Home Care Environment Research Articles

Exploring client violence during home visits: a qualitative study of perceptions and experiences of Israeli nurses

BackgroundHome care provides an excellent opportunity for personalizing treatment as nurses see patients in their natural environment. Along with its many advantages, the home care environment carries unique risks, as nurses are usually alone, without the protection and security provided by primary care clinics. There are no accurate data in Israel on the scope and characteristics of client violence against nurses during home visits. We conducted a qualitative study to investigate the nature of client violence faced by Israeli nurses during home visits, to gain insights into their perceptions and experiences, and to contribute to the development of effective policies and strategies to combat client violence in the healthcare sector.MethodsTwenty-seven female nurses from primary care clinics, who were exposed to client violence during a home visit, were interviewed using a semi-structured interview guide. The interviews were transcribed and analyzed, and categories and themes were extracted.ResultsMost nurses interviewed experienced at least three incidents of client violence, the most common of which was verbal abuse. The nurses perceived that the location of the encounter between the nurse and the patient in the patient’s natural surroundings, rather than within the controlled boundaries of a clinic, contributes to the risk of violence. Violence affected the nurses’ professional decisions. The nurses reported that their organization had no established guidelines or instructions for safely conducting home visits, they were not provided with protective or security measures for emergencies, nor did they perceive that they had sufficient training to deal with client violence in clients’ homes.ConclusionsNurses encounter a range of challenges that make it difficult for them to deal with client violence during home visits, affecting their personal safety and professional decisions. Their ability to manage such situations is shaped by a complex interplay of personal and organizational factors and requires a range of strategies and resources to effectively address them.

Phthalate and DINCH metabolites in the urine of Hungarian schoolchildren: Cumulative risk assessment and exposure determinants

A human biomonitoring study was conducted to assess the exposure of Hungarian children aged 8–11 years to ten phthalate esters (PEs) and DINCH between 2017 and 2018. In addition to collecting urine samples from 262 participants, a questionnaire was completed by the parents or legal guardians to identify potential determinants of exposure.The highest geometric mean concentration was observed for MiBP, followed by MBP, cx- MEHP, OH-MEHP and MEP. Three out of the four DINCH metabolites were detected in more than 90% of the samples. The comparison of the urinary concentrations measured in this study with those observed in the DEMOCOPHES study revealed a significant decreasing trend in all PE metabolites investigated in both studies between 2011/2012 and 2017/2018. Different approaches were used to assess the health risks associated with the exposure to PEs and DINCH. Our results highlighted that the hazard index (HI) values were higher than 1 in 17.6% of the children when the human biomonitoring guidance values were applied. In contrast, less than 3% of the children had HI values exceeding 1 when other sources of reference values were used. By applying a safety factor of 10 for the risk assessment, 17.6–91.6% of the children were characterized by HI values higher than 0.1, indicating the need for risk reduction measures. Overall, DnBP, DiBP and DEHP were identified as the main drivers of the mixture risk. Although PEs and DINCH are ubiquitous contaminants, there are still inconsistencies and gaps in our understanding of the determinants of exposure. The results of the multivariate regression analysis showed significant associations between PE or DINCH metabolite concentrations and certain individual characteristics, use of personal care products, home and school environment and food and beverages consumption 24 h prior to sample collection.

Anthropometric and sociodemographic variables, but not preconception or prenatal maternal nutrition supplementation, predict neurodevelopment in offspring of the 'Women First'trial.

Multiple factors influence infant and child neurodevelopment in low resource settings. In offspring of participants in the preconception maternal nutrition trial, Women First(WF), we examined the impact of providing a preconception (Arm 1) or prenatal (Arm 2) nutrient supplement (compared to controls, Arm 3) on neurodevelopmental outcomes at 24 months; predictors of neurodevelopment scores; and associations of infant anthropometrics with neurodevelopmental scores. Follow-up visits for anthropometry were conducted at 6-, 12-, 18-and 24-monthof age. At 24-months, in a randomized subset,the Bayley Scales of Infant Development, 3rdedition (BSID-III), including cognitive, motorand social-emotional subscales,and the Family Care Indicators (FCI) questionnaire, assessing family and home environment, were completed. Multiple covariates (intervention arm, site, maternal sociodemographic characteristics, FCI subscales, birthweightand 6-24 months'change in anthropometry z-scores, (e.g., ΔLAZ6-2 4) were evaluated by linear regression to predict BSID-III outcomes and to assess associations of anthropometric changes with BSID-III scores. The analysis consisted of 1386 infants (n = 441, 486, 459 for Arms 1, 2and 3, respectively). None of the domain-specific BSID-III subscale scores differed by maternal intervention arm. Four covariates significantly predicted (p ≤ 0.01) all 3 BSID-III subscales: secondary maternal education, ΔLAZ6 - 24, birthweight >2500 g, and FCI play materials. Linear growth was associated with all domains of neurodevelopment. The results underscore the multi-dimensional aspects of child development represented by the nurturing care framework, including prenatal maternal nutrition, post-natal growth, maternal education for responsive caregivingand opportunities for early learning.

Reminiscence respecified: A conversation analytic examination of practice in a specialist dementia care home

Although discussion of reminiscence is prevalent in dementia care research, few studies have examined what actually occurs in these interactions, and how they are structured. This study examined how reminiscence activities are structured and negotiated in a care home environment. Informal one-to-one reminiscence interactions between people living with dementia and professional carers were transcribed from a larger video dataset. We used Conversation Analysis to examine reminiscence sequences in a novel relational approach that explored the interactional practices used by carers and people living with dementia. We identified divergences between manualised practice recommendations and observed interactional practices, such as the rarity of open questions, and frequent use of closed questions. This was contrary to current practice recommendations. These and other divergences demonstrate the value of interactional research in informing reminiscence practice and training manuals. By examining how reminiscence operates in practice, our approaches to conducting such activities can be more empirically informed. Our findings can be used to advise and guide those doing reminiscence work in care home settings, and improve the inclusiveness of reminiscence interactions. Through incorporating empirically informed techniques that both carers and people with dementia use in practice, we can facilitate interactions around memories which are supportive of people with dementia's identity.

Assessment of the occupational exposures within homes for home healthcare workers in the United Kingdom

Many of the tasks being conducted by home healthcare workers are associated with significant complex demands. Each home is a unique work environment with potentially different exposures. The purpose of this study was to investigate the plethora of exposures for home healthcare workers in the United Kingdom. The study was a cross-sectional study that utilized a trained supervisor to complete the direct observation of the healthcare worker (nursing aide and nurse). Environmental hazards that were captured included mold/mildew (8.7%) and dogs (14.5%), and secondhand smoking (15.9% with smell in home and 8.7% with active smoking). Verbal abuse was prominent for nurse aides (31% experiencing it). Ergonomic hazards were observed through various tasks such as repositioning in bed (34.8%), transfer from bed to chair (30.4%), transfer from bed to chair (26.1%), and transfer from chair to chair (26.1%) and particularly for nursing aides. The results of the current observations indicated that home healthcare workers faced a multitude of exposures that could lead to injuries. This provides a rigid platform for occupational safety and ergonomics specialists to appreciate the occupational exposures and challenges that home health care workers face in the unique home care environment and proactively identify mitigation measures of the respective occupational hazards.

FP-GCN: Frequency Pyramid Graph Convolutional Network for Enhancing Pathological Gait Classification.

Gait, a manifestation of one's walking pattern, intricately reflects the harmonious interplay of various bodily systems, offering valuable insights into an individual's health status. However, the current study has shortcomings in the extraction of temporal and spatial dependencies in joint motion, resulting in inefficiencies in pathological gait classification. In this paper, we propose a Frequency Pyramid Graph Convolutional Network (FP-GCN), advocating to complement temporal analysis and further enhance spatial feature extraction. specifically, a spectral decomposition component is adopted to extract gait data with different time frames, which can enhance the detection of rhythmic patterns and velocity variations in human gait and allow a detailed analysis of the temporal features. Furthermore, a novel pyramidal feature extraction approach is developed to analyze the inter-sensor dependencies, which can integrate features from different pathways, enhancing both temporal and spatial feature extraction. Our experimentation on diverse datasets demonstrates the effectiveness of our approach. Notably, FP-GCN achieves an impressive accuracy of 98.78% on public datasets and 96.54% on proprietary data, surpassing existing methodologies and underscoring its potential for advancing pathological gait classification. In summary, our innovative FP-GCN contributes to advancing feature extraction and pathological gait recognition, which may offer potential advancements in healthcare provisions, especially in regions with limited access to medical resources and in home-care environments. This work lays the foundation for further exploration and underscores the importance of remote health monitoring, diagnosis, and personalized interventions.

'I wasn't on the front line per se, but I was part of health care': Contributions and experiences of ancillary staff in care homes in England during the COVID-19 pandemic.

Ancillary staff - cleaning, catering, housekeeping and laundry workers - play a crucial role in care homes, by promoting infection control, food preparation and hygiene, and contributing to the care home environment. This study sought to understand the experiences of ancillary staff working in English care homes during the COVID-19 pandemic. The results will inform policy makers, employers, care home managers and others, both in England and overseas, as how to best support the ancillary workforce. Between March and August 2021, video and telephone interviews were conducted with those working or living in care homes in England. Participants comprised ancillary staff (n = 38), care home managers (n = 8), care home residents' family members and friends (n = 7), human resource managers (n = 5) and care home residents (n = 5). Ancillary staff often had increased responsibilities and contributed to pandemic efforts by changing working practices, routines and job roles with the aim of supporting residents and other staff. Teamwork, underpinned by strong leadership, helped ancillary staff feel supported. Ancillary staff should be better recognised as being central to care home care. They are essential workers helping to keep residents safe and well.

Full-coverage unobtrusive health monitoring of elders at homes

Due to the fast increase of the elderly population, in-home eldercare has emerged as an important topic of research. Existing studies in intelligent health monitoring have yielded promising outcomes. Nevertheless, these approaches fall short of achieving round-the-clock, unobtrusive surveillance. Herein, we introduce a system offering full-dimensional and unobtrusive in-home health monitoring for elderly individuals living alone. We deploy smart sensors, including infrared, bed, sound, and physiological sensors, to provide all-around coverage of the elderly living space. The proposed system proficiently identifies activities such as cooking, coughing, snoring, talking, listening to music, and walking, while concurrently estimating the indoor location and providing intelligent sleep monitoring and assessment of physiological parameters. Our proposed algorithm has undergone evaluation using real-world data, encompassing a 30-day activity record of ten subjects aged 65 and older. The results demonstrate the remarkable effectiveness of our method, showcasing a high degree of accuracy in recognizing a diverse range of activities. This substantiates the practical implementation of our system in authentic homecare environments.

Exploring the impact of care home environments and culture on supporting residents to ‘wander’ safely

Objectives Up to 60% of people with dementia living in care homes will ‘wander’ at some point, which has typically been seen by staff as a problematic behaviour. A range of non-pharmacological interventions have been tested to either support or prevent wandering. However, even recent innovative practice continues to maintain a focus on reducing or preventing wandering. This study aimed to identify, for the first time, care home staff perspectives on home level factors that facilitate or hinder them supporting residents to wander safely. Method Semi-structured qualitative interviews were conducted with 19 care home staff, working in the North of England. Framework analysis was used to analyse the data. Results A range of environmental considerations were identified by staff. Care home design influenced how residents were able to move safely around, and inclusion of points of interest encouraged walking to different locations, such as a garden. Staff worried about managing access to other residents’ rooms by people who wander. Within the care home culture, prioritising safe staffing levels, training and awareness, involving external healthcare professionals where required and mentorship from experienced staff members, all contributed towards safe wandering. Staff support for positive risk-taking within the care home was key to promote person-centred care, alongside careful oversight and management of relationships between residents. Conclusion We identified a range of cultural and environmental factors that contribute towards safe wandering. A positive approach to risk-taking by staff is required to support residents to engage in wandering as an enjoyable activity, whilst acknowledging that there are inherent risks associated with this.

Brain vital signs as a quantitative measure of cognition: Methodological implementation in a care home environment

IntroductionManaging cognitive function in care homes is a significant challenge. Individuals in care have a variety of scores across standard clinical assessments, such as the Mini-Mental Status Exam (MMSE), and many of them have scores that fall within the range associated with dementia. A recent methodological advance, brain vital sign monitoring through auditory event-related potentials, provides an objective and sensitive physiological measurement to track abnormalities, differences, or changes in cognitive function. Taking advantage of point-of-care accessibility, the current study evaluated the methodological feasibility, the assessment of whether a particular research method can be successfully implemented, of quantitatively measuring cognition of care home residents using brain vital signs. Secondarily, the current study examined the relationship between brain vital signs, specifically the cognitive processing associated N400 component, and MMSE scores in care home residents. Materials and methodsBrain vital signs used the established N100 (auditory sensation), P300 (basic attention), and N400 (cognitive processing) event-related potential (ERP) components. A total of 52 residents were enrolled, with all participants evaluated using the MMSE. Participants were assigned into homogeneous groups based on their MMSE scores, and were categorized into low (n = 14), medium (n = 17), and high (n = 13) MMSE groups. Both brain vital sign measures and underlying ERP waveforms were examined. Statistical analyses used partial least squares correlation (PLS) analyses in which both MMSE and age were included as factors, as well as jackknife approaches, to test for significant brain vital sign changes. ResultsThe current study successfully measured and analyzed standardized, quantifiable brain vital signs in a care home setting. ERP waveform data showed specific N400 changes between MMSE groups as a function of MMSE score. PLS analyses confirmed significant MMSE-related and age-related differences in the N400 amplitude (p < 0.05, corrected). Similarly, the jackknife approach emphasized the N400 latency difference between the low and high MMSE groups. Discussion and conclusionIt was possible to acquire brain vital signs measures in care home residents. Additionally, the current study evaluated brain vital signs relative to MMSE in this group. The comparison revealed significant decreasing in N400 response amplitude (cognitive processing) as a function of both MMSE score and age, as well as a slowing of N400 latency. The findings indicate that objective neurophysiological measures of impairment are detectable in care home residents across the span of MMSE scores. Direct comparison to MMSE- and age-related variables represents a critical initial step ahead of future studies that will investigate relative improvements in sensitivity, validity, reliability and related advantages of brain vital sign monitoring.

Usefulness of the Palliative Prognostic Index in Predicting Prognosis when Considering the Transition from Hospital to Home Care in Patients with Terminal Stage Cancer.

No accurate prognostic tool is available for patients with cancer who spend their final days at home. In this study, we examined whether performance status (PS) and the palliative prognostic index (PPI), a well-known prognostic tool in palliative care units, could be used to predict prognosis in the home care setting at the time of intervention by home physicians. Using medical records, we conducted a retrospective analysis of 132 patients who were referred to the Home Clinic Naginoki for home care for terminal stages of carcinoma in situ. Based on the status at the time of the first visit, the PPI-Low group was defined as those scoring six or below and the PPI-High group as those scoring greater than six. The PPI-high group had a significantly poorer prognosis within 21 days than the PPI-low group (21-day-OS; Low 71.4% vs. High 13.2%; p<0.001). The Eastern Cooperative Oncology Group (ECOG) PS alone predicted better prognosis in the group with PS of one or two (21-day survival 90.1%), and the PPI score further significantly stratified the prognosis for patients with PS three or four, with a trend toward poor prognosis (p ≤ 0.005). ECOG PS 1 or 2 has a favorable prognosis and that using PPI in ECOG PS 3 or 4 leads to a more accurate prognosis prediction. PPI evaluated during the hospital-based treatment of patients with terminal cancer can also be used to predict prognosis if the patient is transitioned to a home care environment.

Living well and healthy ageing in the care home environment

Sarah Palmer looks at how care homes can meet older people's needs to help them to live well.

Disability and Health Services: The Case of Women in Spain

Background: For as long as data have been collected, women with disabilities have had worse health conditions than other women. Moreover, women with disabilities make more use of healthcare services than women without disabilities. Objective: The main aim of this study is to analyze the impact of various factors on the use of healthcare services by this group of women at risk of exclusion. Methods: Binary logistic regression models are used to examine seven indicators of the use of healthcare services and evaluate the influence of factors, such as age and emotional and personal support. To that end, the analysis uses data from the most recent Spanish National Health Survey (SNHS, 2017) published by the Spanish Statistical Office (INE). Results: Studies on the use of healthcare services have focused on the influence of social status on economic factors and do not include explanatory variables relating to the social and family environment of women with disabilities. Therefore, this study includes variables representing home care services and emotional and personal support to capture the impact of human relationships and the home care environment on health in such a way that its importance and its effect on the use of health services can be determined, distinguishing between the general population and the female population with disabilities. Conclusion: The data in this study revealed important differences in the use of healthcare services by women with disabilities compared to other women and the population in general, as mentioned in the table and the results indicated above. It is essential that healthcare workers and policymakers identify and account for the different requirements of women with disabilities.

Responding to child sexual exploitation in Australia: Challenges and opportunities from the perspectives of case workers in a statutory care environment

There is a growing interest in understanding and responding to child sexual exploitation (CSE) in Australia, but limited empirical research from Australian contexts. The research reported here contributes to the evidence base by considering challenges and best practices for responding to CSE from the perspectives of 15 caseworkers in a statutory child protection and out of home care environment in one Australian region. In so doing, the paper also offers insight into CSE along with consideration of the emerging practice directions and systems surrounding these in the Australian context. Findings point to potential problems arising from existing frameworks for understanding and responding to CSE. Participants held concerns about a narrow focus on young people’s sexualised behaviours in the wider multi-agency care context. This was understood to obscure a more complex understanding of CSE and its broader context of vulnerability and connection to unmet needs – some of which can arise from the care context itself – making identification and intervention difficult. Findings align with research that emphasises outreach and intensive support for young people centring on strengthening connections, identifying and addressing unmet needs and sustaining safety through consideration of placements and living circumstances. Consideration of practice challenges and opportunities signals the importance of child-centred, wellbeing-oriented directions allowing for multiple models of CSE victimisation, underpinned by a shared language in the multi-agency context and enhanced provision in existing systems.

6.P. Workshop: Responding to violence and abuse across the life-course

Abstract Much research on the mental health effects of violence focus on domestic violence as experienced in adulthood. The mental health impacts are often gauged using cross-sectional studies and focus on current associations between violence and health. This workshop presents a range of analyses - drawing on data from New Zealand, Germany and the UK - that address the ways in which violence and abuse manifest at different life stages, including in childhood, among working-age adults, and in later life. The presentations highlight differences across the life course, as well as commonalities. They provide evidence of the long-term, even life long, shadow that violence and abuse can cast over people's health, and provide evidence of the extensive costs for society. Health impacts are shown to be broad, not only anxiety and depression, but substance dependence, chronic physical health conditions, and related health risks such as obesity. This workshop comprises four presentations that each consider violence and abuse prevalent at a particular stage of life, and provide evidence to inform the sensitive tailoring of responses from and for families, schools, health and social services, workplace human resource employees, and care and residential homes. The format of the workshop comprises brief presentations, with a focus on extended audience discussions. We invite engagement from people from a range of disciplines interested in how different forms of violence and abuse present at different life stages, the impacts on health, and the ways in which society should respond. This workshop is submitted on behalf of the EUPHA Public Mental Health Section. Key messages • Violence occurs across the life course. While its prevalence and form often vary between life stages, at every stage it has major, long-term, and diverse implications for health. • Interventions need to be tailored to the life course and sensitive to changing context, including domestic, workplace, and care home environments.

193 A review of the bed rail use and use of a bed rail risk assessment tool in a rehabilitation unit

Abstract Background Bed rails are used frequently throughout acute, community and home care environments to reduce the risk of bed occupants falling out of bed and causing injury. The use of risk assessment, along with patient preference, has been advised by HSE. Methods A chart review in a rehabilitation ward was undertaken to determine consideration and compliance of a Bed Rail Risk Assessment Tool (BRRAT) by nursing staff during inpatient stay. Results 44 patients were assessed. 31(70%) used a bed rail, with documented hourly observation noted in 97% of these charts. Of the 31, 30 patients (71%) voiced preference for a bed rail, specifying safety (n = 5) or fear of falling (n = 3) as a reason. Patient preference for no bed rail was documented in the majority (n = 7/9). Where bed rails were used, no patients were deemed at high risk of injury or entrapment. 4 patients at medium risk elected not to use a bed rail with the remaining 3 patients at medium risk choosing to have a bed rail despite the risk, due to fear of falling. All patients at low risk chose to have a bed rail (n = 25). Four patients had no BRRAT documented. 82% of decisions were documented to have been discussed with the patient. 18% were not assessed by the BRRAT as patient preference was taken solely into account. Conclusion A high proportion of patients were involved in decision-making, and the majority chose to use bed rails in a rehabilitation setting. Most had documented hourly observation of rails. The use of a BRRAT tool allows one to assess the risk of bed rails also on an individual basis, to ensure a well-rounded decision can be made. A full assessment should be carried out however, to inform the patient of their risk before taking their final decision into account.

Long-Term Adoption or Abandonment of Smart Technology in the Chinese Elderly Home Care Environment: A Qualitative Research Study.

China's rapidly aging population and shortage of care resources have made it difficult for its traditional model to meet the home care needs of the elderly. On this premise, China is implementing home digital health interventions based on smart technology. During implementation, instead of the expected explosion in long-term adoption, there has been a large amount of abandonment. But so far, the relationship between service experience and these behaviors has been ignored. This study aims to explore the reasons for the long-term adoption or abandonment behaviors of technology by elders in the home care environment. A qualitative study was conducted based on Golant's framework of smart technology adoption behaviors among elders. Semi-structured interviews were conducted with 26 elders who are long-term or former users of smart technology in a home care environment, and data from the interviews were analyzed using directed content analysis. This study identified three themes that influence elders' adoption behaviors of smart technology in the home care environment, including immediate effectiveness, long-term usability, and possible collateral damage. The findings indicated that the experience of the elders is the key point that affects long-term adoption behavior. For more elders to use smart technology in the home care environment, it is necessary for the government, technology developers, and nursing institutions to further reform the existing system.

Evaluating the performance of wearable devices for contact tracing in care home environments

COVID-19 has had a devastating impact worldwide, including in care homes where there have been substantial numbers of cases among a very vulnerable population. A key mechanism for managing exposure to the virus and targeting interventions is contact tracing. Unfortunately, environments such as care homes that were most catastrophically impacted by COVID-19 are also those least amenable to traditional contact tracing. A promising alternative to recall and smartphone-based contact tracing approaches is the use of discrete wearable devices that exploit Bluetooth Low Energy (BLE) and Long-Range Wide Area Network (LoRaWAN) technologies. However, the real-world performance of these devices in the context of contact tracing is uncertain. A series of experiments were conducted to evaluate the performance of a wearables system that is based on BLE and LoRaWAN technologies. In each experiment, the number of successful contacts was recorded and the physical distance between two contacts was compared to a calculated distance using the Received Signal Strength Indication (RSSI) to determine the precision, error rate, and duration of proximity. The overall average system contact detection success rate was measured as 75.5%; when wearables were used as per the manufacturer’s guidelines the contact detection success rate increased to 81.5%, but when obstructed by everyday objects such as clothing or inside a bag the contact detection success rate was only 64.2%. The calculated distance using RSSI was close to the physical distance in the absence of obstacles. However, in the presence of typical obstacles found in care home settings, the reliability of detection decreased, and the calculated distance usually appeared far from the actual contact point. The results suggest that under real-world conditions there may be a large proportion of contacts that are underestimated or undetected.

Family Caregivers as Employers of Migrant Live-In Care Workers: Experiences and Policy Implications

ABSTRACT As policymakers globally recognize aging in place as the preferred option for most adults, there is a growing need to supplement family or informal caregiving for frail older adults with formal homecare services, particularly for those who require 24/7 care due to significant physical and/or cognitive impairment. The core objective of this qualitative study was to explore family members’ experiences in employing live-in care workers, particularly the nature of their engagement and the quality of their relationships with these care workers. Our analysis of semi-structured interviews with 35 family caregivers revealed four themes: 1) challenges in acquiring support and developing dependency; 2) negotiation of roles, responsibilities, and moral dilemmas; 3) shifting emotions between trust and suspicion; and 4) role confusion, expectations, and disappointments. The study suggests that families might benefit from formal guidance regarding fostering and maintaining positive relationships in the homecare environment. This paper provides nuanced knowledge that may inform the development of such interventions.

Identifying barriers and facilitators to the inclusion of older adults living in UK care homes in research: a scoping review

BackgroundWith an ageing population, older adults will have more complex health and social care needs and many of these older adults will be living in care homes. Despite the growth in care home populations, care home residents are often excluded from research that could potentially benefit their care. The purpose of this scoping review is to explore resident-related barriers and facilitators to including older people living in UK care homes in research and to identify potential approaches to modify such barriers.MethodThe 6-stage scoping review methodology framework proposed by Arksey and O’Malley guided this review. Five electronic databases (MedLine, PsychINFO, Scopus, Web of Science, CINAHL) and grey literature were searched. Identified articles went through two levels of screening, and those deemed relevant were collated, summarised and reported using a thematic analysis approach.Results90 reports were eligible for inclusion and were synthesised into 7 themes and related subthemes: (1) research design; (2) understanding and beliefs about research (resident and care home staff); (3) communication; (4) relationships; (5) eligibility criteria (resident and care home); (6) preference-based decisions; and (7) care home staff and environment. Given the complex interplay of the factors identified, both direct and indirect factors were included.ConclusionsA number of recurring barriers and facilitators to the inclusion of care home residents in research are reported. However, isolating resident-related barriers was complex as both direct and indirect factors must be considered as influential. Understanding the barriers and facilitators to inclusion will enable these factors to be addressed and increase the evidence-base for care provided to older people living in care homes.