Residential Care Facilities Research Articles

Neural correlates of automatic emotion regulation and their association with suicidal ideation in adolescents during the first 90-days of residential care

Background: Suicide is the second leading cause of death for adolescents in the United States. However, relatively little is known about the forms of atypical neuro-cognitive function that are correlates of suicidal ideation (SI). One form of cognitive/affective function that, when dysfunctional, is associated with SI is emotion regulation. However, very little work has investigated the neural correlates of emotion dysregulation in adolescents with SI. Methods: Participants (N = 111 aged 12-18, 32 females, 31 [27.9%] reporting SI) were recruited shortly after their arrival at a residential care facility where they had been referred for behavioral and mental health problems. Daily reports of SI were collected during the participants’ first 90-days in residential care. Participants were presented with a task-fMRI measure of emotion regulation – the Affective Number Stroop task shortly after recruitment. Participants were divided into two groups matched for age, sex and IQ based on whether they demonstrated SI. Results: Participants who demonstrated SI showed increased recruitment of regions including dorsomedial prefrontal cortex/supplemental motor area and parietal cortex during task (congruent and incongruent) relative to view trials in the context of emotional relative to neutral distracters. Conclusions: Participants with SI showed increased recruitment of regions implicated in executive control during the performance of a task indexing automatic emotion regulation. Such data might suggest a relative inefficiency in the recruitment of these regions in individuals with SI.

Evaluation of an Infection surveillance program in residential aged care facilities in Victoria, Australia.

Infection surveillance is a key element of infection prevention and control activities in the aged care sector. In 2017, a standardised infection surveillance program was established for public residential aged care services in Victoria, Australia. This program will soon be expanded to a national level for all Australian residential aged care facilities. It has not been evaluated since its inception. The current study aimed to evaluate the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Aged Care Infection Indicator Program (ACIIP), to understand its performance and functionality. A mixed methods evaluation was performed using the Updated Guidelines for Evaluating Public Health Surveillance Systems developed by the United States Centers for Disease Control and Prevention as a framework. VICNISS staff who coordinate and manage the ACIIP were invited to participate in interviews. Residential aged care staff who use the program were invited to participate in a survey. Document analysis was also performed. Four VICNISS staff participated in the interviews and 38 aged care staff participated in the survey. The ACIIP is stable and able to be adapted quickly to changing definitions for infections. Users found the system relatively easy to use but have difficulties after the long intervals between data entry year on year. VICNISS staff provide expert guidance which benefits users. Users appreciated the benefit of participating and many use the data for improving local practice. The ACIIP is a usessful state-wide infection surveillance program for aged care. Further development of data validation, IT system capacity and models for education and user support will be required to support future scalability.

The reality of transitioning from orphanages to family homes: Life in extended families in Zimbabwe

Summary Many young orphans in Zimbabwe grow up in residential care facilities, but according to governmental policies and literature in this field, these children should be transitioned to extended families to ensure optimal development. Thus, semi-structured interviews was conducted with a social worker, two residential care administrators and five extended families; whereas the participating orphans were asked to draw and narrate their lives in RCC and their extended families. This article provides empirically derived insights to the inner experiences of the transition processes of five young orphans and their extended family members, two residential care administrators, and one social worker. The theoretical approach taken to analyze the data consisted of the inductive data analysis. Findings Although transitioning to a family is deemed ideal for orphans it was apparent in this study that most of the orphans found their new family life challenging and stressful. Several themes emerged from the data, namely financial constraints hindering the transition experiences in families; lack of training of family members on how to support orphans in their families, as well as emotional and cognitive challenges faced by orphaned children. Application The insights of this study can be used to improve the transition experiences of young orphans, especially in Zimbabwe. Future practical and policy changes are also suggested.

Dentists' perspectives on structural and system barriers hindering oral healthcare provision in residential care facilities.

Oral healthcare service is not well integrated with existing healthcare policy in nursing homes (NHs) globally. This qualitative study aimed to identify dentists' perspectives on structural and system barriers that hinder oral healthcare (OHC) provision to seniors in NHs in Singapore and to understand the consequences of these barriers. Nineteen dentists (8 males and 11 females, 36.0 [IQR: 32.0-48.5] years old) were recruited through combination of purposive and snowball sampling. Four focus group discussions were conducted via teleconferencing, and each discussion had 4-5 anonymised participants. Sessions lasted 90-120 min and were audio-recorded and transcribed verbatim. Thematic analysis was conducted on data collected using NVivo software (Version12, QRS International). Participants agreed that the current OHC system for seniors in NHs is not well developed. The challenges dentists faced were categorised in three themes: [1] general oral healthcare system level; [2] local nursing home setting level; and [3] geriatric oral healthcare education level. These challenges are complexly intertwined and have contributed to several consequences such as a shortage of dentists in NHs and their diminished motivation to serve. It has also limited the quality of dental service they are able to provide in NHs, contributing to the current poor access of dental services for seniors in NHs. Dentists in Singapore face many structural and systemic barriers in providing OHC to seniors in NHs, some of which are unique to the local context. Newfound understanding of these barriers and its consequences will be helpful in developing strategic approaches to overcome these challenges.

Impact of Motivation for Eating Habits, Appetite and Food Satisfaction, and Food Consciousness on Food Intake and Weight Loss in Older Nursing Home Patients.

This study analyzed data from the Long-term care Information system For Evidence (LIFE) database to examine the effects of motivation to eat, appetite and food satisfaction, and food consciousness on food intake and weight loss. Of the 748 nursing home residents enrolled in the LIFE database, 336 met the eligibility criteria for this cross-sectional study. Motivation to eat, appetite and food satisfaction, and food consciousness were rated on five-point Likert scales (e.g., good, fair, normal, not so good, and not good). We applied Spearman rank correlation coefficient and multiple regression analyses to analyze the relationships between these three items, daily energy and protein intake, and body weight loss over 6 months. The mean participant age was 87.4±8.1 years and 259 (77%) were female. The required levels of care included-level 1, 1 (0%); level 2, 4 (1%); level 3, 107 (32%); level 4, 135 (40%); and level 5, 89 (27%). The mean daily energy intake was 28.2±7.8 kcal/kg. The mean daily protein intake was 1.1±0.3 g/kg. The mean weight loss over six months was 1.2±0.7 kg. We observed strong positive correlations among motivation to eat, appetite and food satisfaction, and food consciousness (r>0.8). These three items were significantly associated with higher daily energy intake but not with daily protein intake. Only appetite and food satisfaction were significantly associated with lower weight loss over six months. The observed associations of appetite and food satisfaction suggest that these factors may be more important to assess than motivation to eat or food consciousness among older adult residents of long-term care facilities.

Oral and rectal colonization of methicillin-resistant Staphylococcus aureus in long-term care facility residents and their association with clinical status.

Staphylococcus aureus is a commensal bacterium in humans, but it sometimes causes opportunistic infectious diseases such as suppurative skin disease, pneumonia, and enteritis. Therefore, it is important to determine the prevalence of S. aureus and methicillin-resistant S. aureus (MRSA) in individuals, especially older adults. In this study, we investigated the prevalence of S. aureus and MRSA in the oral cavity and feces of residents in long-term care facilities (LTCFs). S. aureus was isolated from the oral cavity of 61/178 (34.3%) participants, including 28 MRSA-positive participants (15.7%), and from the feces of 35/127 (27.6%) participants, including 16 MRSA-positive participants (12.6%). S. aureus and MRSA were isolated from both sites in 19/127 individuals (15.0%) and 10/127 individuals (7.9%), respectively. Among 19 participants with S. aureus isolation from both sites, 17 participants showed the same sequence type (ST) type. Then, we analyzed the correlation of S. aureus and MRSA in the oral cavity and rectum with the participant's condition. S. aureus and MRSA positivity in the oral cavity was significantly related to tube feeding, while there was no correlation of rectal S. aureus/MRSA with any factors. Our findings regarding the oral inhabitation of MRSA and its risk factors indicate the importance of considering countermeasures against MRSA infection in LTCFs.

Protein or branched-chain amino acid intake at breakfast for muscle mass gain in older persons: A protocol for systematic review and meta-analysis

Background: In recent years, prevention of sarcopenia and frailty is a matter of concern for community dwelling older persons. The recommended protein daily intake is not fulfilled by 10% of community-dwelling elderly and 35% of residents in aged-care facilities. Furthermore, the optimum time of protein consumption is unclear because of the varying combinations of intake timing and exercise. Although it is desirable to increase protein intake at breakfast and lunch without reducing intake at supper to maximize muscle protein synthesis, this is not clear for older people. Therefore, before considering whether protein consumption at breakfast is superior to other times of the day, its effectiveness needs to be clarified in older adults. Methods: The inclusion criterion will be healthy or frail adults older than 60 years. This protocol of systematic review adhered to the PRISMA 2020 statement. A comprehensive study strategy is designed for PubMed, EMBASE, CENTRAL, and Clinical Trials.gov. Search strategies will be made using Boolean Search Logic by an experienced librarian in systematic review search formula design. Two authors will carry out independent screening of titles, abstracts, and data extraction for randomized controlled trials. Statistical heterogeneity will be assessed by meta-analysis. Assessment of the risk of bias will be conducted using the Risk-of-bias 2 tool. Integrated data will be analyzed using Review Manager software to create summary tables. Findings summary tables for primary and secondary outcomes will be produced in accordance with the procedures in the Cochrane Handbook. Results: We believe that the effects of protein or BCAA intake at breakfast in older people analysed in this review will provide evidence that contributes to the establishment of treatment strategies to prevent frailty and sarcopenia. Conclusion: The benefits of protein intake at breakfast for the elderly will be clarified. This will encourage hospitals and elderly care facilities to review the content of the diet and encourage the elderly to change their own behavior. This is expected to ultimately reduce healthcare costs.

Enabling Personalization for Digital Cognitive Stimulation to Support Communication With People With Dementia: Pilot Intervention Study as a Prelude to AI Development.

Maintaining good communication and engagement between people with dementia and their caregivers is a major challenge in dementia care. Cognitive stimulation is a psychosocial intervention that supports communication and engagement, and several digital applications for cognitive stimulation have been developed. Personalization is an important factor for obtaining sustainable benefits, but the time and effort required to personalize and optimize applications often makes them difficult for routine use by nonspecialist caregivers and families. Although artificial intelligence (AI) has great potential to support automation of the personalization process, its use is largely unexplored because of the lack of suitable data from which to develop and train machine learning models. This pilot study aims to evaluate a digital application called Aikomi in Japanese care homes for its potential to (1) create and deliver personalized cognitive stimulation programs to promote communication and engagement between people with dementia and usual care staff and (2) capture meaningful personalized data suitable for the development of AI systems. A modular technology platform was developed and used to create personalized programs for 15 people with dementia living in 4 residential care facilities in Japan with the cooperation of a family member or care staff. A single intervention with the program was conducted with the person with dementia together with a care staff member, and for some participants, smell stimulation was provided using selected smell sticks in conjunction with the digital program. All sessions were recorded using a video camera, and the combined personalized data obtained by the platform were analyzed. Most people with dementia (10/15, 67%) showed high levels of engagement (>40 on Engagement of a Person with Dementia Scale), and there were no incidences of negative reactions toward the programs. Care staff reported that some participants showed extended concentration and spontaneous communication while using Aikomi, which was not their usual behavior. Smell stimulation promoted engagement for some participants even when they were unable to identify the smell. No changes in well-being were observed following the intervention according to the Mental Function Impairment Scale. The level of response to each type of content in the stimulation program varied greatly according to the person with dementia, and personalized data captured by the Aikomi platform enabled understanding of correlations between stimulation content and responses for each participant. This study suggests that the Aikomi digital application is acceptable for use by persons with dementia and care staff and may have the potential to promote communication and engagement. The platform captures personalized data, which can provide suitable input for machine learning. Further investigation of Aikomi will be conducted to develop AI systems and create personalized digital cognitive stimulation applications that can be easily used by nonspecialist caregivers.

Older residents experience of loneliness in nursing homes: A qualitative study

Aims: This qualitative study investigates the multifaceted experiences of loneliness among elderly residents in long-term care facilities, delving into the intricacies of this pervasive issue. Loneliness is a detrimental issue among this vulnerable group, and understanding its impact on the well-being of older individuals is crucial in that it shows requirements of both humanitarian spirit and traditional moral code. Methods: In this research, a qualitative approach is employed among a diverse group of residents in a certain care home, including in-depth interviews, observational data, and content analysis of personal narratives. Results: Thematic analysis revealed accordingly several common themes related to loneliness, including the common feelings of loneliness, its contributing factors, and individual coping strategies. Conclusion: The findings underscore the complexity of the loneliness experience among the elderly living in care facilities and highlight the need for targeted interventions and policies in long-term care settings to address this significant issue. The insights gained from this research provide valuable information for future policymakers, healthcare providers, and care facility administrators in improving the well-being of elderly residents.

Healthcare-Associated Infections and Prevention Programs in General Nursing versus Residential Homes-Results of the Point Prevalence Survey in Polish Long-Term Care Facilities.

Background and Objectives: The number of residents of long-term care facilities (LTCFs) is expected to increase. Determining the epidemiological situation in the context of organizational conditions is therefore extremely important for planning the necessary future activities in the field of infection prevention. The aim of this study was to analyze the prevalence rates in Polish nursing vs. residential homes, in the context of the medical and functional burdens of residents and the organizational conditions of both types of units. Material and Methods: the data that were analyzed came from a point prevalence survey of infections and antibiotic consumption in LTCFs, conducted in accordance with the HALT-3 protocol in Poland in 2017, between April and June. Results: This study included a total of 2313 residents in 24 LTCFs. The most common risk factors for infections in the study population were urinary and fecal incontinence (77.0%), impaired mobility (the patient was in a wheelchair or lying down) (68.7%), and impaired spatial and temporal orientation (52.5%). The median prevalence in nursing homes (NHs) was 3.2% and that in residential homes (RHs) was 0.7%, but without statistical significance. The median for the entire group was 2.6%. A total of 93 healthcare-related infections were detected in 91 residents. The most frequently reported forms of infections were urinary tract infections, lower respiratory tract infections, and skin infections. A statistically significant positive correlation was found only between the percentage of residents with pressure ulcers and other wounds and the incidence of gastrointestinal infections (correlation coefficient = 0.413, p < 0.05). Infection prevention and control measures were implemented mainly in nursing homes, and in residential homes, only hand hygiene procedures were commonly available. Conclusions: For the two types of LTCFs, the epidemiological situation in terms of nosocomial infections is diverse. Consequently, both types of facilities require different approaches to infection control and prevention and outcomes analysis.

COVID-19 Pandemic Impact on the Trajectories of Cognitive Decline and Depression Symptoms in Long-Term Care Facility Residents

ObjectivesTo compare the longitudinal rates of change in cognition and depressive symptoms between 2019 (pre–COVID-19 pandemic) and 2020 (COVID-19 pandemic) among long-term care facility (LTCF) residents in Iowa, which ranked among the top 10 US states that suffered from extreme nursing staff shortages during this crisis. DesignA longitudinal cohort study analyzing the Long-Term Care Minimum Data Set (MDS) version 3.0 between January 1, 2019, and December 31, 2020. Setting and ParticipantsLTCF residents from the state of Iowa, with a first assessment before March 10 for each year (2019 and 2020), LTCF stay period >60 days, and at least 2 documented assessments with a minimum of 45 days in between. LTCF residents with a Brief Interview for Mental Status score (BIMS) <3 were excluded. MethodsWe computed doubly robust estimators by combining regression and propensity score models for BIMS (cognitive decline) and Nine-item Patient Health Questionnaire (PHQ-9; depression symptoms) monthly scores for 2020 vs 2019. ResultsA total of 24,025 residents from 436 LTCFs were included. Our research revealed a marginally accelerated monthly decline in BIMS scores during 2020 as opposed to 2019, with a rate of −0.012 per month (95% CI −0.022, −0.002; P = .016). Simultaneously, we observed a monthly increment of 0.016 in the PHQ-9 scores among LTCF residents in 2020 (95% CI 0.006, 0.028; P = .003). Conclusions and ImplicationsOur study identified a notable yet modest increase in cognitive decline and depressive symptoms among NH residents in Iowa during the COVID-19 pandemic. Although statistically significant, the changes were small and may not have clinical relevance over 1 year. Further research is needed to examine risk factors for cognitive decline during pandemic scenarios such as social isolation, loneliness, inappropriate patient-centered care, and the relationship with staff shortage and facility resources.

Public views of sexual assault, and its prevention, in residential aged care facilities

The prevalence of sexual assaults against older people in Residential Aged Care Facilities (RACFs) is estimated to be more than double the incidents in the community, yet there is a paucity of empirical research focused on this context. Considering significant revelations and community concerns stemming from Australia's recent Royal Commission into Aged Care Quality and Safety, the current study sought to assess public knowledge of sexual assaults in RACFs, specifically, the causes, delegations of responsibility, and possible solutions to limit reoccurrences. Thematic analysis was conducted on 2,398 social media comments made in response to posts concerning sexual assault in RACFs ( n = 27 sources). Results suggest systemic factors frequently contributed to incidents (e.g., staffing insufficiencies, apathetic management, and meagre regulatory requirements), while improved guardianship, sanctions, and regulation were expected to mitigate risk. Notably, the government was frequently blamed for its role in establishing and maintaining conditions that manifest in abuse within RACFs, with responsibility also delegated to family members. Importantly, public opinion strongly coincided with prior empirical prevention recommendations, endorsing the implementation of identified measures to limit sexual victimisation risk in RACFs.

Assessing infection prevention and control programs in residential aged care in Australia: A multi-methods cross-sectional study.

To assess infection prevention and control programs in residential aged care facilities. A cross-sectional survey and structured interviews from 10 residential aged care facilities in Victoria, Australia, were used. Infection prevention and control nurse leads from each facility completed a purpose-built survey based on best practice infection prevention control program core components, including staff training, policies and procedures, governance, and surveillance. Follow-up interviews with residential aged care staff, residents and family visitors were carried out to elaborate and verify survey data. Surveys from all 10 facilities were received and 75 interviews carried out. All facilities had an infection prevention and control lead nurse who had undergone additional training, and 60% of facilities had an infection prevention and control lead position description. All facilities had a committee to oversee their infection prevention and control program, and all had policies and procedures for standard and transmission-based precautions. One facility did not have a policy on healthcare-associated infection surveillance, and two facilities did not have an antimicrobial stewardship policy. All facilities provided staff training in hand hygiene and personal protective equipment use, but not all routinely assessed competency in these. The residential aged care facilities' infection prevention and control programs were generally in a strong position, although there were some areas that require improvement. Further assessment of the quality of infection prevention and control program components, such as content of education and training, and policies and procedures, and ongoing evaluation of programs is recommended. Geriatr Gerontol Int 2024; 24: 358-363.

Benefits of a digital health technology for older nursing home residents. A de-novo cost-effectiveness model for digital health technologies to aid in the assessment of toileting and containment care needs.

The aim of this study was first, to introduce a comprehensive, de-novo health economic (HE) model incorporating the full range of activities involved in toileting and containment care (T&CC) for people with incontinence, capturing all the potential benefits and costs of existing and future Digital Health Technologies (DHT) aimed at improving continence care, for both residential care and home care. Second, to use this novel model to evaluate the cost-effectiveness of the DHT TENA SmartCare Identifi in the implementation of person-centred continence care (PCCC), compared with conventional continence care for Canadian nursing home residents. The de-novo HE model was designed to evaluate technologies across different care settings from the perspective of several stakeholders. Health states were based on six care need profiles with increasing need for toileting assistance, three care stages with varying degrees of toileting success, and five levels of skin health. The main outcomes were incremental costs and quality-adjusted life years. The effectiveness of the TENA SmartCare Identifi was based primarily on trial data combined with literature and expert opinion where necessary. Costs were reported in CAD 2020. After 2 years, 21% of residents in the DHT group received mainly toileting as their continence care strategy compared with 12% in the conventional care group. Conversely, with the DHT 15% of residents rely mainly on absorbent products for incontinence care, compared with 40% with conventional care. On average, residents lived for 2.34 years, during which the DHT resulted in a small gain in quality-adjusted life years of 0.015 and overall cost-savings of $1,467 per resident compared with conventional care. Most cost-savings were achieved through reduced costs for absorbent products. Since most, if not all, stakeholders gain from use of the DHT-assisted PCCC, widespread use in Canadian residential care facilities should be considered, and similar assessments for other countries encouraged.

Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises?

COVID-19 and resulting health system and policy decisions led to significant changes in healthcare use by nursing homes (NH) residents. It is unclear whether healthcare outcomes were similarly affected among older adults in assisted living (AL). This study compared hospitalization events in AL and NHs during COVID-19 pandemic waves 1 through 4, relative to historical periods. This was a population-based, repeated cross-sectional study using linked clinical and health administrative databases (January 2018 to December 2021) for residents of all publicly subsidized AL and NH settings in Alberta, Canada. Setting-specific monthly cohorts were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. Monthly rates (per 100 person-days) of all-cause hospitalization, hospitalization with delayed discharge, and hospitalization with death were plotted and rate ratios (RR) estimated for period (pandemic wave vs historical comparison), setting (AL vs NH) and period-setting interactions, using Poisson regression with generalized estimating equations, adjusting for resident and home characteristics. On March 1, 2020, there were 9,485 AL and 14,319 NH residents, comparable in age (mean 81 years), sex (>60% female) and dementia prevalence (58-62%). All-cause hospitalization rates declined in both settings during waves 1 (AL: adjusted RR 0.60, 95%CI 0.51-0.71; NH: 0.74, 0.64-0.85) and 4 (AL: 0.76, 0.66-0.88; NH: 0.65, 0.56-0.75) but unlike NHs, AL rates were not significantly lower during wave 2 (and increased 27% vs NH, January 2021). Hospitalization with delayed discharge increased in NHs only (during and immediately after wave 1). Both settings showed a significant increase in hospitalization with death in wave 2, this increase was larger and persisted longer for AL. Pandemic-related changes in hospitalization events differed for AL and NH residents and by wave, suggesting unique system and setting factors driving healthcare use and outcomes in these settings in response to this external stress.

Investigations into the limited uptake of Ambient Assisted Living systems in the home and an approach for increasing acceptance

Research and development in the area of Ambient Assisted Living has been undertaken for many years. The aim of Ambient assisted Living is to manage the risks due to aging and living alone so that the older person can remain in their familiar home environment longer. Despite the many years of research and development there is apparently only limited uptake in the real world. Some researchers have suggested that insufficient focus on user needs, focus on the technology not the user, little concern for ethical issues in deployment, and lack of user-centered system design are causes for the limited uptake. These and other reasons should be understood else it is likely that when further systems are developed they too will not be accepted. Subsequently, the aim of the present research is to explore the issues that affected the uptake of the Assistive Technology and Ambient Assisted Living systems that are currently in Australian homes. Due to privacy concerns and commercial confidentiality issues, this has proven difficult, so an innovative approach is being used to obtain data. Some preliminary information has emerged from the ongoing data gathering that indicates that specific Assistive Technology is being used but little consideration has been given to Ambient Assisted Living. This appears due to differing perceptions of usefulness. To improve the perception of Ambient Assisted Living systems usefulness we are developing simple devices that target specific needs raised by potential users. Through using such devices, appreciation of the usefulness of comprehensive home Ambient Assisted Living systems may increase. The devices are specifically low-cost to encourage trial and are designed with a user-centered approach that incorporates important earlier researchers’ findings regarding older people and technology.

Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account.

Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care. To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures. Cross-sectional online survey with descriptive data. Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media. Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not. Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.

Prevalence of methicillin-resistant Staphylococcus aureus in residents who died with pressure ulcers in residential aged care facilities

Background: As mobility in the elderly declines, dependence on care increases, and that care involves preventing pressure ulcers (PUs). PUs may become colonized with methicillin-resistant Staphylococcus aureus, causing cross-infection problems and leading to sepsis and death. Aims and Objectives: The aim of this paper was to examine the prevalence of methicillin-resistant S. aureus in residents with PUs and consider regulations. Materials and Methods: A retrospective review of 80 records of residents aged ≥65 years from eight residential aged care facilities (RACFs) in Australia was undertaken. Records were reviewed for sex, age at death, source of admission, Stage of PU, and colonization with methicillin-resistant S. aureus. Results: A third of residents, 34% (95% confidence interval [CI] 25%–44%, 27/80), had PUs in the last week of life. Of residents admitted from hospital 13% (95% CI 9%–32%, 7/40) had PUs. Most (63%, 95% CI 44–78%, 17/27) residents with a PU had been admitted from hospital, and most PUs (78%, 95% CI 59–89%, 21/27) were open wounds, stages 2–4. Half of all residents with a PU (48%, 95% CI 30–67%, 13/27) were colonized with methicillin-resistant S. aureus, and a third of residents with stages 2–4 PUs (31%, 95% CI 13–58%, 4/13) were colonized with methicillin-resistant S. aureus. Conclusion: Nearly half of all PUs were colonized with methicillin-resistant S. aureus, suggesting PUs may be a reservoir for methicillin-resistant S. aureus. Regulations that could reduce PUs in RACFs “an air mattress appropriate to each care recipient’s condition” are not being utilized. If PUs were prevented, reservoirs for methicillin-resistant S. aureus would be eradicated.

A Collaborative Approach to Improving Care Outcomes for Residents in Assisted Living.

Purpose: Assisted Living (AL) residents are embedded in "care convoys" comprised of a dynamic network of formal and informal care partners. Using the convoys of care model-a multi-level framework connecting care convoy properties to resident outcomes-we examined healthcare management and communication between convoy members. We recommend strategies to engage primary care in supporting collaboration, communication, and consensus-building for older adults and their convoys. Methods: Data were collected from the longitudinal study, Convoys of Care: Developing Collaborative Care Partnerships in AL. Fifty residents and their care convoy members (N = 169) were followed in eight AL homes in Georgia over 2 years. Original data were analyzed using Grounded Theory Methods of qualitative data, including formal and informal interviewing, participant observation, and record review. Results: The convoys of care model provide an innovative perspective that will assist providers in supporting AL residents and their care partners to achieve better care outcomes. Findings demonstrate the utility of understanding the structure and function of social resources and implications for improving healthcare outcomes. Conclusion: This research informs the work of physicians and mid-level providers with patients in AL by providing strategies to uncover specific social determinants of health. Recommendations for use in patient encounters are enumerated.

The Intelligent Built-Environment as Cyber-Physical System

This thesis presents an alternative approach to intelligence in the built-environment, departing from the two established yet divergent branches in the discourse: the Technical, centered around Information and Communication Technologies (ICTs), and represented by Ambient Intelligence (AmI) and Ambient Assisted Living (AAL); and the Architectural, centered around architectural / spatial experiences and considerations, and represented by Interactive Architecture and Adaptive Architecture. The promise of both AmI/AAL and IA/AA is constrained by rigid and increasingly outdated assumptions in their approaches—i.e., AmI’s / AAL’s approach to the built-environment, and IA’s / AA’s approach to ICTs. Moreover, it is impossible to combine them to yield a cohesive system due to disparity in their typical Technology Readiness Levels. That is, the sophistication of a system depends on that of its mutually complementing subsystems; and two or more subsystems may not mutually complement, sustain, and/or support one another if their levels of development do not correspond. Consequently, the presented alternative conceives the intelligent built-environment as a Cyber- Physical System. Under this approach, ICTs and Architectural considerations in conjunction instantiate intelligence fundamentally. The presented approach’s promise is illustrated via its application to a constrained use-case focused on the elderly. Twelve proof-of-concept demonstrators are developed based on key parameters pertaining to Indoor Environmental Quality and Quality of Life. While each demonstrator is presented as a discrete proof-of-concept, all build on the same core System Architecture and technological ecosystem, and are intended to be viewed as a collection of systems and services expressed within a same hypothetical environment.