced at many Danish care homes. This study aimed to evaluate experiences from the interprofessional team-based collaboration between designated general practitioners and care home staff with regular contact with the designated general practitioners in an urban Danish setting. Methods A qualitative design was applied using semi-structured interviews. Eight interviews (three group interviews and five individual interviews) were conducted with four designated general practitioners and seven care home staff members at four care homes in an urban setting of Central Denmark Region, Denmark. The interviews were transcribed verbatim, and data were analysed using content analysis with inspiration from the theory of relational coordination. The study followed the guidelines addressed in the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework. Results The initiation of the designated general practitioner model was experienced to contribute to more clear, precise, and timely communication between care homes and the general practitioner. An improved mutual acknowledgement of roles and competencies was experienced between designated general practitioners, care home nurses, and sometimes also social and health care assistants. The more frequent visits by the general practitioners at the care homes, as a result of the designated general practitioner model, resulted in more face-to-face communication between care home staff and designated general practitioners. Professional differences in the interpretation of the patient’s needs were still present, which at times caused a frustrating compromise of own professional competencies. An important reason for the overall perception of improved collaboration was attributed to the more frequent dialogue in which the care homes staff and the designated general practitioners exchanged knowledge that could be applied in future patient encounters. Conclusion The designated general practitioner model implied an improved collaboration between general practitioners and care homes staff. Clear, precise, and timely communication between care homes and the general practitioners, as well as mutual trust and acknowledgement was experienced to be essential for the collaboration. An important reason for the overall perception of an improved collaboration was attributed to the more frequent dialogue (more frequent general practitioner visits at the care homes) in which the care homes staff and the designated general practitioners exchange knowledge which again could be applied in future patient encounters.

Background: The rise of the aged population in Malaysia has resulted in the increased need for services, especially in terms of healthcare. Hence, continuous support is crucial to managing the daily living activities of this group. This study aimed to identify the knowledge, attitudes, and practices of older adults residing in Malaysian aged care homes concerning daily living activities and their provision of assistance to other residents with more significant disabilities. Methods: Semi-structured interviews were conducted on ten older adults and six staff members of two selected residential aged care homes. The interview session concerned the knowledge, attitudes, and practices of older people related to the basic activities of daily living (BADL) and instrumental activities of daily living (IADL). We also applied a qualitative content analysis method. Results: Three themes emerged after the interviews: (1) knowledge of older adults on BADL and IADL (highest response); (2) attitudes toward the assistance given to other residents; (3) types of assistance given to other residents and the staff. Conclusions: The knowledge, attitude, and practices related to the assistance in activities of daily living by older adults may contribute to the development of a program or module that can fulfill the needs of other residents with more significant disabilities, especially in aged care homes.

Abstract Background Older people were subjected to significant restrictions on physical contacts with others during the COVID-19 pandemic. Social distancing impacts older people’s experiences of anxiety and loneliness. Despite a large body of research on the pandemic, there is little research on its effects on older people in residential care facilities (RCF) and in home care services (HCS), who are the frailest of the older population. We aimed to investigate the effect of the first wave of the COVID-19 pandemic in March-May 2020 on experiences of anxiety and loneliness among older people living in RCF or receiving HCS and the impact of the progression of the pandemic on these experiences. Methods A retrospective cross-sectional design using data from the national user satisfaction survey (March − May 2020) by the Swedish National Board of Health and Welfare. Survey responses were retrieved from 27,872 older people in RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 years). Proportional-odds (cumulative logit) model was used to estimate the degree of association between dependent and independent variables. Results Loneliness and anxiety were more prevalent among the older persons living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 47%, respectively). Proportional odds models revealed that among the RCF and HCS respondents, the cumulative odds ratio of experiencing higher degree of anxiety increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated health was the most influential factor for anxiety in both RCF and HCS. Living alone (with HCS) was the most influential factor affecting loneliness. Experiences of disrespect from staff were more strongly associated with anxiety and loneliness in RCF than in HCS. Conclusion Older people in RCF or receiving HCS experienced increasing levels of anxiety and loneliness as the first wave of the pandemic progressed. Older people’ mental and social wellbeing should be recognized to a greater extent, such as by providing opportunities for social activities. Better preparedness for future similar events is needed, where restrictions on social interaction are balanced against the public health directives.