Long-term Care Facilities For Elderly Research Articles

Footwear and falls in long-term residential aged care facilities: an analysis of video capture data

Introduction: Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate. Methods: Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and falls characteristics (proposed mechanism and fall direction). Results: There were 300 falls experienced by 118 older adults aged 58 years to 98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%) and wearing shoes (7/99 falls, 7%). Conclusion: Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.

Exploring the effects of antimicrobial treatment on the gut and oral microbiomes and resistomes from elderly long-term care facility residents via shotgun DNA sequencing.

Monitoring antibiotic-resistant bacteria (ARB) and understanding the effects of antimicrobial drugs on the human microbiome and resistome are crucial for public health. However, no study has investigated the association between antimicrobial treatment and the microbiome-resistome relationship in long-term care facilities, where residents act as reservoirs of ARB but are not included in the national surveillance for ARB. We conducted shotgun metagenome sequencing of oral and stool samples from long-term care facility residents and explored the effects of antimicrobial treatment on the human microbiome and resistome using two types of comparisons: cross-sectional comparisons based on antimicrobial treatment history in the past 6 months and within-subject comparisons between stool samples before, during and 2-4 weeks after treatment using a single antimicrobial drug. Cross-sectional analysis revealed two characteristics in the group with a history of antimicrobial treatment: the archaeon Methanobrevibacter was the only taxon that significantly increased in abundance, and the total abundance of antimicrobial resistance genes (ARGs) was also significantly higher. Within-subject comparisons showed that taxonomic diversity did not decrease during treatment, suggesting that the effect of the prescription of a single antimicrobial drug in usual clinical treatment on the gut microbiota is likely to be smaller than previously thought, even among very elderly people. Additional analysis of the detection limit of ARGs revealed that they could not be detected when contig coverage was <2.0. This study is the first to report the effects of usual antimicrobial treatments on the microbiome and resistome of long-term care facility residents.

Optimizing floor plans of accessible restrooms in elderly long-term care facilities: a path planning approach

ABSTRACT Navigating narrow restrooms is challenging for the elderly using wheelchairs or walkers (EUWW). Existing research focuses on the convenience of furniture use in the restroom and overlooks the convenience of mobility between furniture pieces. However, the floor plans of accessible restrooms determine the mobility path of EUWW, affecting mobility convenience. Thus, to improve mobility, floor plans should be evaluated to shorten movement distances and reduce bends. Experiments in constructed environments were expensive. This study instead proposes a novel path-planning based method for accessible restroom floor plan evaluation, simulating mobility paths in a virtual environment, and evaluating how the floor plans of accessible restrooms affect mobility and convenience. The results showed that: (1) wheelchair users, who approach the toilet from the rear, and walker users find opposite wall toilet-sink arrangements convenient. While Wheelchair users, who approach the toilet from the side or front, find it convenient if the toilet and sink are situated on different walls at a 90° angle. Toilets and sinks on the same wall are inconvenient. (2) Corner sinks and toilets reduce EUWW's turning angles. (3) The farther the sink is from the side wall, the more convenient it is for EUWW. (4) The 45° side approach is the most convenient for moving, followed by the frontal approach, and lastly the 90° approach. Theoretically, this study uses path planning algorithms, simulating the movement of EUWW with varying capabilities and offering a new perspective for barrier-free architectural design. Practically, this study provides recommendations for optimizing accessible restroom floor plans.

COVID-19 and Care for the Elderly in Long-Term Care Facilities: The Role of Information Communication Technology.

To review the changes in communication in long-term care facilities (LTCF) during the COVID-19 pandemic. A systematic literature review was conducted through a keyword search of the PubMed and Ovid Embase databases. In accordance with the inclusion and exclusion criteria, 11 articles were selected and analysed qualitatively. The use of information communication technology was heterogeneous, and it was used to bring together several different groups of users: LCTF residents' families, hospitals, specialists, and general practitioners. The modes of communication and preferred ways to reduce the social isolation of LTCF residents from their family members were described. Various smartphone applications have been designed for both socializing and the use of telemedical solutions. Opportunities for peer-to-peer social interaction between the elderly through information communication technologies have been neglected. Video calls may bring greater satisfaction to residents and their families. Telemedicine and interdisciplinary cooperation between healthcare professionals have increased the quality of medical care in long-term care institutions during the COVID-19 pandemic.

Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019: Systematic review and meta-analysis.

Antibiotic misuse is a key contributor to antimicrobial resistance and a concern in long-term aged care facilities (LTCFs). Our objectives were to: i) summarise key indicators of systemic antibiotic use and appropriateness of use, and ii) examine temporal and regional variations in antibiotic use, in LTCFs (PROSPERO registration CRD42018107125). Medline and EMBASE were searched for studies published between 1990-2021 reporting antibiotic use rates in LTCFs. Random effects meta-analysis provided pooled estimates of antibiotic use rates (percentage of residents on an antibiotic on a single day [point prevalence] and over 12 months [period prevalence]; percentage of appropriate prescriptions). Meta-regression examined associations between antibiotic use, year of measurement and region. A total of 90 articles representing 78 studies from 39 countries with data between 1985-2019 were included. Pooled estimates of point prevalence and 12-month period prevalence were 5.2% (95% CI: 3.3-7.9; n = 523,171) and 62.0% (95% CI: 54.0-69.3; n = 946,127), respectively. Point prevalence varied significantly between regions (Q = 224.1, df = 7, p<0.001), and ranged from 2.4% (95% CI: 1.9-2.7) in Eastern Europe to 9.0% in the British Isles (95% CI: 7.6-10.5) and Northern Europe (95% CI: 7.7-10.5). Twelve-month period prevalence varied significantly between regions (Q = 15.1, df = 3, p = 0.002) and ranged from 53.9% (95% CI: 48.3-59.4) in the British Isles to 68.3% (95% CI: 63.6-72.7) in Australia. Meta-regression found no association between year of measurement and antibiotic use prevalence. The pooled estimate of the percentage of appropriate antibiotic prescriptions was 28.5% (95% CI: 10.3-58.0; n = 17,245) as assessed by the McGeer criteria. Year of measurement was associated with decreasing appropriateness of antibiotic use over time (OR:0.78, 95% CI: 0.67-0.91). The most frequently used antibiotic classes were penicillins (n = 44 studies), cephalosporins (n = 36), sulphonamides/trimethoprim (n = 31), and quinolones (n = 28). Coordinated efforts focusing on LTCFs are required to address antibiotic misuse in LTCFs. Our analysis provides overall baseline and regional estimates for future monitoring of antibiotic use in LTCFs.

Effectiveness of mRNA COVID-19 vaccines in preventing SARS-CoV-2 infections and COVID-19 hospitalisations and deaths in elderly long-term care facility residents, Spain, weeks 53 2020 to 13 2021.

Residents in long-term care facilities (LTCF) experienced a large morbidity and mortality during the COVID-19 pandemic in Spain and were prioritised for early COVID-19 vaccination. We used the screening method and population-based data sources to obtain estimates of mRNA COVID-19 vaccine effectiveness for elderly LTCF residents. The estimates were 71% (95% CI: 56–82%), 88% (95% CI: 75–95%), and 97% (95% CI: 92-99%), against SARS-CoV-2 infections (symptomatic and asymptomatic), and COVID-19 hospitalisations and deaths, respectively.

노인장기요양시설 요양보호사의 직무스트레스와 조직몰입이 서비스 질에 미치는 영향

노인장기요양시설 요양보호사의 직무스트레스와 조직몰입이 서비스 질에 미치는 영향

Improvement of hand hygiene adherence among staff in long-term care facilities for elderly in Japan

IntroductionHand hygiene is crucial for infection control in long-term care facilities for elderly (LTCFEs), because it can be easily implemented in the low-resource settings of LTCFEs. This study investigated the actual status of hand hygiene adherence in LTCFEs, identified the factors inhibiting its appropriate implementation, and evaluated the effectiveness of a hand hygiene promotion program. MethodsIn this before-and-after study, participants were staff members (n = 142) at two LTCFEs in Gunma Prefecture, Japan. We modified the World Health Organization's “five moments for hand hygiene” and assessed participants' hand hygiene adherence rates in four situations: (1) Before touching around a resident's mucous membrane area; (2) Before medical practice or clean/aseptic procedures; (3) After body fluid exposure/risk or after touching around a resident's mucous membrane area; and (4) After touching a resident's contaminated environments. The study was divided into four phases. In Phase 1, participants self-assessed their hand hygiene adherence using a questionnaire. In Phase 2, we objectively assessed participants' pre-intervention adherence rates. In Phase 3, an intervention comprising various hand hygiene promotion measures, such as education and hands-on training on hand hygiene practices and timings, was implemented. In Phase 4, participants' post-intervention adherence rates were objectively measured. ResultsAlthough most participants reported high hand hygiene adherence rate in the self-assessment (93.1%), the pre-intervention evaluation revealed otherwise (16.8%). Participants’ post-intervention adherence rates increased for all four situations (77.3%). ConclusionThe intervention program helped increase participants’ hand hygiene adherence rates, indicating its effectiveness. Similar interventions in other LTCFEs may also improve adherence rates.

A Study on Facilites Safety of Long-Term Care Facilities for Elderly :Focused on the Factual Survey of Seoul Metropolitan Area

A Study on Facilites Safety of Long-Term Care Facilities for Elderly :Focused on the Factual Survey of Seoul Metropolitan Area

시설거주노인의 주관적 건강상태, 근감소증 및 건강관련 삶의 질 간의 상관관계

본 연구는 시설거주노인의 주관적 건강상태, 근감소증 및 건강관련 삶의 질의 관계를 분석한 조사연구이다. D지역소재 노인요양시설에 거주하는 65세 이상 노인 107명을 대상으로 하였으며, 주관적 건강상태는 Lawton, Moss, Fulcomer와 Kleban (1982)의 Health self rating scale, 근감소증은 Baumgartner et al.(1998)의 공식을 사용한 근육지수(Skeletal muscle index), 건강관련 삶의 질은 European Quality of Life 5 Dimensions (EQ-5D) Index로 측정하여 χSUP2/SUP, t-test, ANOVA, Pearson’s correlation coefficient로 분석하였다. 연구결과 주관적 건강상태에는 성별, 종교유무, 자녀유무, 월평균 용돈, 시설입소기간, 만성질환, 만성질환 수가 유의한 영향을 미쳤고, 건강관련 삶의 질에는 성별, 배우자, 자녀유무, 월평균 용돈, 만성질환 수가 유의한 영향을 미치는 것으로 나타났다. 주관적 건강상태와 건강관련 삶의 질은 통계적으로 유의한 양의 상관관계가 있었고(r=.37, p.001), 근감소증과 건강관련 삶의 질은 통계적으로 유의한 음의 상관관계가 있었으나(r=-.26, p.05) 주관적 건강상태와 근감소증은 상관성이 없는 것으로 나타났다. 이를 토대로 시설거주노인의 건강관련 삶의 질을 높이기 위해 주관적 건강상태에 영향을 미치는 요인을 파악하여 이를 향상시킬 수 있는 중재전략과 근감소증을 관리할 수 있는 전략이 필요할 것으로 사료된다.

Factors Affecting Mistreatment of the Elderly in Long-Term Care Facilities.

In long-term care facilities, elderly mistreatment occurs routinely and frequently. However, few studies have empirically explored the multifaceted risk factor of mistreatment. The purpose of this paper was to explore the factors affecting elderly mistreatment by care workers in Japanese long-term care facilities and to examine the relationship between these factors and mistreatment. This analysis was based on a sample of 1473 care workers from long-term care facilities and used multiple regression analyses. The results revealed that the nursing care level, work period, resilience, and attitude towards mistreatment among residents and staff were factors significantly associated with the degree of mistreatment. Facility size, an institutional environment that does not limit the behavior of residents, and family and community support for the elderly were among the institutional environment factors that had significant relationships with mistreatment. Staff gender, care-related qualifications, and workload were not associated with mistreatment. These findings suggest that strengthening the staff’s attitude and coping skills to prevent mistreatment, as well as interventions for changes in the institutional environment, are needed to prevent and reduce the prevalence of mistreatment in Japan. In addition, raising staff resilience to stress situations and building a resident-centered facility care environment is an important measure to reduce mistreatment.

Effects of training with nintendo wii on balance and mobility in institutionalized elderly

Background: One of the consequences of the institutionalization of the elderly is the increased risk of falls. Games of video games have shown ability to improve balance in the elderly population, but there is no data on their use in institutionalized elderly. Objective: To evaluate the effects of training with Nintendo Wii on static balance and functional mobility in elderly living in Long-Term Care Facilities for Elderly. Methods: Participated in the research 10 institutionalized elderly, who underwent training with Nintendo Wii for eight weeks, twice a week. Functional mobility was assessed by the Timed Up and Go (TUG) test and the static balance by a force platform. Results: Significant improvement in TUG was observed (17.65 ± 4.38s pre-treatment and 15.30 ± 3.70s p= 0.03). There was no significant improvement in the static equilibrium variables, but there was a tendency for improvement. Conclusion: The results demonstrated that the intervention with Nintendo Wii significantly improved the functional mobility, but with no improvement in the static balance in the institutionalized elderly.

A Study on the Perception and Emergency Coping Ability of the Elderly in Long-term Care Facilities

A Study on the Perception and Emergency Coping Ability of the Elderly in Long-term Care Facilities

Body mass index and albumin levels are prognostic factors for long-term survival in elders with limited performance status.

Elderly long-term care facility residents typically have musculoskeletal conditions that may lead to long-term disability and increased mortality. Our main objective was to explore the relationship between body mass index (BMI), albumin levels, and mortality in elderly individuals with limited performance status. Among 182 participants (mean age, 78.8 years; 57% women), 11%, 64%, and 25% had serum albumin levels of <2.8, 2.8-3.5, and >3.5 g/dL, respectively. After multivariate adjustments, diastolic blood pressure >90 mmHg was associated with all-cause mortality [hazard ratio (HR) = 2.08, 95% confidence interval (CI) = 1.13-3.82; P = 0.018]. In addition, BMI <18.5 kg/m2 and albumin level <2.8 g/dL associated with higher mortality than BMI = 18.5-24 kg/m2 and albumin level > 3.5 g/dL (HR = 1.80, 95% CI = 1.11-2.94 and HR = 2.54, 95% CI 1.22-5.30, respectively; P = 0.018 and 0.013, respectively). Highest mortality was noted in participants with albumin levels <2.8 g/dL and BMIs <18.5 kg/m2 (HR = 6.12, 95% CI = 1.85-20.21, P = 0.003). Combined hypoalbuminemia (albumin level < 2.8 g/dL) and low BMI (<18.5 kg/m2) may be a useful prognostic indicator of high mortality risk in elderly individuals with limited performance status.

An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65years living with and without dementia: a population-based cohort study.

To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. A population-based retrospective cohort study of adults aged ≥ 65years hospitalised with a hip fracture during 2007-2017 in New South Wales, Australia. Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI - 6.6 to - 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5-1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

ObjectivesThere are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or...

Environmental risk factors associated with falls among older people living in long-term aged care facilities: a prospective study

BackgroundFalls are the most common safety problem among older people living in long-term aged care facilities in China. Unsupportive environments can increase the risk of falls among this population. We aimed to understand the distribution of environmental risk factors in long-term aged care facilities and their associations with falls among residents. MethodsThe environmental risk factors in 25 long-term aged care facilities in Changning, Shanghai, were investigated on site using a 75-item questionnaire on potential fall-related risk factors. Residents in participating facilities were interviewed and prospectively followed up for 1 year to ascertain the occurrence of falls. Univariate and multivariate analyses were applied to measure the associations between environmental exposures and falls. FindingsBetween Nov 1, 2017, and Dec 31, 2018, 739 residents were interviewed at baseline and 605 completed 1-year follow-up. 132 (22%) of 605 participants had at least one fall during follow-up. The number of environmental risk factors in each care facility ranged from two to 22 (mean 11 [SD 5]). The three most common factors, which were significantly associated with the occurrence of falls, were inadequate or inappropriate handrails (24 [96%] facilities; risk ratio [RR] for fall occurrence 1·878 [95% CI 1·128–3·126]), unsafe ground (23 [92%]; 2·496 [1·111–5·606]), and insufficient lighting (21 [84%]; 2·008 [1·103–3·656]). Risk factors were most frequently distributed in bedrooms (in 24 [96%] facilities), shared toilets or showers (20 [80%]), and individual toilets or showers (17 [68%]). On univariate analysis, falls were significantly associated with the presence of environmental risk factors in corridors (RR 1·571 [1·058–2·334]), elevators (1·826 [1·224–2·724]), and living rooms (1·843 [1·249–2·720]). After adjusting for demographics and individual risks of falls by Morse Scale, residents in facilities with eight or more environmental factors had significantly increased risk of falls (adjusted RR 2·207 [1·378–3·534]). InterpretationEnvironmental risk factors in long-term aged care facilities are associated with increased risk of falls among residents. Improving lighting and ground safety and installing adequate handrails, especially in corridors, elevators, and living rooms, could reduce the incidence of falls. FundingShanghai Municipal Commission of Health and Family Planning (grant number 201640040), Chinese Center for Disease Control and Prevention.

The Dual Mediation Effect of Satisfaction with the Quality of Service and Satisfaction with Resident in the Relationship between Subjective Health and Depression among the Elderly in Long-Term Care Facilities

This study aimed to investigate whether satisfaction with the quality of service and satisfaction with residentmediate the relationship between subjective health and depression. Toward this end, the following researchquestions were set. First, what is the correlation between satisfaction with the quality of service, satisfactionwith resident, subjective health, and depression? Second, does satisfaction with the quality of service andsatisfaction with resident mediate the relationship between subjective health and depression? The surveywas conducted by visiting the nursing homes that allowed this study after a phone call request. Face-to-faceinterviews with the elderly people in the institutions were done by the investigator and trained graduatestudents. The survey was completed with 381 elderly people in long-term care facilities (Jan ~ Feb 2017).The analysis of frequency, reliability, and correlation was done using the SPSS PC+ Win. 23.0programs. Themediation analysis and bootstrapping were done using the SPSS PROCESS macro program (model 6). Thisstudy found out that, in the effect of physical health on depression, satisfaction with the quality of serviceand satisfaction with resident have dual mediating effects. These findings were, first, the worse subjectivehealth is, the higher depression is. Second, raising their satisfaction with the quality service provided byfacilities can reduce their depression. Third, because satisfaction with resident can also reduce depression,it is necessary to lead the elderly to adjust themselves to the facilities, and to increase their residentialsatisfaction, which will reduce depression. First, by encouraging those in facilities to participate in varioushealth programs and take care of their diets and by giving proper treatment, it is necessary to improve theirhealth, which will reduce their depression. Second, by providing various environmental, physical, and socialservices which fit the demands of the elderly, it is possible to reduce their depression.

The effects of a Socially Supportive Activities Program (SSAP) on mood in long term care: A pilot study

This study examined the effects of a facilitated 10-week Socially Supportive Activities Program (SSAP) designed to improve mood in a geriatric institutional setting. A sample of 68 Taiwanese elders in long-term care facilities with depressive symptoms were randomly assigned to either an experimental group (N = 35) or a control group (N = 33). Outcomes were measured before the intervention, week 1, and at week 12, one-week post intervention. In the experimental group, pre-post measurement results demonstrated significant reductions in depressive symptoms, measured by Geriatric Depression Scale, and significantly higher levels of self-transcendence, measured by the Self-Transcendence Scale. An additional post-intervention measure of mood was collected with the Apparent Emotional Rating Scale. The AERS also demonstrated a significantly higher score (better mood) in the experimental group than in the control group. This study supports the use of a structured, facilitated, well-designed social activities program like the SSAP, to enhance and improve mood in elders who live in long-term care facilities.

The Dual Mediation Effect of satisfaction with the Quality of service and satisfaction with resident in the relationship between subjective Health and Depression among the Elderly in Long-term Care Facilities

This study aimed to investigate whether satisfaction with the quality of service and satisfaction with resident mediate the relationship between subjective health and depression. Toward this end, the following research questions were set. First, what is the correlation between satisfaction with the quality of service, satisfaction with resident, subjective health, and depression? Second, does satisfaction with the quality of service and satisfaction with resident mediate the relationship between subjective health and depression? The survey was conducted by visiting the nursing homes that allowed this study after a phone call request. Face-to-face interviews with the elderly people in the institutions were done by the investigator and trained graduate students. The survey was completed with 381 elderly people in long-term care facilities (Jan ∼ Feb 2017). The analysis of frequency, reliability, and correlation was done using the SPSS PC+ Win. 23.0programs. The mediation analysis and bootstrapping were done using the SPSS PROCESS macro program (model 6). This study found out that, in the effect of physical health on depression, satisfaction with the quality of service and satisfaction with resident have dual mediating effects. These findings were, first, the worse subjective health is, the higher depression is. Second, raising their satisfaction with the quality service provided by facilities can reduce their depression. Third, because satisfaction with resident can also reduce depression, it is necessary to lead the elderly to adjust themselves to the facilities, and to increase their residential satisfaction, which will reduce depression. First, by encouraging those in facilities to participate in various health programs and take care of their diets and by giving proper treatment, it is necessary to improve their health, which will reduce their depression. Second, by providing various environmental, physical, and social services which fit the demands of the elderly, it is possible to reduce their depression.