Residential Care Research Articles

As Fit as a Fiddle

Abstract Background The EDITH (emergency department in the home) team is an alternative pathway for older adults requiring emergency care. The team consists of an occupational therapist (OT) and a doctor who provide specialized geriatric care in patients' homes thus negating the need for an emergency department (ED) presentation. The patients' profile is typically frail older adults however this service can be accessed by any person over 65 years within the catchment. Methods Clinical frailty scales (CFS) are routinely completed as part of the OT assessment process. A review of the OT logbooks and electronic healthcare records was completed over an 18-month period. The average CFS was 6 however 11 patients with a CFS of 1 or 2 were identified. The health care records was analysed to identify similarities in this subset patient population group. Results It was found that none of these patients had formal supports, and none were living in residential care. The age range was 65 to 90 years old. None of these patients required an onwards referral to community services or provision of OT equipment. Presenting complaint breakdown: explained falls (2), DVT (2), Blood pressure issues (2), pain (2), catheter (1), covid (1), INR problems (1). At 3 months post EDITH review it was found that no patients had a re attendance to ED. Conclusion Patients with a low level of clinical frailty make up a very small sub set of the general EDITH patient population. These patients appear to be living independently within the community and do not require extensive OT input. Their presenting complaints appear to be predominately isolated medical events as opposed to chronic medical issues.

Antipsychotic Prescribing and Falls Risk in Nursing Home Residents with Dementia

Abstract Background Falls are a common syndrome in older adults leading to adverse outcomes including functional decline, activity restriction, injury and death. They can still occur in residential care. We examined prescribing of medications included in STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) (1) in nursing home residents with dementia. Methods A point prevalence audit was conducted in a dementia-specific nursing home. Data were collected from the electronic healthcare record on demographics, dementia severity, and number of falls in the preceding 12 months. The number and class of regular medications were recorded. Non-cognitive symptoms of dementia were quantified using the Cohen Mansfield Agitation Inventory (CMAI). Results Seventy-four residents were included with mean age 82 years, 59(70%) female. The average Mini Mental State Examination (MMSE) was 5/30 and 80% had severe dementia. The average CMAI score was 50. The mean number of falls was 3 (range 0-14). Regular prescribing of specific STOPPFall medications was as follows: antipsychotics 42/74 (57%), benzodiazepines 8/74 (11%), opioids 13/74 (18%), antidepressants 44/74 (59%), antiepileptics 11.74 (15%), diuretics 12/74 (16%). Prescription of a regular antipsychotic was associated with one or more falls (OR 3.19, p = 0.029). There was no significant difference in falls with the other medications studied. The number of falls increased with higher agitation scores. Conclusion Antipsychotics increased the risk of falls in a nursing home setting. Fallers had higher rates of agitation, perhaps explaining the increased usage of antipsychotics. Medications should be reviewed on a regular basis and deprescribing considered where appropriate. Reference 1. Seppala LJ, Petrovic M, Ryg J, Bahat G, Topinkova E, Szczerbińska K, et al. STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drgs. Age and Ageing. 2020;50(4):1189-99.

Improving Advanced Care Planning: Documentation of DNA CPR Orders and TEPs in Residential Care Admissions

Abstract Background Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders and Treatment Escalation Plans (TEPs) are key components of advanced care planning for managing patients with progressive life-limiting illnesses and significant frailty. Our study aimed to determine the proportion of such patients being transferred from residential care facilities with documented TEPs upon medical admission, examine whether these TEPs were revised during the hospital stay, and assess patient outcomes at 14 days post-presentation. Methods We reviewed the lists of patients who had been referred for medical admission via the emergency department over a one-month period and identified those presenting from residential care facilities. We excluded those under the age of 65. We reviewed relevant medical notes and collected anonymised data into an Excel spreadsheet on a password protected computer. Results We identified 34 patient’s relevant patients. Notes were available for review in 31 cases (17 male; age range 66 to 96 years old, mean age 82.3). Of the 31 cases reviewed, the mean Clinical Frailty Score was 7.4. Residential care facilities sent documentation outlining TEPs in 19/31 cases. In those cases, 4/19 specified full resuscitation. In 3/4 of these cases, the TEP was revised during their admission. In one case, documentation specified that the patient did not want to be transferred to hospital under any circumstances. A total of 14 patients had no documentation regarding TEP. Of those, 7/14 went on to have DNA CPR orders filled out during their admission. At 14 days post presentation, 7 had died in hospital, 16 were discharged back to their residential care facility, and the remainder remained inpatient. Conclusion These findings underscore the need for better advance care planning, potentially improving patient management and reducing the emotional burden on patients, healthcare providers and families during critical moments.

Validation of a Self- Administration of Medications Assessment Tool for Home Dwelling Older Adults During an Elective Admission for Rehabilitation

Abstract Background Safe medication management is challenging among older adults due to an increased prevalence of multiple chronic diseases often requiring complex multi-drug pharmacotherapy. Poly-pharmacy can increase the risk of non-adherence to medications in home dwelling older adults, reported as ranging from 6 to 55%. During hospital stays older adults may lose control over their medication management due to the shift in responsibilities from patient to healthcare professionals. Self-administration of medication (SAM) can increase patients’ understanding about their medication and promote independence and autonomy in the hospital setting. Methods From January -December 2023, all elective admissions were assessed for inclusion in SAM during their inpatient stay (n-74). An assessment tool, validated for use in the residential care setting was used. The tool, comprising of 17 items assesses the patients experience of self- medication, capability to self-medicate (cognition and function) and knowledge of their medications. Criteria for inclusion in SAM included older adults who self-administered their medication at home prior to admission and assessed as suitable using the assessment tool. Medication reconciliation was undertaken by a pharmacist for all patients prior to commencing SAM. Results 42% of admissions (n=31) were deemed suitable for SAM during their inpatient stay. Mean age 79 years (age range: 68-96 years). Number of medications > 5 medications daily. 90% (n-28) successfully completed SAM throughout their stay with 10% (n-3) reverting to nurse administration due to changes in medication during their inpatient stay Conclusion The use of the assessment tool supported a 90% success rate for SAM in this cohort. Further testing is recommended to evaluate the tool in other in-patient settings. An evaluation of SAM for the prospective of older adults and nursing team is also recommended.

Day Centre Functional Physiotherapy Classes for Older People; Client Survey

Abstract Background Our Long-Term Residential Care facility provides physiotherapy services for approximately 117 Day Care clients. As part of our local Quality Improvement Programme, we wished to assess client perception of Day Centre Functional physiotherapy classes to help ascertain their perception regarding exercise intensity of classes, ability to follow guidance in class and ask questions. Emphasis of the class is to promote a learning environment, improve health literacy and functional independence of clients. As Falls Prevention is key re National Programme for older people (NCOP) and National Frailty Education, questions related to falls frequency and fear of falls prevalence. Methods This was a survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (> 65 years), This was a qualitative survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (> 65 years) Results 70% response rate. 100% reported feeling comfortable asking Physio instructor questions & that exercise guidance was clear and understandable. 96% reported being physically able to keep up with class intensity. 80% reported class intensity as moderate, 20% as high, 0% reported class intensity as easy. 84% reported a fear of falling. 17% reported no fall in the previous year. 68% reported 1-3 falls, 15% reported > 3 falls in last year. Class attendances reported: 4% 0-5 classes, 18% 5-10 classes, 78% more than 10 classes. Conclusion Results obtained from the survey have provided worthwhile feedback and supports that Falls prevention measures should address fear of falls. Significant findings on client satisfaction/perception of exercise intensity noted. Next steps will include tailoring physiotherapy classes for this demographic to include fear of falling, optimising exercise intensity, promoting health literacy and best practice for exercise prescription. Also, consideration of further objective testing of balance post physio class programme period to ascertain success of exercise classes.

Identification of the Needs of Patients ≥ 75 Years Admitted to an Acute Hospital

Abstract Background More than 30% of older people are discharged with new or additional disability following an acute hospital admission.1, 2 Older adults who are frail experience even higher levels of hospital-associated disability.3 For patients who experience hospital-associated disability, fewer than half will recover to their pre-illness level of functioning after 1 year and rates of death and nursing home placement are high.4 The economic consequences of hospital-associated disability are longer hospital length-of stay, increased rates of re-admission after discharge, an increased requirement for home care packages and long-term residential care beds. Methods An observational study was undertaken to determine the profile and needs of adults ≥75 years admitted to an acute hospital. Medical records were reviewed by two advanced nurse practitioners on day 1 of admission. From January 8th -22nd 2024, 352 hospital admission episodes were reviewed. Objectives Results Conclusion In conclusion, the results highlighted a need for 1. An increase in beds available in a Specialist Geriatric ward 2. A greater awareness at ED level of admitting specialty 3. An increase in the number of beds to be made available such as rehabilitation beds to facilitate early discharge from the acute hospital.

Advance Care Planning Practices For Nursing Home Residents Referred To Specialist Palliative Care In An Acute Hospital Setting

Abstract Background Advance care planning (ACP) is a structured process of discussion between patients, their loved ones and health care professionals, which aims to establish and record an individual’s goals and preferences for future medical treatment and care. It is of significant relevance to nursing home residents, a comorbid and frail population at high risk of clinical deterioration. Methods This prospective, observational study included all nursing home residents referred to an inpatient specialist palliative care (SPC) service in a model four hospital over a six-month period (November 2023 to May 2024). Basic clinical and demographic information as well as data on functional status and advance care planning was anonymised and collated using Microsoft excel. Results 36 patients (mean age 79 years) were recruited. 36% (n=13) were referred within 48 hours of admission. The average Australia-modified Karnofsky Performance Scale score was 40 on admission. 94% (n=34) had a clinical frailty score of ≥7 on admission. 72% (n=26) had an advance care plan in the nursing home. However, 22% (n=8) had not recorded their wishes pertaining to hospital readmission and 3 patients were admitted despite documenting a preference to remain in the nursing home. 53% (n=19) had not documented their preferred place for end-of-life care. 69% (n=25) died in hospital. Conclusion Most nursing home residents referred to the inpatient SPC team had severe frailty and died in hospital, reflecting the prognostic implications of severe frailty. Crucial components of the advance care plan were omitted in a significant proportion of patients, which may have influenced their referral to hospital. Provision of increased support to staff caring for older, frail adults in the residential care setting should be considered to enhance ACP.

Bridging The Gap: Between an Older Adult Attending The Ambulatory Day Unit and An Acute Hospital Presentation

Abstract Background Older adults attending the ambulatory day units within the hospital group have a comprehensive geriatric assessment (CGA) completed. This identifies the older adult’s functional, physical, social, environmental and psychological baseline, in order to develop and implement a coordinated plan of care and follow up. The CGA is the gold standard in caring for older adults who are frail or at risk of frailty (HSE, 2016). The units are off site from the main hospital, therefore valuable information may not be available to the acute hospital. Valuable information from the CGA can provide the older adult’s functional and cognitive baseline and prevent unnecessary duplication of assessments and increased length of stay. Methods Plan-Do- Study-Act (PDSA) cycle was used. A questionnaire was produced to ascertain acute care staff’s understanding of; whether an older adult is attending the ambulatory unit? Would this information and a review by the RANP Gerontology be beneficial? A Registered Advanced Nurse Practitioner (RANP) Gerontology Pathway was developed. Education was provided to nursing, and the wider multidisciplinary team. An alert sheet was introduced and provided to older adult attending the ambulatory day units. The alert was for the older adult to produce, if attending or admitted to the acute hospital. This initiates the RANP pathway. Older adults are then seen by the RANP at source of admission. Clinic letters with baseline is documented in the Healthcare record, including advice plan and follow-up. Post-implementation questionnaire and verbal feedback were obtained. Results Positive feedback from older adults, family and staff. Avoidance of unnecessary duplication of assessments, data sharing, optimization of plan of care, treatment and rehabilitation potential. Effective discharge planning, reduction of unnecessary transfer to residential care. Conclusion Bridging the gap promotes positive outcomes: Reducing length of stay, positive impact on overall wellbeing, and an organizational cost containment.

Health professionals’ and caregivers’ perspectives on improving paramedics’ provision of palliative care in Australian communities: a qualitative study

ObjectivesParamedics have the potential to make a substantial contribution to community-based palliative care provision. However, they are hindered by a lack of policy and institutional support, as well as targeted...

Household willingness-to-pay for formal residential care for the elderly in an urban setting in Accra, Ghana

BackgroundLong-term, informal care for the elderly in many sub-Saharan African countries is the responsibility of the family. However, urbanization, migration and the gradual nucleation of families is threatening this responsibility. As the burden of long-term care increases, traditional family support may no longer suffice and as such formal systems of care needs to be explored. While formalized care comes at a cost, it is unclear whether households will be willing and able to pay for these services. This study therefore sought to assess households’ willingness-to-pay (WTP) for formal residential care for the elderly in an urban setting in Ghana.MethodsThis was a cross-sectional study, conducted at the La Nkwantanang-Madina Municipality in Accra among 460 households. The study used a mixed sampling design, combining purposive and stratified random sampling techniques. A structured questionnaire was employed to gather data on socio-economic, demographic, health characteristics of the elderly and caregivers. The Contingent Valuation Method (CVM) was used to assess households’ WTP for formal residential care for the elderly, while multiple logistic regression was employed to identify factors influencing households' WTP.ResultsThe study showed that about 72% of households indicated their willingness to pay for formal residential care for the elderly, with an average amount of US$122.35 (US$27.3–US$272.7) per month for the holistic service. Age of household head (OR = − 0.034, p = 0.02), household income (OR = 1.60, p < 0.01), employment status of household head (OR = 2.75, p = 0.01), awareness of the existence of the service (OR = 2.07, p < 0.01), belonging to the richer household (OR = 2.56, p < 0.00) and presence of an elderly member in the household (OR = 2.84, p < 0.01) were all significantly associated with households' WTP for formal residential care for the elderly.ConclusionThe study revealed a significant proportion of households were willing to pay for formal residential care for the elderly. Factors such as age, income, employment status, presence of elderly and awareness of care options were significantly associated with the households' decision-making processes. This increased interest offers a potential market for provision of formalized elderly care homes services within the capital. Raising awareness and benefits is key in unlocking this service package to the population.

Antibiogram development for Australian residential aged care facilities.

Knowledge of local antibiotic resistance data, provided by antibiograms (a cumulative summary of in vitro-antimicrobial-susceptibility-test results), can aid prescribing of appropriate empirical antibiotics. This study aimed to explore the feasibility of antibiogram development for residential aged care facilities (RACFs). Retrospective observational study of culture and sensitivity data. Nine RACFs in Queensland, Australia. Available antimicrobial susceptibility results were collected retrospectively for all residents of recruited RACFs from January 1, 2020, to December 31, 2022. Data were managed and analyzed with WHONET software®, and antibiograms were developed in accordance with the CLSI-M39 guidelines. Antibiogram data beyond the standard 12-months and pooling of data from geographically similar RACFs were explored as options to improve feasibility and validity of the antibiograms. The most prevalent bacteria in the RACFs were Escherichia coli and Staphylococcus aureus. Due to the low number of positive cultures (less than 30) for individual RACFs, an annual antibiogram was not feasible. Extending the time-period to three years improved feasibility of antibiograms for E.coli in seven RACFs and S.aureus in five RACFs. Combining the data from closely located RACFs allowed for sufficient urinary and skin swab isolates to produce annual pooled antibiograms for all three years. Use of extended time period antibiograms can provide RACF specific urinary and skin/soft tissue resistance data without the necessity of private pathology provider input. However, pooled syndromic antibiograms can be made available on an annual basis, which may be the preferred option.

Examining Care Network Characteristics in Older Adults' Relocation to Residential Care Settings.

When older adults face increasing care needs or limited support, remaining safely and comfortably at home becomes challenging. Extant research has primarily concentrated on characteristics of the older adult or their primary caregiver on nursing home admission. This study examines the risk of older adults transitioning to residential care (e.g., assisted living, nursing home), focusing on the influence of their care network or involvement of multiple helpers. Using the National Health and Aging Trends Study, we conducted competing risk regression models that account for mortality, following 7,085 initially community-dwelling older adults across Rounds 1-9 (2011-2019). We assessed network composition, size, shared tasks, and the number of in-network specialists or generalists while controlling for individual sociodemographic and health factors. Individuals with care networks that shared medical tasks had the highest risk of moving to a residential care setting, followed by those sharing household tasks. Conversely, shared mobility or self-care and transportation responsibilities were associated with lower risks. Having more generalists, but not specialists, increased the risk. Larger networks were associated with heightened risk, although having close family members like a spouse was protective. The findings underscore that care network characteristics are critical to older adults' ability to age in place. Specifically, older adults with larger networks, lacking a spouse or child, and providing complex care are at greater risk for relocating. Understanding care networks can guide interventions related to care network coordination and resource allocation to help avoid or postpone a residential care move.

Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015-2018: a retrospective population-based study.

To determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator. Retrospective population-based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data. People aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 - 31 December 2018. Thirty-day (primary outcome), 120-day, and 365-day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator. Registry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015-2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre-admission walking ability, and residential status, 30-day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30-0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46-0.82) than for low indicator adherence hip fractures, as was 365-day mortality (high adherence: aRR, 0.59 [95% CI, 0.51-0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63-0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61-0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67-0.83) were associated with lower mortality risk at each time point. Clinical care for two-thirds of hip fractures attained a high level of adherence to the six quality care indicators, and short and longer term mortality was lower among people who received such care than among those who received low adherence care.

Children's out-of-home placements: Associations with parental substance use and neighbourhood sociodemographics.

Background: Studies have shown an association between parental problematic substance use (PSU) and children's out-of-home care (OHC). But there is little researech on the kind of urban neighbourhoods in which such associations typically show up. This study aims to shed light on the associations between neighbourhood characteristics, parental PSU and children's OHC. Using register data, we explore the spatial concentration of parental PSU and children's OHC in urban areas. Methods: Register data of all children born in Finland in 2002 and their biological parents living in 14 Finnish cities were used to follow the children from birth until their 18th birthday or first OHC episode. The study looks at parental PSU andother individual-level indicators as well-as the sociodemographic neighbourhood characteristics. Cox proportional hazards modelling was used as the analysis method. Results: Parental PSU increased the probability of children's OHC regardless of neighbourhood type. The probabilty was highest if both parents had PSU (hazard ratio [HR] = 8.05, 95% confidence interval [Cl] 6.38-10.16), but this outcome did not look the same for all neighbourhoods. The risk of children's OHC placements was higher in suburbs compared to city centres (HR = 1.76, 95% Cl 1.38-2.25). Conclusion: As parental substance use is a complex problem that is often intertwined with other life challenges, such as financial difficulties and mental health problems, it is insufficient to treat caregiver conditions, such as problematic substance use in isolation. Services that increase positive, pro-social connections may be lacking in the neighbourhoods with the most challenges.

“I would have to walk around to find the best Wi-Fi connection…”: qualitatively exploring challenges associated with rapid rollout of telehealth in Canadian long-term care homes

BackgroundEarly in the COVID-19 pandemic, long-term care (LTC) homes in British Columbia, Canada, restricted visitation to ensure the safety of their residents against transmission of the novel coronavirus. As such, these LTC homes had to quickly implement a rapid rollout of telehealth services to maintain physician care for residents while avoiding the infection risk of in-person visits amidst lockdown measures. The abrupt transition from traditional in-person physician care to telehealth presented significant challenges. Investigating these challenges is pivotal to the development of strategies for sustained telehealth use for physician services in LTC homes. This analysis is part of a broader qualitative, utilization-focused evaluation study of telehealth services rapidly implemented for physician care in LTC homes within the Fraser Health Authority region of British Columbia. The evaluation has aimed to consider integral factors such as telehealth challenges, facilitators, preferences, and continued use. Semi-structured interviews and focus groups were conducted with 70 physicians, staff, residents, and family caregivers across 27 different LTC homes in the region. All interviews and focus groups were transcribed verbatim and were analyzed using a thematic approach to identify common barriers surrounding the rapid rollout of telehealth in LTC across relevant groups.ResultsFrom the data, four challenges were identified: connectivity challenges (e.g., inconsistent or no Wi-Fi or cellular connectivity), device challenges (e.g., lack of accessible devices and software issues), privacy challenges (e.g., lack of private space to support telehealth use), and informational challenges (e.g., lack of electronic medical record access). All challenges posed barriers to telehealth access for both care provider and recipient groups in LTC settings.ConclusionsThe challenges identified in this analysis are supported by existing literature, which is significant given the different contexts within which such research has been undertaken. Collectively, this knowledge base can support evidence-informed improvements to telehealth for physician care in LTC settings. Future research should capture the perspectives of diverse cultural groups, LTC residents with cognitive impairments, and those who provide and receive care in rural settings.

A National Survey of Obstetrics and Gynecology Resident Perspectives on Their Preparedness to Provide Care for Underserved Patients with Gynecologic Malignancies.

Obstetrics and Gynecology (Ob/Gyn) residents will encounter, screen for, and diagnose gynecologic malignancies. This survey assessed residents' confidence in providing NCCN Guidelines-based care to Gynecologic Oncology patients of differing racial/ethnic backgrounds and insurance statuses while accounting for residents' backgrounds. An anonymous, novel Qualtrics survey was disseminated to current US Ob/Gyn residents, with multiple-choice questions about subject demographics and Likert scale questions about their readiness to care for diverse patients. Differences in responses between racial groups were analyzed using the Kruskal-Wallis Rank Sum test. Differences in responses between ethnic groups were evaluated using the Wilcoxon Rank Sum test. Regardless of their backgrounds, residents feel "somewhat prepared" to care for diverse patients. There was no statistical between ethnic groups regarding confidence in caring for racial minorities or insurance types. Similarly, there was no statistical difference between racial groups regarding caring for racial minorities, but a difference did exist for insurance types (p = 0.027). No significant racial/ethnic differences were found in opinions on trial enrollment or chemotherapy delays, though most residents agreed that racial/ethnic minorities face delays in chemotherapy. Finally, resident ethnicity and race both impacted resident perceptions of difficulties for Medicaid and minority patients in obtaining non-operative gynecologic care (p = 0.044; p = 0.017) and scheduling outpatient appointments (p = 0.016; p = 0.032). Ob/Gyn residents feel prepared to provide NCCN Guidelines-based care to socioeconomically diverse patients with gynecologic malignancies, though differences exist when accounting for residents' racial/ethnic backgrounds. These results reflect the importance of emphasizing on culturally competent care in residency, particularly for patients with cancer.

Ongoing and emerging issues for residential long-term care in the context of Covid-19.

Background: Long-term care facilities have been confronted with various workforce challenges, including a poor image within the nursing profession, a shortage of staff, and a growing demand for long-term care. Furthermore, these facilities have been significantly impacted by the pandemic and the respective measures with detrimental effects on residents, staff, and their family members. Aim: This study explored issues in working in residential long-term care from the perspective of nurses and their perception on amplifying and additional effects of Covid-19. Methods: It applied a qualitative design focusing on experiences and views of 25 LTC nurses working in Austrian long term care facilities during the pandemic. Data were collected by conducting in-depth interviews either virtually or in presence. The data analysis was conducted by applying a thematic analysis. Results: The four identified themes are: (1) Work motivation, (2) Dealing with vulnerability, (3) Human Resource Planning and (4) External view on long-term care. For each theme it was delineated which aspects have been present in the pre-Covid-19 situation and which became more visible or arose additionally. Conclusions: Nurturing connection between LTC nurses and with residents and relatives as well as signaling the positive aspects of LTC such as relationships, challenge and responsibility may allow to tackle Human Resource Planning issues.

"Doing Housework with a Walker? No Way!": Exploring the Perceptions of Community-Dwelling Frail Older Adults and Their Informal Caregivers on "Informal Caregiver-Induced Forced Immobility".

Family caregivers should focus on maintaining independence when assisting older adults with mobility. This may, however, bring about a counterproductive effect, namely Informal Caregiver-induced Forced Immobility (ICFI). This study explored the perceptions and experiences of older adults and their informal caregivers regarding ICFI. This qualitative study used a conventional content analysis approach and was conducted from January to September 2023 in Tabriz, Iran. Twenty older adults (aged 60 years and above) who had used a mobility aid, such as a cane or walker, and 14 informal caregivers were purposefully (purposive sampling) selected to participate in the study. Individual semi-structured interviews were conducted until data saturation was achieved. MAXQDA ver. 20.0 software (VERBI Software, Germany) was used to manage and analyze the data. Based on the participants' perceptions, ICFI means that for an older adult, "social interaction/social participation is limited," "performing activities of daily living is disallowed," and "engaging in physical activities and exercising is prohibited." Our findings revealed the concept of ICFI from various perspectives in Iranian families with older adults, leading to a clearer understanding of this phenomenon. This aspect should be considered when developing intervention strategies for the care of older adults in home and residential care settings by, health practitioners, gerontologists, and policymakers. This research can serve as a foundation for future studies to develop pertinent indicators and tools for measuring ICFI in the hope of providing sufficient evidence to support interventions that aim to prevent or stop ICFI.

Meaningful Associations Between Motivation for Treatment and Interpersonal Needs Within a Residential Sample of Women With Eating Disorders

ABSTRACTObjectivePerceived burdensomeness (PB) and thwarted belongingness (TB), two proximal risk factors for suicide, may rise during residential eating disorder (ED) treatment when patients are separated from support and face exorbitant costs of care. In this setting, fostering motivation for treatment is challenging, and low motivation for treatment may exacerbate feelings of PB and TB. Simultaneously, PB and TB could reduce motivation for treatment, though no studies have explored this relationship longitudinally. Accordingly, this study examined associations between interpersonal needs (TB, PB) and motivation for treatment across the first 6 weeks of residential ED treatment.MethodsParticipants (n = 98) completed the Interpersonal Needs Questionnaire (INQ) and rated treatment motivation weekly. Pearson bivariate correlations examined the relationship between motivation and interpersonal needs at each timepoint. Two autoregressive cross‐lagged panel models (AR‐CLPMs) tested reciprocal relationships between these constructs longitudinally across the first 6 weeks of treatment.ResultsMotivation was significantly negatively correlated with PB and TB at all timepoints. In AR‐CLPM 1, Week 2 Motivation predicted Weeks 3 PB, then Week 3 PB predicted Week 4 Motivation. In AR‐CLPM 2, Week 2 TB predicted Week 3 Motivation, but Motivation did not predict TB at any timepoint.DiscussionThis study is the first to examine longitudinal relations between interpersonal needs and treatment motivation in residential ED care. PB and TB may influence one's motivation for treatment, although motivation and PB had a stronger reciprocal relationship than motivation and TB. Interpersonal needs should be addressed early in residential treatment to mitigate negative cycling.

Influence of Digital Health Technologies among Healthcare Providers on Long-term Care Services Implementation for Elderly with Disabilities

Purpose: The traditional paradigm of home care in China is not up to the challenges posed by the country's increasing population's advancing age and lack of available resources. Digital monitoring technology solutions are thought to be advantageous for managing caregivers' workloads while also improving resident safety and care quality in assisted living facilities. To effectively provide the best possible services, teamwork is crucial in New Hampshire. Due to several issues such staffing shortages, rising resident expectations, and increased demands, NH are consequently embracing the use of Knowledge Management (KM) activities more and more to facilitate knowledge development, storage, transfer, and application. Method: In China, the lack of an established system for caring for the elderly is having a significant impact on society as a whole, making it imperative to establish one. The researcher examined the real impacts of their quality management system and KM efforts on service quality, as well as the KM adjustments made by two China state NH that adopted the E-Qalin management of quality model, in the qualitative research. Additionally, the researchers looked at the approaches used by two China private NH that address service quality from a knowledge management standpoint but have not implemented a certified management of quality program. There were eighty nursing professionals in the sample. Teamwork is crucial in every NH included in this study, and each participant in the researcher’s poll is a member of a team. In this work, the researchers used linear regression to analyse connections between individual variables. Results: Between the development, transmission, and application of knowledge in the state of New Hampshire regardless of the E-Qalin certificate, the researchers discovered a strong and favourable correlation. The researchers found a statistically significant and favourable association between knowledge storage and service quality, but only in New Hampshire with an E-Qalin certificate. Thus, the researcher’s study's findings highlight the necessity of learning more about quality control and knowledge management in the context of New Hampshire. Conclusion: The government, tech companies, and nursing homes need to further restructure the current system before more elderly people adopt sophisticated technology in home care settings. The study's findings, which centre on the transmission of tacit knowledge, substantially advance the field of knowledge management research in New Hampshire.