Care Home Residents Research Articles

Assessing the feasibility of measuring residents’ quality of life in English care homes and the construct validity and internal consistency of measures completed by staff proxy: a cross-sectional study

ObjectivesTo assess the feasibility of capturing older care home residents’ quality of life (QoL) in digital social care records and the construct validity (hypothesis testing) and internal consistency (Cronbach’s alpha)...

Lockdown through a Chinese lens: A qualitative study.

COVID-19-related lockdowns resulted in strict visiting restrictions in care homes, placing a vulnerable population at further risk of functional and cognitive decline, and psychological difficulties due to isolation. Experiences of vulnerable minority groups of older persons who reside in care homes are not well researched. In New Zealand, the Chinese community is a fast-growing ethnic group that faces challenges such as language barriers, differing cultural beliefs and COVID-19-related discrimination. The aim of this study was to explore the experiences of Chinese care home residents in New Zealand during COVID-19 lockdowns. In this qualitative study, we interviewed residents (n = 6), family members (n = 6) and facility staff (n = 6) across two Chinese-run care homes in Auckland, New Zealand. Resident and family member participants were exclusively Chinese. Interviews were conducted and transcribed in either English or Mandarin Chinese. Transcripts were coded and analysed to synthesise themes. We identified five themes: (a) acceptance and pragmatism; (b) attitudes towards authority; (c) the concept of máfan: (to trouble); (d) challenges to fulfilling filial duties; and (e) responding to pandemic challenges. This research reframes the narrative of older Chinese care home residents during COVID-19-related restrictions. We recommend integrating the findings and philosophical values identified in this study to develop future protocols that consider the cultural and language needs of Chinese care home residents.

Developing a set of key principles for care planning within older adult care homes: study protocol for a modified Delphi survey

BackgroundOlder adult care homes in England are required to develop care plans on behalf of each of their residents and to make these documents available to those who provide care....

AI and machine learning for detection and management of delirium in care home residents

Background Presently, diagnosing delirium in older people is a challenge. Diagnostic support tools such as the Confusion Assessment Method and 4AT provide structure but require specialist training, resources, and implementation support, while some subjectivity persists in diagnosis. This is particularly the case in people who live with dementia who often experience rapid fluctuation in cognitive abilities and behaviours. This leads to variation in diagnosis between settings and care providers, with consequent harmful impact on those experiencing delirium. These challenges become greater in care homes where dementia is prevalent, daily fluctuation is the norm and where the majority of staff are not trained healthcare professionals. Summary Here we outline the potential for AI-based Human Activity Recognition (HAR) approaches to identify and flag deviations from normal behaviour that may be precursors of a delirium state, enabling earlier detection and management, and better outcomes. We outline how Statistical Process Control (SPC) approaches could form the basis of diagnostic algorithms and the steps required to test the feasibility of this approach in the care home setting. Key Messages Delirium detection and diagnosis, difficult in any setting, is more difficult in care homes because of resident, staff and organisational factors. Artificial intelligence, machine learning and human activity recognition have potential to make diagnosis more reliable because of their ability to recognise changes from normal patterns of behaviour at an individual level.

A qualitative interview study of care home managers’ experiences of medicines optimisation for residents with dementia during the COVID-19 pandemic

ObjectivesTo explore care home managers’ views and experiences of optimising medicines use for residents with dementia during the COVID-19 pandemic.Design, setting and participantsA descriptive exploratory qualitative study using semistructured interviews...

An exploratory study on the prevalence of dysphagia and malnutrition risk among older residents in care homes

An exploratory study on the prevalence of dysphagia and malnutrition risk among older residents in care homes

Public Involvement to Enhance Care Home Research; Collaboration on a Minimum Data Set for Care Homes.

Information on care home residents in England is captured in numerous data sets (care home records, General Practitioner records, community nursing, etc.) but little of this information is currently analysed in a way that is useful for care providers, current or future residents and families or that realises the potential of data to enhance care provision. The DACHA study aimed to develop and test a minimum data set (MDS) which would bring together data that is useful to support and improve care and facilitate research. It is that utility that underscores the importance of meaningful public involvement (PI) with the range of groups of people affected. This paper analyses the involvement of family members of care home residents and care home staff through a PI Panel. The objective for the PI activities was to consistently bring the knowledge and perspectives of family members and care home staff to influence the ongoing design and conduct of the DACHA study. The bespoke methods of PI included a dedicated PI team and a PI Panel of public contributors. Meetings were recorded and minutes agreed, resulting actions were tracked and reflections on the PI recorded. A democratic, social relations approach was used to frame the analysis. A PI panel met 17 times. All meetings included both family members and care home staff. Analysis of the records and reflections developed the following themes about the operation of the PI: deepened understanding of the data environment in care homes; Influence on the pilot MDS; aiming for best research practices with care homes; personal/professional development for PI members; expectations of the project. Learning points for future research projects are developed. PI shaped the design and conduct of the DACHA study, grounding it in the needs and perspectives of people using and providing social care. Data research has a huge responsibility to accurately incorporate relevant public perspectives. There is an implicit assumption that records and data are objective and 'speak for themselves' however there can be unintended consequences from introduction of new data requirements in practice. Public contributors to this manuscript include family members of older people living in care homes and staff of care homes. The wider study also involved as the public, older people living in care homes. Public contributors helped develop the project, contributed throughout the conduct of the study and some chose to be involved in preparing this manuscript.

A Scoping Review of Educational and Training Interventions on Parkinson's Disease for Staff in Care Home Settings.

Parkinson's disease (PD) is a complex neurodegenerative disorder that presents significant challenges for care home residents and staff. This scoping review aimed to synthesize evidence on PD education and training available to care home staff, examine existing programs and their effectiveness, and identify gaps in current educational approaches. A scoping review (ScR) was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR) checklist. A comprehensive search of six electronic databases was conducted in September 2024. Studies focusing on PD education and training for care home staff were included. Data extraction and quality appraisal were performed, followed by thematic analysis to identify key patterns and themes. Seven studies met the inclusion criteria. The thematic analysis revealed four main themes: improvements in PD knowledge and confidence, improvements in care practices and outcomes, the need for increased specialist education, and the incorporation of communication training. Educational interventions led to significant improvements in staff knowledge, confidence, and care practices. However, these studies also highlighted a critical need for more specialized PD training among care home staff. This review provides evidence of promise regarding the potential impact of PD-specific education on care home staff knowledge and practices. Future research should focus on developing and evaluating comprehensive, tailored educational programs to enhance the quality of care for people with PD in care home settings.

Wisdom and socio-cognitive mindfulness as predictors of loneliness in late adulthood: the mediating role of meaning in life

Objectives This research aimed to examine whether (1) socio-cognitive mindfulness, defined as actively noticing novel distinctions in events and situations, negatively predicted loneliness in older adults and whether (2) meaning in life mediated the relationships between wisdom and loneliness and between socio-cognitive mindfulness and loneliness. Method Two cross-sectional studies were conducted. In Study 1 (N = 76), participants aged 60 to 85 years completed questionnaires measuring wisdom, loneliness, meaning in life, and self-rated health. In Study 2 (N = 117), care home residents aged 60 to 87 years completed measures of socio-cognitive mindfulness, loneliness, meaning in life, and self-rated health. Results Study 1 found a negative relationship between wisdom and loneliness, even after accounting for socio-demographic factors and meaning in life. Study 2 revealed a negative relationship between socio-cognitive mindfulness and loneliness. The relationships of both wisdom and socio-cognitive mindfulness to loneliness were mediated by meaning in life. Conclusion The two studies indicate that attributes associated with wisdom and socio-cognitive mindfulness, such as perceiving events from multiple perspectives and maintaining a compassionate attitude, contribute to an increase in meaning in life, which in turn reduces loneliness in late adulthood.

Development of a predictive model for loss of functional and cognitive abilities in long-term care home residents: a protocol

IntroductionLong-term care (LTC) residents require extensive assistance with daily activities due to physical and cognitive impairments. Medical treatment for LTC residents, when not aligned with residents’ wishes, can cause discomfort...

Distribution and determinants of the utilization of senior residential care homes in Saudi Arabia: a cross-sectional study.

With the accelerated increase in the population of seniors aged 60 years or older in Saudi Arabia, understanding the utilization of senior residential care homes is crucial for improving service delivery and policy planning to meet the care transformation objectives of Vision 2030. To assess the distribution and determinants of senior residential care home utilization across Saudi Arabia's 13 administrative regions, focusing on predictors of functional dependency among different socio-demographic groups. This study analyzed data from 283 Saudi individuals aged ≥65 admitted to social residential care homes in 2021. Variables included age, sex, education level, marital status, region, and reasons for service use. Statistical analyses comprised descriptive statistics, chi-square tests, independent t-tests, and multivariable logistic regression. The Makkah region had the highest number of senior residential care home users (56.8%; p < 0.0001). Most participants were men (67.8%), while women constituted 32.2%. The mean age was 78.9 years (SD = 10.6), with women being significantly older than men (p = 0.014). Illiteracy was prevalent (73.5%), particularly among women (82.4% vs. 69.3% for men; p = 0.006). Most participants were divorced (68.2%), with higher rates among men (84.9% vs. 33% for women; p < 0.0001). The primary reasons for utilizing residential care home services were old age and functional dependency (88.5% of men and 83.4% of women). Multivariable logistic regression indicated that being in the age group 75-84 years (odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.02-1.81, p < 0.001), 85 years and above (OR = 2.63, 95% CI = 1.28-3.11, p < 0.001), and being single (OR = 2.43, 95% CI = 1.14-5.13, p = 0.019) were significant predictors of old age and functional dependency. The study highlights regional and socio-demographic variations in senior residential care home service utilization in Saudi Arabia, emphasizing the need for targeted interventions and policies aligned with Saudi Arabia's Vision 2030 to enhance service accessibility and effectiveness for the aging population.

Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK.

There is wide variation in antibiotic prescribing across care-homes for older people, with implications for resident outcomes and antimicrobial resistance. To quantify variation in antibiotic prescribing and associations with resident, care-home and general practice characteristics. Population-based analyses using administrative data. 148 care-homes in two Scottish regions, with 6633 residents registered with 139 general practices. Prescriptions for any antibiotic and for broad-spectrum antibiotics between 1 April 2016 and 31 March 2017 were analysed using cross-classified multilevel negative binomial regression. For any antibiotics, the mean prescription rate was 6.61 (SD 3.06) per 1000 resident bed-days (RBD). In multivariate analysis, prescribing was associated with resident age [incidence rate ratio (IRR) 1.30 [95% confidence interval 1.19 to 1.41] for 90+ versus <80years old] and comorbidity (1.88 [1.71 to 2.06] for Charlson Comorbidity Index 3+ versus 0), and the care-home's sampling rate for microbiological culture (1.53 [1.28 to 1.84] for >7 versus <3.5 samples per 1000 RBD), with residual unexplained variation between care-homes (median IRR 1.29 [1.23 to 1.36]) and general practices (1.11 [1.05 to 1.18]). For broad-spectrum antibiotics, the mean rate was 0.98 (0.92) per 1000 RBD. Broad-spectrum prescribing was also associated with resident age, sex, comorbidity and sampling rate, with larger residual unexplained variation between care-homes (1.56 [1.36 to 1.77]) and general practices (1.51 [1.31 to 1.72]). Variation in prescribing was influenced by resident case-mix, but there is significant unexplained variation between care-homes and between general practices, indicating a need for antibiotic stewardship to target both.

Exploring the Impact of Different Approaches to Healthcare Support for Older Care Home Residents in Greater Manchester on Ambulance Services and Unplanned Hospital Admissions

Exploring the Impact of Different Approaches to Healthcare Support for Older Care Home Residents in Greater Manchester on Ambulance Services and Unplanned Hospital Admissions

Temperament Characteristics of Children in Residential Care and Perceived Acceptance/Rejection and Style of Discipline Used by Care Workers.

The ability to adapt interpersonal interactions to temperamental characteristics is essential for high-quality care. We analyzed how temperamental and self-regulation differences among children in residential care were related to the affective relationships and discipline styles of their caregivers. A total of 144 children aged 9-16 years (42.6% boys) and their caregivers from 22 residential care homes (Spain) participated. The Early Adolescent Temperament Questionnaire-Revised (EATQ-R) was used to assess temperament, the Affect Scale and Rules and Demands Scale was used to assess children's perceptions of affective relationships and discipline styles among their caregivers, and BRIEF-2 was used to assess children's self-regulation. Perceived warmth/communication was significantly higher than criticism/rejection and children perceived more inductive than rigid or permissive styles. Temperamental-scale fear was positively related to warmth/communication and an inductive style, and negatively related to criticism/rejection and a rigid style, whereas high-intensity pleasure showed the opposite pattern. In addition, some self-regulation and temperament scales explained 26% of the perception of warmth/communication, while others explained 15% of the variability of the rigid discipline style used by care workers. These results can help care workers to adjust their educational strategies according to the temperamental characteristics of this specific population.

Care homes and primary care in England working together: A multi-method qualitative study.

In England, most long-term care for older people with complex health care needs is provided by private care homes. They rely on primary care to provide medical care and access to specialist health care services. This study explored the working relationships between care homes and primary care in one region in England to inform a theory of change for achieving improved relationships. We carried out a multi-method qualitative study using appreciative inquiry. We thematically analysed data from 33 survey responses, 15 interviews, and eight workshops with care home and primary care staff, family carers, and other community specialists to populate the theory of change. A patient and public involvement representative supported data collection, analysis, and write-up. Study participants described activities that encouraged role understanding, communication, and learning together benefitting staff, relationships, and quality of services. The lessons and experiences from the COVID-19 pandemic had shaped participants' understanding of what is required to sustain cross-sector collaboration. Key inputs included time, staff, and funding to facilitate learning how to work together effectively, as well as the capacity to adapt to diverse care settings and address the complex, individual needs of care home residents. Participants noted the few opportunities they had to share their learning and discuss best practice. The theory of change identified different dimensions of good practice, providing insight into areas for action to inform service design and practice. Ongoing organisational changes should consider what is already working well and build on these achievements to enable positive care home and primary care working relationships and so foster high quality care and equitable access to services.

Valuable resources in a residential care home: healthcare supply chain resilience before and after the COVID-19 pandemic

ABSTRACT Understanding how health organisations respond to crises, particularly in comparison to previous studies, is crucial for identifying gaps in resilience and resource allocation strategies. This research aims to analyse the reactions of health organisations to crises, with a focus on the recent coronavirus disease (COVID-19) pandemic. This pandemic has impacted the health sector, more specifically institutions caring for the elderly. Hence, it is important to study how resources are valued and how organisations react to crises. To this end, a longitudinal study was carried out, between 2015 and 2020, within a health institution, considering two key stages: the budget restrictions imposed by the French State (the non-health crisis) and the COVID-19 pandemic (the health crisis). Results from this research show that healthcare supply chain resilience during Stage 1 only concerned the strategic level, while Stage 2 affected all hierarchical levels. Consequently, non-strategic resources became strategic resources. This study also shows that building a collective capacity for healthcare supply chain resilience improves well-being at work among health workers.

Navigating a New Normal: A Qualitative Look at Long-Term Care Planning for Children with Intellectual Disabilities Post-COVID-19

Background: Family caregivers of individuals with intellectual disabilities (ID) face numerous challenges in long-term planning, which have been exacerbated amidst the COVID-19 pandemic. Specific triggers raise awareness of future planning needs, but barriers like painful emotions and exhaustion often impede the process. This study aimed to explore Hong Kong (HK) caregivers’ perspectives on long-term planning for family members with ID at the later period of the pandemic. Methods: A qualitative phenomenological approach was utilized. In-depth interviews regarding experiences with long-term care preparation during COVID-19 were conducted with 12 purposively sampled HK caregivers of adults with ID. Data were analyzed using Colaizzi’s method. Results: Four key themes emerged: planning a loved one’s future alone, the burden of arranging care for disabled loved ones, planning a child’s future care amid family tensions, and the pandemic worsening future caregiving worries. Conclusion: Caregivers urgently require encouragement and support from policymakers and professionals to build confidence in long-term strategy and access robust assistance. Implications include identifying caregiver concerns, aiding gradual planning implementation, increasing respite options, and facilitating discussions regarding future residential care homes. This study provides initial valuable insights into an overlooked population during an unprecedented crisis.

Living restricted lives - Understanding the impact of isolation, social distancing and other restriction measures on older care home residents and their relatives in England during the COVID-19 pandemic: A qualitative study.

During the COVID-19 pandemic, care homes for older adults in England implemented isolation, social distancing and other restriction measures to help protect residents from contracting the virus. Little was known about the physical and psychological impacts that these measures would have upon residents and their relatives. To explore the experiences of residents and their relatives of living restricted lives during the pandemic. This qualitative study was conducted as part of a 12-month, mixed-methods, phased design. From six purposively sampled care homes in England, 17 purposively sampled residents (all older adults) and 17 purposively sampled relatives participated in an individual, on-line interview, where they discussed their experiences of the restrictive measures implemented within their care home. Interviews were audio- and video-recorded with participants' permission and analysed using an inductive orientation to thematic analysis, with coding and theme development driven by the data content. Participants' experiences of care home restrictions varied; their impact was influenced by the existing pattern of relationships that residents and their relatives maintained within and beyond the care home. It was further influenced by the fact that many residents and relatives were still learning how to manage their relationships in the new context of living in a care home. Social distancing measures made care homes feel less homely and denied residents, staff and relatives physical touch and other forms of non-verbal communication. Many residents expressed a broad sense of gratitude that was associated with safety and well-being beyond the pandemic. As older adults, they put the pandemic, and its associated restrictions, within the larger context of their lives. Learning from the COVID-19 pandemic is paramount for governments, societies, policy makers, care home providers, care homes and their staff, residents and their families and friends, and researchers. Our study makes an important contribution as one of the first to study the impact of implementing isolation, social distancing and other restrictive measures for care home residents and their relatives in England.

How aged care home staff and health care professionals understand the Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE tool)? A cognitive interview study

IntroductionHigh use of psychotropic medications continues to be common in residential aged care homes despite the risk of harm and limited efficacy in people living with dementia. Research has shown that the organizational culture of aged care homes influences psychotropic medication use in residents with dementia. The PRACTICE (Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence) tool was developed to evaluate the organizational culture of aged care homes specific to the use of psychotropic medications. ObjectivesTo evaluate the comprehensibility, relevance, and comprehensiveness of the PRACTICE tool among end-users. MethodCognitive interviews were conducted with participants representing a broad range of health disciplines across Australia. Interviews were performed using a combination of the think-aloud technique and verbal probing. Interviews were transcribed and content coded for participants’ perceptions of the PRACTICE tool. Items were modified based on findings from the cognitive interviews, participants’ suggestions for rewording of items and discussions with the research team. ResultsA total of 20 cognitive interviews were conducted. Based on the cognitive interviews, 48 out of 63 items were modified. Reasons for modification were categorized into three themes: 1) Items changed to align with the aged care home staff’s scope of practice; 2) Items adjusted to prevent unintended blame from reading the items; and 3) Items modified to prevent potential misinterpretation of their intended meaning. Three items were added to improve the comprehensiveness of the tool. Most participants reported that they understood the items and considered them as relevant and acceptable for the evaluation of organizational culture and use of psychotropic medication in aged care homes. ConclusionThis study confirms that the PRACTICE tool is a comprehensive tool appropriate for the assessment of organizational culture specific to psychotropic medication use and is important for aged care settings.

Effects of one-to-one music therapy in older adults with cognitive impairment: A randomized controlled trial.

This study investigated the effects of music therapy (MT), a nonpharmacological therapy, on cognitive, behavioral, and physiological outcomes in older adults with mild-to-moderate cognitive decline residing in care home settings. A randomized controlled trial design was employed, with 42 care home residents (Mage = 86.25 years) randomly assigned to either a one-to-one 16-week MT intervention or an active control group receiving storytelling. Experimental and control activities were matched on key aspects, and groups were equivalent at baseline concerning demographic factors, general health, cognitive-behavioral characteristics, and cognitive reserve levels. Pre/postintervention neuropsychological and behavioral measures were collected, alongside saliva samples for cortisol/dehydroepiandrosterone ratio and respiratory sinus arrhythmia analysis as indicators of overall stress and autonomic regulation. The MT group exhibited benefits in cognitive, behavioral, and physiological domains, suggesting potential advantages in maintaining cognitive functioning and reducing neuropsychiatric symptoms. Biomarkers indicated possible mechanisms underlying the effectiveness of MT. The 16 one-to-one interactive MT sessions-delivered over 5 months-had a positive impact on older adults with mild-to-moderate cognitive decline living in care home settings. The implications of these findings for healthy aging and suggestions for future research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).