Adults In Long-term Care Settings Research Articles

Information technology-supported integrated health service for older adults in long-term care settings

BackgroundTo examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients.MethodsWe applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention.ResultsWe screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37–4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41–8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24–3.16, p = 0.0042), and number of PIMs use (ꞵ = − 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20–1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75–2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups.ConclusionsThe information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization.Trial registrationClinical Research Information Service, KCT0004360. Registered on 21 October 2019.

Engaging Sexual and Gender Minority Older Adults to Elicit Concerns and Recommendations for Communicating Care Preferences in Long-Term Care: Focus Group Findings

ABSTRACT Objectives 1) Describe sexual and gender minority (SGM) older adults’ current practices and concerns for communicating end-of-life (EOL) and daily care preferences in long-term care (LTC); 2) Elicit ideas about adapting a video-based intervention to facilitate communication. Methods After consulting a community advisory board, we conducted two focus groups with SGM older adults ≥55 years of age recruited from a community-based service organization (n = 4) and a continuing care retirement community (n = 9). We audio-recorded, transcribed, and coded data using directed content analysis methods and summarized results descriptively. Results Most participants were cisgender (n = 12), female (n = 11), lesbian (n = 10), White and non-Hispanic (n = 13); mean age was 70.62. Participants’ concerns included discrimination, autonomy, chosen family, and community; they linked daily care preferences with personhood and quality of life. They advocated for building intentional community-based support networks to help peers discuss preferences and produce videos before LTC transition and ensure compliance after. Conclusions For SGM older adults, asserting and protecting their full personhood, through daily care preferences, is essential to quality of life in LTC. Clinical Implications Video-recorded statements of daily preferences, facilitated and supported by a peer network, could promote culturally competent, person- and community-centered care for SGM older adults in LTC settings.

Information technology-supported integrated health service for older adults in long-term care settings: A cluster randomized controlled study

Information technology-supported integrated health service for older adults in long-term care settings: A cluster randomized controlled study

Evidence-based Recommendations to Inform Best Practices for LGBTQ Older Adults in Long-term Care Settings

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are more likely to live alone and have less familial support, which disproportionately contributes to a reliance on long-term care facilities as they age. Best-practice guidelines supported by scholarly literature to care for LGBTQ older adults in long-term care settings do not exist. This review synthesizes literature about LGBTQ older adults in long-term care facilities and provides recommendations for best practice guideline development. Four electronic databases were searched in June 2019 for studies conducted between 2000 – 2019 related to caring for LGBTQ older adults in long-term care settings. An integrative literature review was completed on the twenty eligible studies. Findings showed that LGBTQ participants fear discrimination in long-term care leading to the invisibility of their identities. They recognize a need for increased staff training and the importance of community networks and facility preferences. Long-term care staff have mixed experiences with inclusive practices and complex views of LGBTQ older adults. They experience training deficits and have a need for more expansive training modalities. The recommendations offered by both LGBTQ participants and long-term care staff are to revise policies and forms as well as provide widespread training and education. LGBTQ participants recommend that their unique identities be recognized within long-term care while long-term care staff recommend leadership involvement to change culture and practice. This review provides evidence-based recommendations to promote equitable healthcare to the LGBTQ older adult population and calls to attention the need for long-term care settings to uniformly follow best-practices.

IPE in LTC Immersion Experience: Creating a Bridge to Careers in Long-Term Care

The Utah Geriatric Education Consortium seeks to enhance healthcare provider workforce capacity. The purpose of our interprofessional education (IPE) in Long Term Care (LTC) course is to enhance students’ understanding of team-based care for older adults, presenting avenues for career opportunities. The course was offered via distance learning technology to adapt to the COVID-19 pandemic. Health sciences students (n=55) enrolled in the course and completed pre- and post-course work asynchronously. The course also included a two-hour virtual session in partnership with a LTC interprofessional team with a resident case study and discussion using the 4M’s Framework. We will discuss the a) COVID-19 course adaptations, b) IPE case study using the 4M’s Framework to help students conceptualize older adult care, and c) student pre- and post-course discussion responses demonstrating their prior experience with older adults and course impact on their views about caring for older adults in LTC settings.

Preliminary Effect and Acceptability of an Intervention to Improve End-of-Life Care in Long-Term-Care Facilities: A Feasibility Study.

The number of deaths of older adults in long-term care settings will increase with the aging population. Nurses and care workers in these settings face various challenges in providing end-of-life care, and interventions for quality end-of-life care may be useful. This feasibility study aims to explore the preliminary effect and acceptability of an intervention named the EOL Care Tool to improve end-of-life care in long-term-care facilities. We conducted a single-arm quasi-experimental study using mixed methods. This tool consisted of multiple components: professionalized lectures, newly developed structured documents, regular conferences regarding end-of-life care, and educational support from administrators. Twenty-four nurses and fifty-five care workers employed in a long-term care facility participated. For nurses, improvement in attitudes toward end-of-life care (p < 0.05) and interdisciplinary collaboration (p < 0.05) were shown quantitatively. Regarding acceptability, nurses and care workers evaluated the tool positively except for the difficulty of using the new documents. However, qualitative results showed that care workers felt the reluctance to address the work regarding end-of-life care. Therefore, a good preliminary effect and acceptability for nurses were indicated, while acceptability for care workers was only moderate. Revision to address the mentioned issues and evaluation of the revised tool with a more robust research design are required.

Understanding Nursing Knowledge of Continence Care and Bladder Scanner Use in Long-Term Care: An Evaluation Study.

Because urinary continence is an essential indicator for quality of life for older adults in long-term care, it is important to accurately assess and treat those at risk for incontinence. This evaluation study was to increase understanding of the issues related to the implementation of bladder scanners while exploring nursing staff knowledge about continence care of older adults in long-term care settings. Using a mixed-methods design, nursing care staff (RN, LPN, Care Aide) at six long-term care homes completed a bladder care knowledge survey and participated in focus group discussions to explore continence care knowledge and use of bladder scanners to manage continence issues. Twenty-eight nursing care staff participated; findings showed continence care knowledge varied by profession, and the use of portable bladder scanners is affected by knowledge, training, and scopes of practice. Going forward, exploring scopes of practice and education are needed for effective assessment, management, and treatment of continence.

Maybe She’ll Make Some Friends?: Family Members Cultivating Intimacy in Assisted Living

Intimacy continues to be important in later life, including for older adults in long-term care settings such as assisted living (AL). Our past work shows that intimacy is a multi-dimensional process and can involve a variety of partners. Drawing on data from the qualitative longitudinal “Convoys of Care” study (R01AG044368), we extend this research to examine the role family members play in cultivating intimacy and close relationships of AL residents. Using a grounded theory approach, we analyzed 2,224 hours of participant observation, and formal interviews with 28 assisted living residents (aged 58-96) and their formal and informal care partners (n=114) from four diverse AL communities. Findings show that family members can play integral roles in residents’ experiences with intimacy, directly as relationship partners, and by facilitating or impeding residents’ contacts with others. Family members cultivated residents’ intimacy opportunities and experiences by direct engagement, resident advocacy, to non-involvement and disengagement. Family members’ roles in cultivating intimacy fluctuated over time, increasing at times of health concerns and family change. Perceptive family members considered older adults’ intimacy preferences when cultivating their intimate relationships. Family members concerned for the safety of their loved one sometimes acted as “gatekeepers” to intimacy by interfering in intimate relationships. We conclude with a discussion of implications for policy and practice aimed at improving the intimacy process and opportunities for older adults receiving long-term care.

Non-pharmacological interventions to improve constipation amongst older adults in long-term care settings: A systematic review of randomised controlled trials

Constipation is a highly prevalent condition amongst older adults in long-term care settings and laxatives are not always the solution. We aimed to examine the characteristics and the effects of non-pharmacological interventions to improve constipation amongst older adults in long-term care settings. Eligible studies were identified using PubMed, CINAHL, Scopus, Web of Science, Cochrane and EMBASE (up to April 2019). We included 7 studies with a total of 657 patients. Five interventions improved the number of bowel movements (i.e. laxative tea, fermented oat drink, patient education, probiotics and multi-component intervention). The administration of probiotic capsules and fermented oat drinks also improved stool form. Auricular acupressure improved constipation symptoms and constipation-related quality of life. After appraising the trials’ methodological quality and risk of bias, we cannot recommend any non-pharmacological interventions to improve constipation amongst older adults in long-term care settings until more robust studies have been conducted.

Mental Health Care for LGBT Older Adults in Long-Term Care Settings: Competency, Training, and Barriers for Mental Health Providers

ABSTRACTObjectives: To assess mental health providers’ experience with LGBT older adults in long-term care (LTC) settings and perceived barriers to quality care.Methods: Providers (N = 57) completed an online survey on demographics and practice characteristics. They were also asked about: number of LGBT residents they’ve worked with, relevance of LGBT issues to their practice, preparedness, willingness to learn, hours of formal/informal training, and barriers to providing care to LGBT patients.Results: Respondents were 63% psychologists, 16% social workers, 14% psychiatrists, and 5% nurses, most of whom practiced in LTC consulting roles. Most providers felt working with LGBT issues was relevant to their practice and felt well-prepared and willing to learn, though they were unaware of evidence based practices (EBTs), especially for LTC settings. They had little coursework on LGBT issues, and identified lack of training, stigma, and residents concealing their identity as the greatest barriers to quality care.Conclusions: Mental health providers in LTC facilities would benefit from more training in LGBT-specific mental health problems and evidence-based treatments, and efforts to destigmatize LGBT identities in these settings might improve access to mental health care.Clinical Implications: LGBT-specific training and EBTs are needed. Facilities need to address stigma with residents and providers.

CE: Malnutrition in Older Adults.

: Older adults are at risk for compromised nutritional status because of physical changes associated with aging, as well as cognitive, psychological, and social factors such as dementia, depression, isolation, and limited income. Malnutrition negatively affects quality of life, increases health care costs, and increases the risk of short-term mortality. Nurses and other members of interdisciplinary health care teams play important roles in preventing malnutrition in community-dwelling older adults and in older adults in long-term care settings. This article provides an overview of screening tools and interventions nurses can use to minimize the risk of malnutrition in older adults.

Fall risk assessment tools for use among older adults in long-term care settings: A systematic review of the literature.

To conduct a systematic review of published fall risk assessment tools (FRATs) tested for predictive validity among older adults in long-term care (LTC). A systematic search was conducted using five databases. Only studies reporting on sensitivity and specificity values, conducted in LTC on populations primarily aged over 60 years, were considered. Fifteen papers were included and three different categories of FRATs emerged: multifactorial assessment tools, functional mobility assessments and algorithms. Several FRATs showed moderate-to-good predictive validity and reliability, with the Modified Fall Assessment Tool and the Peninsula Health Falls Risk Assessment Tool (PHFRAT) also demonstrating good feasibility. Evidence for the best choice of FRAT for use in LTC remains limited. Further research is warranted for the PHFRAT, recommended for use in LTC by best practice guidelines, before its establishment as the tool of choice for these clinical settings.

중년기 요양 환자의 건강사정도구 개발

Purpose: This was a methodological study to develop a valid and reliable health assessment tool for middle-aged adults in long-term care settings (HATMAL). Methods: At the first stage of this study, initial 56-items HATMAL were derived via literature review, survey for needs assessment, and focus group interviews with experts. At the second stage, 54 items HATMAL were finalized via content validity test with 5 experts and a pilot study with 30 nurses. At the third stage, validity and reliability tests were conducted with 100 middle-aged patients in a long-term care hospital. Data were analyzed by factor analysis using SPSS 18.0 program. Results: Exploratory factor analysis resulted in 3 factors; functional assessment, symptom assessment, and comfort assessment. These 3 factors explained 83.8% of total variance and construct validity was confirmed. Test-retest reliability was .67 for appetite changes, .76 for regulating for behavior problems, and 1.0 for other items. Conclusion: Results indicate that HATMAL is valid and reliable to assess the health for middle-aged patients in long-term care settings. This study would contribute to provide more effective personalized treatment and care for middle-aged patients in long-term care settings considering their own characteristics.

Care as narrative practice in the context of long-term care: Theoretical considerations.

In this article, we introduce care itself as a narrative practice. We emphasise that all interactions between care providers and older adults in long-term care settings are narrative in nature and foreground experience. Every person consists of innumerable stories based on experiences over time. Some experiences can be recalled and told as narratives, while others are inscribed into our bodies; they are embodied. These narratives shape who we are and are becoming, and influence how care providers experience and provide nursing care in long-term care settings. We highlight the importance of stories to narrative identities and focus on the embodied act of coconstructing new stories in interaction. We emphasise the idea that care in gerontological nursing would benefit from acknowledging and fostering embodied narratives in a systematic way with older adults. To foster, elicit, and coconstruct evolving and forward-looking narratives based on older adults' verbal and embodied narratives is essential forthe quality of care in long-term settings. Care providers must be aware that they are co-authors of older adults' continuous storying and restorying of their lives. To recognise that both residents and care providers are narrative beings shift the current culture of care away from rationalised and emotionally devoid consequences of care. Understanding the theoretical underpinnings of care itself as narrative practice is a first step in developing care practices that place relationships between residents and care providers at the centre of practice. There is a need for the implementation of strategies to think and work narratively in long-term care settings.

Intergroup Contact: Using Storytelling to Increase Awareness of Lesbian and Gay Older Adults in Long-Term Care Settings

ABSTRACTDue to societally imposed stigmatization, lesbian and gay (LG) older adults fear and prolong accessing long-term care (LTC) even though they need LTC at higher rates. Interventions that decrease negative attitudes toward LG older adults among LTC staff are a first step in addressing this problem. In this study, the influence of intergroup contact (IGC) on LTC staff members’ attitudes toward LG was explored through the use of storytelling as a training mechanism. An embedded mixed-method approach was employed to collect and analyze responses of 60 LTC staff who participated in a storytelling event. Participants completed pretests, posttests, and participated in audio-recorded group discussions. The findings showed that storytelling had a significant (p =0.001) and positive effect (d =0.57) on participants attitudes toward LG. Qualitative analysis revealed 90 codes, 13 process codes, and 4 themes: making meaning of stories, seeking understanding, application to LTC setting, and debating. When guided by IGC theory, storytelling has potential for positively influencing attitudes of LTC staff members toward LG older adults. There is a need for longitudinal work to further test this model.

Burden of Hepatitis C Virus Infection Among Older Adults in Long-Term Care Settings: a Systematic Review of the Literature and Meta-Analysis.

Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality worldwide. The magnitude of the HCV burden has previously been the subject of debate, as representative data tend to exclude high-risk populations, including institutionalized persons. The purpose of this systematic review and meta-analysis was to estimate the prevalence of HCV infection among older adults in long-term care (LTC) and assess factors associated with the prevalence of HCV in this setting. The Preferred Reporting Items for Systematic Review and Meta-Analyses checklist was used as the methodological guide. Two reviewers independently assessed the study quality using a validated modified quality assessment tool. Six articles met inclusion criteria; the majority were cross-sectional studies (83.3%) designed to estimate HCV infection prevalence rates and identify associated risk factors. HCV prevalence ranged from 1.4 to 11.8%. A pooled HCV infection prevalence of 3.3% (95% confidence interval: 1.5-7.2%) was estimated based on 1920 LTC residents with substantial heterogeneity noted (Q = 51.1, p < 0.001; I (2) = 90.2). Three of six studies reported statistically significant factors associated with an increased risk for HCV infection, including older age, female gender, history of blood transfusions, short duration of LTC residence, and hepatitis B virus positivity. This study reports a higher prevalence of HCV infection among older adults in LTC settings compared to community-dwelling older adults; however, accurate estimation of prevalence is limited by heterogeneity between and within studies, variation in sampling and recruitment methodologies, and absence of the HCV-RNA test to confirm active infection.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.

The Self-Efficacy for Functional Abilities Scale for older adults in long-term care: two-level exploratory and confirmatory factor analysis.

This study examines the underlying factor structure of the Self-Efficacy for Functional Abilities (SEFA) scale among older adults in long-term care settings. A secondary analysis of SEFA data for 568 residents in 16 long-term care facilities was applied. The sample was randomly split into 2 subsamples. A 2-level exploratory and confirmatory factor analysis adjusting for clustering effect of facilities was used to identify and determine the factor structures respectively. There were 1- and 2-factor models that were identified. Both models demonstrated acceptably mixed model fit. The 2-factor model had poor discriminant validity with high correlation between factors (r = .92, p < .001). The single-factor model was considered valid with moderate correlation with function (r = .301, p < .001). The SEFA scale demonstrated a unidimensional construct among older adults in long-term care settings. Future testing is needed among other older adult populations.

Pain Variability and Its Predictors in Older Adults

The purpose of this secondary data analysis is to determine whether depression, cognition, functional status, health, and pain severity are predictors of day-to-day pain variability in older adults in long-term care settings. Seventy-seven adults aged 68 years and older were included in the multiple linear regression analyses. Pain severity mean and variability were measured over 30 days of daily self-reported pain levels. The Geriatric Depression Scale (GDS), Blessed Memory-Information-Concentration test, Physical Self-Maintenance Scale (PSMS), baseline pain severity, mean of daily health, and mean of daily pain severity were used as predictors. Pain variability was measured by examining intra-individual standard deviations of daily pain scores. Results show that global depression and pain severity are predictors of pain variability in that greater baseline depression and pain severity predicted higher pain variability. Daily mean pain and health were also found to be predictors of pain variability. Pain variability is an important characteristic that is not given enough emphasis in current literature. Understanding pain variability may give insight into older adults' experiences with both pain and depression, and may essentially improve quality of care and quality of life.

Improving Patient Safety through User-Centered Healthcare Background Check System Design

The Michigan Workforce Background Check (MWBC) system is a cost-effective, usable web application for conducting employability screenings for healthcare workers in long-term care settings. This system is an exemplar for demonstrating how a user-centered design process facilitated the flow of critical information, improved applicant data accuracy, and improved patient safety by eliminating access by known abusers and criminals to vulnerable adults in long-term care settings. The redesigned system 1) increases the efficiency in the background check process, 2) collects more accurate and comprehensive applicant data, and 3) ultimately improves patient safety by quickly identifying unfit workers.