Adults In Long-term Care Research Articles

Association Between Falls, Head Impacts, and Mortality Among Older Adults in Long-Term Care

ObjectivesResidents in long-term care (LTC) are at high risk for falls, and falls in LTC often result in impact to the head, with clinical consequences that may be challenging to detect. We examined whether the survival of LTC residents associates with falls and fall-related head impacts. DesignProspective cohort study. Setting and ParticipantsThis study was conducted in 2 Vancouver-area LTC homes where falls were captured on video from surveillance cameras. A total of 232 participants (133 females, 99 males) experienced at least 1 fall captured on video, among whom 84% (n = 194) died between January 2011 and January 2020. The mean age at death was 86.5 (SD = 8.5) years, and the mean survival time after enrollment to this study was 3.8 (SD = 2.1) years. MethodsUnivariable and multivariable models were used to determine how survival time depended on the rate of falls (falls per 365 days), the percentage of falls on video involving head impact, sex, age at death, and baseline physical and cognitive status. ResultsOn average, participants experienced 6.2 (SD = 7.0) falls per 365 days, and 36.9% (SD = 36.3) of video-captured falls resulted in head impact. In multivariable analyses, an increase of 1 fall per 365 days resulted in a 4.2% higher risk of death [hazard ratio (HR) = 1.042, 95% CI 1.023-1.062, P < .001]. A 1% increase in falls involving head impact resulted in an 0.5% higher risk of death (HR 1.005, 95% CI 1.001-1.010, P = .015). Participants who experienced head impact in all video-captured falls had a 50% higher risk for death than those who always avoided head impact. Conclusions and ImplicationsSurvival in LTC is associated with the rate of falls and percentage of falls involving head impact. Improved efforts are required to prevent falls in LTC, and reduce the frequency and consequences of head impacts during falls (eg, through compliant flooring).

Designing Feasible and Effective Cognitive Assessment for Older Adults in Long-Term Care

Cognitive assessment and training are needed to avoid accelerated cognitive decline. We have developed BrainTagger, a suite of serious games that evaluate and potentially train cognitive abilities such as inhibitory control, processing speed, cognitive flexibility, and working memory. Ideally, cognitive assessments can be used as sentinels to detect problems that might damage brain functions (e.g., dehydration, poor nutrition, depression, delirium, inappropriate medication). In this paper, we report on a multi-year effort to develop hardware and software solutions that support effective implementation of cognitive assessment games (CAGs) in long-term care. Issues and constraints addressed include accommodating physical disabilities; making cognitive assessment enjoyable and engaging; providing scientific evidence that each game is measuring the intended construct; and reporting game results in a meaningful way. This article describes how we addressed some of these issues and demonstrates the sustained effort required to make this type of functionality work in practice. We also include some preliminary design guidelines, based on our experience, that may be useful in guiding future work on developing CAGs.

Early Omicron infection is associated with increased reinfection risk in older adults in long-term care and retirement facilities

Older adults are at increased risk of SARS-CoV-2 Omicron infection and severe disease, especially those in congregate living settings, despite high SARS-CoV-2 vaccine coverage. It is unclear whether hybrid immunity (combined vaccination and infection) after one Omicron infection provides increased protection against subsequent Omicron reinfection in older adults. Incidence of SARS-CoV-2 Omicron infection was examined in 750 vaccinated residents of long-term care and retirement homes in the observational cohort COVID in Long-Term Care Study in Ontario, Canada, within a 75-day period (July to September 2022). Risk of infection was assessed by Cox proportional hazards regression. Serum anti-spike and anti-RBD SARS-CoV-2 IgG and IgA antibodies, microneutralization titres, and spike-specific T cell memory responses, were examined in a subset of 318 residents within the preceding three months. 133 of 750 participants (17.7%) had a PCR-confirmed Omicron infection during the observation period. Increased infection risk was associated with prior Omicron infection (at 9-29 days: 47.67 [23.73-95.76]), and this was not attributed to days since fourth vaccination (1.00 [1.00-1.01]) or residence outbreaks (>6 compared to ≤6: 0.95 [0.37-2.41]). Instead, reinfected participants had lower serum neutralizing antibodies to ancestral and Omicron BA.1 SARS-CoV-2, and lower anti-RBD IgG and IgA antibodies, after their initial Omicron infection. Counterintuitively, SARS-CoV-2 Omicron infection was associated with increased risk of Omicron reinfection in residents of long-term care and retirement homes. Less robust humoral hybrid immune responses in older adults may contribute to risk of Omicron reinfection. COVID-19 Immunity Task Force of the Public Health Agency of Canada.

The Effect of a Standing Intervention on Falls in Long Term Care: a Secondary Analysis of a Randomized Controlled Trial.

Older adults in long term care (LTC) spend over 90% of their day engaging in sedentary behaviour. Sedentary behaviour may exacerbate functional decline and frailty, increasing the risk for falls. The purpose of this study is to explore the impact of a 22-week standing intervention on falls among LTC residents at 12-month follow-up. This was a planned secondary analysis of the Stand if You Can randomized controlled trial. The original trial randomized 95 participants (n = 47 control; n = 48 intervention) to either a sitting control or a supervised standing intervention group (100 minutes/week) for 22 weeks. Falls data were available to be collected over 12 months post-intervention for 89 participants. The primary outcome was a hazard of fall (Yes/No) during the 12-month follow-up period. A total of 89 participants (average age 86 years ± 8.05; 71.9% female) were followed for 12-months post-intervention. Participants in the intervention group (n=44) had a significantly greater hazard ratio of falls (2.01; 95% CI = 1.11 to 3.63) than the control group (n=45) when accounting for the history of falls, frailty status, cognition level, and sex. Participants who received a standing intervention over 22 weeks were twice as likely to fall 12 months after the intervention compared with the control group. However, the prevalence of falls did not surpass what would be typically observed in LTC facilities. It is imperative that future studies describe in detail the context in which falls happen and collect more characteristics of participants in the follow-up period to truly understand the association between standing more and the risk of falls.

Starting conversations about intimacy and sexuality: designing a tool for healthcare professionals and older adults in long-term care

Background: Intimacy and sexuality are essential aspects of quality of life for older adults in long-term care. Numerous tools and interventions are available to support healthcare professionals in their conversations about intimacy and sexuality but they are often unfamiliar with these, or do not know when or how to use them. Aim: To develop a tool to help healthcare professionals choose from existing interventions to facilitate conversations with older adults on the subject of intimacy and sexuality. Methods: A design study, comprising five substudies and 16 workshops, was carried out in inpatient and outpatient settings for older adults. Participants were healthcare and design professionals, older adults and their relatives, undergraduate students and researchers. Data collection and analysis took place in several iterations, with insights from one phase guiding the design of the next. Findings: A paper brochure and a digital knowledge programme (IntiME) was developed to inform the selection of interventions and tools to initiate conversations about intimacy and sexuality with older adults. Initial experiences with IntiME suggest it can support healthcare professionals in this area. Conclusions: The IntiME tool has the potential to improve person-centred care around intimacy and sexuality by matching the personal characteristics of healthcare professionals and older adults with available interventions and tools. Further research into experiences with the use of IntiME is warranted. Implications for practice: IntiME has the potential to improve person-centred care by matching the personal characteristics of staff and older adults with available interventions and tools Co-creation with older adults and staff plays an important part in designing tools for person-centred care Using IntiME may help staff become more aware of their own needs and thereby enhance competence in conversations about intimacy and sexuality

Multidisciplinary DEprescribing review for Frail oldER adults in long-term care (DEFERAL): Implementation strategy design using behaviour science tools and stakeholder engagement

IntroductionDeprescribing is a strategy for reducing the use of potentially inappropriate medications for older adults. Limited evidence exists on the development of strategies to support healthcare professionals (HCPs) deprescribing for frail older adults in long-term care (LTC). ObjectiveTo design an implementation strategy, informed by theory, behavioural science and consensus from HCPs, which facilitates deprescribing in LTC. MethodsThis study was consisted of 3 phases. First, factors influencing deprescribing in LTC were mapped to behaviour change techniques (BCTs) using the Behaviour Change Wheel and two published BCT taxonomies. Second, a Delphi survey of purposively sampled HCPs (general practitioners, pharmacists, nurses, geriatricians and psychiatrists) was conducted to select feasible BCTs to support deprescribing. The Delphi consisted of two rounds. Using Delphi results and literature on BCTs used in effective deprescribing interventions, BCTs which could form an implementation strategy were shortlisted by the research team based on acceptability, practicability and effectiveness. Finally, a roundtable discussion was held with a purposeful, convenience sample of LTC general practitioners, pharmacists and nurses to prioritise factors influencing deprescribing and tailor the proposed strategies for LTC. ResultsFactors influencing deprescribing in LTC were mapped to 34 BCTs. The Delphi survey was completed by 16 participants. Participants reached consensus that 26 BCTs were feasible. Following the research team assessment, 21 BCTs were included in the roundtable. The roundtable discussion identified lack of resources as the primary barrier to address. The agreed implementation strategy incorporated 11 BCTs and consisted of an education-enhanced 3-monthly multidisciplinary team deprescribing review, led by a nurse, conducted at the LTC site. ConclusionThe deprescribing strategy incorporates HCPs’ experiential understanding of the nuances of LTC and thus addresses systemic barriers to deprescribing in this context. The strategy designed addresses five determinants of behaviour to best support HCPs engaging with deprescribing.

449 Multidisciplinary deprescribing review for frail older adults in long-term care: Development of a theory informed implementation strategy using a Delphi survey and Roundtable discussion with stakeholders

Abstract Introduction Deprescribing, the systematic process of stopping or altering inappropriate medicines, has been suggested as a safe, effective and appropriate process to optimise prescribing for older adults (1). There is still a lack of understanding of how best to implement sustainable deprescribing in long-term care (LTC). Aim Design a theory-driven implementation strategy, based on consensus from healthcare professionals (HCPs), to facilitate their engagement with deprescribing for frail older adults in LTC. Methods This study consisted of three phases and was designed in conjunction with HCPs working in LTC. Firstly, barriers and enablers to deprescribing in LTC previously identified by the research team were mapped to behaviour change techniques (BCTs) (2). Secondly, a Delphi survey of HCPs (General Practitioners (GPs), Pharmacists, nurses, geriatricians and psychiatrists of old age) was conducted to select feasible BCTs to support deprescribing. HCPs were purposively sampled and recruited via email, divided into HCPs working in Ireland and internationally. Experts were identified from existing professional relationships, engagement with LTC or deprescribing research. Using the results from the Delphi process, the literature on deprescribing interventions and research team knowledge, the BCTs which could form components of an intervention in LTC were shortlisted based on was acceptability, effectiveness, affordability, safety and equity (APEASE). Finally, a roundtable discussion was held with a purposeful, convenience sample of GPs, Pharmacists and nurses working in LTC in Ireland, to prioritise the previously identified barriers/enablers and operationalise the proposed deprescribing strategies created from feasible BCTs and identify the most important strategy to facilitate deprescribing. Results Overall, 34 BCTs were mapped to previously identified barriers/enablers to deprescribing in LTC. For the Delphi survey, 33 HCPs were invited, 20 agreed and it was completed by 16 participants. The Delphi consisted of two rounds. Participants reached consensus that 26 of the BCTs could feasibly be implemented in LTC. Following the APEASE assessment, 21 BCTs were considered eligible for operationalisation. The roundtable discussion, consisting of eight HCPs, identified that lack of resources (time, staffing, technology), was the most important barrier to address. The agreed implementation strategy to enhance engagement with deprescribing processes was an education session prior to a multidisciplinary team (MDT) meeting, led by a nurse from the LTC setting. This was designed from 11 BCTs, including action planning, social support and environmental restructuring addressing the predominant barrier. Incorporating the MDT reduces the burden which would exist if the responsibility was placed on one HCP. Meeting at the LTC site addresses the insufficient technology, as patient information is available. Conclusion This study describes an implementation strategy design process following principles of behavioural and implementation science. Engaging targeted end users throughout the process allows for the creation of a strategy which is intended to address the main perceived barrier to deprescribing of insufficient resources. A limitation of this study is the specificity of the intervention for Irish LTC context, which may have different staffing and organisational structures compared to international healthcare systems.

Pilot testing the knowledgeable nursing assistants as creative caregivers (KNACC) guide

Knowledgeable Nursing Assistants as Creative Caregivers (KNACC) was developed to train certified nursing assistants (CNAs) to apply arts-based techniques to enhance care and support to older adults in long-term care (LTC) settings. We piloted (n=8) KNACC techniques for use in LTC and assessed its potential for influence on the CNA outcomes of structural empowerment and job satisfaction. During preliminary implementation, CNAs working in memory care units were more open to applying all techniques. The techniques in KNACC have the potential to improve CNA skills in working with long-term care residents.

Compensatory stepping responses during real-life falls in older adults

BackgroundLaboratory studies of postural responses suggest that stepping is a common strategy for balance recovery. Yet little is known about the frequency and characteristics of stepping responses during real-life falls in older adults. Research questions(1) Among falls experienced by older adults in long-term care (LTC), what is the prevalence of attempts to recover balance by stepping? (2) How often are steps aligned to the direction of the fall? (3) Do the prevalence and characteristics of steps associate with intrinsic and situational factors? MethodsWe collected and analyzed video footage of 1516 falls experienced by 515 residents of LTC (of mean age 82.7 years). Using generalized estimating equations, we tested whether the prevalence, direction and size of steps associated with sex, age, fall direction, activity at the time of falling, cause of imbalance, and holding or grasping objects. ResultsStepping after imbalance was observed in 76% of falls, and 80% of these cases involved multiple steps. The direction of steps aligned with the initial fall direction in 81% of cases. The size of the first step was less than one-half foot length in 64% of cases. Secondary steps tended to be similar in size to the first step. Steps were more common for falls during walking than standing, and for sideways falls. Steps were less common in falls involving held objects, and steps were less likely to be aligned with the fall direction when reach-to-grasp responses were observed. SignificanceOlder adults in LTC tended to respond to falls with multiple compensatory steps. Steps were tailored to the direction of the fall, but small in size (less than one-half foot length in size). Exercise programs for fall prevention in older adults should focus on increasing step size to enhance the effectiveness of step recovery responses.

Getting the Seal of Approval: A Critical Literature Review of the Evidence for the Use of the PARO Robotic Companion Seal with Older Adults with Cognitive Impairment in Long-Term Care

Social isolation and disruptive dementia-related behaviors are common concerns among older adults with cognitive impairment and their caregivers within residential long-term care settings. However, many interventions aiming to improve the quality of life of residents through the reduction of dementia-related behaviors and isolation rely on human contact interventions that often require significant time and resources on behalf of care staff. Robotic companion interventions have recently emerged to meet the growing need for unique, easily implemented interventions for this population. The current literature review examined existing empirical evidence for the use of the PARO seal, one of the leading animal-based robotic interventions currently available, in improving outcomes among older adults in residential long-term care. Seventeen publications that examined the impact of PARO intervention on outcomes specifically related to dementia-related behaviors and social isolation among older adults in long-term care were included in the review. Overall, most studies demonstrated some efficacy of the PARO robot in reducing either dementia-related behaviors (e.g., improvements in irritability/agitation, aggressive behavior, sleep symptoms, and affect) or social isolation. However, findings varied widely, likely due to variations in the application of the intervention, sample characteristics (e.g., range of cognitive impairment, small sample sizes), and methodology (e.g., types of outcome measures used, control group). The current literature generally supports the efficacy of the PARO seal in long-term care. However, further studies are needed to fully parse the extent of its effectiveness while accounting for variability in intervention implementation.

Addressing Vicarious Trauma in the Legal Profession through a Webinar-Based Format

Objective: This article describes a multiple session training on vicarious trauma which were delivered to groups of professionals (N = 2 to 24) working as legal advocates for domestic violence, elder abuse victims and adults in long term care. Hypothesis: Addressing vicarious trauma of legal professionals through a webinar-based format will lower trauma exposure responses and lead to better self-care and well-being. Methods: The training participants were mostly lawyers employed with legal aid and state entities and were regularly exposed to details of traumatic experiences of their clients. They also experienced challenges in dealing with systems that may not be acting in their client’s best interests. Many of the participants were working with less than adequate resources. The training took place mainly over video conference and addressed issues such as: understanding neurobiology of trauma, providing trauma-informed services, vicarious trauma, assessing professional quality of life, exploring one’s trauma exposure response, and developing adequate self-care strategies. To evaluate the program a mixed method, post-test survey was conducted via Survey Monkey (N = 16) that assessed the level of trauma exposure response before and after the training, the likelihood of engaging in self-care strategies, and qualitative data was used to evaluate the relevance of various training topics. Results: Results indicated a statistically significant reduction in trauma exposure response, willingness to engage in several types of self-care, and specific suggestions for their organization to engage in further Trauma Stewardship activities. Conclusion: Using a webinar-based format was an effective approach to addressing vicarious trauma in legal professionals. A detailed description of the training will be provided and suggestions for ongoing education on trauma stewardship, vicarious trauma, trauma exposure response, and self-care strategies will be offered.

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.

FAMILY CAREGIVING FOR OLDER ADULTS IN LONG-TERM CARE DURING THE PANDEMIC: STRESS, SOCIAL SUPPORT, AND ADAPTATION

Abstract Older adults residing in long-term care (LTC) are especially vulnerable to the COVID-19 pandemic. Federal and local health officials have issued strict visitation guidelines, including family caregivers. Given that family caregivers are essential in the well-being for older adults in LTC, these measures have had an enormous impact. As little is known about the experiences of family caregivers, the purpose of this study was to explore how the COVID-19 pandemic impacted family caregivers’ roles, mental health, and adaptation. Semi-structured interviews (N=25) were conducted with family caregivers of older adults in LTC (Mean age= 59.7; 92% female) via phone/Zoom. An interview guide led the question asking process and participants were asked open-ended questions about the impact of COVID-19 related protocols on their caregiving, mental health, and sources of social support. Interviews were transcribed verbatim and analyzed in Nvivo, guided by Grounded Theory methods. The majority of participants (76%) identified as a child of their care recipient. Findings highlight that most participants experienced numerous changes to their caregiving tasks, such as assisting with activities of daily living (ADLs), limited monitoring for their loved ones, and a reduction of social support provided to the care recipient. Family caregivers also reported other changes in their roles that resulted in increased stress and mental health concerns. These concerns were discussed in detail, including ways in which family caregivers adapted to their new roles and managed their stress. Findings from this study will inform interventions geared to better support family caregivers, particularly during times of crisis.

RESILIENCE AMONG RESIDENTS, THEIR FAMILY, AND STAFF OF A CONTINUING CARE RETIREMENT COMMUNITY

Abstract There is emerging literature about older adults’ experience of loneliness during the COVID-19 pandemic in long term care (LTC) facilities due to isolation protocols. Additionally, staff challenges while providing care for older adults in LTC has also been highlighted. While the literature emphasizes negative pandemic experiences, a gap exists with understanding resilience during the pandemic in LTC settings. The aim of this qualitative descriptive study was to explore the experience of resilience in a Continuing Care Retirement Community (CCRC) among residents, their family members, and staff. We conducted 19 in-person interviews and 1 via Zoom in fall 2021 with 5 residents (65 and older), 5 family members, and 10 staff (e.g., administrators, nurses, nursing assistants). A conventional content analysis was employed. While we did hear how the pandemic had a negative impact on everyone, the main themes of resilience identified were: 1) overcoming the pandemic together (sense of community); 2) experience and adaptation (over time being able to adapt to the disruption in their life); 3) staying safe (engaging in precautions and self-care strategies); and 4) positivity (mindset of getting through anything and relying on spirituality). Study findings can inform CCRC administrators on how to support residents, their family, and staff during future pandemics and other challenging times that may disrupt normal routines.

A SUCCESSFUL MODEL FOR AMPLIFYING THE VOICES OF OLDER ADULTS IN LONG-TERM CARE AND SERVICES AND SUPPORT RESEARCH

Abstract The experiential voice of older adults receiving long term services and supports (LTSS) is largely absent from health research hampering the development of effective interventions. While many have the capacity to participate in the design, development, and delivery of research, researchers traditionally do not recognize such capacity, may be unsure how to seek input, or may not appreciate the extent to which such input can improve the research enterprise. But the participation of these older adults can ensure that patient-centered research meaningfully addresses their care preferences and desired health outcomes, and can improve the effectiveness of care and patients’ quality of life. Through three PCORI-funded projects, we developed a successful model for addressing barriers to amplify these voices. We outline barriers to the dissemination and implementation of this model, and suggest next steps to test strategies to amplify the voices of older adults in long-term care.

Nurse-Led Virtual Delivery of PIECES in Canadian Long-Term Care Homes to Support the Care of Older Adults Experiencing Behavioral Expressions During COVID-19: A Qualitative Descriptive Study.

Worldwide, the COVID-19 pandemic has resulted in profound loss of life among older adults living in long-term care (LTC) homes. As a pandemic response, LTC homes enforced infection control processes including isolating older adults in their rooms, cancelling therapeutic programs, and restricting family member visits. Social isolation negatively impacts older adults in LTC, which may result in increased rates of anxiety, depression, physical and cognitive decline, disorientation, fear, apathy, and premature death. Isolation of older adults can also cause an increase in responsive behaviours (e.g., yelling, hitting, calling out) to express frustration, fear, restricted movement and boredom. To respond to the challenges in LTC and support frontline staff, older adults and family members, a novel Registered Practical Nurse (RPN)-led delivery of the PIECESTM approach for addressing responsive behaviours among older adults with dementia using virtual training/mentoring was implemented in Canadian LTC homes. PIECESTM employs a person and family/care partner-centred, collaborative team-based approach to provide education and capacity building for nurses, engages families as active participants in care, and embeds evidence-informed practices to provide person- and family-centered care to older adults with complex needs including dementia. To describe experiences of LTC staff, family/care partners, and older adult research partners with implementing a novel RPN-led virtual adaptation of the PIECES care planning approach for responsive behaviors in two Canadian long-term care homes during the COVID-19 pandemic. Using a qualitative descriptive design, two focus groups were held with three to four staff members (e.g., RPNs, managers) per LTC home in Ontario. A third was held with three PIECES mentors. Individual semi-structured interviews were conducted with RPN champions, family/care partners, and older adult research partners. Research team meeting notes provided an additional source of data. Content analysis was conducted. A total of 22 participants took part in a focus group (n=11) or an in-depth individual interview (n=11). Participant experiences suggest that implementation of RPN-led virtual PIECES fostered individualized care, included family as partners in care, increased interdisciplinary collaboration and improved staff practices. However, virtual PIECES, as delivered, lacked opportunities for family member feedback on older adult outcomes. Implementation facilitators included the provision of mentorship and leadership at all levels of implementation, and suitable technological infrastructure. Barriers were related to availability and use of virtual communication technology (family members) and older adults became upset due to lack of comprehension during virtual care conferences. Findings give promising support to adopting virtual PIECES - a team approach to gather valuable family input and engagement to address residents' unmet needs and responsive behaviours in LTC. Future research should investigate a hybridized communication format to foster sustainable person and family-centered care planning practices to include active collaboration of families in individualized care plans. Not applicable.

Identification of Potentially Inappropriate Medications in Frail Older Adults Residing in Long-Term Care: A Retrospective Chart Review Study.

Deprescribing is associated with positive health outcomes for older adults in long-term care (LTC), however deprescribing is not universally implemented. The primary aim of this study was to estimate the prevalence of potentially inappropriate medications (PIMs) prescribed to frail older adults in Irish long-term care facilities (LTCFs), as identified by the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy, version 2 (STOPPFrail v2). A retrospective chart review was conducted in two publicly funded LTCFs in Ireland. Eligible participants were those (1) ≥65 years of age; (2) resident in a LTCF; (3) eligible as per the STOPPFrail v2 criteria by the site's Medical Officer; and (4) receiving regular medication. Data collected included age, sex, drug, dose, frequency, regular/pro re nata prescribing and indication/relevant diagnoses. Rates of polypharmacy (taking five or more medications) and excessive polypharmacy (taking 10 or more medications) were calculated. STOPPFrail v2 was used to identify PIMs; however, clinical measurements were not taken. Descriptive and association statistics were calculated. Of the 103 residents, 89 were ≥65 years of age and categorised as frail and were therefore eligible for inclusion in the study. Of those eligible, 85 (95.5%) had polypharmacy and 57 (64%) experienced excessive polypharmacy. The mean number of regular medications was 10.8 (±3.8), total medications 17.7 (±5) and diagnoses 5.5 (±2.5). The mean number of PIMs per resident was 4.8 (±2.6). Of the eligible participants, 59.6% had at least one medicine without a documented indication, while 61.8%, 42.7% and 30.3% had at least one PIM from the vitamin D, antihypertensives and proton pump inhibitors drug classes, respectively. Medication and PIM use was high among LTC residents, with inappropriate polypharmacy of concern. Lack of clear indication for prescribing medications appears to be an issue in LTC, potentially affecting healthcare professionals' engagement with deprescribing. The prevalence of PIMs may be overestimated in the antihypertensives/antidiabetic classes due to the lack of clinical measurements.

Experiences of residents of long-term-care homes with the use of socially assistive technologies and the effectiveness of these technologies: a mixed methods systematic review protocol.

The objective of this review is to explore the experiences of residents of long-term-care homes using socially assistive technologies and the effectiveness of these technologies in relation to depression, loneliness, and social interaction. Research related to the experiences of residents of long-term-care homes with socially assistive technologies, and their effectiveness, is limited. This population of older adults is projected to steeply increase in the future, as will the need for services, such as long-term care. Older adults (≥65 years) in long-term care are at increased risk of depression, loneliness, and social isolation. Therefore, there is a need to explore the experiences of long-term-care residents with the use of socially assistive technologies and to determine the effectiveness of these technologies in relation to depression, loneliness, and social interaction. This review will include studies about the experiences of older adults in long-term care using socially assistive technologies, and the effectiveness of these technologies. Older adults are defined as people 65 years of age and above. We will consider human-to-human socially assistive technologies, such as computers, smart phones, tablets, and associated applications. We will review quantitative, qualitative, and mixed methods studies. A JBI mixed methods convergent segregated approach will be used. Select databases and gray literature will be searched for published and unpublished studies, with no date or language limits. Titles, abstracts, and full texts of included studies will be screened by at least two reviewers, and undergo quality appraisal, data extraction, and synthesis of quantitative and qualitative data followed by integration of the two types of evidence. PROSPERO CRD42021279015.

38 IDENTIFICATION OF POTENTIALLY INAPPROPRIATE MEDICATIONS IN FRAIL OLDER ADULTS RESIDING IN LONG-TERM CARE: A RETROSPECTIVE CHART REVIEW STUDY

Abstract Background Deprescribing is associated with positive health outcomes for older adults in long-term care, however deprescribing is not universally implemented. This study aims to identify the most prevalent Potentially Inappropriate Medication (PIM) used among frail older adults resident in Irish Long-Term Care Facilities (LTCFs), as identified by the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy version 2 (STOPPFrail V2), to form the basis of a deprescribing intervention. Methods A retrospective chart review was conducted in two publicly-funded LTCFs in the South/Southwest of Ireland (‘Site 1’ and ‘Site 2’). Eligible participants were those: (i) ≥65 years, (ii) resident in Site 1 or 2, (iii) eligible as per the STOPPFrail v2 criteria by the site’s medical officer, and (iv) receiving regular prescribed medication. Data collected included age, gender, drug, dose, frequency, regular/pro re nata and indication/relevant diagnoses. Descriptive and associative statistics were calculated. STOPPFrail was used to identify PIMs. Polypharmacy (taking ≥ 5 medications) and excessive polypharmacy (taking ≥10 medications) were calculated on the percentage of STOPPFrail eligible patients. Results Of the 103 residents screened, 89 were eligible and included in the analysis (86%). The prevalence of frailty for residents aged ≥65 was 93.7% (n=89), polypharmacy 95.5% (n=85) and excessive polypharmacy 64% (n=57). The mean number of regular medications (standard deviation) was 10.8 (±3.8), total medications 17.7 (±5) and diagnoses 5.5 (±2.5). A significant relationship existed between the number of PIMs and the number of medicines prescribed (ρ 0.525, p&amp;lt;0.01). The most common PIMs were those with no clear indication, followed by the antihypertensive medications and ergocalciferol/cholecalciferol. Conclusion Medication and PIM usage was high among LTCF residents, with inappropriate polypharmacy of concern. Potential deprescribing interventions include documenting indications for medications, incorporating routine blood pressure measurements and drug-specific guidelines to support deprescribing PIMs, reducing drug-related morbidity and medication burden.

Associations between fall characteristics and the occurrence of hip fracture among older adults in long-term care

Associations between fall characteristics and the occurrence of hip fracture among older adults in long-term care