People In Care Homes Research Articles

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.

Lifelong learning: supporting older people in care homes to maintain and acquire skills

Swee Hong Chia discusses the ways in which older people can be supported to continue former skills and interests, as well as fostering new hobbies and providing learning opportunities.

Experiences of family caregivers in the home care to people with pressure injuries

Objectives: To analyze the experience of family caregivers in the home care for people with pressure injuries (PI). Methods: Qualitative and descriptive research carried out with family members who received support from the home care service and who were the main informal caregivers of people with PI from stage 3 onwards. A sociodemographic questionnaire and semi-structured interview were applied with the following stimulus for narration: tell me about your experience in the home care to your family member with PI? Data were analyzed according to Bardin's content analysis. Results: Four categories emerged: 1) Performance of family members in PI care; 2) Support of the home care service to the family and patients with PI; 3) Overload of family caregivers; 4) Satisfaction in repaying the care received. Conclusion: This study showed the importance of support to home care service and the difficulties experienced by family members in caring for people with PI, including financial and physical overload; lack of preparation of the caregiver to deal with PI; family conflicts; and the centralization of care responsibility, predominantly performed by women. However, many see in care the opportunity to return the love received, despite all physical and mental fatigue.

Forms of safe application of therapy for elderly people in home care

Forms of safe application of therapy for elderly people in home care

Effects of music therapy in reducing falls among patients with dementia in a long-term facility: a cohort study

Background/Aims Music therapy as an intervention can reduce stress, pain, depression, isolation and anxiety without the risk of side effects associated with pharmacological interventions. Individuals with dementia are at a higher risk of falls compared to older adults with no dementia. The aim of this study was to evaluate the effect of music therapy in reducing the number of falls among patients with dementia in a long-term care facility. Methods The Morse Fall Scale was used pre-intervention and post-intervention to assess at-risk patients. Patient's attendance in music therapy and falls were tracked daily. The music sessions took place three times a week for 30 minutes. Two groups consisting of 13 patients each were included. Results There was a highly significantly higher numbers of falls reported pre-intervention (t(26)=4.108, P<0.001 at P=0.000, 95% confidence interval 0.78–2.33) compared to fall rates post-intervention (t(26)=2.842, P<0.01 at P=0.009, 95% confidence interval 0.08–0.51). A total of 80% reported no falls post-intervention compared to 62.9% reporting falls pre-intervention. Conclusions The study demonstrated that supervised music therapy is effective on fall reduction in people with dementia. Implications for practice Music sessions can be implemented in care homes for people with dementia to help reduce falls.

Distributed agency in HRI-an exploratory study of a narrative robot design.

We explore an alternative approach to the design of robots that deviates from the common envisionment of having one unified agent. What if robots are depicted as an agentic ensemble where agency is distributed over different components? In the project presented here, we investigate the potential contributions of this approach to creating entertaining and joyful human-robot interaction (HRI), which also remains comprehensible to human observers. We built a service robot-which takes care of plants as a Plant-Watering Robot (PWR)-that appears as a small ship controlled by a robotic captain accompanied by kinetic elements. The goal of this narrative design, which utilizes a distributed agency approach, is to make the robot entertaining to watch and foster its acceptance. We discuss the robot's design rationale and present observations from an exploratory study in two contrastive settings, on a university campus and in a care home for people with dementia, using a qualitative video-based approach for analysis. Our observations indicate that such a design has potential regarding the attraction, acceptance, and joyfulness it can evoke. We discuss aspects of this design approach regarding the field of elderly care, limitations of our study, and identify potential fields of use and further scopes for studies.

Outpatient Care Service: Predictors Of Current And Future Use Of Outpatient Care Service By Family Members Providing Informal Care To Elderly Persons In Long-Term Home Care

In Germany, people in need of care are usually cared for at home by their informal caregivers. The outpatient care service represents a central pillar in the home care of people in need of care. The aim of this article was to analyse the factors influencing the current as well the future use of outpatient care service. With the cross-sectional study Benefits of Being a Caregiver (October 2019 - March 2020) overall 958 family caregivers of elderly people in need of care from Bavaria were interviewed. In addition to the characteristics of the caregivers and those in need of care, information on the care situation as well as the current and desired future use of outpatient care service were collected. Two binary logistic regression analyses were carried out to determine the predictors of the use. The outpatient care service was used by 368 (38%) care giving relatives or those in need of care currently or recently. 236 family caregivers (40% of current non-users) stated that they would like to use an outpatient care service in the future. As predictors for the current use, the relationship non-partner, a higher care level of the persons in need of care and the perception of caregivers of not being able to manage care-giving were determined. Predisposing factors for the desired future use were the desire for current informal help and a lower care level. Family caregivers using the outpatient care service state that they are less able to cope with home care. Therefore, this service should focus its counselling on the empowerment of the caregivers. Moreover, the users are predominantly employed daughters or daughters-in-law who live in separate households. Therefore, the reliability of the offer is a basic condition for being able to maintain home care. In the future, a considerable increase in the number of informal care givers wishing to use outpatient care services is to be expected. Efforts should therefore be made to enlarge the range of services.

Evaluating the impact of a daylight-simulating luminaire on mood, agitation, rest-activity patterns and social wellbeing parameters in a care home for people with dementia: A pilot study (Preprint)

Evaluating the impact of a daylight-simulating luminaire on mood, agitation, rest-activity patterns and social wellbeing parameters in a care home for people with dementia: A pilot study (Preprint)

Development and validation of an educational pamphlet: technology for home care of pressure injuries

Objective: To create and validate an educational pamphlet focused on home care for pressure injuries. Method:This methodological study was conducted in three stages: topic development, pamphlet creation, and content validation by experts. The pamphlet was designed using the Canva® digital graphic design platform, considering a dynamic, self-explanatory approach suitable for the target audience, featuring a light and attractive appearance with simple language. For content validation, the Content Validity Index (CVI) was used. Results: The pamphlet, titled “Pressure Injuries and Home Care: Let’s Talk About It?”, was validated by eight experts with an overall CVI above ≥ 0.78. Due to concerns raised by the experts regarding linguistic accessibility, a content review and textual adjustments were made for the final version. Conclusion: The constructed, validated pamphlet has demonstrated potential for use and improvement in home care for people with pressure injuries. Future research should focus on validating the usability of the technology by users.

An exploration of status of chronic diseases and its influencing factors of older people in Chinese home care and long-term care facilities: a cross-sectional study.

As the population ages, the proportion of chronic diseases becomes more prevalent. This study aimed to investigate the current status of chronic diseases among the older people in home care (HC) and long-term care facilities (LTCFs) in China and to analyze its influencing factors. This cross-sectional study was conducted between 2021 and 2022. A multi-stage stratified random sampling and census sampling approach was used in this survey of the health of 389 older people in HC and 202 older people in LTCFs from Western Hunan, respectively. The following instruments were included in the survey "International Resident Assessment Instrument for Home Care (interRAI-HC)" and the "International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF)." Univariate analysis was used to examine the prevalence of chronic diseases among older people with different characteristics. Data were analyzed by IBM SPSS version 25.0 software. A p-value of <0.05 was considered statistically significant. The survey results showed that the prevalence of chronic diseases among older people in HC was 73.26% (95% CI, 68.85-77.68), and the top five chronic diseases were hypertension (26.36%), bone and joint disease (23.36%), gastrointestinal and gallbladder disease (11.78%), heart disease (11.21%), and diabetes (8.97%). The prevalence of chronic diseases among older people in LTCFs was 77.23% (95% CI, 77.23-83.06), and the top five chronic diseases were hypertension (33.11%), bone and joint disease (13.25%), cerebrovascular disease (12.91%), diabetes (11.26%), and heart disease (10.26%). The results showed that long time spent alone, having sleep disorders, and self-rated health status significantly increased HC in older people with the prevalence of chronic diseases (p < 0.05). Having marital status, non-healthy BMI, having sleep disorder, walking with the use of assistive devices, and self-rated health status significantly increased older people in LTCFs with the prevalence of chronic diseases (p < 0.05). There are differences in the prevalence and distribution of chronic diseases among older people in two different aged care models in China, and there are various risk factors for chronic diseases. Therefore, chronic disease healthcare strategies should be tailored to two different aged care models for older people. Further summary found that older people in HC spend a lot of time alone and suffer from loneliness, which ultimately causes psychological disorders. Thus, psychological adaptation interventions are needed for older people in HC. Besides, older people in LTCFs lack social support from their families (divorced/widowed) and have activity disorders (walking with the use of assistive devices). Thus, social adaptation interventions are needed for older people in LTCFs. This study provides a theoretical basis for the distribution of healthcare and the prevention and treatment of chronic diseases in Chinese older people.

What happens when pharmacist independent prescribers lead on medicine management in older people’s care homes: a qualitative study

ObjectiveOlder people in care homes frequently experience polypharmacy, increasing the likelihood of medicine-related burden. Pharmacists working within multidisciplinary primary care teams are ideally placed to lead on medication reviews. A...

"None of us was prepared"-Caring for vulnerable people during the heatwave in Sweden in 2018.

Climate change is increasing the risk for extreme weather events such as heatwaves, including in northern countries like Sweden, which until recent years has had limited experiences of coping with extreme heat. Based on predictions that Sweden will be more frequently exposed to heatwaves in the future, it is imperative to increase the societal resilience and adaptation measures. This paper presents a qualitative interview study involving 19 participants and their experiences of caring for vulnerable people during the heatwave in 2018. The participants represent four different organizations (working directly or indirectly with vulnerable people) in two municipalities in Sweden, including preschools, homes for the elderly, homecare services, and care homes for people with functional impairments, which were all impacted during the heatwave. This study contributes new empirical insights about the heatwave in 2018 and, in particular, similarities and differences in both experiences and adaptation measures across the four organizations. The findings show how both staff and vulnerable people suffered from the consequences of heat which increased vulnerability, how some organizations lacked enough (qualified) staff to secure routines, and that few evaluations and formal changes were done after the heatwave.

Development of an intervention programme theory to increase movement in care homes for people with cognitive impairment: Care homes achieving realistic movement strategies (CHARMS)

There is an increase in both the number of people living in care homes, and the cognitive impairments they experience. Some of these experiences of cognitive impairments can be improved by appropriate movement and physical activity interventions, delivered in ways which take into account an individual’s preferences, needs and abilities. A clear intervention programme theory (how we expect an intervention to work) can improve effectiveness, acceptability, transferability and sustainability. We used a systematic framework (Six Steps in Quality Intervention Development) and a co-production approach, to develop an intervention programme theory for Care Homes Achieving Realistic Movement Strategies (CHARMS). We identified twenty factors contributing to low levels of physical activity and movement which we grouped into four categories for change: i) cultural/staff; ii) residents; iii) environmental and iv) policy/system. A theory of change was developed using these categories plus additional theories to create ownership. It became evident that the intervention (the theory of action) needed to include activities in all categories; intervening in just one category (e.g. providing weekly physical activity) was not sufficient in itself. Developing the programme theory enabled care homes to develop activities to meet their specific contextual needs and develop ownership of the process and the intervention.

Recognising and responding to acute deterioration in care home residents: a scoping review

BackgroundAcute deterioration describes a rapid change in physical and/or mental health resulting from an acute illness – e.g., heart attack or infection. Older people in care homes are some of the frailest and vulnerable in society. They have complex health needs, experience multiple long-term conditions (MLTC) and have weakened immune systems due to the ageing process. They are more susceptible to acute deterioration and delayed recognition and response, is linked to poorer health outcomes, adverse events and death. Over the past five years, the need to manage acute deterioration in care homes and prevent hospital admissions has led to development and implementation of improvement projects, including the use of hospital derived practices and tools to identify and manage this condition. This is potentially problematic as care homes are different from hospitals—options to escalate care vary throughout the UK. Further, hospital tools have not been validated for use in care homes and have shown to be less sensitive in older adults living with frailty.ObjectivesTo collate the available evidence on how care home workers recognise and respond to acute deterioration in residents using published primary research, non-indexed and grey literature, policies, guidelines and protocols.MethodsA systematic scoping review was conducted following Joanna Briggs Institute (JBI) scoping review methodology. Searches were conducted using: CINAHL (EBSCOhost), EMCARE (OVID), MEDLINE (OVID) and HMIC (OVID). Snowball searches of included studies’ reference lists were conducted. Studies that featured care homes with or without nursing and provided 24/7 care to residents were included.ResultsThree hundred and ninety-nine studies were identified. After reviewing all studies against inclusion criteria, n = 11 were included in the review. All studies used qualitative methods and were conducted in Australia, UK, South Korea, USA and Singapore. Four themes were generated from the review: identifying residents with acute deterioration; managing acute deterioration, care home policies and procedures, and factors affecting recognition and response to acute deterioration.FindingsRecognition and response to acute deterioration in residents is determined by multiple factors and is context sensitive. There are several interrelated factors within and external to the care home that contribute to how acute deterioration is recognised and managed.Conclusions and ImplicationsThe available literature on how care home workers recognise and respond to acute deterioration is limited and often subtends other areas of interest. Recognising and responding to acute deterioration in care home residents is reliant on a complex and open system encompassing multiple interrelated components. The phenomenon of acute deterioration remains underexplored and further research is required to examine contextual factors that accompany identification and management of this condition in care home residents.

Realist synthesis protocol for understanding which strategies are effective to prevent urinary tract infection in older people in care homes.

To identify and characterize strategies, which contribute to the prevention of urinary tract infection (UTI) in older people living in care homes. The realist synthesis has four iterative stages to (1) develop initial programme theory; (2) search for evidence; (3) test and refine theory supported by relevant evidence and (4) formulate recommendations. Data from research articles and other sources will be used to explore the connection between interventions and the context in which they are applied in order to understand the mechanisms, which influence the outcomes to prevent UTI. A scoping search of the literature and workshops with stakeholders will identify initial programme theories. These theories will be tested and refined through a systematic search for evidence relating to mechanisms that trigger prevention and recognition of UTI in older people in care homes. Interviews with key stakeholders will establish practical relevance of the theories and their potential for implementation. UTI is the most commonly diagnosed infection in care home residents. Evidence on the effectiveness of strategies to prevent UTI in long-term care facilities does not address the practicality of implementing these approaches in UK care homes. The realist synthesis is designed to examine this important gap in evidence. Our evidence-informed programme theory will help inform programmes to improve practice to reduce the incidence of UTI in older people living in care homes and related research. Patient and public involvement will be crucial to ensuring that our findings reach carers and the public. Involvement of patient and public representatives is embedded throughout the study to ensure it is underpinned by multiple perspectives of importance to care home residents. Our co-investigator representing patient and public involvement is a lay member of the team and will chair the Project Advisory Group, which has two additional lay members. This will help to ensure that our findings and resources reach carers and the public and represent their voice in our publications and presentations to professional and lay audiences.

Researchers’ Experiences of the Challenges of Conducting Two Randomised Controlled Trials in Care Homes

The population of older people in care homes has been under-represented in health research, possibly due to the complexity and challenges of conducting research in this setting. This article describes the challenges faced and solutions found by researchers working on the REACH: research in enhancing physical activity in care homes and PATCH: posture and mobility training for care staff versus usual care in care homes, cluster randomised controlled trials (cRCTs). The researchers successfully recruited residents and collected data for both trials but experienced challenges over the course of their involvement with the participating care homes. These challenges included adapting to the care homes setting; identifying gatekeepers and planning visits; building relationships with staff and residents; collecting data from residents, staff and care notes; and buy-in from managers. Having skilled researchers who have knowledge of and are attuned to care home environments was critical to the trials&rsquo; success.

Barriers and enablers to deprescribing for older people in care homes: The theory-based perspectives of pharmacist independent prescribers.

Over 70% of care home residents are prescribed potentially inappropriate medications (PIMs) associated with morbidity and mortality. Deprescribing is a common recommendation by pharmacists performing medication reviews in care homes, however requiring prescriber authorisation is a barrier. Care home Independent Pharmacist Prescribing Study (CHIPPS), a cluster randomised control trial integrated pharmacist independent prescriber (PIPs) into care homes to improve medication management, providing a unique opportunity to identify their barriers and enablers to deprescribing. To identify barriers and enablers to PIPs deprescribing medications in care homes. Secondary qualitative framework analysis was performed on interviews with CHIPPS' PIPs. A maximum variation sampling approach was used to select from the 14 PIPs included in the process evaluation to achieve diversity of PIPs' contextual factors e.g., previous experience in care homes. Transcripts were coded inductively for barriers and enablers to deprescribing and then mapped to Theoretical Domains Framework (TDF). Eleven PIP's interviews were sampled. Factors acted as enablers and barriers were PIP relationship with General Practitioner (GP), care home staff and residents/families, awareness of the PIP role and family trust in PIPs' deprescribing activities (social influences); PIPs' independent prescribing confidence, previous experience and ability dealing with residents' medications (beliefs about capabilities); understanding of PIP role and PIP confidence in their role as an independent prescriber (Social/professional role and identity); access to residents' records, deprescribing decision support, regular follow-up from care home staff, resident difficulties with medications, teamwork, and time restraints (Environmental context and resources). One factor acted as a barrier: believing negatives of deprescribing outweigh benefits regarding certain medications (Beliefs about consequences). PIPs' involvement in deprescribing within care homes is influenced by multiple barriers and enablers. Data mapped to TDF domains represent barriers that need addressing and enablers that should be highlighted to enhance PIPs' effectiveness in future interventions.

Why the trial researcher matters: Day-to-day work viewed through the lens of normalization process theory

Researchers working in the field, the places where research-relevant activity happens, are essential to recruitment and data collection in randomised controlled trials (RCTs). This study aimed to understand the nature of this often invisible work. Data were generated through an RCT of a pharmacist-led medication management service for older people in care homes. The study was conducted over three years and employed seven Research Associates (RA) working in Scotland, Northern Ireland, and England. Weekly research team meetings and Programme Management Group meetings naturally generated 129 sets of minutes. This documentary data was supplemented with two end-of-study RA debriefing meetings. Data were coded to sort the work being done in the field, then deductively explored through the lens of Normalization Process Theory to enable a greater understanding of the depth, breadth and complexity of work carried out by these trial delivery RAs. Results indicate RAs helped stakeholders and participants make sense of the research, they built relationships with participants to support retention, operationalised complex data collection procedures and reflected on their own work contexts to reach agreement on changes to trial procedures. The debrief discussions enabled RAs to explore and reflect on experiences from the field which had affected their day-to-day work. The learning from the challenges faced in facilitating care home research may be useful to inform future research team preparation for complex interventions. Scrutinising these data sources through the lens of NPT enabled us to identify RAs as linchpins in the successful conduct of a complex RCT study.

An IoT-Based System for Preventing Falls in Elderly People in Home Care

An IoT-Based System for Preventing Falls in Elderly People in Home Care

Making 1-1 Support Person Centred and an Effective Therapeutic Intervention

The use of 1-1 support in care homes within the healthcare system in England and Wales is a recognised protective safeguard. However, it is not without its controversies and conflicts as it can prove to be both a highly restrictive and expensive intervention. This paper will examine the use of 1-1 support within care homes for people who present with behaviours that challenge. It will record the findings from a review of 1-1 support for 23 service users over a 30-month period. It will also make a number of recommendations to make 1-1 support an effective, therapeutic, person centred and a correctly targeted resource.