Disability In Old Age Research Articles

An ambivalent approach to disability in older age: evidence from reporting by states parties under the UN Convention on the Rights of Persons with Disabilities

An ambivalent approach to disability in older age: evidence from reporting by states parties under the UN Convention on the Rights of Persons with Disabilities

Effect of Multimorbidity on Old-Age Disability Among Adults Over 50 Years Old: Evidence From a Meta-Analysis.

This is a meta-analysis study to assess the relationship between multimorbidity and disability among older adults over 50 years old. Population-based studies, aged ≥50 years, assessing associations between multimorbidity (numbers and patterns) and disability in older adults, and reporting risk estimation with odds ratios (OR), were included. Homogeneity (I2), risk of bias, and publication bias were assessed. PROSPERO registration: 411007, and this meta-analysis was reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Twelve studies were included. For the older adults with 2 chronic conditions and ≥3 chronic conditions, the ORs of disability are 2.52 (95% CI 2.30-2.76) and 3.38 (95% CI 3.05-3.75), respectively. Among three multimorbidity patterns, the combination of cardiovascular and metabolic diseases pattern (OR 8.01, 95% CI 7.60-8.44) had the highest disability incidence rate. Chronic conditions in the multimorbidity patterns of combination of cardiovascular and metabolic diseases and mental health problems have an enhancement effect (1 + 1 > 2) on old-age disability impairment, whereas those in the multimorbidity pattern of musculoskeletal disorders have a dampening effect (1 + 1 < 2). The differentiated and specific early interventions should be developed based on the different multimorbidity patterns to prevent the old-age functional decline and disability in older adults.

Identifying older adults at risk for dementia based on smartphone data obtained during a wayfinding task in the real world.

Alzheimer's disease (AD), as the most common form of dementia and leading cause for disability and death in old age, represents a major burden to healthcare systems worldwide. For the development of disease-modifying interventions and treatments, the detection of cognitive changes at the earliest disease stages is crucial. Recent advancements in mobile consumer technologies provide new opportunities to collect multi-dimensional data in real-life settings to identify and monitor at-risk individuals. Based on evidence showing that deficits in spatial navigation are a common hallmark of dementia, we assessed whether a memory clinic sample of patients with subjective cognitive decline (SCD) who still scored normally on neuropsychological assessments show differences in smartphone-assisted wayfinding behavior compared with cognitively healthy older and younger adults. Guided by a mobile application, participants had to find locations along a short route on the medical campus of the Magdeburg university. We show that performance measures that were extracted from GPS and user input data distinguish between the groups. In particular, the number of orientation stops was predictive of the SCD status in older participants. Our data suggest that subtle cognitive changes in patients with SCD, whose risk to develop dementia in the future is elevated, can be inferred from smartphone data, collected during a brief wayfinding task in the real world.

Analysis of the life course effects of the disability dilemma among rural older adults in China.

To analyse whether the accumulation of early adverse experiences among individuals of different generations has an impact on disabilities and evaluate the cumulative effects of disadvantages in rural older adults in China. A Binary Logit Model was used to analyse the life course effects of the disability dilemma among rural older adults. Regarding Activities of Daily Life (ADLs), there was no significant difference between older adults that experienced 1 adverse events and the control group. The probability of older adults experiencing difficulties in 2, 3, 4, or more types of ADLs was 1.486 times, 2.173 times, and 3.048 times higher than that of the control group, respectively. Regarding Instrumental Activities of Daily Life (IADLs), there was no significant difference between the population that experienced 1 or 2 adverse events and the control group. The probability of experiencing difficulties in 3, 4, or more types of IADLs was 1.527 times and 1.937 times higher than that of the control group, respectively. Early adverse events had a cumulative disadvantageous effect on disability in older adults. The longer the duration of adverse experiences, the higher the risk of disability in old age. Education had a significant mitigating effect on health risks. Pay attention to early factors in the life course, strengthen the promotion of health prevention concepts, and pay attention to the moderating and relieving effects of education on health. We should also gradually improve the rural disability care system and family health security capabilities in China's rural areas.

QUANTIFYING CONTRIBUTIONS OF WORK CHARACTERISTICS TO EDUCATIONAL DISPARITIES IN HEALTH-INDUCED WORK LIMITATIONS

Abstract While public policies are incentivizing longer working lives, poor health and inhospitable working conditions pose challenges to working longer, especially for Americans with low educational attainment. This analysis sought to quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in mid life and old age. Using the Health and Retirement Study (2006-2016), we showed that educational disparities in reporting “any impairment or health problem that limits the kind or amount of paid work” in ages 51-80 have been profound and persistent over time. Blinder-Oaxaca three-fold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a health outcome, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates. Therefore, improving work environments holds promise for reducing educational disparities in mid-to-late-life disability.

Влияние сахарного диабета на когнитивные функции в детском и подростковом возрасте

Type 1 diabetes mellitus (DM1) is widespread among children and adolescents in Russia. In addition to the pretty well-studied microvascular complications of the disease, scientific sources also describe the brain damage that is manifested by cognitive impairment. Despite the problem being studied actively by researchers Worldwide, they have reported mixed and sometimes contractionary results. Thus, as of now there are disputes about the etiology, pathogenesis, clinical manifestations and factors affecting the development of the abovementioned complications. Changes in the brain are registered at all age periods with special attention being fairly paid in childhood and adolescence because such disorders of carbohydrate metabolism during active growth can lead not only to functional, but also to structural changes in the brain. This is manifested by memory impairment and decreased attention concentration, which in its turn negatively affects the academic performance of schoolchildren and therefore reduces the quality of life of patients. Further study of this problem would help developing an algorithm for early diagnosis of cognitive impairment among children and adolescents with DM1 in order to increase compliance among patients, reduce the risk of microvascular complications and possible disability in older age. A promising direction in the diagnosis of cognitive disorders are neuroimaging methods, which, as opposed to neuropsychological tests, are helping to identify morphofunctional changes in the brain. This bibliographical review describes the etiology of cognitive disorders in children and adolescents with DM1, the main variants of cognitive dysfunction, the effect of the disease on schooling performance and neuroimaging disorders of the brain.

Quality of life in individuals with knee osteoarthritis versus asymptomatic individuals.

Osteoarthritis (OA) is characterised by joint degeneration and represents the leading cause of disability in old age. OA entails a personal burden, with suffering and reduced quality of life (QoL). To compare the QoL of individuals with OA to that of asymptomatic individuals in order to determine the actual impact of OA on the affected population. Cross-sectional study with a sample of 140 patients diagnosed with OA. Another 51 sex- and age-matched asymptomatic individuals with no clinical signs of knee OA or lower limb osteoarticular symptoms for at least the preceding six months were recruited. Knee OA was stratified radiologically according to the Ahlbäck classification (1968). QoL was measured using the SF-36 questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey). The participants were assigned to "osteoarthritis" (OG) or "asymptomatic" (AG) groups. The OG presented greater body mass and BMI than the AG. Perceived QoL was worse for the OG than the AG across SF-36 domains. In the comparison of the grades of OA degeneration, the group with Ahlbäck grades 4 and 5 (severe) perceived their QoL as poorer than those with grades 1, 2, and 3 (moderate). The grade of OA, older age, and BMI were shown to be strong independent predictors of poor perceived quality of life. Individuals with knee OA showed worse perceived QoL compared with asymptomatic individuals. The domains with the lowest scores were physical functioning and functional limitation. Quality of life was influenced by BMI, age, sex, and grade of osteoarthritis.

Quantifying the Contribution of Work Characteristics to Educational Disparities in Health-Induced Work Limitations.

To quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in midlife and old age. We used the Health and Retirement Study (2006-2016) to examine educational disparities in reporting "any impairment or health problem that limits the kind or amount of paid work" in ages 51-80. We found disparities to be profound and persistent over time. Blinder-Oaxaca threefold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a measure of health, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates. Work environments appear to play an important role in educational disparities in mid- to late-life disability.

Performansi Algoritma Clustering K-Means untuk Penentuan Status Malnutrisi pada Balita

Malnutrition has always been a global problem and is the main cause of child mortality in developing countries. Nutritional status is a measure of success in meeting the nutritional needs of toddlers which can be seen from the achievement of toddler's weight. The short-term effects of malnutrition on toddlers are physical growth disorders in children, metabolic disorders, brain development disorders, and intelligence disorders. In the long term, malnutrition will cause a decrease in learning outcomes and cognitive abilities, decreased immunity, the risk of developing diabetes, heart and blood vessel disease, obesity, stroke, cancer, and disability in old age. To find out about the growth and development of early childhood, especially in relation to the development of early childhood nutritional values, regular measurements of the height and weight of toddlers from an early age are carried out through Posyandu activities. Toddler height and weight data will be grouped according to the nutritional characteristics of each toddler. In this study, infants will be clustered based on their nutritional characteristics using the K-Means algorithm clustering method. Based on the evaluation results, the number of clusters 3 is more optimal than the number of clusters 5 in the toddler dataset used in the study. It is hoped that the research results obtained can serve as a basis or recommendation material for posyandu throughout Indonesia to determine the nutritional status of the under-five age group, so that the handling is more appropriate and can help prevent malnutrition in under-fives.

Characterization of functional disability among older adults in Ghana: A multi-level analysis of the study on global ageing and adult health (SAGE) Wave II

Functional disability is a common public health problem that affects the health and quality of life of older adults. This causes them to be highly dependent on other members of their family, receive home care, or to be institutionalized. Although functional disability has been widely studied in developed country settings, very limited studies have focused on age-related functional disability in sub-Saharan Africa, and in particular Ghana. The purpose of this study is to assess various factors associated with the difficulties in performing basic and instrumental activities of daily living among older adults in Ghana. This cross-sectional study used data on 1610 older adults aged 50 years and above from the Study on Global Ageing and Adult Health (SAGE) survey Wave II conducted in Ghana. Nine standard functioning difficulty tools of WHODAS II was used for the analysis. The WHODAS II offers continuous summary scores with higher scores showing higher disability, and vice versa. A multi-level regression model was used to identify individual and household level risk factors linked to the functional disability of older adults. Female older adults (53.7%) reported having functional disability. The mean functional disability among older adults aged 50 years and above was 5.2 (± 5.9). Results indicated that older adults who are females, aged 70 years and above, and had three or more chronic conditions had a higher functional disability. Also, older adults who have adequate fruit intake and belong to wealthier households were found to have a lower functional disability. The study reveals that functional disability among older adults is frequent in Ghana and is associated with having three or more chronic conditions and being overweight/obese. Prevention of functional disability in old age in Ghana is therefore a matter of great social and economic concern, which calls for coordinate efforts across the board to mitigate this public health challenge.

Does emotional dysregulation mediate the relationship between disability and depressive symptoms in older people?

BackgroundEmotion dysregulation has been consistently linked to psychopathology, and the relationship between disability and depressive symptomatology in old age is well-known. ObjectiveTo examine the mediational role of emotional dysregulation in the relationship between perceived disability and depressive symptomatology in older adults. MethodsTwo hundred eighty-three participants, aged 60–96 years (M±SD=74.22±8.69; 62.9% women; 29.0% with long-term care support [LTC-S] and 71.0% community residents without LTC-S), were assessed with the Geriatric Depression Scale-8 (GDS-8), the World Health Organization Disability Assessment Schedule-2 (WHODAS-2), and the Difficulties in Emotion Regulation Scale-16 (DERS-16). ResultsA mediation model was established, which revealed: (1) a moderate association between WHODAS-2 and GDS-8 (β=0.20; p<.001); (2) DERS-16 partially and weakly mediated the relationship between WHODAS-2 and GDS-8 (β=0.003; p<.01). The model explained 31.9% of the variance of depressive symptoms. An inconsistent mediation model was obtained in the LTC-S group. ConclusionsGlobally, our findings indicate that disability has an indirect relationship with depressive symptomatology through emotional dysregulation (except for those in the LTC-S). Accordingly, we present suggestions for the treatment of depressive symptoms and for the inclusion of other emotion regulation variables in the study of the disability-depressive symptom link in future studies with older people in the LTC-S.

Differential Association of Frailty and Sarcopenia With Mortality and Disability: Insight Supporting Clinical Subtypes of Frailty.

Sarcopenia and frailty have been shown separately to predict disability and death in old age. Our aim was to determine if sarcopenia may modify the prognosis of frailty regarding both mortality and disability, raising the existence of clinical subtypes of frailty depending on the presence of sarcopenia. A Spanish longitudinal population-based study. The population consists of 1531 participants (>65years of age) from the Toledo Study of Health Aging. Sarcopenia and frailty were assessed following Foundation for the National Institutes of Health criteria and the Fried Frailty Phenotype, respectively. Mortality was assessed using the National Death Index. Functional status was determined using Katz index. We ran multivariate logistics and proportional hazards models adjusting for age, sex, baseline function, and comorbidities. Mean age was 75.4years (SD 5.9). Overall, 70 participants were frail (4.6%), 565 prefrail (36.9%), and 435 sarcopenic (28.4%). Mean follow-up was 5.5 and 3.0years for death and worsening function, respectively. Furthermore, 184 participants died (12%) and 324 worsened their functioning (24.8%). Frailty and prefrailty were associated with mortality and remained significant after adjustment by sarcopenia [hazard risk (HR) 3.09, 95% confidence interval (CI) 1.84-5.18; P < .001; HR 1.58, 95% CI 1.12-2.24, P= .01]. However, the association of sarcopenia with mortality was reduced and became nonsignificant (HR 1.43, 95% CI 0.99-2.07, P= .057) when both frailty and sarcopenia were included in the same model. In the disability model, frailty and sarcopenia showed a statistically significant interaction (P= .016): both had to be present to predict worsening of disability. Sarcopenia plays a relevant role in the increased risk of functional impairment associated to frailty, but that seems not to be the case with mortality. This finding raises the need of assessing sarcopenia as a cornerstone of the clinical work after diagnosing frailty.

Why Are Old-Age Disabilities Decreasing in Sweden and Denmark? Evidence on the Contribution of Cognition, Education, and Sensory Functions.

Improvements in educational attainment, cognitive and sensory functions, and a decline in the prevalence of disabilities have been observed in older adults in Sweden and Denmark. In the present study, it was investigated whether better cognition, higher educational attainment, and improved sensory function among older adults aged 60 and older in these countries have contributed to decreasing rates of old-age disabilities. The analyses were based on repeated cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe for the 2004-2017 period. Descriptive data were used to benchmark the declining prevalence of disabilities, improving cognitive and sensory functions, and increased educational level. The association between time and disabilities was analyzed with logistic regression models, and the contribution of the improved cognitive function, education, and sensory function to the declining prevalence of old-age disabilities was estimated using the Karlson-Holm-Breen method for mediation analysis. The analysis suggests that the declining prevalence of old-age disabilities in Sweden and Denmark between 2004 and 2017 can largely be attributed to improved cognitive function and vision and to a lesser extent by education and hearing ability. These findings raise important questions about the causal mechanisms producing the associations between cognition, education, and sensory functions and disability in older age. Future studies should explore the causal nature of the associations between these mediators and old-age disabilities. In addition, they should explore whether these findings differ across regional and cultural contexts and over different time periods.

The role of social resources and trajectories of functional health following stroke

Stroke is a major cause of disability in old age. Research has revealed that social resources available after the onset of stroke can mitigate functional prognosis. However, most studies have conceptualized resources as static rather than dynamic and have not measured changes in social resources from the pre-to post-stroke periods. To better understand the recovery process following stroke, we examined how social resources available before its onset and changes from pre-to post-stroke were associated with trajectories of functional health following stroke. Data were derived from an up to 19-year longitudinal study of a nationally representative sample of Japanese adults aged 60 years and older. We identified 389 people who experienced self- or proxy-reported first stroke during follow-up (age at stroke onset: M = 75.9, SD = 6.8; 49.1% women). The average number of observations was 4.6 (SD = 1.6, range 2–7). Functional health was measured with self- or proxy-reported basic and instrumental activities of daily living. Social resources were indexed as residential status, contact with own non-coresident children, social participation, and perceived support. Analyses were adjusted for age at stroke onset, sex, education, health condition, and cognitive function. A multiphase growth model indicated that individuals who participated more frequently in social groups prior to stroke exhibited less functional deterioration post-stroke than those who participated less frequently. Whereas contact frequency with non-coresident children typically declined following stroke, the analysis further revealed that individuals who maintained contact frequency from pre-to post-stroke showed less steep functional decline over time in the post-stroke period despite minor individual differences. We found that social resources before stroke onset and changes in the resources following stroke may play a protective role against adverse prognoses. Inclusive communities may help older adults remain independent even after serious health events.

Long‐term care in the context of population ageing: What role for social protection policies?

AbstractWith the acceleration of population ageing, healthy ageing is becoming an imperative for all. Social protection systems have an important role to play in this endeavour. Through a life cycle approach, social protection systems can support i) the prevention of disability in old age (i.e. by addressing the social determinants of health and rehabilitation), ii) effective access to long‐term care without hardship for those who need it, and iii) decent work in the care economy. To do so will require adopting a gender‐transformative approach. Indeed, women are disproportionately represented among both older persons and long‐term care providers in their diversity. Further, to adequately contribute to healthy ageing and effective access to long‐term care without hardship as a rights‐based entitlement, social protection systems will need to build strong coordination between health care, social care and other social policies. This article highlights the key entry points for social protection systems to contribute to the United Nations Decade of Healthy Ageing, building on the rights‐based approach of human rights and international social security standards.

A Review on Role of Nutraceutical in Alzhemer’s Disease

Nutraceuticals are the products derive from food sources with extra health benefits. They can prevent malignant processes. The term ‘nutraceuticals’ combines two words ‘nutrients ( a nourishing food component ) and ‘pharmaceuticals’(a medical drug ) The philosophy behind nutraceuticals is according to Hippocrates “ Let food be your medicine”. Categories of nutraceuticals are dietary supplements, functional food, medicinal food, pharmaceuticals. Advance age is often characterized by a declined in large spectrum of cognitive abilities including reasoning, memory, perceptual speed and language. Alzheimer’s disease (AD) is the most common and feared from dementia representing circa 70% of all dementia cases and displaying a dramatic epidemics due to the enormous growth of the aged population worldwide. It is still unclear which factors lead to molecular cascade of neurode generation in AD, but along with genetic environmental factors vascular pathology and risk factor have been recently shown to play crucial role in AD pathogenesis .AD impacts dramatically on everyday life of older adults, being one of the main cause of disability in old age. There is clear evidence that a diet rich in specific nutritional food group (fruit, fish, vegetables) can reduce the incidence and prevalence of some of the main clinical outcomes, such as neurodegenerative disorders, cardiovascular diseases, diabetes, cancer. This specific nutritional food group are rich in micronutrients and vitamins are beneficial for health. The Mediterranean diet is characterized by a high consumption of plant food, fish olive oil as primary source of monounsaturated fat and moderate intake of wine. In this article, we focus our attention on group of substance proposed to prevent or treat Alzheimer’s disease.

Walking the health geographers' talk: Aging and health inequalities in sub‐Saharan Africa

Although inequalities in the production, distribution, and determinants of health are central to health geographers, the discipline of health geography suffers from a “know‐do” gap. These health inequalities are personified in aging populations; older adults in sub‐Saharan Africa experience shorter life expectancies than in high‐income countries and endure higher disability and disease rates in old age. Concomitantly, the region experiences resource shortages and competing population priorities. Evidence‐informed knowledge and practice is imperative. Informed by the Canadian Coalition for Global Health Research Principles, an integrated knowledge translation (iKT) case study with knowledge holders and users in the inception, implementation, and dissemination of research in Uganda was undertaken. This paper presents the capstone iKT event that shared research results with knowledge owners and users, addressed research implications and applications, and identified future research and policy agendas. Although vast contextual inequalities impede aging health disparity solutions, findings indicate that employing an iKT approach generates possibilities that not only support older adults, but also population health across the life course. Research incorporating iKT overcomes many contextual realities deemed to impede old age health equity. Incorporating iTK into health geography can reveal where inequality exists, expose how inequality is (re)produced, and suggest solutions that generates more equitable futures.

Safety and Feasibility of Tele-Supervised Home-Based Transcranial Direct Current Stimulation for Major Depressive Disorder.

Major depressive disorder (MDD) is a worldwide cause of disability in older age, especially during the covid pandemic. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that has shown encouraging efficacy for treatment of depression. Here, we investigate the feasibility of an innovative protocol where tDCS is administered within the homes of older adults with MDD (patient participants) with the help of a study companion (i.e. caregiver). We further analyze the feasibility of a remotely-hosted training program that provides the knowledge and skills to administer tDCS at home, without requiring them to visit the lab. We also employed a newly developed multi-channel tDCS system with real-time monitoring designed to guarantee the safety and efficacy of home-based tDCS. Patient participants underwent a total of 37 home-based tDCS sessions distributed over 12 weeks. The protocol consisted of three phases each lasting four weeks: an acute phase, containing 28 home-based tDCS sessions, a taper phase containing nine home-based tDCS sessions, and a follow up phase, with no stimulation sessions. We found that the home-based, remotely-supervised, study companion administered, multi-channel tDCS protocol for older adults with MDD was feasible and safe. Further, the study introduces a novel training program for remote instruction of study companions in the administration of tDCS. Future research is required to determine the translatability of these findings to a larger sample.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04799405?term=NCT04799405&draw=2&rank=1, identifier NCT04799405.

Pengaruh Proprioceptive Neuromuscular Facilitation terhadap Kekuatan Fungsi Prehension Cylindrical Grip pada Pasien Stroke Non-Hemoragik

Stroke is a disease that is most commonly found today, stroke has a high mortality and disability rate. Stroke can cause physical disability in productive age and old age. This study aims to determine the effect of Proprioceptive Neuromuscular Facilitation (PNF) on the strength of the prehension Cylindrical grip function in non-hemorrhagic stroke patients. This research is a quantitative study with a quasi-experimental design, one group pretest and posttest, the samples were taken by purposive sampling, namely non-hemorrhagic stroke patients who visited the physiotherapy poly at Grandmed Lubuk Pakam Hospital. The results showed a p-value of 0.001 which means that there is an effect of PNF on the strength of the prehension Cylindrical grip function in non-hemorrhagic stroke patients.

Trajectories of Functional Health Following Stroke: The Role of Social Resources

The number of older adults who live in long-term care (LTC) is expected to increase worldwide. The COVID-19 pandemic has caused serious consequences in Canadian LTC homes, while homes in China and Japan reported minimal infection and death rates in residents. The differences in LTC policies may be one of the contributors. The purpose of this literature review was to identify elements of the LTC policies that might have impacted COVID-19 outcomes in LTC homes in Canada, China, and Japan. A scoping review was conducted following the framework proposed by Arksey and O’Malley. Scholarly articles and grey literature published between January 2015 and June 2020 were identified in six databases, four in English (CINAHL, Scopus, ProQuest, and PubMed), one in Chinese (CNKI), and one in Japanese (CiNii), using MeSH terms for LTC and health policy. Grey literature was identified using Google. Data were extracted, summarized and common themes identified through content analysis. A total of 52 articles and 26 grey sources were included in the review based on determined inclusion criteria. They were research articles, reviews, government or association reports, policy briefs, policy documents, and guides. Four common themes of challenges emerged: caregiver workforce, service provision, funding, and physical environments. Three sub-themes were identified for caregiver workforce and service provision. Differences in COVID-19 consequences in LTC homes in the three countries seem to be related mainly to the challenges with the caregiver workforce and the lack of funding. The result suggests Improvements of LTC policies are required, especially in Canada.