Adults In Long-term Care Facilities Research Articles

Feasibility study of a multidisciplinary DEprescribing review for Frail oldER Adults in Long-term care (DEFERAL) targeting potentially inappropriate antihypertensive medications

Abstract Introduction Frail older adults who reside in long-term care facilities (LTCFs) are at a higher risk of adverse drug events due to potentially inappropriate medications (PIMs). Deprescribing is a safe and effective method of reducing PIMs. Despite the benefits, there is evidence that deprescribing is not being conducted. The DEFERAL strategy was designed to support healthcare professionals (HCPs) to deprescribe PIMs for frail older adults in LTCFs. DEFERAL consists of a three-monthly multi-disciplinary team (MDT) deprescribing review, incorporating evidence-based deprescribing tools. It is conducted in person at the LTCF, targeting one pre-determined class of PIMs, organised by a nurse champion on site.[1] Aim To test the DEFERAL strategy, focusing on implementation outcomes of acceptability, feasibility, appropriateness and fidelity while collecting intervention data on deprescribing decision-making. Methods A feasibility study was conducted, recruiting a convenience sample of two LTCFs in the South-West of Ireland. The LTCFs required a general practitioner, pharmacist and nurse to be eligible. To be included in the deprescribing review, patients were required to be ≥65 years, frail, prescribed ≥1 antihypertensive and to have no deprescribing contraindications. The study followed a hybrid type three design,[2] focusing on implementation outcomes whilst collecting intervention data. HCP feedback was collected using a post-meeting survey, which was emailed to HCPs or available in paper format via the on-site nurse champion. Data were analysed quantitatively. Open-ended comment boxes were analysed using content analysis. Data on intervention outcomes were collected using a summary sheet documenting meeting attendance, recruitment and decision-making, and were analysed quantitatively. Results The survey was completed by ten HCPs (83.3%). Of completed surveys, 100% (n=10) agreed that the DEFERAL strategy was acceptable and appropriate to support deprescribing and 90% (n=9) agreed that it was feasible to undertake. The majority (90%) of HCPs indicated that they completed their designated roles exactly as described; however, qualitative feedback described site-specific modifications. In Site 1, the wider MDT were not engaged as intended and the site did not facilitate the education and screening phase as described. Site 2 introduced an additional resource to facilitate documentation of clinical measurements to support deprescribing decision-making. From a total of 90 residents, 56 (62.2%) were prescribed ≥1 antihypertensive medication. Of those resident at the time of the review, 16 (29.6%) patients were eligible and deprescribing occurred for six patients (37.5%) through dose reduction of antihypertensive medications. Documented reasons for not deprescribing included fear of negative consequences and inappropriate blood pressure measurements. Conclusion The DEFERAL strategy led to successful deprescribing of antihypertensive medications in LTCFs, supported with positive feedback on implementation outcomes. A strength of the strategy is its universal nature. DEFERAL could be adjusted to support deprescribing for different PIMs, patient cohorts or organisational structures in LTC. The strategy provides a blueprint to support medication reviews in LTC, integrating the pharmacist into routine practice. Future research is required to test the strategy for effectiveness, considering the site-specific modifications. A study limitation was the lack of completion of the follow-up survey, limiting the completeness of the feedback on the strategy.

Factors associated with poor appetite among residents at selected long-term care facilities in Selangor, Malaysia

Introduction: Poor appetite is prevalent among older adults and may negatively impact on their overall health. This is especially true for institutionalised residents. Despite this, there is a paucity of research on appetite and its associated factors among institutionalised residents, which signified the present study. Methods: A cross-sectional study was conducted among elderly residents at long-term care facilities in the state of Selangor, Malaysia to ascertain their appetite status and its associated factors. Results: A total of 97 residents with mean age of 74.2±8.4 years old were recruited. They comprised 61.9% females and 38.1% males. More than 50% had poor appetite with early satiety. There were 63.0%, 82.4%, and 94.8% who had poor oral health, poor sleep quality, and depression, respectively. Ethnicity (OR=2.73; 95% CI=1.00-7.44; p=0.049) was the only factor that predicted poor appetite among older adults in long-term care facilities, with Malay residents having poorer appetite than their Chinese and Indian counterparts. Conclusion: The prevalence of poor appetite was high among residents staying at long-term care facilities in Selangor, Malaysia, especially among Malays. This issue deserves further studies to identify the specific underlying factors contributing to poor appetite among older adults from different ethnicities. Acknowledging the high prevalence of poor appetite among older adults and its possible unfavourable outcomes, appropriate nutrition interventions are therefore needed to address this issue among institutionalised elderly.

Constipation among Korean older adults in long-term care facilities: A scoping review

Purpose: This study synthesized the literature on constipation among Korean older adults in long-term care (LTC) facilities. Methods: This scoping review utilized the Joanna Briggs Institute protocol. We conducted a literature search using Cumulative Index to Nursing and Allied Health, PubMed, PsycINFO, Korean databases Research Information Sharing Service, Korean Studies Information Service System, and ScienceON. Two reviewers independently selected the studies and extracted their characteristics using pretested forms to determine the final inclusion. In total, 473 articles were identified, and eight were used for the final analysis. Results: Quasi-experimental design was the most common research design. Sex, age, state of mobility, admission periods, LTC classification, sleep satisfaction, depressive symptoms, diet type, daily fluid intake, and history of digestion were identified as factors related to constipation. The most widely used constipation measurement method is measuring the frequency of defecation per week. Massage is the most commonly used nursing intervention to relieve constipation. Conclusion: The diversification of research on constipation is necessary to improve the quality of life of older adults living in LTC facilities. Therefore, the use of reliable tools to determine constipation in older adults in LTC facilities should be expanded. There is a need to develop and implement diverse non-pharmacological interventions for older adults in LTC facilities. The results of this study are intended to serve as a basis for the development of constipation programs for Korean older adults in LTC facilities.

Predictors of malnutrition among older residents in Qatari long-term care facilities: a retrospective study

BackgroundMalnutrition is a prevalent issue among older adults in long-term care facilities and is associated with adverse health outcomes and increased healthcare costs. Identifying the predictors of malnutrition in this population is crucial for developing effective intervention strategies. This study aimed to explore the factors contributing to malnourishment among older individuals living in long-term care facilities in Qatar.MethodsThis cross-sectional study included 75 older adults from two long-term care facilities (Rumailah Hospital and Enaya Specialized Care Center) in Qatar. Baseline characteristics, including age, sex, length of stay, mortality, weight, body mass index, co-morbidities, and laboratory parameters, were assessed. Data were analyzed using the most recent version of the SPSS software, version 29. Predictors of malnutrition and mortality were identified using logistic regression analysis.ResultsOf the 75 older individuals included in the study, 85% (64) were malnourished. The average age of the participants was 74.89 years, with a standard deviation of 10.21. Of all participants, approximately 61% (46) were males, and 39% (29) were females. Most malnourished older adults were classified as either at “moderate (29.69%)” or “severe risk (37.50%),” according to the Geriatric Nutritional Risk Index. Malnourished participants experienced a significant percentage of weight change within 3 months (14.01 ± 7.89); the only statistically significant predictor of malnutrition was the percentage of weight change within 3 months with an odds ratio (OR) of 4.8 (confidence interval [CI] 1.56–14.75) and p-value of 0.006. Statistically significant predictors of mortality were malnutrition (OR 24.84, CI 1.09–564) and age (OR 1.07, CI 1.00–1.14).ConclusionsA significant predictor of malnutrition in older adults identified in this study was the sudden and recent change in weight, which can be employed to detect individuals at risk early and guide tailored interventions. Malnutrition is a significant predictor of mortality. Employing a multidimensional strategy to tackle malnutrition can improve outcomes for the older individuals.

Intrinsic capacity as proposed by the World Health Organization and 30-month mortality among older adults in long-term care facilities

Intrinsic capacity as proposed by the World Health Organization and 30-month mortality among older adults in long-term care facilities

Assessing virtual reality acceptance in long-term care facilities: a quantitative study with older adults

Purpose Our study aimed to investigate the factors associated with the acceptance of virtual reality (VR) games among older adults living in LTC, with a particular emphasis on identifying social and individual factors that have been overlooked in existing technology acceptance models. Materials and methods We conducted VR gaming sessions, followed by a composite questionnaire to explore the factors associated with the acceptance of VR games among residents of LTC with a focus on technology acceptance models (TAM) and social factors derived from Selective Optimization with Compensation (SOC) theory and Socioemotional Selectivity Theory (SST). Results We studied 20 older adults aged 65 and older. Participants were moderately sedentary, with the majority of them having prior gaming experience. Participants with prior gaming experience had higher mean scores in most SOC theory and SST subscales, except for elective selection. Participants perceived the technology as useful and easy to use, with no heightened gaming-related anxiety. Significant correlations were found between perceived ease of use and selection strategies, and between attitudes towards gaming and elective selection strategies. No significant score differences were observed between male and female participants. Conclusions The positive correlation between VR acceptance and using SOC strategies suggests a positive response to straightforward experiences. Our study highlights VR exergaming’s potential benefits for encouraging LTC residents’ engagement in valued activities and pursuing goals. Moreover, social theories of aging can inform technology acceptance and guide the design and marketing of VR exergames to better suit older adults’ needs and preferences in LTC. IMPLICATIONS FOR REHABILITATION The findings of this study have important implications for rehabilitation programs aimed at enhancing physical activity (PA) and engagement among older adults living in long-term care (LTC) facilities. The use of virtual reality (VR) games can be an important tool to promote PA and improve the overall well-being of LTC residents. Based on the results, the following implications can be drawn: Integrating VR exergaming in rehabilitation: The positive perception of VR technology’s usefulness and ease of use among older adults in LTC suggests that VR exergaming can be effectively integrated into rehabilitation programs. Healthcare professionals and rehabilitation specialists in LTC facilities can consider incorporating VR-based exercise routines and gaming sessions to motivate and engage residents in physical activities. By doing so, they can create enjoyable and interactive rehabilitation experiences that may lead to improved adherence to exercise regimens. Addressing social factors for VR acceptance: Our study highlights the significance of social factors derived from theories of aging, such as Selective Optimization with Compensation (SOC) and Socioemotional Selectivity Theory (SST), in influencing VR acceptance among LTC residents. Rehabilitation programs should take into account these social aspects and create a supportive and encouraging environment for older adults to engage with VR exergames. Encouraging social interactions and providing opportunities for residents to share their experiences with VR gaming may enhance acceptance and overall engagement. Tailoring VR exergames for older adults: The correlation between VR acceptance and the use of SOC strategies indicates that customized experiences may be well-received by LTC residents. Game developers and rehabilitation specialists should consider designing VR exergames that align with the specific preferences and needs of older adults. This could involve providing choices and options for users to optimize their gaming experiences based on their individual abilities and interests. Recognizing gaming experience: Our study highlights that prior gaming experience positively influenced participants’ attitudes towards VR gaming. Rehabilitation professionals should acknowledge and leverage this prior experience when introducing VR exergaming to older adults in LTC. By incorporating elements familiar to older adults or providing guidance for those new to gaming, rehabilitation programs can foster a more seamless and enjoyable transition to VR exergames. Promoting goal pursuit and valued activities: Our study suggests that VR exergaming has the potential to encourage LTC residents’ engagement in valued activities and goal pursuit. Rehabilitation programs can utilize VR exergaming as a means to help residents achieve specific rehabilitation goals and engage in activities that are meaningful to them. This approach can contribute to a sense of purpose and satisfaction in the rehabilitation process. Overall, the integration of VR exergaming in rehabilitation for older adults in LTC facilities has promising implications for improving physical activity levels, enhancing engagement, and addressing the holistic well-being of residents. By considering the social factors influencing VR acceptance and tailoring experiences to individual preferences, rehabilitation professionals can optimize the potential benefits of VR technology in LTC settings.

Implementing Tai Chi Exercise in Long-Term Care to Reduce Falls.

Falls are a frequent occurrence in older adults in long-term care facilities. At our long-term care facility, the percentage of patients who fell increased from 45% in 2021 to 68% in 2022, indicating a need for an evidence-based solution. We used an evidence-based quality improvement framework to pilot a tai chi exercise program. Residents were invited to participate in the Tai Ji Quan: Moving for Better Balance program for 12 weeks. Classes were 30 minutes long and included a 5-minute warm-up and 5-minute cooldown. Seventy-five residents participated in the tai chi program. There was a significant 32.3% reduction in falls (P =.001). Residents' fall risk scores decreased 14% (P < .001). Implementing a tai chi exercise project may affect falls and decrease the overall fall risk.

Investigating healthcare workers' technostress when welfare technology is introduced in long-term care facilities

ABSTRACT Welfare technology has recently reached older adults in long-term care facilities (LTCFs). Many Swedish municipalities are introducing emerging technologies such as virtual reality, robotic assistive devices, and social robots in LTCFs as part of everyday care. However, not only older adults are affected by these deployments. Healthcare workers are left to master these technologies – and integrate them into existing care practices. Previous research has identified an increase in work-related stress associated with the introduction of technology for healthcare workers. The literature is, however, sparse on how healthcare workers in LTCFs are affected by the introduction. Therefore, we explored different factors that could affect healthcare workers' technostress through an online survey and semi-structured interviews to get a deeper understanding of how healthcare workers are experiencing deployments of welfare technology. The main findings showed that some of the healthcare workers are finding it difficult to adopt and use welfare technology due to, for example, older age, language difficulties, or a negative attitude toward technology. We conclude that municipalities and LTCFs need to invest in their healthcare workers in order to achieve better on-boarding and reduce technostress.

Prevalence of Chewing Challenges for Older Adults in Long-Term Care Facilities

Prevalence of Chewing Challenges for Older Adults in Long-Term Care Facilities

Skin properties of itching without symptoms and associated factors among older adults in long-term care facilities.

Since itching without rash frequently among older adults' population, study about skin properties of itching without rash is important to develop prevention methods. Therefore, this study explored the skin properties related to itching without rash and the factors associated with them. A correlation, predictive designs study was conducted at Indonesian Long-term Care (LTC) facilities. Skin properties including skin barrier function and skin inflammation were examined by photographs (macroscopic and microscopic), stratum corneum (SC) hydration, skin Potential of Hydrogen (pH), and skin blotting. Itching experience and skincare behavior were obtained by questionnaire. The itching-related skin properties and associated factors were analyzed. A total of 405 residents participated in this study, with mean age was 74 years. The prevalence of itching on the whole body was 69.1%, and 50.3% of those manifesting itching on the left forearm involved itching without macroscopic abnormalities (itching without rash). SC hydration, skin pH, albumin and nerve growth factor β (NGFβ) were associated with itching without rash (p = 0.007, 0.012, < 0.001, and < 0.001, respectively). Additionally, factors associated with skin properties were age, sex, sun exposure experience, skincare, and hygiene care in the linear regression analysis. Measurement of skin biomarkers using skin blotting was a possible objective measurement of itching skin properties without rash regardless of the environmental condition.

Acquisition behaviours for nutrition-related information based on a health promotion model for older adults in a long-term care facility.

To explore the acquisition behaviours for nutrition-related information of older adults in a long-term care facility. A qualitative descriptive design was used in this study. Sixteen older adults in a long-term care facility were recruited using purposive sampling between March and May 2021. Data were collected via face-to-face semi-structured interviews, based on open questions regarding acquisition behaviours for nutrition-related information and flexible question formulation, and the data were analysed using an inductive-deductive method. A health promotion model was used as a conceptual framework to regulate the refinement of themes. Three themes were identified in this study. The first theme discussed the individual characteristics and experiences of older adults that contributed to their acquisition behaviours for nutrition-related information. The second theme described behaviour-specific cognitions of and the effects on the participants regarding the influencing factors involving various internal individual elements and external physical environment. The third theme explored the positive behavioural outcomes of the participants resulting from these acquisition behaviours. Acquisition behaviours for nutrition-related information of older adults in long-term care facilities were affected by both individual characteristics and external physical environment factors. Access to nutritional information can help older adults cultivate a healthy diet. Although they exhibited a significant interest in nutrition, the participants still encountered several difficulties. Based on the actual care needs of the older people, appropriate nutritional information interventions should be provided by healthcare providers working in long-term care facilities so as to improve the ability of the older people to acquire information independently. All 16 participants actively participated in the interview process and the preliminary preparation of the article.

Long-Term Care Research in the Context of COVID-19 Pandemic: A Bibliometric Analysis.

Despite the increasing awareness of long-term care (LTC) research after the outbreak of COVID-19 pandemic, little attention was given to quantitatively describe the evolution of the research field during this period. A total of 1024 articles retrieved from the Web of Science Core Collection database were systematically analyzed using CiteSpace visualization software. The overall characteristics analysis showed that, in the context of the pandemic, attention to LTC research increased significantly-over 800 articles were published in the past two years. The USA, Canada, Italy, and England formed the leading LTC research group, which was consistent with the conclusions of existing bibliometric studies on LTC research before the outbreak. A rigorous analysis based on a dual perspective of references and keywords was applied to reveal that, compared with previous studies, in the context of the pandemic, the focus shifted from the mental and physical health status of older adults in need of LTC to the impact of the pandemic on those of older adults in LTC facilities, from the prevention of general epidemics to the prevention and response of significant public health emergencies, from providing and paying for LTC to strategies for LTC facilities to improve the quality of LTC and well-being of their residents during the pandemic. These findings can provide help and reference for academics, civil folks, and LTC practitioners, as well as help with the sustainable development of LTC research in the context of COVID-19 pandemic.

A Risk Prediction Model for Physical Restraints Among Older Chinese Adults in Long-term Care Facilities: Machine Learning Study.

Numerous studies have identified risk factors for physical restraint (PR) use in older adults in long-term care facilities. Nevertheless, there is a lack of predictive tools to identify high-risk individuals. We aimed to develop machine learning (ML)-based models to predict the risk of PR in older adults. This study conducted a cross-sectional secondary data analysis based on 1026 older adults from 6 long-term care facilities in Chongqing, China, from July 2019 to November 2019. The primary outcome was the use of PR (yes or no), identified by 2 collectors' direct observation. A total of 15 candidate predictors (older adults' demographic and clinical factors) that could be commonly and easily collected from clinical practice were used to build 9 independent ML models: Gaussian Naïve Bayesian (GNB), k-nearest neighbor (KNN), decision tree (DT), logistic regression (LR), support vector machine (SVM), random forest (RF), multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and light gradient boosting machine (Lightgbm), as well as stacking ensemble ML. Performance was evaluated using accuracy, precision, recall, an F score, a comprehensive evaluation indicator (CEI) weighed by the above indicators, and the area under the receiver operating characteristic curve (AUC). A net benefit approach using the decision curve analysis (DCA) was performed to evaluate the clinical utility of the best model. Models were tested via 10-fold cross-validation. Feature importance was interpreted using Shapley Additive Explanations (SHAP). A total of 1026 older adults (mean 83.5, SD 7.6 years; n=586, 57.1% male older adults) and 265 restrained older adults were included in the study. All ML models performed well, with an AUC above 0.905 and an F score above 0.900. The 2 best independent models are RF (AUC 0.938, 95% CI 0.914-0.947) and SVM (AUC 0.949, 95% CI 0.911-0.953). The DCA demonstrated that the RF model displayed better clinical utility than other models. The stacking model combined with SVM, RF, and MLP performed best with AUC (0.950) and CEI (0.943) values, as well as the DCA curve indicated the best clinical utility. The SHAP plots demonstrated that the significant contributors to model performance were related to cognitive impairment, care dependency, mobility decline, physical agitation, and an indwelling tube. The RF and stacking models had high performance and clinical utility. ML prediction models for predicting the probability of PR in older adults could offer clinical screening and decision support, which could help medical staff in the early identification and PR management of older adults.

VR exergame interventions among older adults living in long-term care facilities: A systematic review with Meta-analysis.

To improve the motivation toward exercise in older adults, exergames have shifted from entertainment to rehabilitation. To review the training focus of exergames and analyze the effectiveness of exergame training on physical, psychological, or cognitive outcomes among older adults in long-term care facilities (LTCFs). This review followed the PRISMA guidelines. By searching 7 electronic databases up to April 30, 2022, studies were included if they 1) involved adults ≥65 years old residing in LTCFs, 2) were randomized controlled trials (RCTs) with virtual reality-based exergames as the intervention, 3) compared the effects of exergames to usual care or conventional exercises, and 4) reported physical, psychological, or cognitive outcomes. The Cochrane Risk-of-Bias tool for randomized trials version 2 (RoB 2) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to evaluate the methodological quality of studies and levels of evidence for outcomes. The meta-analysis was conducted with Review Manager 5.4. Results are presented as standardized mean differences (SMDs) and 95% confidence intervals (CIs). A total of 12 RCTs were included in the systematic review and meta-analysis. For overall methodological quality, 10 studies showed some concerns and 2 studies showed high risk. Levels of evidence for outcomes were assessed as low (n=8) and very low (n=4). The studies involved a total of 482 older adults. Most studies implemented balance exercise as the exergame intervention. Older adults who completed exergame interventions showed improvements in cognitive outcomes (SMD 0.90, 95%CI 0.61-1.19, p<0.001) and in balance self-efficacy (SMD 1.04, 95%CI 0.47-1.61, p<0.001) as compared with those in usual care. They also showed improvements in balance (SMD 0.49, 95%CI 0.20-0.78, p<0.001) as compared with those in conventional exercise programs. Overall, exergames had a positive effect on balance (SMD 0.62, 95%CI 0.29-0.95, p<0.001). This review revealed that exergames can improve the balance ability of older adults in LTCFs.

Relationship of occlusal status with health-related quality of life among older adults in long-term care facilities.

Loss of teeth is common among residents in long-term care facilities (LTCF). To maintain occlusal support, lost teeth may be replaced with removable dentures. The relationship of occlusal status with health-related quality of life (HRQoL) was evaluated. A cross-sectional FINORAL study (FINnish ORAL Health Studies in older adults), including comprehensive geriatric assessment, was performed in LTCF. Demographic and medical information was retrieved from medical records. HRQoL was assessed with the 15D instrument and nutritional status with Mini-Nutritional Assessment (MNA). A standardised questionnaire filled in by trained nurses collected information on need for assistance in personal care or mobility, eating, and food consistency and swallowing difficulties. Clinical oral examination focusing on occlusal status was conducted for 338 residents. Four study groups (Gr) were established: Gr1 ≥ 10 natural teeth occlusal contact units (CU) (N= 51), Gr2 < 10 natural teeth CU (N= 87), Gr3 having CU of removable denture/s with or without natural teeth (N= 89), and Gr4 no CU (N= 111). 15D index score (adjusted for age, sex, MNA, and Charlson comorbidity index) showed higher HRQoL in Gr1 and Gr3; Gr1 participants had significantly higher crude values in mobility and Gr3 participants in eating, speech, and mental function than the other groups. Differences were present between the study groups in nutritional status, swallowing difficulties, and need for assistance in eating and mobility. Occlusal status of partial or complete denture/s with or without natural teeth or natural teeth having 10 or more occlusal CU was associated with higher HRQoL than other statuses.

Respiratory Syncytial Virus Disease Burden in Community-Dwelling and Long-Term Care Facility Older Adults in Europe and the United States: A Prospective Study.

Data on respiratory syncytial virus (RSV) disease burden in adults remain scarce. We assessed the burden of confirmed RSV-acute respiratory infections (cRSV-ARIs) in community-dwelling (CD) adults and those in long-term care facilities (LTCFs). In this prospective cohort study covering 2 RSV seasons (October 2019-March 2020 and October 2020-June 2021), RSV-ARIs were identified through active surveillance, in medically stable CD-adults ≥50 years (Europe) or adults ≥65 years in LTCFs (Europe and the United States). RSV infection was confirmed by polymerase chain reaction from combined nasal and throat swabs. Of 1981 adults enrolled, 1251 adults in CD and 664 LTCFs (season 1) and 1223 adults in CD and 494 LTCFs (season 2) were included in the analyses. During season 1, overall incidence rates ([IRs] cases/1000 person-years) and attack rates (ARs) for cRSV-ARIs were 37.25 (95% confidence interval [CI], 22.62-61.35) and 1.84% in adults in CD and 47.85 (CI, 22.58-101.4) and 2.26% in adults in LTCFs. Complications occurred for 17.4% (CD) and 13.3% (LTCFs) of cRSV-ARIs. One cRSV-ARI occurred in season 2 (IR = 2.91 [CI, 0.40-20.97]; AR = 0.20%), without complications. No cRSV-ARIs led to hospitalization or death. Viral pathogens were codetected in ≤17.4% of cRSV-ARIs. RSV is an important cause of disease burden in adults in CD and LTCFs. Despite the observed low severity of cRSV-ARI, our results support the need for RSV prevention strategies among adults ≥50 years old.

The unmet needs of older adults living in nursing homes in Mainland China: a nation-wide observational study

BackgroundThe unmet needs of older adults in nursing homes could result in their poor health status physically and psychologically. The aim of this study was to understand the characteristics of unmet needs of older adults residing in nursing homes in China, and to probe into the contributing factors.MethodsIn this cross-sectional design, the demographic and health status questionnaire, Modified Barthel Index, the Numerical Rating Scale for pain assessment, Geriatric Depression Scale, Camberwell Assessment of Need for the elderly were employed to survey older adults living in 38 nursing homes in 13 cities in China from July 2017 to June 2018 through a multi-stage, stratified sampling scheme. The Short Portable Mental Status Questionnaire was adopted to exclude participants with severe cognitive impairment. Aside from descriptive analysis, a raft of hierarchical logistic regression models were run by sequentially controlling for the independent variables at 5 levels (demographic characteristics, health status, pain, ADL, and depression), aiming to identify the influencing factors of the unmet needs of the residents.ResultsThe effective sample size involved 2063 older adults (63.4% female versus 36.6% male), with a response rate of 98.5%. The median and inter-quartile range of the total needs and unmet needs of the sample was 3(1, 4) and 0(0, 1) respectively, with 122 older participants having more than 3 unmet needs (high unmet need category) versus 1922 older ones having ≤ 3 unmet needs (low unmet need category). The unmet needs of older adults in nursing homes mainly fell into social domains. Gender, religion, educational background, marital status, living condition before admission, room type, incomes, staffing, number of diseases, pain, Barthel Index, and depression were contributive to unmet needs of older adults in long-term care facilities in the final model that was adjusted for all levels of variables (all p < 0.05).ConclusionUnderstanding the influencing factors of the unmet needs of older adults in long term care provides clues for healthcare professionals to offer better care for this population. System-level support to nursing homes and training of staff are highlighted. Plus, taking measures to beef up social connections for the older adults to meet their social needs was suggested.

Factors associated with mental health outcomes among caregivers of older adults in long-term care facilities during COVID-19 post-epidemic era in Shandong, China.

BackgroundCOVID-19 pandemic has altered the work mode in long-term care facilities (LTCFs), but little is known about the mental health status of caregivers of older adults.MethodsA total of 672 formal caregivers of older adults in LTCFs and 1,140 formal patient caregivers in hospitals (comparison group) responded to an online survey conducted from March 25, 2022 to April 6, 2022. Five psychological scales, including Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), The 5-item World Health Organization Wellbeing Index (WHO-5) and Perceived Stress Scale-14 item (PSS-14), were applied to assess participants’ mental health status. Factors, including sex, profession, marital status, economic conditions, length of working experience, frequent night shift beyond 1 day per week and having organic diseases, were included in logistic regression analysis to identify associated factors with mental health outcomes of formal caregivers of older adults in LTCFs.ResultsCaregivers of older adults in LTCFs developed similar severe psychological symptoms with patient caregivers in hospital setting. For caregivers of older adults in LTCFs, unmarried status was a potent risk factor for insomnia, anxiety, impaired wellbeing and health risk stress, with odds ratios ranging from 1.91 to 3.64. Frequent night shift beyond 1 day per week was associated with higher risks of insomnia, depression and impaired wellbeing. Likewise, having organic disease or inferior economic condition, and being nurses appeared to be independent predictors for multiple mental health-related outcomes.ConclusionDuring COVID-19 post-epidemic era, caregivers of older adults in LTCFs had a higher prevalence of psychological symptoms, especially those with particular risk factors. Special attention should be paid to promote their mental health.

노인장기요양시설에서의 활동적 노화 척도 개발 및 타당화: 문항반응이론을 적용하여

The purpose of this study is to develop the active aging scale for older adults in long-term care facilities and evaluate its reliability and validity. In-depth interviews and focus group interviews were conducted, finally 28 items were derived. We conducted a survey of 1,039 older adults in long-term care facilities, and analyzed the data by applying factor analysis and item response theory. As a r es ult of the analysis, it was found that 2 items were misfit, and the item difficulty was lower than the person ability. A 5-point Likert was appropriate, and there were items that functioned differently by gender. The active aging scale provides an academic basis for assessing the quality of life for older adults in long-term care facilities.

Effectiveness of Elastic Band Exercises on the Functional Fitness of Older Adults in Long-Term Care Facilities.

Population aging has caused a rise in the institutionalization, disability, and mortality rates of older adults worldwide. Older adults are able to engage in muscle training. Elastic band exercises can safely and effectively improve the upper and lower muscle strength and balance of older adults. This study was developed to examine the effects of a 3-month elastic band exercise program on the activities of daily living (ADLs), hand muscle strength, balance, and lower limb muscle strength of older adults living in institutional settings. This was a randomized controlled trial. Sixty-one participants were randomly sampled from two long-term care facilities (LTCFs) in northern Taiwan (31 participants in the experimental group and 30 participants in the control group). Both groups underwent pretesting concurrently. The experimental group participated in 3 months of elastic band exercises, whereas the control group participated in the routine exercise program in their LTCFs. All of the participants were tested 1 and 3 months after the intervention. The average ADL, hand muscle strength, balance, and lower limb muscle strength scores of participants in the experimental group had improved significantly more than those of the control group at posttest (all p s < .05). Elastic band exercises positively affect ADLs, hand muscle strength, balance, and lower limb muscle strength in older adults living in LTCFs. Moreover, the high benefit-to-cost ratio of these exercises helps lower the threshold of health promotion. We recommend including elastic band exercises in routine activities and designing different elastic band exercises for older adults at different proficiency levels. Furthermore, an elastic band exercise network should be established to improve the policy and implementation aspects of elastic band activities, raise awareness among community-dwelling and institutionalized older adults, and promote elastic band exercises to LTCFs nationwide.