Geriatric Health Services Research Articles

‘Mental health is a mystery’: patient perspectives on treatment engagement in the referral process to specialty geriatric mental health services

Objectives Raue and Sirey proposed a theoretical treatment engagement model for older adults outlining steps from identifying mental health problems, referral to specialty care, and involvement in treatment. Using this model as a guide, the current study aimed to explore patient perspectives of their experience in the process of referral and first meeting with geriatric mental health services. Furthermore, the current study aimed to identify opportunities to enhance patient engagement in these beginning steps of the treatment engagement process. Method Thirteen geriatric outpatients (7 psychology, 6 psychiatry) presenting with concerns of anxiety, depression, and/or stress were interviewed. Interviews were analyzed using the framework method. Results Themes emerged as suggested by Raue and Sirey’s model, including attitudes toward treatment (e.g. stigma), treatment expectations, and treatment preferences. In addition, new themes emerged related to modifiable individual factors (the patient as a passive recipient of care, mental health literacy, and ageism) as well as social influences on treatment engagement. Participants primarily noted opportunities for psychoeducation as a potential treatment engagement intervention to implement within the current referral system. Conclusions This is the first study to examine the applicability of Raue and Sirey’s theoretical engagement model in a clinical sample. Findings both support and expand the model and offer several recommendations for improving treatment engagement for older patients.

Dietary fibre intake in Kuwaiti older adults assessed by validated food frequency questionnaire

Adequate dietary fibre (25-30g/day) is essential in a healthy diet preventing several health problems (1). Age-related changes reduce gut function and increase risk of constipation. A better understanding of fibre in those over 60y is required. This study aimed to measure fibre intake in those over 60y in Kuwait using the Kuwaiti Food Frequency Questionnaire for fibre (KWFFQ-DF) and explore local food sources of fibre and laxative use.Recruitment was conducted Dec 2022 to April 2023 in Geriatric Health Services in Kuwait and geriatric units across the six main governorates in Kuwait. The study was approved by the University of Glasgow Research Ethics Committee (project No. 200220066) and the Medical Research Ethics Committee of the Ministry of Health in Kuwait (project No 9512018)18). The validated KWFFQ-DF assessed intake of total fibre (TDF), soluble fibre (SF) and insoluble fibre and included seven food groups and 134 food items. The last two questions asked if the participant consumed supplementary fibre and if they took laxatives (type and amount). The associations between fibre intake and gender, age and governorate and between TDF and laxative use were assessed by Chi squared test (P < 0.05 considered significant).The study recruited 210 people (61 males and 149 females; 61- 96y (median 66y). BMI ranged from 18 to 68 (median 29). Mean TDF intake was 28.7 g/d (SD 6.6; 13 to 46 g/ day). Most participants (n= 186, 89%) did not use laxatives. Several foods high in fibre were frequently consumed by participants including dates, as a snack with coffee eaten 2-6 times/day at 2.2 g TDF per portion and almonds once a day as a snack with 12 g of TDF. Whole grain toast, eaten 1-2 times daily contributed 4g TDF but with eggs or cheese at breakfast so higher in fat. Other key sources were barley bread, (8g TDF), vegetable soup, 2-4 times a week (4 g/d TDF) and Tabouleh Salad, typically eaten with grilled meat or chicken at 2g/d TDF. There was no significant association between fibre intake and gender (χ2= 1.033; P < 0.597) or governorates (χ2= 14.66; P < 0.145). However, the findings identified a significant association between fibre intake and age of participants (χ2= 10.066; P < 0.039). Moreover, there was a highly significant negative association between the TDF intake and laxative use frequency (χ2= 25.63, P<0.001).In contrast to some populations, fibre intake for people in Kuwait over 60y is within dietary guidelines and laxative use is low. Foods high in fibre in Kuwaiti cuisine can be, however, associated with high calories due to the sugar and fat content and may be associated with high BMI. The consequences of this need to be explored.AcknowledgementsWe would like to express our sincere gratitude to Dr Ali Alqattan and the medical team at the Geriatric Clinic in Mubarak Hospital for their valuable assistance in facilitating the interviews with participants in this research project.

Association between the change in the job facilitating and inhibiting factors of care staff due to the employment of older assistant workers and the emotional exhaustion among care staff

Objectives The mental health condition of care staff in Japan is becoming problematic. Older assistant workers are currently being employed to assist care staff with their jobs and alleviate their job burden. This employment of older assistant workers is drawing attention; however, their influence on the job facilitating and inhibiting factors of care staff and the association with the care staff's emotional exhaustion remains unclear. In this study, we aim to examine how the employment of older care assistant workers relates to the job-facilitating and job-inhibiting factors of care staff and explore that association with the care staff's emotional exhaustion.Methods Data from a mail survey of geriatric health services facilities with older assistant workers were analyzed. Among the answers obtained from the care staff, answers from 5,185 who reported working in facilities that employ older assistant workers (over the age of 60) were analyzed. The Emotional Exhaustion subscale of the Japanese Version of the Burnout Questionnaire was used as the dependent variable. The change in job-facilitating and job-inhibiting factors of care staff due to the employment of older assistant workers (improve, maintain/exacerbate) was explored for nine contents.Results Care staff reported a decrease in the total volume of the task (63.6%), less stress during daily tasks (39.8%), and more concentration on the tasks that require expert care knowledge (38.0%). The results of multiple regression analysis showed that the emotional exhaustion score of care staff was low when the total volume of tasks decreased (β=－0.383, 95%CI=－0.719, －0.047), when less stress was perceived during daily tasks (β=－0.432, 95%CI=－0.796, －0.068), when concentration on tasks that required expert care knowledge increased (β=－0.574, 95%CI=－0.937, －0.210), and when human relationships among staff improved (β=－0.871, 95%CI=－1.263, －0.480). Conversely, an increase in tasks requiring work with regional personnel and organizations (β=0.800, 95%CI=0.162, 1.437) was associated with a high emotional exhaustion score.Conclusion The employment of older care workers was related to the job-facilitating or job-inhibiting factors of care staff, and the change in these factors was associated with lower emotional exhaustion. The employment of older personnel may lower the risk of burnout among care staff.

Proposed System of Integrated Geriatric and Disability Care Services in Sri Lanka (A Concept Note)

The global landscape is witnessing a significant transformation marked by a rapid increase in the aging population, driven by epidemiological and demographic transitions. Sri Lanka, like many other countries, is experiencing a significant demographic shift with an increase of older population. Notably, Sri Lanka stands out in South Asia, with 12.3% of its population aged 60 or older, the highest proportion in the region. Similar to other countries Sri Lanka also experiencing the increasing of elderly population. Sri Lanka is not geared to cater the elderly population and their needs as well as related health conditions, hence; it is the need in the current context. Objective of this paper is to propose a service delivery framework for elderly and related health care to the Sri Lankan health system based on the current findings. Methodology used are a desk reviews and key informant interviews to gather current data on elderly care and develop the model based on these findings. The development of geriatric health services in Sri Lanka is crucial to ensure that the growing elderly population receives the care and support they need to age healthily and maintain their quality of life. By addressing the unique healthcare challenges faced by the elderly, we can enhance the overall health and well-being of the elderly population in the nation.

Examination of the relationship between tasks in geriatric health service facilities and benefits of working for older assistant care workers

Objective In this study, we clarified the characteristics of tasks performed by older assistant care workers at geriatric health services facilities, by individual characteristics and work status. Additionally, we examined the relationship between the tasks and benefits of working for older assistant care workers.Methods A self-administered questionnaire survey was provided to 2,571 elderly care facilities employing assistant care workers aged ≥60. A total of 1,606 responses were obtained, and personal characteristics, working conditions, tasks, and benefits of working for older care assistants were surveyed. Thirteen work tasks were established and categorized into four broad categories; user transfer assistance, facility maintenance, meal-related assistance, and managing and talking to users. Seven benefits of working as care assistants were "contribution to society," "social connection," "purpose of life," "income," "learning from caregiving," "health maintenance and promotion," and "time utilization."Results Most of the respondents were women and relatively young workers. Among tasks, men, younger workers, and those working >5 days weekly represented a high proportion of those performing user transfer assistance tasks. Tasks on managing and talking to users were not correlated with sex, age, and number of days worked, but those with more flexible work patterns were more likely to be engaged in such tasks. Logistic regression analysis showed that user transfer assistance was correlated with benefits of working, such as "contribution to society," "social connection," and "learning from caregiving." Moreover, facility maintenance was associated with "income," "health maintenance and promotion," and "time utilization" and meal-related assistance was associated with "learning from caregiving." Managing and talking to users was associated with "contribution of society," "social connection," "purpose of life," and "learning from caregiving."Conclusion The tasks of the workers were associated with individual characteristics and work status. The perception of benefits between the working tasks that involved frequent contact with users and those that did not were considerably different.

The Scientific Production of Providing Health Services to the Elderly: A Scientometric Study

Introduction: Today, paying due attention to providing primary health services for the elderly is of high importance, and significant studies have been conducted in this regard in the world. The present study aimed to analyze the performance and drawing a scientific map of publications in the field of geriatric health services with a scientometric approach. Methods: In this scientometric study, all the scientific outputs in the field of geriatric health services in the Science Citation Index Expanded (SCIE-Web of Science) in the period from 1980 to August 18, 2023 were included. For data analysis, biblioshiny and Excel software were used. Results: Among 33238 documents in the field of geriatric health services indexed in the SCIE, the most of them were original articles. The growth trend of these documents was increasing so that the lowest number is related to 1987 with two documents and the highest number is related to 2022 with 3315 documents. BMJ Open was the most productive journal and Lancet was the most cited journal in this field. Univ Toronto was the most prolific institution and Cohen AD was the most prolific author. The keywords health services research and epidemiology were the most frequent. Conclusion: By presenting a comprehensive picture of the current state of studies in the field of geriatric health services, this study can determine the direction of future research. In addition, the findings of the present study can guide the direction and effectiveness of the research in this field.

ENHANCING CARE FOR OLDER VETERANS WITH COMPLEX PHYSICAL, COGNITIVE, AND PSYCHOLOGICAL COMORBIDITIES

Abstract Older veterans present in healthcare settings with more diagnoses than younger veterans and non-veteran older adults. Older veterans are also more likely to present with co-occurring physical, cognitive, and psychological conditions that are difficult to assess and treat. This is further complicated by the fact that many older veterans reside in rural areas without easy access to specialty care and, even in non-rural settings, there is a dire shortage of providers with geriatric expertise both within and outside of the Veterans Health Administration (VHA) system. The current symposium highlights promising findings from a variety of VHA programs aimed at enhancing the quality and reach of care provided to older veterans with complex needs. First, Dr. Bamonti will present mixed-methods results from her work in the development of Step-Cognitive Behavioral Therapy, a novel virtual intervention for older veterans with COPD. Second, Ms. Carlson will describe program evaluation outcomes from a project aimed at expanding geriatric mental health services via telehealth to older veterans with complex needs residing in rural areas. Third, Dr. Peeples will discuss factors affecting the implementation of the VA Behavioral Recovery Outreach Team model, which is aimed at facilitating successful discharge from inpatient settings and preventing rehospitalization for older veterans. Finally, Dr. Gregg will describe qualitative findings examining a component of the Geriatric Scholars Program for Psychologists, a national post-licensure training program for psychologists treating older rural veterans with complex needs. Dr. Karel, National Director of VHA Geriatric Mental Health, will close with discussion and highlight future directions.

The structural characteristics of the lifestyle among older adults and its impact on the health in China.

Enhancing overall health remains a primary global objective, with lifestyle being a crucial factor impacting the health status among older adults. This study focuses on the lifestyle of Chinese older adults, systematically exploring the evolution and characteristics of their lifestyle and investigating its impact on their health. Utilizing panel data from the Chinese Longitudinal Health Longevity Survey (CLHLS) from 2008, 2011, 2014, and 2018, we adopted 15 indicators reflecting older adults' lifestyle. Latent class analysis and ordinary least square regression were used to uncover the structural nuances of the Chinese older adults' lifestyle and its effects on health. The study identifies three distinct lifestyle categories for the older adults: relatively positive, mixed, and relatively negative. It reveals that the Chinese older adults do not predominantly adopt a positive lifestyle, and this trend persisted from 2008 to 2018. Each improvement in lifestyle category significantly boosts the older adults' physical health, mental health, and self-assessed health by 11.2%, 3.6%, and 17.1%, respectively. To attain the strategic aim of healthy aging, efforts should prioritize encouraging the older adults to adopt a positive lifestyle, enhance the geriatric health service system, and promote an intelligent lifestyle management model.

A factual investigation of the information nurses transfer between facilities through nursing summary reports

Objective: To clarify the medical care information nurses share among multiple facilities such as hospitals and visiting nursing stations, specialized nursing homes, and geriatric health service facilities in Japan.Methods: The research design was an exploratory survey study. We administered a questionnaire survey to registered nurses with at least three years of clinical experience from August 2020 to September 2021. Data from 257 participants were analyzed using simple tabulation, chi-square test, and univariate and multivariate analyses. Items that could not be addressed by nursing summaries alone included how to interact with patients and families, activities of daily living, and nursing procedures.Results: The results indicate that nurses require information on nursing procedures, how to interact with patients and their families, and care. Essential nursing summary report items included infectious disease, allergy, medications, final bowel movements, and tube feeding. The essential items that varied across facilities were commissioned physicians, patients’ perspectives on the disease, regular medical examinations, and peripheral symptoms.Conclusions: The summary reports were used to exchange information with other nurses, get confirmation of nursing procedures, and get confirmation of the history of the present illness. In the future, they should include customized content depending on the information requirements of each institution. These results can be used as a reference for the nursing summaries sought by recipients, leading to improved quality of care after a transition.

Relationship between the perceived benefits of working and emotional exhaustion among older assistant care workers: A cross-sectional study

Objectives This study is intended to clarify the perceived benefits of working among older assistant care workers employed in geriatric health service facilities and examine the relationship between perceived benefits and emotional exhaustion.Methods We analyzed data from a mail survey of older assistant care workers employed in geriatric health service facilities that the Japan Association of Geriatric Health Services Facilities conducted in 2020. In this survey, those aged ≥60 were defined as older assistant care workers. Responses were obtained from 1,606 older assistant care workers at 599 facilities. The dependent variable was the emotional exhaustion subscale of the Japanese version of the Burnout Questionnaire. The independent variables were the seven benefits of working as an assistant care worker: 1) I can contribute to society; 2) I am connected to society; 3) I have a sense of purpose in life; 4) I am earning the income I expected since I started working as an assistant care worker; 5) I am learning about care; 6) It has maintained and improved my health; and 7) I can use my time effectively. Latent class analysis (LCA) was performed using these seven benefits as independent variables. Multiple regression analysis was performed using emotional exhaustion and the perceived benefits as dependent and independent variables, respectively. The missing values were supplemented by the multiple imputation method.Results Overall, 1,601 responses were analyzed after excluding 5 respondents who did not answer all the questions. Four patterns were identified from the LCA results: the "benefit-full type," who perceived all benefits; the "benefit-less type," who perceived few benefits; the "benefit-extroverted type," who perceived social contribution and connection as benefits; and the "benefit-introverted type," who perceived health maintenance and improvement and time utilization as benefits. The multiple regression analysis showed that emotional exhaustion scores were higher for the "benefit-extroverted" and "benefit-less" types than for the "benefit-full" type (b=2.465, P<.001 and b=1.931, P<.001, respectively). No difference was found in the case of the "benefit-introverted" type (b=0.050, P=.851).Conclusion The perceptions of diverse and introverted benefits were associated with lower emotional exhaustion scores among older assistant care workers. Future intervention studies are needed to examine whether obtaining diverse or introverted benefits can decrease the emotional exhaustion score.

Changes in cerebrovascular disease–related deaths and their location during the COVID-19 pandemic in Japan

ObjectiveThe COVID-19 pandemic placed an enormous strain on healthcare systems and raised concerns for delays in the management of patients with acute cerebrovascular events. In this study, we investigated cerebrovascular excess deaths in Japan. Study designVital mortality statistics from January 2012 to May 2022 were obtained from the Japanese Ministry of Health, Labour and Welfare. MethodsUsing quasi-Poisson regression models, we estimated the expected weekly number of cerebrovascular deaths in Japan from January 2020 through May 2022 by place of death. Estimates were calculated for deaths in all locations, as well as for deaths in hospitals, in geriatric health service facilities, and at home. The age subgroups of ≥75 and <75 years were also considered. Weeks with a statistically significant excess of cerebrovascular deaths were determined when the weekly number of observed deaths exceeded the upper bound of 97.5% prediction interval. ResultsExcess deaths were noted in June 2021 and became more pronounced from February 2022 onward. The trend was notable among those aged ≥75 years and for those who died in hospitals. With respect to the location of deaths, the excess was significant in geriatric health services facilities from April 2020 to June 2021, whereas no evidence of excess hospital deaths was observed during the same period. ConclusionsBeginning in the late 2021, excess cerebrovascular deaths coincided with the spread of the Omicron variant and may be associated with increased healthcare burden. In 2020, COVID-19 altered the geography of cerebrovascular deaths, with fewer people dying in hospitals and more dying in geriatric health service facilities and at home.

Innovative Models of Geriatric Mental Health Services

The demographics of residents residing in long term care facilities is changing in many ways. There is a substantial increase of those admitted with serious mental illness, and at a younger age. Greater than 50% of residents have a neurodegenerative illness, such as dementia, and subsequently they all will experience behavioral and psychological symptoms of dementia during their admission. The new ICD-10 codes are integral to quality care and outcomes for this population. Most current approaches to the behavioral health needs of this population fall short of meeting resident and facility needs. This presentation seeks to consider a bold, interprofessional, and integrated approach to the bedside care of geriatric mental health services in long term care. Consideration includes proper ICD-10 code diagnosis and a culture of care that emphasizes the patient as an individual to improve quality of life and quality of care. This falls directly in line with the President's Commission on Aging Quality and Best Practices in Geriatric Psychiatric services and includes: a multidisciplinary team approach, specific geriatric expertise, individualized assessment, collaborative treatment planning between the consultant and facility staff, as well as a strong educational component. Current barriers to success will be explored to improve overall performance of the mental healthcare team.

Utilizing Telehealth to Meet the Needs of Rural Veterans: Introduction the VA's Clinical Resource Hubs Geriatric Mental Health Programs

The Department of Veterans Affairs Clinical Resource Hubs (CRHs) offer a variety of telehealth initiatives designed to expand access to care. Each VA Integrated Service Network (VISN) or region has its own CRH to provide telehealth services to veterans residing in that region. Many older veterans receiving services through the telemental health programs reside in rural areas, with limited access to specialty care. Several CRHs offer geriatric mental health consults to expand older veterans’ access to specialty mental health treatment. By utilizing telehealth consultations, older veterans are able to receive high quality mental health care in their homes or at small local clinics.At this time, the CRHs serving VISN 9 (Tennessee and Kentucky), VISN 23 (North Dakota, South Dakota, Nebraska, Iowa, and Minnesota), VISN 1 (New England), VISN 20 (Washington, Oregon, Idaho and Alaska), and VISN 4 (Pennsylvania) offer specialized geriatric mental health services. All of these CRHs offer consultative care with exception of VISN 20, which offers fully virtual continuity clinics to highly underserviced areas within that region. VISN 23 was the first region to offer such a program and has been in operation through the CRH since 2018 (although its geriatric psychiatrist was providing consultative telehealth services prior to that). VISN 9, VISN 20, and VISN 1 began program development and services in 2021. The programs receive additional support from the VA Office of Rural Health, which has also funded a program evaluation team.Each region's geriatric mental health program has a geriatric psychiatrist as well as additional team members with geriatric specialty experience in various fields such as psychology, pharmacy, neuropsychology, internal medicine, and nursing. Care is provided through a range of modalities, including electronic consultations (e-consults), direct to home video visits, video visits at local clinics and inpatient/residential settings, and telephone evaluations. A range of diagnosis and concerns are addressed including, but not limited to, dementia diagnosis and management, caregiver support, treatment of complex psychiatric conditions in late life, and capacity. Veterans residing in outpatient, inpatient, and VHA residential/long term care settings are all eligible for care through CRH programs. Although these programs share a common goal to expand access to geriatric mental health treatment, each program operates uniquely, with different models of care based on the needs of their region's specific population. Our session will start by highlighting the care offered by CRHs and the VA Office of Rural Health's program evaluation research. The geriatric psychiatrist from VISN 9, VISN 23, and VISN 1 will present the specifics of their program, focusing on program development, types of care provided, and population served.

Effectiveness of Intergenerational Interaction on Older Adults Depends on Children's Developmental Stages; Observational Evaluation in Facilities for Geriatric Health Service.

The demand for intergenerational exchange is growing in the world, where the size of a family is becoming smaller. To promote intergenerational exchange, it is important to know whether different stages of child age have different effects. This study aimed to examine effects of intergenerational exchange using children at different developmental stages through a questionnaire survey. The subjects were 296 employees of 116 facilities for geriatric health services that routinely conduct intergenerational exchanges. A questionnaire was designed to ask the employees what effects were observed on old adults and on the employees themselves after intergenerational exchanges were conducted. The results indicated that younger children caused better effects both for older adults and for the employees regarding some of the items, while older children caused equal or lesser effects for all items. It was suggested that the developmental stage of children should be considered according to the purpose of intergenerational exchange.

Phase angle as a prognostic factor for one-year mortality in geriatric health service facility residents.

[Purpose] The present study aimed to investigate the association of phase angle with the continuing activities of residents in a geriatric health service facility for one year. We compared the phase angle among current residents in a geriatric health service facility with those who died within one year. [Participants and Methods] This one-year prospective observational study included 149 residents who entered a geriatric health service facility. We divided participants into two groups: an over one-year survival group and a death within one year group. The receiver operating characteristic curves were created to determine the sensitivity and specificity for predicting one-year mortality based on the phase angle. [Results] The phase angle was significantly higher in the one-year survival group than in the death within one year group and was independently and significantly associated with one-year mortality using binomial logistic regression analysis. The phase angle was shown to have predictive power (based on the area under the receiver operating characteristic curve). Based on the calculation for identifying one-year survival, the optimal cut-off value for the phase angle was 2.95° (area under the receiver operating characteristic curve=0.76, sensitivity 55.6%, specificity 83.3%). [Conclusion] The phase angle may contribute to the prognosis of one-year mortality for residents of geriatric health service facilities.

Change in end-of-life care and staff thinking at a geriatric health services facility after the introduction of the "My Wishes" notebook

A geriatric health services facility had been working to improve end-of-life care since 2014. In 2017, the facility introduced the My Wishes notebook, which confirms individual's medical choices and distributed the Explaining Practices and Intentions of End-of-life Care book in 2018, in order to help their staff improve care for older adults. Care staff used their learning in caregiving for older adults. This study aimed to clarify the change in end-of-life care and staff thinking at a geriatric health services facility after the introduction of the My Wishes notebook. We requested cooperation from all care staff at a geriatric health services facility, and focus group interviews were conducted with 13 staff members over two days in June 2019. The responses in relation to two parameters, the staff members' thoughts and the change in end-of-life care, following the introduction of My Wishes were recorded and qualitatively analyzed. Six categories of responses were extracted from the qualitative analysis: "Difficulty in using My Wishes", "Effects of the use of My Wishes ", "The practice of sought care", "Intentional involvement with patients' families", "Self-confidence in end-of-life care", and "End-of-life care becoming common practice". After the introduction of My Wishes, the care staff found that there were difficulties in using My Wishes, such as writing on paper and difficulties in them hearing. On the other hand, they felt the effects of using My Wishes, such as knowing a new side, feeling further possibilities of care, and activating communication among interdisciplinary healthcare providers. Then, while intentionally engaging with patients' families, they will seek and practice the care that the older adults want. Furthermore, while repeatedly searching for and practicing the care that older adults want, they will gain confidence in providing care and change to normalize these care practices.

Oral and Rectal Colonization by Antimicrobial-Resistant Gram-Negative Bacteria and Their Association with Death among Residents of Long-Term Care Facilities: A Prospective, Multicenter, Observational, Cohort Study

Introduction: The prevalence of antimicrobial-resistant bacteria (ARB) in long-term care facilities (LTCFs) remains unclear. Furthermore, the effect of ARB colonization on the clinical outcomes of LTCF residents has not been explored. Methods: We conducted a prospective multicenter cohort study and investigated the residents (N = 178) of six Japanese LTCFs (three Welfare Facilities for the Elderly Requiring Long-term Care and three Geriatric Health Service Facilities) for oral and rectal carriage of ARB. The clinical outcomes of the residents were evaluated based on isolating bacterial strains and subjecting them to whole-genome sequencing. Results: Of the 178 participants, 32 belonging to Geriatric Health Service Facilities with no information on their clinical outcome were excluded, and the remaining 146 were followed up for at most 21 months. Extended-spectrum β-lactamases (ESBL)-producing Enterobacterales and Pseudomonas aeruginosa were detected in 42.7% (n = 76) and 2.8% (n = 5) of the rectal swabs and 5.6% (n = 10) and 3.4% (n = 6) of the oral swabs, respectively. Detection of ARB in the oral and rectal cavities showed remarkable association with enteral nutrition. Further, P. aeruginosa was significantly associated with an increase in mortality of the residents, but there were not significant association between ESBL-producing Enterobacterales and mortality. Core-genome phylogeny of P. aeruginosa revealed a wide-spread distribution of the isolated strains across the phylogeny, which included a cluster of ST235 strains with substantially higher biofilm formation ability than the other isolated P. aeruginosa strains. Discussion/Conclusion: This study is the first to investigate the carriage of both oral and rectal ARB, genomic relatedness and determinants of antimicrobial resistance in isolated strains, and clinical outcomes of LTCF residents. Our study provides the first direct evidence for the burden of antimicrobial resistance in LTCFs.

Morbidities, health problems, health care seeking and utilization behaviour among elderly residing on urban areas of eastern Nepal: A cross-sectional study.

Morbidity increases with age and enhances the burden of health problems that result in new challenges to meet additional demands. In the ageing population, health problems, and health care utilization should be assessed carefully and addressed. This study aimed to identify chronic morbidities, health problems, health care seeking behaviour and health care utilization among the elderly. We conducted a community based, cross-sectional study in urban areas of the Sunsari district using face-to-face interviews. A total of 530 elderly participants were interviewed and selected by a simple proportionate random sampling technique. About half, 48.3%, elderly were suffering from pre-existing chronic morbidities, of which, 30.9% had single morbidity, and 17.4% had multi-morbidities. This study unfurled more than 50.0% prevalence of health ailments like circulatory, digestive, eye, musculoskeletal and psychological problems each representing the burden of 68.7%, 68.3%, 66.2%, 65.8% and 55.7% respectively. Our study also found that 58.7% preferred hospitals as their first contact facility. Despite the preferences, 46.0% reported visiting traditional healers for treatment of their ailments. About 68.1% reported having difficulty seeking health care and 51.1% reported visits to a health care facility within the last 6 months period. The participants with pre-existing morbidity, health insurance, and an economic status above the poverty line were more likely to visit health care facilities. Elderly people had a higher prevalence of health ailments, but unsatisfactory health care seeking and health care utilization behaviour. These need further investigation and attention by the public health system in order to provide appropriate curative and preventive health care to the elderly. There is an urgent need to promote geriatric health services and make them available at the primary health care level, the first level of contact with a national health system.

Decision-making support for elderly individuals with dementia in a geriatric health service facility: A questionnaire survey on concrete care methods to draw wills of individuals

The purpose of this study was to clarify the care methods used by healthcare staff in service facilities to draw up wills for elderly individuals with dementia in daily life and the final stage in decision-making support. A questionnaire survey was conducted among healthcare staff in a geriatric health service facility in August 2020. There were 45 subjects (16 males [35.6%]; 29 females [64.4%]). The average age was 42.2 (±12.3) years old, and the mean number of years of experience in a geriatric health service facility was 17.4 (±10.7) years. Deathbed care was provided to ≥90% of the subjects. A factor analysis of items related to decision making in elderly individuals with dementia revealed the first factor to be "support and communication to draw wills", the second factor to be "support and communication for expression to realize decision making", and the third factor to be "understanding, communication, and family support for decision-making realization." The totals of each of these three factors and "having confidence in care focusing on the viewpoint of elderly individuals with dementia" were significantly different. The correction between the Personhood of Approaches to Dementia Questionnaire Japanese version and the three subscales of decision making in elderly individuals with dementia had a significant coefficient of correlation. More polite communication methods are necessary for the formation, expression, and realization of the intentions of elderly individuals with dementia to support their decision making.

Integrating geriatric medicine and mental health services to better serve older adults in Southwestern Ontario

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.