Elderly Home Care Research Articles

Prediction of malnutrition using combined index of different nutritional parameters in elderly home care patients

<b>Aim: </b>This descriptive and cross-sectional study was conducted to assess nutritional status in elderly home care patients using a combined index.<br /> <b>Methods: </b>The combined index was calculated as a reference tool based on the results of five nutritional parameters (Mini Nutritional Assessment-Short Form [MNA-SF], Short Nutritional Assessment Questionnaire [SNAQ], body mass index, dietary energy, and dietary protein). If a patient was assessed as malnourished or undernourished in at least three of these five parameters, he/she was considered as “any stage of malnutrition” according to the combined index.<br /> <b>Results: </b>The prevalence of malnutrition was 48.6%, 28.3%, and 47.4% according to the MNA-SF, SNAQ, and combined index, respectively. Dietary energy had the best sensitivity (92.7%) and negative predictive value (91.3%), while SNAQ had the highest specificity (100.0%) and positive predictive value (100.0%) according to the combined index. MNA-SF had the highest inter-rater agreement (kappa [κ]) with the combined index (κ =0.792).<br /> <b>Conclusions:</b> The use of combined index based on both screening tools and other nutritional parameters could be effective in the diagnosis of malnutrition in elderly home care patients.

Using double-debiased machine learning to estimate the impact of Covid-19 vaccination on mortality and staff absences in elderly care homes.

Machine learning approaches provide an alternative to traditional fixed effects estimators in causal inference. In particular, double-debiased machine learning (DDML) can control for confounders without making subjective judgements about appropriate functional forms. In this paper, we use DDML to examine the impact of differential Covid-19 vaccination rates on care home mortality and other outcomes. Our approach accommodates fixed effects to account for unobserved heterogeneity. In contrast to standard fixed effects estimates, the DDML results provide some evidence that higher vaccination take-up amongst residents, but not staff, reduced Covid mortality in elderly care homes. However, this effect was relatively small, is not robust to alternative measures of mortality and was restricted to the initial vaccination roll-out period.

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.

Community-based elderly home care services policy and household consumption enhancement: Evidence from China

The influence of elderly consumption is increasing, and community-based elderly home care service (CEHCS), as an important social security system, will have a significant impact on household consumption levels and consumption structure. This paper utilizes data from five batches of CEHCS pilot policies implemented in China from 2016 to 2020, combined with data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, to design a dynamic difference-in-differences model to systematically evaluate the dynamic effects and mechanisms of CEHCS on elderly household non-durable goods consumption. The study found that after the coverage of CEHCS, the consumption levels of non-durable goods such as clothing, daily necessities, and cultural and entertainment products in middle-aged and elderly households significantly increased year by year, while consumption of durable goods significantly decreased. Moreover, the impact of CEHCS was more pronounced in households with lower housing assets and rural households. Mechanism analysis suggests that CEHCS promote the increase in non-durable goods consumption by alleviating children's labor constraints, reducing the family's caregiving burden, and diminishing precautionary savings. This paper provides further empirical evidence on the pathways through which elderly care services influence household consumption behavior, which holds significant implications for proactively addressing population aging and unlocking household consumption potential through micro-institutional design.

New Approaches to Contemporary Elderly Care Home Design

In a developing world today, elderly citizens need extra care and attention. Still, at a point, family members may notbe able to provide proper attention to their older ones for various reasons, which may include busy schedules, theskill required, and equipment; hence, a care home becomes an option that can provide a sustainable livingenvironment for the older people. This paper describes socialization as a major problem faced by the elderly in carehomes, which causes isolation and progresses into depression; hence, it proposes a paradigm shift in design thatgoes beyond the boundaries of a hospital or an isolation center. The architectural solutions propose creating a safespace where the elderly can make new connections and rediscover themselves by integrating a vocational schoolwith the elderly care homes that meet the social needs of elderly citizens, providing them with an adaptive andconducive space. Identifying the needs of elderly people is one of the factors considered very important, as it isnecessary to understand that the care of elderly people can be a bit challenging because they become very sensitiveas they age.

SARS-CoV-2 detection in aerosol from community indoor environments

Since its emergence, the COVID-19 pandemic has profoundly and extensively affected global health and society. Numerous studies have focused on detecting SARS-CoV-2 in air samples collected in healthcare indoor spaces, but few have analysed its presence in air samples from other public community spaces. In addition, limited studies have surveyed indoor spaces where it was not known if individuals with COVID-19 were present or had been present at the time of sampling. This study aimed to determine the SARS-CoV-2 genetic load in aerosol samples collected in public community indoor environments where prior knowledge of the presence of infected individuals with COVID-19 cases is not available at the time of sampling.Air samples (N = 497) were collected from healthcare settings, elderly care homes, and educational settings in the Valencian Community, Spain. RNA was extracted and the N1, N2, and E gene fragments of SARS-CoV-2 were quantified using RT-qPCR. SARS-CoV-2 RNA was detected in 8.9 % of air samples. The highest positivity rates were observed in hospitals (16.2 %), elderly care homes (15.3 %), and primary care centres (12.7 %). Concentration of the N1 gene in positive samples ranged 4.3–504 gc/m3 (n = 10), 6.2–77 gc/m3 (n = 8) and 5.1–14 gc/m3 (n = 7), respectively. The genes N2 and E were less frequently detected and generally reported lower concentrations.The frequency of detection of SARS-CoV-2 in aerosols increased at the same time that the population COVID-19 cumulative incidence increased.

Predicting Hospitalization Risk Among Home Care Residents in the United Kingdom: Development and Validation of a Machine Learning-Based Predictive Model

Preventable hospital admissions in elderly home care residents are a major socioeconomic burden, whilst early detection of deterioration may improve outcomes. Our goal was to develop and validate a machine learning-based algorithm to predict hospitalization risk among home care users. Our primary outcome was hospitalization. An existing risk score (1-5) was assessed for its discriminatory capacity over time. We subsequently developed a new machine learning model using carer concerns, service user demographics, and other home care data between January and July 2021. We randomly selected 150 service user records for validation, which were evaluated by both the model and 10 clinicians (9 doctors and 1 nurse) to compare prediction time and accuracy to human experts. Comparison between model and human was via area under the receiver operating characteristic curve (AUC). A score of 5 conferred an 8x higher likelihood of hospitalization in the subsequent 7 days (15.4% vs 1.8%, p &lt; .05), compared to a score of 1. The new model and risk score increased performance, detecting 182 hospitalizations/month (3.7x chance). The AUC for the model was significantly higher than for clinicians (0.87 vs 0.41-0.57, respectively; p &lt; .05). The model took &lt;1 minute, while clinicians typically took over 40 minutes. A risk prediction model using carer concerns and other home care data features detects 3.7x more hospitalizations than chance. The model is faster and more accurate than human clinicians, enabling low-cost scale-up. This study supports linking the model to a triage and intervention service to reduce preventable hospitalizations in the home care sector.

Caregiver interactions, perceived control, and meaning in life of elderly: the moderating effect of the elderly-to-social worker ratio

BackgroundMeaning in life is a widely accepted aim in promoting psychosocial health in institutional care. However, how caregiver interaction and perceived control impact meaning in life among the elderly remains unclear. This study explores the effect of institutional caregiver interaction, family caregiver interaction, and perceived control on meaning in life among elderly residents in China, and the potential moderating effect of elderly-to-social worker ratio in these associations.MethodsMultistage random sampling was used to recruit a sample of 452 elderly residents from 4 elderly care homes in urban China. A structural equation model was used to test the study hypothesis.ResultsInstitutional caregiver interaction is positively related to meaning in life, and perceived control among elderly residents has a positive impact on meaning in life. Moreover, the elderly-to-social worker ratio moderated the relationship between institutional caregiver interaction and meaning in life, as well as between family caregiver interaction and meaning in life.ConclusionsIncrease elderly’s meaning in life is an important service target for the caring professions in institutional care. Social workers affect the effectiveness of interventions on elderly’s meaning in life in institutional care. A higher elderly-to-social worker ratio could improve the effectiveness of interventions on meaning in life for elderly residents.

WiFi-CSI Difference Paradigm

Passive tracking plays a fundamental role in numerous applications such as elderly care, security surveillance, and smart home. To utilize ubiquitous WiFi signals for passive tracking, the Doppler speed extracted from WiFi CSI (Channel State Information) is the key information. Despite the progress made, existing approaches still require a large number of samples to achieve accurate Doppler speed estimation. To enable WiFi sensing with minimum amount of interference on WiFi communication, accurate Doppler speed estimation with fewer CSI samples is crucial. To achieve this, we build a passive WiFi tracking system which employs a novel CSI difference paradigm instead of CSI for Doppler speed estimation. In this paper, we provide the first deep dive into the potential of CSI difference for fine-grained Doppler speed estimation. Theoretically, our new design allows us to estimate Doppler speed with just three samples. While conventional methods only adopt phase information for Doppler estimation, we creatively fuse both phase and amplitude information to improve Doppler estimation accuracy. Extensive experiments show that our solution outperforms the state-of-the-art approaches, achieving higher accuracy with fewer CSI samples. Based on this proposed WiFi-CSI difference paradigm, we build a prototype passive tracking system which can accurately track a person with a median error lower than 34 cm, achieving similar accuracy compared to the state-of-the-art systems, while significantly reducing the required number of samples to only 5%.

FeedKind: Bridging Generosity and Need

This project describes the FeedKind application which is designed to address the critical societal challenges of food waste and food insecurity by establishing an efficient system to redistribute surplus food from restaurants, caterers, and food providers to vulnerable populations such as elderly care homes and orphanages. The overarching goal is to create a structured framework that minimizes food wastage while simultaneously ensuring that nutritious meals reach those who face difficulties in accessing them. Through strategic coordination with food providers and recipient organizations, this initiative aims to streamline the collection, safe handling, and timely delivery of surplus food. It recognizes the logistical complexities involved in handling surplus food and emphasizes compliance with legal regulations, ensuring food safety and quality throughout the redistribution process. The project places a strong emphasis on collaboration and awareness building within the community. By encouraging engagement from food providers and recipient organizations, this initiative seeks to establish a sustainable network that facilitates the transfer of surplus food to those in need.

The impact of facility and staff characteristics on infection control of COVID-19: Perceptions of elder care home managers in Stockholm, Sweden.

To examine the perceptions of managers of elder care homes on the impact of facility and staff characteristics on infection control of COVID-19. Case study. Six purposively sampled care home managers in the city of Stockholm were interviewed. Through content analysis, three categories and nine subcategories were identified. According to the interviewed care home managers, a home-like environment that allows for isolation of residents and possibilities for staff to get changed and store personal protective equipment outside each resident's room was considered ideal. Experienced employees were reported as invaluable when facing an infectious outbreak. A mix of permanent and temporary staff was considered essential although some thought that temporary staff who work in multiple care homes might negatively influence the spread of infection. Language barriers among staff were considered an obstacle when trying to disseminate information.

‘Social’ robot and social relations in care settings: Undefined positionality and fixed temporality

Socially assistive robots in eldercare settings, i.e. ‘social’ robots, are currently being promoted and studied, particularly in Japan. Among these studies, clinical evaluation of their effectiveness in experimental research predominates, while studies that critically and analytically describe relations between actors in long-term care settings where robots are present are growing but still scarce. In this paper, we argue that understanding how older adults facing the loss of autonomy and their caregivers interact with robots in relational terms is helpful to explain the usage and non-usage of, and eventual resistance to social robots entering into care settings. This is why, in order to understand human relationships with social robots in elder care homes, this paper combines a ‘script’ approach and a ‘critical care’ one. Based on content analysis of a unique set of reports on trials of a social robot in multiple care facilities in Japan from 2018 to 2020, as well as interviews with stakeholders and ethnographic observations conducted in 2022, we answer two questions: 1) how do social robots shape social relations of care? 2) how do social robots affect social relations between care professionals, care recipients and robots? We proceed to discuss two of the characteristics emphasised in the ethics of care and examine them in depth: the positional and temporal aspects. Our major result is that, while the robot was easily adaptable to care environments because its position in relationships is not defined, embedded clock time flow in the robot was objective and linear, which indicates that some robot-created situations were seen as problematic by actors in care settings.

Exploring the knowledge and skills for effective family caregiving in elderly home care: a qualitative study.

Family caregivers play a crucial role in providing physical, emotional, and social support to the elderly, allowing them to maintain their independence and stay in their preferred living environment. However, family caregivers face numerous challenges and require specific knowledge and skills to provide effective care. Therefore, understanding the knowledge and skills required for effective family caregiving in elderly home care is vital to support both the caregivers and the elderly recipients. The research was carried out in Mekelle City, Ethiopia, utilizing the phenomenology study design and purposive sampling technique. A total of twenty-two in-depth interviews were conducted. Individuals with experience in providing care for elderly people in their homes were targeted. Data was gathered through the use of an open-ended guide, transcribed word-for-word, inputted into ATLAS.ti8 software, and translated. Codes and themes were then extracted from the transcribed data, and a thematic analysis was performed. To minimize personal biases, the collected data were coded independently by the data collection assistants and the PI. The analysis was carried out by authors who were not involved in the data collection process. The interviews were conducted in a quiet place. A total of 22 in-depth interviews were conducted as part of this research. The results indicated that although the participants had knowledge about common health problems experienced by older people, they were uninformed about how to manage these conditions at home and were unaware of specialized healthcare resources for the elderly. Furthermore, they had limited knowledge about suitable exercise routines, strategies to prevent falls, and home healthcare practices for older individuals. On the other hand, they exhibited a solid comprehension and awareness of abusive behaviors specifically directed at older adults. The results emphasized the importance of enhancing education and training for family caregivers in handling elderly health issues, raising awareness about specialized healthcare services catered to the elderly, improving understanding of activities of daily living (ADLs) and fall prevention, and offering inclusive training in healthcare tasks related to elder care. Participants should receive comprehensive education and training programs to enhance their knowledge and skills in managing these conditions. Efforts should also be made to raise awareness about the availability of geriatric hospitals or specialized nurses for the elderly. Participants need to be educated about suitable exercise routines for the elderly and fall prevention strategies. Healthcare skills training is also necessary for participants, focusing on activities such as wound dressing, vital sign monitoring, and establishing a specific schedule for changing positions.

‘Proto-conversation’ as a practice in late-stage dementia care

Abstract This study suggests that the concept of proto-conversation may be used to describe and understand communication with people with late-stage dementia who have lost their abilities to produce verbal language. In the study, a multimodal conversation analytic method is used to analyze sequences of interactions between professional caregivers in an elderly care home and people with late-stage dementia. The study shows how minimal actions (shift of gaze directions, vocalizations or bodily movements) not instantly recognizable as intentional, communicative conduct, may be recognized and treated as communicative contributions by engaging the person living with dementia in proto-conversations. In such interactional sequences, the caregivers do not only turn the contributions of persons with dementia into actions through their responses, but they also treat the persons as agentive actors and position them as partners in interaction.

How do advanced nurse practitioners enhance healthcare outcomes in frail older patients living in care homes?

Background: As the UK healthcare service strains to meet the demand from its ageing population for 24-hour care, there is an increased need to develop an effective way to provide quality care to frail residents living in care homes. The role of the advanced nurse practitioner (ANP) has evolved over the last 20 years, developing in part to meet the shortfall of GPs and geriatric specialist doctors. Despite research having been previously conducted in the US and Canada into how the ANP role can function within care homes, there has been limited exploration into how the role can enhance UK healthcare outcomes in relation to the 2019 NHS Long-Term Plan, which aimed to provide care closer to home for ageing patients. Aims: This paper was designed to critically review published primary research papers and evaluate the impact of the ANP role on healthcare outcomes for frail elderly care home residents. Its objective was to help guide future healthcare delivery policy within the UK. Methods: A saturated systematic search of primary research literature was conducted. An inclusion/exclusion criterion was also utilised. Key papers identified were subject to critical synthesis, using ratified critical appraisal tools from the Joanna Briggs Institute and mixed-method appraisal tool by Hong et al (2018) . A thematic/narrative approach was employed to evaluate the findings of the mixed-method heterogenic-style research. Results: A total of 14 primary research papers met the criteria, which included mixed methods of study from across four English language-speaking countries. Five outcome themes were recurrent throughout the synthesis of the results, including, in order of prevalence: improved/equivalent quality of care; successful collaborative role; reduced hospitalisations; timely access to primary/secondary care; colleague/patient/family satisfaction. Discussion: Following the review of the highlighted themes, there was a consensus that ANPs positively influence the care quality of elderly patients living within care homes. Although no superiority over a physician approach was found, there was indication of supplementary benefits when including ANPs in the care home setting. These include instilling positive role models into the healthcare environment, increasing the general knowledge and education capacity of care staff, and streamlining communication—especially within advanced care planning and coordination of care. These qualities clearly encompass the current NHS priorities of the 2019 Long-Term Plan and the Enhanced Health in Care Homes Framework, which are set to be fully achieved by 2024.

Market characteristics and entry strategy decision making: The market perspective of Croatian elderly care homes

Background: Socio-demographic changes increase the need for long-term elderly care. Consequently, providing formal institutional service in elderly care homes is an interesting opportunity for entrepreneurs. However, the entry strategy decision is influenced by numerous external variables. Purpose: The main goal is to answer what determines market concentration as one of the most important market entry determinants. Study design/methodology/approach: A linear regression model has been formed and tested on the Croatian elderly care home market, observed on a county level, using data for 2021. Further, a cluster analysis, as a decision-support tool, has been made to assess market characteristics that are more likely to attract new entrants to the elderly care home market. Findings/conclusions: Results indicate that demand for long-term care services plays a significant role, and the market with more elderly will attract more competitors. When the level of GDP per capita and the unemployment rate are observed together, markets with stronger economies tend to attract entrepreneurs. In other words, it is more likely that someone will open an elderly care home in a densely populated county with individuals that can afford formal institutional long-term care for themselves or family members. Limitations/future research: The shortcomings are mainly related to the lack of data on prices and quality measures. Further, information on the number of beds in each elderly care home would enable an alternative calculation of the Herfindahl-Hirschman index, while data on service prices and structure of employees as a proxy for quality (medical and non-medical staff) would enable a more reliable comparative analysis of obtained results. Future studies on this subject include variables related to the portion of unemployed females in the market since female family members more often provide informal care, and at the same time, they are more likely to be employed in formal long-term care institutions.

Estratégias de gestores no cuidado com idosos dependentes em domicílio no Brasil

Abstract Objective To investigate the strategies Brazilian health managers employ to supply dependent elderly home care. Methods This is qualitative hermeneutics-based research with a comprehensive perspective on elderly home care. Sixteen managers working in Primary Health Care and specific elderly healthcare programs from the five Brazilian regions participated in this study. Data were collected from June to September 2019 with semi-structured interviews, and later systematized and consolidated into two themes in light of hermeneutics. Results Managers articulated health education practices, mapped vulnerabilities, implemented care flows and protocols, and organized community support and health promotion groups, besides integrative and complementary practices to consolidate and improve elderly home care. Conclusion Multiple strategies in dependent elderly home care stand out, such as individual and collective health education actions and work management processes, in which the manager plays a crucial role in developing services for the elderly.

Demanding yet supportive and developing: Nurse preceptors’ experiences of peer learning in nursing education in municipal elderly care homes

Nursing students commonly engage in clinical education in municipal elderly healthcare. Therefore, it is important to use a pedagogical model that provides the best conditions for nursing students to develop clinical competence. The aim of this study was to describe and interpret nurse preceptors’ experiences of a newly implemented pedagogical model, peer learning, in municipal elderly care home settings. Nine registered nurses from elderly care homes with precepting experience participated. Data were collected through individual interviews, and a thematic content analysis was performed. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. The findings revealed four sub-themes: ‘requiring careful preparation’; ‘contributing control and trust in the learning process’; ‘changing perspectives brings new opportunities and challenges’; and ‘enabling students to believe in themselves’, all interpreted into the main theme of ‘demanding yet supportive and developing’. In conclusion, municipal elderly care homes seemed to be a learning environment well suited for using the peer learning pedagogical model.

Choice Preference of Middle-Aged and Elderly People on Integrated Medical Services and Elderly Care Model: A Cross-Sectional Study.

Facing the increasingly severe aging situation, China has started to implement the "integrated medical services and elderly care (IMSEC)" policy, which covers a variety of IMSEC models. However, there is currently little research on middle-aged and elderly people's choice preference for these IMSEC models and their associated factors. Through the face-to-face questionnaire method, the choice preference of middle-aged and elderly people aged 45 years and over in Zhejiang Province, China, to the IMSEC model is explored. Through the multinomial logistic regression model, the influencing factors of choice preference are analyzed. A total of 1034 people are included in 2022. Their choice preference for the 4 major types of IMSEC models are Home IMSEC model (48.07%), Community IMSEC model (23.79%), Institutional IMSEC model (21.76%), and Internet Plus IMSEC model (6.38%). "C1. Home elderly care and contracted with a family doctor" is the most chosen subtype, accounting for 34.53%. The rural elderly are more likely to choose "Home IMSEC model" (OR(95%CI) = 2.977(1.343-6.601)). Elderly people with relatively large life care needs are more likely to choose "Institutional IMSEC model" (OR(95%CI) = 1.114(1.042-1.190)). Moreover, age, education, and self-reported health status are also influencing factors of choice preference. The government should focus on promoting the development of the "Home IMSEC model" and increase the promotion of "Internet Plus IMSEC model." In addition, the life care service capacity and spiritual comfort capacity of IMSEC institutions, as well as the medical service capacity of the community, need to be enhanced.

Research on the Application of Smart Elderly Care Services in Home Elderly Care

The conventional wisdom about caring for the elderly inside families is crumbling under the weight of a fast-changing society and the mounting problems caused by an aging population. Smart senior care services leverage cutting-edge technology like AI, IoT, and big data analytics to provide comprehensive, specifically personalized care. This paper explores the theoretical foundations, practical applications, challenges, and recommended solutions for smart care services for the elderly using specific case studies to illustrate possible trends in future development. These services’ technical foundation consists of big data analysis to help identify the needs of the elderly, internet of things (IoT) to enable real-time monitoring, and artificial intelligence (AI) algorithms that offer smart health management solutions. These services include a wide range of tasks, such as monitoring health, helping with everyday tasks, and responding to emergencies. Costs, data security, and privacy protection are three of the many obstacles to marketing and expanding these services. A variety of approaches, including increased public awareness, supporting legislation, and regulatory actions, are proposed in the paper as potential solutions to these problems. Smart senior care services show great potential for home-based care, according to case studies. As time goes on and society evolves, these services are predicted to become more popular, making life easier and more pleasant for elders.