Bioethics Peer Review: A Structured Evaluation Framework for Long-Term Care Environments.

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

To describe the characteristics associated with suicide in older persons residing in long-term care (LTC) facilities, to compare the characteristics of suicide cases in LTC with those of cases in the community, and to evaluate trends in suicide in these settings over the past 15 years. The New York City (NYC) Office of the Chief Medical Examiner (OCME). Suicide deaths in NYC from 1990 to 2005. Location and method of suicide death reported by OCME. Suicides in older persons in LTC and community-dwelling older adults were compared in terms of demographic characteristics and method used. Trends in suicide rate ratios (RRs) were examined using zero-inflated Poisson regression. Over the study period, there were 1,771 suicides among NYC residents aged 60 and older: 47 in LTC and 1,724 in the community. Cases in LTC tended to be older (P<.02) but did not differ from community cases in terms of race or sex. Suicides in LTC were significantly less likely (RR=0.05, P<.002) to be due to firearms and 2.49 times as likely to be due to a long fall (P<.002) as community cases. Over the 15-year period, there was a significant decrease in the relative rate of suicide in community-dwelling adults (RR=0.97, P<.001) but no change in residents of LTC (RR=1.05, P<.17). Suicide risk in community-dwelling older adults has declined over the past 15 years but has not changed in LTC facilities. This suggests that prevention efforts may not be reaching this population effectively.

Nursing Programs Could Sharpen LTC Focus

While debate over the appropriate scope and goals of COVID‐19 lockdowns has raged, all public health agencies have been clear on one matter: older adults have the highest rates of mortality (Comas‐Herrera et al., 2020) and should be isolated (Public Health Agency of Canada, 2020). Older adults and individuals with complex health conditions are most vulnerable to the virus. Yet, social isolation contributes to the onset and intensifies depression, feelings of despair and, in older adults with dementia, further cognitive decline.

Introduction older persons in Long-Term Care (LTC) facilities have functional impairments and a higher disease prevalence. Nurses’ comprehensive assessment of older persons’ health is highlighted, including using tools for screening dental treatment needs. Objective to report the intra- and inter-observer reliability of older adults’ oral health assessment in LTC facilities by video. Material and method descriptive study, in three LTC facilities, in the Florianópolis region, Southern Brazil. Data were collected according to Oral Health Assessment Tool (OHAT), which presents 8 categories (“lips, tongue, gums/tissues, saliva, natural teeth, dentures, dental hygiene, and toothache”), and the scores 0=healthy, 1=presence of changes (could be a need for care), 2=unhealthy (need for dental service); final score from 0 to 16. In each LTC facility, a Nurse assessed oral conditions and made a video of each older adult using a smartphone. The dentist performed the oral health assessment through the videos. Estimated Kappa test, p&lt;0.05. Result the sample was 34 older adults, 71% were female. Interobserver reliability between Nurses 1 and 2 and Dentist for “lips” and “natural teeth” was classified as poor and excellent/very good for toothache and denture conditions. The nurse’s intraobserver reliability was classified as weak for the “natural teeth” assessment. Conclusion the OHAT showed reliability for assessing denture conditions and pain. However, nurses’ training for recognizing oral conditions that require dental care is suggested, as well as the management of this action by the dentist and LTC facilities.

Uncovering the Devaluation of Nursing Home Staff During COVID-19: Are We Fuelling the Next Health Care Crisis?

The impact of a PARO intervention on depression and well-being in older adults in long-term care in Taiwan

Why Non-Clinicians Should Not Be Doing Clinical Ethics

The Impact of the COVID-19 Pandemic on Scientific Publishing

We appreciate the comments1 by Onishi and Otsuka on our article.2 We ascertained the predictors of physical function decline over a 6-month period among nursing home residents using Long-Term Care Information System for Evidence (LIFE) items and data collected from July 2021 to January 2022. Onishi and Otsuka provided insightful comments regarding the influence of the social impact of COVID-19 on the study results and the limitation of the study setting including only Yuryo-rojin-homes, without considering various other long-term care (LTC) facilities. This reply presents additional information and our opinions regarding the two concerns raised. The COVID-19 outbreak in 2020 spread gradually in Japan, significantly affecting LTC facilities. In particular, from the end of 2021 to January 30, 2022, the number of new infections in Japan increased to 502 845 cases/week owing to greater interactions between people during the year-end holiday season and New Year's celebrations.3 During this period, if the number of infected residents at the nursing home increased, the nursing home took the following actions: restricting related organizations from entering the facility, restricting visits by family members, restricting meal consumption to private rooms, and canceling group recreation. These preventive actions may have interrupted social interaction and social activity among residents. One study showed that COVID-19 led to physical and cognitive functional decline in nursing home residents.4 We collected additional information on nursing home facilities and periods with reported COVID-19 cases. COVID-19 cases were reported in 7 of 45 facilities between June 2021 and January 2022. The number of study participants from COVID-19–positive facilities was 229 (13.9%), while that from COVID-19–negative facilities was 1419 (86.1%). We reanalyzed the data stratified by facilities with COVID-19 cases (Table 1); physical function declined in 44% and 36% of the residents in facilities with and without COVID-19 cases, respectively (P = 0.021). Moreover, 37.4% and 37.3% of residents with mild and severe cognitive impairment showed declined physical function in COVID-19–negative and positive facilities, respectively. Contrastingly, 40.6% and 43.7% of participants with body mass index <18.5 showed a decline physical function in COVID-19–negative and –positive facilities, respectively. Thus, our study could have overestimated the risk factor of physical function decline. Further research using data not collected during the COVID-19 pandemic period is needed. Regarding the limitation of the study setting—that is, including only Yuryo-rojin-homes1—the service provisions of these homes have expanded in recent years, as they provide continuous support from before nursing care to end-of-life care. Traditionally, Japan has three types of LTC facilities: LTC welfare facilities, Kaigo-rojin-fukushi-shisetsu, which provide care for older adults with severe physical and cognitive impairment; LTC health facilities (also called geriatric health service facilities or Kaigo-rojin-hoken-shisetu), which provide rehabilitation; and integrated medical and LTC facilities (Kaigo-iryoin) providing medical and long-term care.5 However, these facilities alone are no longer able to cover the needs of the older adults in a super-aging society, and the number of residents at Yuryo-rojin-homes is increasing. The facilities we studied have a philosophy of providing support up to the end of life and provide care comparable to other types of LTC facilities. The percentage of residents in Yuryo-rojin-homes who need level 3 or greater care is much lower (52%) than that in LTC health facilities (68%) and LTC welfare facilities (96%).6 The residents in Yuryo-rojin-homes have relatively higher cognitive and physical functions than those of residents in other facility types. Because we aimed to evaluate possible declines in physical function and identify residents with high risk of physical function decline, we opted to study populations with relatively high physical function baselines. Therefore, we chose to examine residents of Yuryo-rojin-homes rather than other nursing home facilities. We first present the results of an analysis of LIFE data, shortly after LIFE began in Japan. As Onishi and Otsuka1 highlighted, there is still significant room for improvement. Further research using LIFE data unaffected by the COVID-19 pandemic that cover participants from various care settings, including several types of nursing homes, senior residences, and home care, and linking their findings with other national databases is needed to enhance the quality of long-term elderly care. The authors thank Mr Horiba for his cooperation. This study was supported by the Japan Society for the Promotion of Science Grants-in-Aid for Scientific Research KAKENHI (grant numbers: 21H04849 and 23H03222), and Tokyo Medical and Dental University priority research areas grant. The authors declare no conflict of interest. This study was approved by the Tokyo Medical and Dental University ethical review board (No. M2021-285). The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

BackgroundRelocation to a long-term care (LTC) facility is a major life change for most elderly people. Following relocation, many elderly experience difficulties in adapting to changes in the living environment. Taiwan is increasingly becoming an “aging society” and the numbers of those who relocate from family residences to long-term residential care facilities have increased over years. However, in-depth evidence on the experiences of the elderly of their stay in LTC facilities in Taiwan is relatively sparse. This study aimed to explore the relocation experiences of the elderly to a LTC facility to inform policy and practice to address their needs effectively.MethodsA qualitative study, using semi-structured in-depth interviews, was conducted to explore the experiences of 16 elderly people who have relocated to and lived in a LTC facility in Taiwan for up to a period of 12 months. All interviews were recorded, transcribed, and analyzed using grounded theory approach.ResultsParticipants’ accounts reflected four interrelated key themes: wish to minimize the burden, but stay connected with the family; perceived barriers to adaptation; valuing tailored care; and acceptance and engagement. Each theme included interrelated subthemes that influenced one another and represented the different stages in the relocation journey. Most participants viewed relocation as a way of minimizing the burden of their care from family members, but desired to keep a close connection with family and friends. Participants recounted experiences of psychological resistance while making the decision to relocate. Fear of losing autonomy and the ability to perform self-care was a major reason for resistance to adapt. Provision of tailored care was accorded much value by the participants. The decision to accept the relocation and to adapt themselves to the new environment due to their needs for constant care was explicit in some accounts.ConclusionsRelocation to LTC facility is a dynamic process in the first year of moving into the facility, and involves a range of emotions, feelings and experiences. Adaptation of the elderly into the LTC facility can be maximized if the relocation is well planned with provisions for individually tailored care and family involvement.

Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference.

Information exchange is essential for transitioning high-quality care between care settings. Inadequate or delayed information exchange can result in medication errors, missed test results, considerable delays in care, and even readmissions. Unfortunately, long-term and postacute care facilities often lag behind other health care facilities in adopting health information technologies, increasing difficulty in facilitating care transitions through electronic information exchange. The research gap is most evident when considering the implications of the inability to electronically transfer patients' health records between these facilities. This study aimed to design and evaluate an open standards-based interoperability solution that facilitates seamless bidirectional information exchange between acute care and long-term and postacute care facilities using 2 vendor electronic health record (EHR) systems. Using the design science research methodology, we designed an interoperability solution that improves the bidirectional information exchange between acute care and long-term care (LTC) facilities using different EHR systems. Different approaches were applied in the study with a focus on the relevance cycle, including eliciting detailed requirements from stakeholders in the health system who understand the complex data formats, constraints, and workflows associated with transferring patient records between 2 different EHR systems. We performed literature reviews and sought experts in the health care industry from different organizations with a focus on the rigor cycle to identify the components relevant to the interoperability solution. The design cycle focused on iterating between the core activities of implementing and evaluating the proposed artifact. The artifact was evaluated at a health care organization with a combined footprint of acute and postacute care operations using 2 different EHR systems. The resulting interoperability solution offered integrations with source systems and was proven to facilitate bidirectional information exchange for patients transferring between an acute care facility using an Epic EHR system and an LTC facility using a PointClickCare EHR system. This solution serves as a proof of concept for bidirectional data exchange between Epic and PointClickCare for medications, yet the solution is designed to expand to additional data elements such as allergies, problem lists, and diagnoses. Historically, the interoperability topic has centered on hospital-to-hospital data exchange, making it more challenging to evaluate the efficacy of data exchange between other care settings. In acute and LTC settings, there are differences in patients' needs and delivery of care workflows that are distinctly unique. In addition, the health care system's components that offer long-term and acute care in the United States have evolved independently and separately. This study demonstrates that the interoperability solution improves the information exchange between acute and LTC facilities by simplifying data transfer, eliminating manual processes, and reducing data discrepancies using a design science research methodology.

BackgroundDemographic trends show an increasing number of elderly people and thus a growing need for palliative care (PC). Such care is increasingly being provided by long-term care (LTC) facilities. The present study aimed at exploring PC indicators of residents at LTC facilities belonging to a non-profit provider in Lower Saxony, Germany, in order to identify potential improvements.MethodsA descriptive cross-sectional study was conducted, drawing on routine nursing chart data. Structural data from 16 participating LTC facilities and the care data of all residents who died in 2019 (N = 471) were collected anonymously between March and May 2020. Based on key literature on quality indicators of PC in LTC facilities in Germany, a structured survey was developed by a multidisciplinary research team. The descriptive, comparative and inferential data analysis was conducted using the SPSS software package.ResultsIn total, the complete records of 363 (77%) residents who died in the participating LTC facilities in 2019 were retrieved. The records reflected that 45% of the residents had been hospitalized at least once during the last 6 months of their lives, and 19% had died in hospital. Advance care planning (ACP) consultation was offered to 168 (46%) residents, and 64 (38%) declined this offer. A written advance directive was available for 47% of the residents. A specialized PC team and hospice service volunteers were involved in caring for 6% and 14% of the residents, respectively. Cancer patients received support from external services significantly more frequently (p < .001) than did non-cancer patients. Differences emerged in the distribution of PC indicators between LTC facilities. Facilities that have more PC trained staff offered more ACP, supported by more specialized PC teams and hospice services, and had fewer hospitalizations. In addition, more volunteer hospice services were offered in urban facilities.ConclusionsOverall, a rather positive picture of PC in participating LTC facilities in Germany emerged, although there were differences in the expression of certain indicators between facilities. ACP consultation, volunteer hospice services, and hospital admissions appeared to be superior in LTC facilities with more trained PC staff. Therefore, PC training for staff should be further promoted.

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic