Residents Of Assisted Living Facilities Research Articles

The efficacy of a mobile-based multidomain program on cognitive functioning of residents in assisted living facilities

ObjectivesThe purpose of this study is to test the efficacy of a mobile-based multidomain application, Silvia Program, on cognitive functioning of residents in assisted living facilities (ALFs). Study designPilot randomized controlled trial using a two-group pretest-posttest design. MethodsTwenty participants living in ALFs were randomized to a Silvia group or usual care group. Silvia group received mobile-based Multidomain lifestyle intervention for 50–60 min, twice weekly, for 12 weeks. We assessed the cognitive functioning using the Montreal Cognitive Assessment (MoCA). ResultsResults are that the total MoCA scores of the Silvia group showed significant improvement while the total scores of the control group declined. ConclusionThe present study provides suggestive evidence for an overall positive effect of the use of the Silvia Program on the cognitive functioning among residents in ALFs.

Assessing the Potential of Technology to Describe Resident and Staff Interactions in Assisted Living Facilities.

Falls are a significant financial burden and health hazard for residents in assisted living facilities (ALFs). However, limited capacity to observe residents has hindered understanding of resident-staff interactions within rooms. The current study aimed to describe nurse-resident interactions using data from a remote technology combining computer vision and staff location tracking. Eighty-three staff working at an urban ALF with 215 residents were trained at the initiation of the study. Remote surveillance devices were installed in 32 residences and staff and resident interactions were tracked over 170 days. Staff visited residents an average of 20.7 times per day for short durations (mean = 1.08 minutes). Urgent alert response times averaged 3.0 minutes, with faster response times through the mobile application (mean = 2.7 minutes) compared to in-person (mean = 3.3 minutes) response. By better understanding staff activity patterns in ALFs, this study has the potential to improve fall prevention and care for residents in ALFs. [Journal of Gerontological Nursing, 50(7), 7-11.].

Objectively Measured Physical Activity and Sedentary Behaviors Among Older Adults in Assisted Living Facilities: A Scoping Review.

Older adults in assisted living facilities (ALF) are at risk for low physical activity (PA) and high sedentary behavior (SB), both of which place them at risk for negative health outcomes. The purpose of this scoping review was to synthesize evidence describing the volume of device-measured PA/SB, factors associated with PA/SB, and interventions designed to change PA/SB in older adults living in ALF. Twenty articles representing 15 unique studies were identified from eight electronic databases and grey literature. Residents in ALF spent 96-201 min/day in light PA (n = 2 studies), 1-9.74 min/day in moderate to vigorous PA (n = 2 studies), and 8.5-11.01 hr/day of SB during waking hours (n = 3 studies). Factors associated with PA included 16 personal factors (n = 6 articles), one social factor (n = 2 articles), and two environmental factors (n = 2 articles). Factors associated with SB included 14 personal factors (n = 4 articles) and one social factor (n = 1 article). No intervention successfully changed PA/SB.

THE POTENTIAL OF MULTIDOMAIN MOBILE PROGRAMS IN SUPPORTING COGNITIVE HEALTH OF SENIORS IN RESIDENTIAL FACILITIES

Abstract This study pilot tested the efficacy of a mobile-based multidomain application, Silvia Program, on cognitive functioning of residents in assisted living facilities (ALFs). After a 12-week randomized pilot trial using a two-group pretest-posttest design (Silvia group vs. usual care group), we assessed the cognitive functioning using the Montreal Cognitive Assessment (MoCA). Results are that the total MoCA scores of the Silvia group showed significant improvement while the total scores of the control group declined. The present study provides suggestive evidence for an overall positive effect of the use of the Silvia Program on the cognitive functioning among residents in ALFs.

Effect of Quarantine on Body Weight Among Residents of Assisted Living Facilities During the COVID-19 Pandemic.

Assisted living facility (ALF) residents are at greater risk of declining health and death from coronavirus disease 2019 (COVID-19) due to advanced age, frailty, chronic conditions, and transmission prevention methods. One method, room quarantine, can lead to isolation and potential weight changes. Continuous room quarantine was mandated by the state for all nursing home and ALF residents. The objective of the current study was to determine the degree and significance of weight loss during quarantine through retrospective chart review and use these findings to guide a quality improvement project. Pre-and post-COVID-19 weights were compared for 53 house call program residents. Descriptive statistics and logistic regression were used. This small convenience sample demonstrated significant weight loss for 40% of ALF residents quarantined during the COVID-19 pandemic. Males showed a greater risk of significant weight loss. Weight loss of 5% in 1 month is considered problematic in older adults. As quarantine measures continue to be used for COVID-19 outbreaks, weight changes, particularly among males, need to be monitored and reported for intervention. [Journal of Gerontological Nursing, 49(9), 29-34.].

The Challenge of Integrating Behavioral Health Care in Assisted Living Facilities

Residents of Assisted Living Facilities (ALFs) often experience a range of psychiatric disorders and behavioral symptoms, the usual care for which is marked by fragmentation from medical care, overreliance on Emergency Department visits and psychiatric hospitalizations, and variable collaboration between clinical and facility staff. Given the high and increasing burden of mental illness and cognitive disorders among ALF residents and the growth of Assisted Living industry, there is a considerable need for the integration of high-quality behavioral health care into Assisted Living and Memory Care facility settings. Geriatric mental health workforce shortages demand innovative solutions in order to embed and scale this clinical expertise in communities whose design may lack clinical infrastructure. Existing attempts to address these challenges are marked by heterogeneity and a lack of high-quality evidence.This presentation will describe two different models of the integration of behavioral health care into Assisted Living Facilities and the strategic planning approaches to their development. First, we will present the development and implementation of a Behavioral Health program for ALF-residing patients of ConcertoCare, an innovative risk-bearing in-home and virtual healthcare provider offering interdisciplinary care to geriatric patients across the US. Next, we will discuss a model of embedding a geriatric psychiatrist and neuropsychologist from an academic medical center into a for-profit memory care facility, including the process of forming the business and care models. Both presentations will address challenges and strategies of approaches to clinical care, management of staff, patients, and families, and implementation of behavioral assessments and interventions. Also discussed will be future opportunities including scalability and need for further research into best practices.

Unveiling the Strains: A Qualitative Study on Work Stress among Health Care Aides in Assisted Living Facilities

Introduction: Health Care Aides (HCAs) are the primary caregivers for older adults in assisted living facilities (ALFs). However, they often experience work stress, which can affect their health and performance. The aim of this study was to explore the sources, impacts, and coping strategies of work stress among HCAs in ALFs. Methods: This was a descriptive, exploratory, qualitative study. Fourteen HCAs working in ALFs were recruited through purposive sampling. Semi-structured face-to-face interviews were conducted, and audio recorded. The data were transcribed and analyzed using thematic analysis. Results: The study reveals HCAs’ experiences of work stress in ALFs. Stressors include high workloads, time pressure, lack of support, and emotional demands. Stress negatively affects HCAs’ health and personal lives. Coping strategies include seeking support, self-care, and finding meaning in work. Main themes are stress definition, contributing factors, consequences, and coping mechanisms. The study also identifies HCAs’ ideal workplace. Conclusion: This study offers valuable insights into the perception and coping of work stress among HCAs in ALFs. The themes and findings enhance the understanding of the challenges and coping mechanisms of HCAs. The results can help employers and service providers to identify stressors in the workplace and implement interventions to reduce work stress. Improving working conditions and supporting the well-being of HCAs will ultimately improve the quality of care provided to residents in ALFs. Recommendations: Future research on HCAs should delve deeper into their work stress experiences, exploring coping mechanisms and extending theories to a broader population. National-level studies are recommended to address the limited knowledge about HCAs in Canada, focusing on demographics, violence prevention, and support strategies.

FEASIBILITY OF INTEGRATED TECHNOLOGIES TO PROMOTE LEISURE ACTIVITY ENGAGEMENT AMONG ASSISTED LIVING RESIDENTS

Abstract Research suggests that advanced technologies, such as wearable technology and tablets, can serve an important role in the cost-effective, accessible delivery of health promotion that is individualized, immersive, and engaging for users. The present study was designed to test the feasibility and acceptability of two integrated technologies among assisted living facility residents: CareBand’s wearable technology and Eperture’s RememberStuff (R/S) tablet platform. The purpose of the qualitative component of the project was to provide preliminary information from the perspective of the assisted living facility participants on these two technologies. Another goal was to assess the challenges of their participation. Drawing on qualitative thematic analyses of data collected from semi-structured interviews with 16 participants (four staff members and 12 residents) prior to and following the 6-week integrated technology program, three themes emerged as positive outcomes of the technology experiences: (a) leisure activity engagement, (b) exploration of tablet features, and (c) cognitive stimulation. This finding suggests that these technologies may enhance leisure engagement and cognitive function. On the other hand, there were three challenges that participants experienced while participating in the program: (a) inability to grasp functionality, (b) need for continued education for the technology, and (c) negative stereotypes toward technology use. These challenges provide guidance for future protocol design in follow-up studies to further explore the integrated technology efficacy for older adult users. The practical implications of this study and suggestions for health professionals are discussed.

FAMILY MEMBERS’ COMMUNICATION WITH LONG-TERM CARE PROVIDERS AND ITS INFLUENCE ON RESIDENT WELL-BEING

Abstract Considerable research has examined communication dynamics among family members and staff in nursing homes (NHs) and has demonstrated that better communication is associated with more optimal psychosocial outcomes in both family caregivers and formal care providers. However, the literature on how communication dynamics influence resident functioning is limited, and it has yet to be determined how communication impacts residents across other care contexts, such as Assisted Living Facilities (ALFs). Thus, using data from the National Health and Aging Trends Study and the National Study on Caregiving, the purpose of this study was to examine family perceptions of communication with formal care providers (i.e., frequency, availability, and helpfulness of communication) and its influence on resident outcomes in two samples of long-term care residents (n=337 in ALFs, n=112 in NHs) and their family caregivers, and to compare how results differ across care setting. When examining the full sample of long-term care residents, findings showed that better communication was associated with lower depressive symptoms and negative affect. When investigating differences across care settings, we found that those residing in NHs exhibited higher levels of depressive and anxiety symptoms compared to ALF residents. Further, better communication was associated with lower levels of depressive symptoms only among ALF residents. Our findings provide insights into how interpersonal dynamics between family and formal care providers influence resident functioning and underscores the importance of enhanced communication among all members of the primary care team – that is, healthcare providers, residents, and their family members.

Staying in the loop: Quality of family-paid caregiver communication and influences on resident mental health in long-term care.

Considerable research has examined communication dynamics among family members and staff in nursing homes (NHs) and has demonstrated that better communication is associated with more optimal mental health outcomes in both family caregivers and paid caregivers. However, the literature on how communication dynamics influence mental health in long-term care residents is limited and it has yet to be determined how communication impacts residents across care contexts, such as assisted living facilities (ALFs). The purpose of this study is to examine family caregivers' perceptions of communication with paid caregivers and its influence on long-term care resident outcomes and to compare how results differ across care settings (NHs vs. ALFs). Data were drawn from a subsample of the National Health and Aging Trends Study (NHATS) and the National Study on Caregiving (NSOC). The sample consisted of 142 NHATS participants residing in long-term care (n=93 ALF residents; n=49 NH residents) with an eligible family caregiver who participated in the NSOC. Family caregivers' perceived quality of communication was assessed via questions regarding the frequency, availability, and helpfulness of communication with paid caregivers. Resident mental health was assessed via measures of positive and negative affect, depressive symptoms, and anxiety. Across the total sample, greater availability of communication between paid and family caregivers was associated with lower depressive symptoms and negative affect in residents. When examining how these relationships varied across care settings, communication was a stronger predictor of fewer depressive symptoms among residents in ALF settings. Study findings provide insights into how interpersonal dynamics between family and paid caregivers influence resident mental health and underscore the importance of enhanced communication among all members of the primary care team, that is, paid caregivers, residents, and their family members.

Mental Disorders in Assisted Living Facilities. A Narrative Review of the Prevalence, Existing Models of Care Delivery, and Outcomes

<h3>Introduction</h3> Arising in the late 1970s as an alternative to nursing homes, Assisted Living Facilities (ALFs) are residential communities for older and disabled adults needing assistance with activities of daily living but in a less restrictive, less institutional/medical setting. Offering a variety of communal home-like living arrangements as well as providing a broad range of health-related services, ALFs are highly heterogeneous. As a whole, they seek to preserve resident independence and autonomy, social wellbeing, and flexibility of service offerings to accommodate evolving resident needs. As of 2016, approximately 811,500 individuals resided in ALFs in the US, across 28,900 facilities with 996,100 licensed beds. The number of licensed beds continues to increase, a trend driven in part by consumer preference; a large national survey indicated that 78% of older adults would prefer to reside in Assisted Living versus 12% in a nursing home in the event they needed more care outside their home. While nursing homes are tightly regulated on the federal level, ALFs are regulated by states and vary widely in their approaches to standards, procedures, and staffing. Regardless of setting, community prevalence of mental illness, defined as "mental, behavioral, or emotional disorders," is 14.1% in adults over 50. In addition, about 11% of people aged 65 and older in the United States have dementia. It is becoming increasingly important to monitor the prevalence of mental illness, including dementia, in ALFs, especially as the older adult population and ALF occupancy increase. The aim of this review is to describe the prevalence of mental illness, including dementia, in Assisted Living residents, to detail existing models of mental health care for Assisted Living residents, and to discuss implications for clinical outcomes, health care utilization, and Assisted Living occupancy. For the purposes of this paper, dementia will be included under the rubric of "mental illness" due to its prevalence among Assisted Living residents, and the overlap of care delivery considerations with non-cognitive mental disorders. <h3>Methods</h3> This narrative review followed the best-practice recommendations outlined by Ferrari (2015). PubMed and Google Scholar were searched in June 2021 for the following key words: assisted living facility, psychiatric illness, limitations, hospitalization, discharge, and behavioral health integration, in addition to synonymous words related to three categories of interest including, prevalence of mental illness in ALFs, behavioral health care models in ALFs, and clinical outcomes of ALF residents. Articles were limited to the English language and to the United States or Canada. Emphasis was placed on recent systematic reviews and randomized controlled trials. All articles were initially screened according to title and abstract and were retained if they contained information on prevalence of mental illness in ALFs, behavioral health care models in ALFs, or clinical outcomes of ALF residents. Reference lists were hand-searched for additional research articles. <h3>Results</h3> Many articles reported various rates of mental illness and cognitive disorders in ALFs, however, the prevalence remains high and continues to increase as the older adult population increases. Across articles, prevalence of non-cognitive psychiatric disorders in ALFs ranged from 26% to 33% depending on methodology and study population. Prevalence of cognitive disorders in ALFs range widely depending on the type of facility: some ALFs admit exclusively persons with dementia, whereas other ALF facilities specialize in residents with fewer functional impairments. Studies have demonstrated that both depression and dementia in ALF residents are more prevalent when compared with community-dwelling controls. Behavioral health problems and high health care needs of ALF residents are common reasons for ALF discharge. Integrated models, which bring together specialty behavioral health care providers with health and supportive service providers, have been shown to reduce behavioral health symptoms and contribute to improved health of residents, improve care, and decrease associate care costs including staff turnover. <h3>Conclusions</h3> This narrative review addresses the importance of behavioral health needs in ALF residents. Articles identified limitations in ALF infrastructure and research, specifically relating to data collection and varying definitions of terms, which limits the generalizability of the results. Greater attention to the study, design, and implementation of behavioral health care for ALF residents may reduce the prevalence of distressing symptoms in those with psychiatric and cognitive disorders, and in turn decrease the need for unnecessary Emergency Department visits, hospitalizations, and premature facility discharge. Future research should consider measuring the effectiveness of mental health care in ALFs since there is limited research currently available. <h3>This research was funded by</h3> Unfunded.

Determining the Needs of Newly Transitioned Residents in an Assisted Living Facility: A Mixed-Methods Assessment

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This mixed-methods study classified new residents in an assisted living facility (ALF) for frailty and explored each resident's occupational needs upon their transition to the ALF. Results revealed a spectrum of personal narratives, functional abilities, and psychosocial needs among new residents. Findings implicate the need for standardized data collection upon admission, followed by program development and refinement, to best meet the needs of new ALF residents. Primary Author and Speaker: Nicole A. Fidanza Additional Authors and Speakers: Nicole Baker, Rachel Brown, Hope Gallagher, and Kiera Godusky

Underappreciated Benefits of Reading Own and Others' Memories

These studies investigate underappreciated benefits of reading memories, including memories of other people, for happiness, psychological well-being, and loneliness. In the studies, college students (Study 1), residents of assisted-living facilities (Study 2), and MTurk workers online (Study 3) wrote down memories. They also predicted how they would feel after reading their own and others' memories at a later date. Then, later on, participants read memories that they or another participant had written. Individuals felt happier, less lonely, and higher in well-being after reading memories, regardless of whether those memories were their own or someone else's. Participants underpredicted the affect boost that they would gain from reading memories. This affective forecasting error was related to individuals' perceptions of the “mundaneness” of the memories, and the error was especially pronounced when individuals read others' memories rather than their own. Implications of reading memories for promoting well-being and reducing loneliness are discussed.

Characteristics of On-Site Infection Prevention and Control Visits for COVID-19—California, February 2020–December 2020

Background: The novel coronavirus (COVID-19) pandemic has caused significant morbidity and mortality in California: 2,218,000 cases and 24,598 deaths had occurred by December 31, 2020. Deaths at skilled nursing facilities (SNFs) and assisted living facilities (ALFs) comprise 26.2% of deaths in California; the fatality rate (299 per 10,000 SNF and ALF residents) in such facilities is nearly 50 times the statewide COVID-19 mortality rate (6.4 per 10,000 California residents). For healthcare facility (SNF, ALF, acute-care hospitals) and correctional facility outbreak management, the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program deployed trained infection preventionists (IPs) to perform on-site infection prevention and control (IPC) assessments and to provide recommendations to staff and local health departments (LHDs). We describe the number and distribution of visits across the state and common IPC challenges identified. Methods: From February 1, 2020, to December 31, 2020, CDPH IP visits were requested directly by facilities, coordinated through LHDs and other state agencies, or prompted by a facility’s increasing case count on twice weekly review of the daily California healthcare facility data survey (Survey 123). Deployed IPs evaluated facility COVID-19 IPC protocols, assessed facility staff adherence using a standardized assessment tool, and provided verbal feedback followed by written summary reports and recommendations. We categorized visits geographically into 5 California Health Officer Association regions and by month, and we reviewed visit reports for common findings. Results: In total, 623 visits were performed for 489 outbreaks at 465 distinct facilities across 46 LHDs; 71 facilities received ≥2 visits. Southern California facilities received 292 visits (46.9%), San Joaquin region facilities received 138 visits (22.2%), Bay Area facilities received 131 visits (21%), Greater Sacramento facilities received 54 visits (8.7%), and Rural North facilities received 8 visits (1.3%) (Figure 1). The highest number of visits per month occurred in December (n = 143, 22.9%), followed by July (n = 87, 13.9%), and April (n = 83, 13.3%). Common IPC challenges included inappropriate resident cohorting practices, improper use of personal protective equipment, and lapses in physical distancing, and source control in breakrooms. Conclusions: On-site visits by CDPH IPs during the COVID-19 pandemic in California, though resource-intensive, provided substantial technical support for healthcare facilities during outbreaks and identified key areas for IPC improvement. Ongoing CDPH HAI guidance and training materials for facility-based IP staff are now being informed by these IPC challenges.Funding: NoDisclosures: None

Perceived Decisional Control as a Mediator between Moving to Assisted Living Due to Caregiver Burden and Relocation Adjustment.

ABSTRACT Objectives The rapid growth of the older population in the United States has led to increased utilization of assisted living facilities (ALFs), and it is important to understand what factors may facilitate better adjustment. This study examined the mediating role of perceived decisional control in the relationship between moving to assisted living (AL) to prevent/alleviate caregiver burden and post-relocation adjustment. Methods Participants were 91 newly-transitioned residents of ALFs in Alabama and Maryland. Data were gathered through in-person interviews and questionnaires. Mediation analyses were done using the PROCESS macro for SPSS, applying 5,000 bootstrap resamples with 95% bias-corrected confidence intervals estimated around the indirect effect. Results The effect of moving to AL to prevent/alleviate caregiver burden on post-relocation depression and socialization was indirect and dependent on the degree of perceived decisional control. Conclusions Perceived decisional control may be a key factor in adjusting to AL, even when the move is catalyzed by such a complex and emotionally laden construct as caregiver burden. Clinical Implications Greater perceived decisional control over potential relocation may facilitate better adjustment, and other parties involved in the decision-making process should strive to involve the older adult in question in this process to the greatest extent possible.

Does Service Provider Matter During a Pandemic? COVID-19 Cases and Deaths Among Nonprofit vs. For-Profit Assisted Living Facilities in Florida

When COVID-19 hit the U.S. in early 2020, individuals aged 65+ were identified as a higher risk population. In Florida, Governor DeSantis issued Emergency Order 20-006 to prohibit visitation to facilities housing groups of high-risk people, including assisted living facilities (ALFs). Regardless, 672 ALFs of the 3,019 in Florida had reported at least one positive case of COVID-19 by a resident or staff member as of June 30, 2020. Prior research has highlighted the differences in service delivery between nonprofit and for-profit health care providers. This manuscript fills the void of minimal research on quality of care differences among ALFs based on ownership status. We find that nonprofit ALFs have experienced fewer positive cases of COVID-19 among their residents, but less evidence of a difference between nonprofit and for-profit ALFs in terms of resident deaths. We also find evidence that the type of nursing services matters for protecting ALF residents from COVID-19.

Calf Circumference as an Optimal Choice of Four Screening Tools for Sarcopenia Among Ethnic Chinese Older Adults in Assisted Living.

IntroductionSarcopenia is highly prevalent among residents of assisted-living facilities. However, the optimal screening tools are not clear. Therefore, we compared the performance of four recommended screening tools for predicting sarcopenia.MethodsThe study recruited 177 people over 65 years of age in assisted-living facilities. Appendicular muscle mass index was measured using bioelectrical impedance analysis. Calf circumference (CC), handgrip, six-meters walking speed, and screening questionnaires including SARC-CalF, SARC-F and 5-item Mini Sarcopenia Risk Assessment (MSRA-5) were evaluated. The diagnosis criteria for sarcopenia were based on the Asian Working Group for Sarcopenia 2019 consensus. The area under the receiver operating characteristic curves (AUC) was used to contrast the diagnostic accuracy of screening tools.ResultsThe prevalence of sarcopenia was 52.7% among men and 51.2% among women. After adjusting for age, sex, body mass index and SARC-CalF score, CC remained significantly associated with sarcopenia in logistic regression analysis. The prediction model for sarcopenia based on CC alone had the highest accuracy compared to SARC-CalF, MSRA-5 and SARC-F (AUC, 0.819 vs 0.734 vs 0.600 vs 0.576; sensitivity/specificity, 80.4%/71.8% vs 38.0%/80.0% vs 60.7%/54.2% vs 10.9%/91.8%). Differences in AUCs between the prediction models were statistically significant (CC vs. SARC-CalF, P = 0.0181; SARC-CalF vs. MSRA-5, P = 0.0042). Optimal cutoff values for predicting sarcopenia were CC <34 cm in men and <33 cm in women.ConclusionTo predict sarcopenia based on low CC alone is accurate, easy and inexpensive for use in assisted-living facility settings. Further validation studies in different populations are suggested.

Characterization of COVID-19 in Assisted Living Facilities - 39 States, October 2020.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the vulnerability of residents and staff members in long-term care facilities (LTCFs) (1). Although skilled nursing facilities (SNFs) certified by the Centers for Medicare & Medicaid Services (CMS) have federal COVID-19 reporting requirements, national surveillance data are less readily available for other types of LTCFs, such as assisted living facilities (ALFs) and those providing similar residential care. However, many state and territorial health departments publicly report COVID-19 surveillance data across various types of LTCFs. These data were systematically retrieved from health department websites to characterize COVID-19 cases and deaths in ALF residents and staff members. Limited ALF COVID-19 data were available for 39 states, although reporting varied. By October 15, 2020, among 28,623 ALFs, 6,440 (22%) had at least one COVID-19 case among residents or staff members. Among the states with available data, the proportion of COVID-19 cases that were fatal was 21.2% for ALF residents, 0.3% for ALF staff members, and 2.5% overall for the general population of these states. To prevent the introduction and spread of SARS-CoV-2, the virus that causes COVID-19, in their facilities, ALFs should 1) identify a point of contact at the local health department; 2) educate residents, families, and staff members about COVID-19; 3) have a plan for visitor and staff member restrictions; 4) encourage social (physical) distancing and the use of masks, as appropriate; 5) implement recommended infection prevention and control practices and provide access to supplies; 6) rapidly identify and properly respond to suspected or confirmed COVID-19 cases in residents and staff members; and 7) conduct surveillance of COVID-19 cases and deaths, facility staffing, and supply information (2).

Engagement with life among the oldest-old in assisted living facilities: enriching activities and developmental adaptation to physical loss

AbstractThe objective of this study was to examine the activities, motivations, and barriers of activity engagement in the oldest-old residing in assisted living facilities (ALFs). Semi-structured interviews were conducted with 20 participants, aged 80–94 (standard deviation = 4.38), from two ALFs. Thematic analyses were used to identify and corroborate clusters of experiences. All residents stated that they desired enriching activities, most often in the form of productive work or community events. Although engaging in enriching activities was a universal desire, residents who experienced more functional limitations had an increased difficulty satisfying this need. Participants believed that activities offered by the ALF primarily served those who are cognitively impaired. ALF residents with severe mobility issues were not able to access more enriching activities outside the ALF compared to those with fewer physical limitations. However, the more physically impaired residents used a range of adaption methods that fit into the selection, optimisation, and compensation framework to overcome barriers to participate in meaningful activities. ALF residents who are cognitively fit but experience severe mobility limitations may be the most in need of enriching activities. To help these residents maintain a high quality of life, ALFs need to provide activities that appeal to residents of varying cognitive abilities and provide interventions to help aid their adaption to physical loss.

Network Modeling of Assisted Living Facility Residents' Attendance at Programmed Group Activities: Proximity and Social Contextual Correlates of Attendance.

Social engagement, including participation in group activities, supports older adults' mental and physical health. However, many residents of assisted living facilities do not participate in their facility's programmed group activities. Explaining residents' attendance at group activities is complex; attendance is associated with a confluence of individual-level and contextual factors. The aim of this study was to assess the effects of multilevel factors on attendance, including residents' proximity to activity location and the potential for one resident's attendance to depend on other residents' attendance. We used bipartite exponential random graph models to examine the attendance of 35 residents at 563 programmed group activities. We simultaneously modeled the effects of the geospatial distance from a resident's apartment to the activity and the tendency for residents to attend activities with similar groups of other residents (i.e., shared attendance) on the likelihood of attendance, while controlling for individual-level factors (demographic and health indicators) and activity popularity. Greater distance was associated with a reduced likelihood of attendance (p < .001) and residents tended to attend activities with similar subsets of other residents (p < .001). Findings suggest that greater distance to group activities may be a barrier to attendance. Implications include facility design, placement of activities and apartments, and mobility-related strategies to increase activity participation. It is also important to recognize that participation in activities is dependent on social context. We recommend that proximity to activities and social contextual factors be considered in future examinations of attendance at group activities.