Exploring the quality of life of older people in long-term care facilities in the Sub-Saharan region: a scoping review

BackgroundAs the population ages, the proportion of chronic diseases becomes more prevalent. This study aimed to investigate the current status of chronic diseases among the older people in home care (HC) and long-term care facilities (LTCFs) in China and to analyze its influencing factors.MethodsThis cross-sectional study was conducted between 2021 and 2022. A multi-stage stratified random sampling and census sampling approach was used in this survey of the health of 389 older people in HC and 202 older people in LTCFs from Western Hunan, respectively. The following instruments were included in the survey “International Resident Assessment Instrument for Home Care (interRAI-HC)” and the “International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF).” Univariate analysis was used to examine the prevalence of chronic diseases among older people with different characteristics. Data were analyzed by IBM SPSS version 25.0 software. A p-value of <0.05 was considered statistically significant.ResultsThe survey results showed that the prevalence of chronic diseases among older people in HC was 73.26% (95% CI, 68.85–77.68), and the top five chronic diseases were hypertension (26.36%), bone and joint disease (23.36%), gastrointestinal and gallbladder disease (11.78%), heart disease (11.21%), and diabetes (8.97%). The prevalence of chronic diseases among older people in LTCFs was 77.23% (95% CI, 77.23–83.06), and the top five chronic diseases were hypertension (33.11%), bone and joint disease (13.25%), cerebrovascular disease (12.91%), diabetes (11.26%), and heart disease (10.26%). The results showed that long time spent alone, having sleep disorders, and self-rated health status significantly increased HC in older people with the prevalence of chronic diseases (p < 0.05). Having marital status, non-healthy BMI, having sleep disorder, walking with the use of assistive devices, and self-rated health status significantly increased older people in LTCFs with the prevalence of chronic diseases (p < 0.05).ConclusionThere are differences in the prevalence and distribution of chronic diseases among older people in two different aged care models in China, and there are various risk factors for chronic diseases. Therefore, chronic disease healthcare strategies should be tailored to two different aged care models for older people. Further summary found that older people in HC spend a lot of time alone and suffer from loneliness, which ultimately causes psychological disorders. Thus, psychological adaptation interventions are needed for older people in HC. Besides, older people in LTCFs lack social support from their families (divorced/widowed) and have activity disorders (walking with the use of assistive devices). Thus, social adaptation interventions are needed for older people in LTCFs. This study provides a theoretical basis for the distribution of healthcare and the prevention and treatment of chronic diseases in Chinese older people.

Background In 2019, Health and Information Quality Authority (HIQA) in Ireland produced a human rights-based care guidance document for long-term care (LTC) facilities. Despite the guidance launch in 2019, little is known of the staff’s understanding of human rights-based care in Ireland. Also, internationally various bodies have acknowledged a deficit in knowledge of human rights in healthcare. The aim was to establish the staff’s understanding and knowledge of the human rights-based care framework in LTC facilities in Ireland. Methods Semi-structured interviews with 15 staff members in three LTC facilities were conducted between January and April 2022 as part of a more extensive study into the human rights of older people in LTC facilities in Ireland. Trinity College Dublin granted ethical approval. Staff were asked if they had heard of a human rights-based care framework. Transcribed interviews were analysed to establish knowledge of human rights-based care. Results Interviews with seven staff nurses and six healthcare assistants were conducted. Their professional experience varied, but the average length of employment in the LTC sector was 7.76 years. Only one staff member, a staff nurse with over 20 years of experience, had heard of the human rights-based care framework. There was no significance in understanding between staff nurses and healthcare assistants. Very little was known when asked for more detailed knowledge of human rights and how to apply it to care delivery for older people. Conclusion Although the guidance document being in place since 2019 and regulating bodies raising awareness of human rights-based care in LTC facilities, staff’s awareness about human rights-based care was limited. Similar to previous international studies, this study highlights the enormous gap in knowledge of human rights-based care for older people in LTC facilities and robust systematic awareness programmes are needed.

BackgroundOlder people in long-term care facilities face clinical uncertainty and unpredictable decline. Advance care planning enables older people to identify preferences and wishes for future treatment and care before any loss of capacity. However, it is unclear how, why and under what circumstances the implementation of advance care planning for older people can be normalised into routine practice within long-term care facilities. ObjectiveTo identify and explain mechanisms and contextual factors that underpin the implementation of advance care planning for older people in long-term care facilities. DesignRealist review. Setting(s)Long-term care facilities. MethodsConsistent with realist review methodology, we developed the initial programme theory by scoping reviews, engaging UK and China stakeholders and utilising the Normalisation Process Theory. MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus were subsequently searched from 01/01/1990 to 11/06/2021. Inductive and deductive coding was used to generate context-mechanism-outcome configurations, which were iteratively tested to refine the programme theory. Results5459 records were identified, and 48 were retained for final synthesis. Seven context-mechanism-outcome configurations were identified: (1) carry out sensitive conversation gradually in a nonthreatening way; (2) identify ‘a window of opportunity’; (3) deliver sustainable and available training; (4) build a collaborative and multidisciplinary network; (5) conduct collaborative negotiation to achieve shared decision-making; (6) secure active leadership buy-in; (7) keep conversation and documentation on track. A logic model was developed to conceptualise the causal pathways between the contexts, mechanisms, and outcomes. ConclusionsNormalising conversations about death is paramount to mainstreaming advance care planning implementation in long-term care facilities. The key to achieving this is older people, family members and staff have a shared understanding of the aims, values, and potential benefits of advance care planning. Advance care planning should be introduced at a time that is important to older people and families, rather than being process-driven. Nurse facilitators play a vital role in ensuring older people's voices are heard and in building bridges between participants in advance care planning. The findings of this study inform the appropriate development and evaluation of advance care planning interventions for older people in long-term care facilities. Further research is needed to explore mechanisms that underpin the implementation of advance care planning in Asian countries. RegistrationThis review is registered with the International Prospective Register of Systematic Reviews (CRD42021214317).

Background COVID-19 fundamentally impacted Long-Term Care Facilities (LTCFs) in Ireland and worldwide. The pandemic resulted in a series of restrictions and limited older people in LTCFs in their daily lives. Learning and understanding the impact COVID-19 had on older people in LTCFs is crucial for future care delivery planning, as those in LTCFs are some of the frailest in society. This study aimed to provide a perspective of that understanding. Methods The study’s objective was to capture a description of the residents’ in-depth experience of COVID-19 in a communal long-term care facility for older people. Individual semi-structured interviews with residents who could consent were held between September to November 2021. Results Ten residents participated in the interview study. Their average stay in the LTC facility at the time of the interview was 3.25 years, with the shortest stay being 1.5 years and the longest being seven years. The gender distribution was 50/50 among the ten residents interviewed. Four main themes were concluded from the transcriptions; coping, loss &amp; grief, resilience and social activities. The themes are interlinked and provide insight into residents’ ability to adapt to critical changes in the LTC facility in an extremely challenging period. Conclusion Although residents mentioned loss, not only about people but also the loss in doing activities, being active within the LTC facilities was essential and helped with coping with COVID-19 restrictions. Understanding residents’ experiences of COVID-19 in nursing homes is crucial to implement improvements as well as acknowledging the impact of COVID-19. Older people in LTCFs are already marginalised by their need for care. Further understanding of older people in LTC experience of a pandemic such as COVID-19 is required. This requires innovative solutions to capture the experience of all living in LTC facilities.

“Small” things matter: Residents' involvement in practice improvements in long-term care facilities

Palliative Care Implementation in Long-Term Care Facilities: European Association for Palliative Care White Paper

Quality of life (QOL) among elderly individuals in long-term care (LTC) facilities encompasses several dimensions, ranging from social interaction, health status, and support systems. With the aging of populations across the globe, the identification of factors that influence QOL among elderly residents in LTC facilities provides a key factor to enhance care delivery and better well-being. The study examines the QOL of elderly people in LTC facilities in Chennai, India, and identifies factors that affect their well-being in physical, psychological, as well as social arenas. Assessment could be beneficial in tailoring care. A 2-year cross-sectional study among 302 elderly people with an age group of >60 years residing in selected LTC facilities in the city of Chennai was evaluated using a structured questionnaire eliciting sociodemographic characteristics and health status, for which QOL was determined on the World Health Organization QOL-BREF scale. The data were collected, and results of the study were analyzed through SPSS with the aid of descriptive and inferential statistics to establish significant influences on QOL. Physical and psychological domains of QOL were notably low among residents experiencing health problems, social isolation, and lack of personalized care. Those with high QOL scores have received consistent social support and retained autonomy. The findings are consistent with earlier research stating that social engagement and enough hours of care are important for improvement in the QOL in LTC. The research also strengthens support systems, formal programs of organized social activities, and adequate personnel in LTC facilities, among other things, to enhance the QOL in the elderly. All these should be enhanced to provide a more supportive and fulfilling environment.

Loneliness has proved to be common in long-term care facilities (LTCF) and is associated with adverse health outcomes. Although older residents have expressed their experiences of loneliness in previous studies in various ways, researchers have rarely distinguished or explored the three dimensions of loneliness: social, emotional and existential. Furthermore, descriptions of existential loneliness in LTCF is still a neglected area of research. The aim of this study was to explore how the experiences of loneliness of older people in LTCF are manifested and divided into these dimensions. We used an ethnographic multi-method approach. The analysis leaned on abductive reasoning. In terms of social loneliness, the respondents missed company and lacked peer support, but also felt lonely in a crowd. Emotional loneliness felt miserable and could not be shared with anyone. It was related to a feeling of meaninglessness of life and a lack of meaningful others. Existential loneliness was characterised by waiting and a feeling of emptiness. It reflected the fundamental issues of humanity. The present study is one of the first to explore the dimensions of the experiences of loneliness among frail and cognitively impaired older people in LTCF. According to the voices of the lonely respondents, loneliness has many social, emotional and existential aspects. These features of loneliness should be recognised in studies, care practices and interventions.

This scoping review examines the underexplored impact of the transition to residential care on conjugal relationships among older couples in long-term care facilities (LTCFs). With an aging population and evolving care policies, understanding marital experiences in residential care settings becomes increasingly essential. Using the Joanna Briggs Institute methodology and the Population, Concept, and Context framework, a systematic search across six databases identified 17 studies from 529 articles. These studies were classified into three living arrangements: spouses in LTCFs with partners in the community, co-residing couples, and those addressing both scenarios. Findings reveal variations in living arrangements and the emotional complexity of these transitions, emphasizing the importance of maintaining marital bonds and relational identity. Influenced by institutional care policies and staff training, these outcomes highlight the need for longitudinal, quantitative and intervention-based research. Policy recommendations advocate relationship-centred care to promote privacy, marital continuity, and interventions enhancing marital well-being in LTCFs.

With the growing population in South Africa, there is a need for long-term care facilities. Using institutional ethnography, this study investigates the quality of life for older adults in South African long-term care facilities. Twenty key informants and 10 staff members were purposively sampled across 5 long-term care facilities in Gauteng, South Africa, for participation in in-depth interviews and observations. An analysis of institutional texts was conducted, focusing on legislative frameworks and practices. The findings include three analytic threads, namely: (a) Healthcare Access and Physical Well-Being, (b) Institutional Constraints on Meaningful Engagement, and (c) Efficiency Overriding Privacy and Autonomy. A significant gap exists between legislative policies and actual practices, with older adults seeking more autonomy and decision-making involvement. This institutional ethnography, rooted in the perspectives of older residents and care workers, highlights how long-term care facilities are shaped by regulatory frameworks and institutional ideologies. These frameworks often restrict care workers in fully leveraging their intimate knowledge of residents to address individual needs, as their care work interventions are bound to compliance with the textual and accountability demands of the Older Persons Act 13 of 2006.

COVID-19 highlights Canada's care home crisis

Background The COVID-19 pandemic has exposed the vulnerability of older people living in long-term care facilities (LTCF), highlighting the urgent need for research on the quality of care for this group of the population. There is no universal definition for quality of care in LTCF, and yet, multiple tools and indicators have been developed to measure it. In this rapid scoping review, we aim to provide a comprehensive overview of the current knowledge on quality of care concepts and indicators for older people in LTCF in OECD countries. Methods This review follows the World Health Organization (WHO) guide for rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) extension for scoping reviews, including protocol registration (https://doi.org/10.17605/OSF.IO/34B2S). The electronic bibliographic databases MEDLINE (PubMed), EMBASE, and CINAHL were searched in September 2023 for studies published between 2013 and 2023 for quality indicators in LTCF. Experts in quality of care in LTCF were contacted and consulted to retrieve sources of grey literature. Information on the definition or framework of quality of care, quality of care dimensions, measurement instruments, context and purpose of the measurement will be extracted. Results Of the 8,516 identified records, 6,449 were screened by title and abstract after removing duplicates. A total of 469 publications will be screened in full-text. Experts recommended 40 websites to be screened for quality indicators. The PRISMA flowchart diagram will be provided to describe the selection process. Conclusions This review aims to improve the quality of care for older people living in LTCF. Our results will identify which concepts and dimensions of care are currently being measured in OECD countries, whether they are backed by any definition and scientific framework of quality of care for older residents of LTCF, and whether there is consideration of closing gaps in quality measurement. Key messages • Quality of care is an understudied field in the context of long-term care facilities for older people. • In order to further improve quality in long-term care for older people, it is necessary to systematically review the current state of knowledge on quality concepts and indicators.

As the population of the elderly in long-term care facilities has grown, the number of users of potentially inappropriate medication (PIM) is also increasing. With this study, we aimed to investigate the pattern of PIM usage and related factors among the elderly receiving long-term care services. Using the South Korean National Health Insurance Service Elderly Cohort Database, we conducted a retrospective matched cohort study. Elderly residents (n = 1980) in long-term care facilities in 2013 were selected and matched 1:1 with elderly persons living in the community applying propensity score method. The matching variables were sex, age, health insurance type, long-term care grade, Charlson's Comorbidity Index score, presence of dementia, cerebrovascular disease, or Parkinson's disease, and number of drugs prescribed. PIM use was assessed according to Beers criteria 2019. The prevalence of PIM was found to be higher among the elderly in long-term care facilities (86.77%) than among community-dwelling individuals (75.35%). Logistic regression showed that long-term care facility residents were 1.84 odds more likely to use PIM than community-dwelling older adults. We also confirmed that the average number of medications taken per day and the number of outpatient visits were the major influencing factors affecting PIM prescriptions. In addition, elders living in long-term care facilities were prescribed more PIM drugs acting on the central nervous system than community-dwelling older adults. The results of this study show that among those receiving long-term care services, older people in long-term care facilities use PIM more than do the elderly living at home. Medication management programs need to be developed to reduce the use of PIM in long-term care facilities.

This study adopted mixed-methods research to explore the effects of reminiscing about nostalgic smells on the physiological and psychological responses of older people in long-term care facilities. A total of 60 participants were randomly divided into two groups and each participant was either interviewed regarding their reminiscence about nostalgic smells (experimental group) or were engaged in daily conversation (control group). The results indicated that anxiety and depression symptoms were more effectively relieved in the experimental group than in the control group. Moreover, most of the nostalgic smells recalled by the experimental group were associated with naturally occurring smells. Regarding heart rate variability, the normalised low-frequency of the experimental group decreased significantly. The results verified the utility of using reminiscence about olfactory memories in reminiscence therapy as this can calm anxiety and lessen depression, which can be very important for older adults living in long-term care facilities.

More than half of older people in long-term care facilities have dementia. Little is currently known about the methods and instruments which can be used to capture the perspectives of older people, including those with dementia, regarding the quality of care provided in such facilities. The main aims of this scoping review were two-fold. Firstly, to identify quality of care instruments that have been applied in long-term care settings. Secondly, to evaluate how these instruments have been developed and validated, particularly in terms of their applicability among older people with dementia. Seven databases (Medline, Web of Science, Scopus, ProQuest, Ageline, CINHAL and google scholar) were searched for relevant literature without any date limit. We used quality criteria adapted from COSMIN (Consensus-based Standards for the selection of health status Measurement Instruments) guidelines to assess the psychometric properties of the instruments. The search identified 16 quality of care instruments which had been used in long-term care settings. Of which, two (12.5%) were specifically designed for older people with dementia, and three instruments (18.7%) were modified for use with older people with mild to moderate dementia. A variety of methods were used to develop the identified instruments including literature reviews, qualitative interviews, expert panel reviews, pre-testing and piloting with older people. None of the identified instruments had been subjected to comprehensive psychometric assessment. Most instruments for assessing quality of care in long term care settings lack alternative communication techniques tailored to people with dementia. This review highlights the need for more rigorous psychometric testing of existing instruments for assessing quality of care in long-term care settings. Several existing measures show promise and may be taken forward for further testing and development for widespread application with older people, including those living with dementia, in long term care settings.