Home Care Setting Research Articles

Predicting adolescent and young adult outcomes from emotional support and cognitive stimulation offered by preschool-age home and early care and education settings.

Children's early environmental experiences are often considered highly influential for later life development. Yet, environmental contexts, such as the home and early care and education (ECE) setting, and multiple aspects of each setting, are not typically examined concurrently. In this study, we examined associations between cognitive stimulation and emotional support in the home and ECE setting during the preschool years (36-54 months) with adolescent (age 15; n = 708; 52% female) and adult (age 26; n = 584; 54% female) outcomes using data from the Study of Early Child Care and Youth Development, a study conducted at 10 sites across the United States. Cognitive stimulation in the home was significantly related to increased academic achievement at age 15 and educational attainment at age 26. Home emotional support was related to decreased behavior problems and increased social skills at age 15. No significant associations were found between either emotional support or cognitive stimulation in ECE and children's later development. These findings provide further support that the child's home environment during early childhood plays a substantial role in development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interpreting and evaluating open norms of person-centred care in daily regulatory practice of the Dutch nursing home care setting

Objective:The emphasis on person-centred nursing home care poses a key challenge for inspectors who regulate quality of care, because of its situated characteristics (i.e., for each client different and changing over time). This makes it difficult to assess with predetermined norms in contrast to for example requirements of medication safety. In this paper, we therefore empirically investigate how inspectors operationalize and evaluate open norms of person-centred care in the Dutch healthcare setting.Methods:Qualitative methods were used to study the work of inspectors who assess the quality of nursing home care within the Dutch Health and Youth Care Inspectorate. The first author7it observed the inspection process of nursing home care organizations (preparation, inspection visit, consults between inspectors and team meetings) and conducted semi-structured interviews with the observed inspectors and managers of the assessed organizations. Furthermore, different versions of the quality report were analyzed.Results:Easy made operationalizations of person-centred care (e.g., choice for meal) received more attention than other, less easily made, operationalizations of person-centered care (e.g., group dynamics). The following three exclusion mechanisms show why certain aspects of person-centred care got less attention than others: 1) not being able to triangulate information 2) doubting the trustworthiness of a person 3) not being able to deviate from the structure of the inspection program. Furthermore, there are two exclusion mechanisms that show how the assessment of person-centred care is ignored or overruled by other values in the assessment framework: 1) downplaying person-centredness by mitigating circumstances and, 2) prioritization of safety risks over risks of lacking person-centredness.Conclusion:In evaluating person-centred nursing home care using open norms, certain mechanisms are in place that exclude the assessment of quality of (certain aspects of) person-centered care. To overcome these mechanisms, a different, more reflexive approach for regulation might be needed to encourage stakeholders to engage in self-observation and self-criticism. Reflexive regulation using narrative methods can be especially helpful with complex issues, which are associated with uncertainty about standards and where different perspectives play a role. In further participative action research, we will experiment with and study the use of reflexive regulation using narrative methods in long-term care.

Seeing people living with dementia through the lens of technology: pain assessment and clinical impact

Objective:Due to communication difficulties, pain assessment in people living with dementia (PLWD) is challenging. In this study we explore vocalisations and facial expressions during assessment of pain and provide evidence in regards to clinical impact of pain assessment, as part of a targeted care program.Methods:In order to determine key facial and vocalisation features and their relationship with pain we analysed a total of 22,194 pain assessments in PLWD (n = 3,144) from 34 different Australian residential aged care homes. Pain assessments were conducted using PainChek, which is a technology-based system comprised of three key components: point-of-care AI-powered application, training and digital analytics. Additionally, we examine the 6-months clinical impact of introducing this system, as part of a wider psychosocial care intervention (i.e., the Reconnect program) in the UK care home setting. Here we focus on how this pain assessment system contributed to the use of psychotropics and issues such as safeguarding.Results:Likelihood of vocalization feature presence varied based on the intensity of pain. In this regard, sighing and screaming were more likely during experience of higher pain (eight times). During experience of severe pain eyelid tightening was the most frequent facial expression (48.6%) whereas higher pain levels were mostly predicted by horizontal mouth stretch feature. Use of PainChek system as part of the Reconnect program contributed to a more consistent pain management approach, benzodiazepine reduction (29%) and cessation (46%) and reduction of antipsychotic prescribing (22%). Compared to the 6 monthly period from the year prior to implementation of the Reconnect program, a 92% reduction in safeguarding events was reported.Conclusion:In this study we demonstrate the potential to digitally phenotype key pain behaviours such as vocalizations and facial expressions using the PainChek system. We also evidence the positive impact of pain assessment combined with psychosocial care, on use of psychotropics and safeguarding incidents.

Resource Utilization Groups in transitional home care: validating the RUG-III/HC case-mix system in hospital-to-home care programs

BackgroundTransitional hospital-to-home care programs support safe and timely transition from acute care settings back into the community. Case-mix systems that classify transitional care clients into groups based on their resource utilization can assist with care planning, calculating reimbursement rates in bundled care funding models, and predicting health human resource needs. This study evaluated the fit and relevance of the Resource Utilization Groups version III for Home Care (RUG-III/HC) case-mix classification system in transitional care programs in Ontario, Canada.MethodsWe conducted a retrospective analysis of clinical assessment data and administrative billing records from a cohort of clients (n = 1,680 care episodes) in transitional home care programs in Ontario. We classified care episodes into established RUG-III/HC groups based on clients’ clinical and functional characteristics and calculated four case-mix indices to describe care relative resource utilization in the study sample. Using these indices in linear regression models, we evaluated the degree to which the RUG-III/HC system can be used to predict care resource utilization.ResultsA majority of transitional home care clients are classified as being Clinically complex (41.6%) and having Reduced physical functions (37.8%). The RUG-III/HC groups that account for the largest share of clients are those with the lowest hierarchical ranking, indicating low Activities of Daily Living limitations but a range of Instrumental Activities of Daily Living limitations. There is notable heterogeneity in the distribution of clients in RUG-III/HC groups across transitional care programs. The case-mix indices reflect decreasing hierarchical resource use within but not across RUG-III/HC categories. The RUG-III/HC predicts 23.34% of the variance in resource utilization of combined paid and unpaid care time.ConclusionsThe distribution of clients across RUG-III/HC groups in transitional home care programs is remarkably different from clients in long-stay home care settings. Transitional care programs have a higher proportion of Clinically complex clients and a lower proportion of clients with Reduced physical function. This study contributes to the development of a case-mix system for clients in transitional home care programs which can be used by care managers to inform planning, costing, and resource allocation in these programs.

Remote Monitoring of Patients after Allogeneic Stem Cell Transplantation: A Mobile Phone Application to Report Symptoms, Vital Signs and Activity in Real Time

Introduction: One of the major obstacles for early inpatient discharge after allogeneic stem cell transplantation (aSCT) is, aside from frailty and bloodwork required, the high risk for infections and the need for monitoring of graft versus host disease (GvHD). This requires frequent hospital visits which are often a challenge especially when travelling to hospitals imposes significant costs for the patient. Furthermore, structured data acquisition in the home care setting is missing. Methods: We have developed a fully patient centered, easy to operate mobile phone application for aHSCT patients that allows for treatment specific symptom reporting. In combination with a wearable device (smart watch), a blood pressure monitor and a thermometer, this application incorporates online monitoring of all major vital signs in almost real time. The application currently captures more than 50 static and dynamic metrics relevant for aSCT and provides a photo function to capture skin images in a patient specific image library. Daily symptom reporting can be performed as often as necessary and data from wearable devices are obtained in very high frequency. Symptom reporting includes information on general wellbeing, nausea, oral mucositis, bowel movement frequency and consistency, information on oral calorie and fluid uptake, and it captures and calculates body surface areas affected by rash. All data are streamed in almost real time and displayed on a browser-based dashboard to the healthcare team. The user interface for the physician dashboard was developed using the React JavaScript library whereas the mobile application utilized React Native to enable Android and iOS applications. The collection, storage, and presentation of patient data via the physician dashboard is facilitated using various AWS technologies such as Lambda, S3 and Timestream. Data can be stored according to federal laws and regulations the software is operating in. Access to the dashboard is center-specific and secured by a dual verification process. Summary: Daily symptom reporting by the patient is easy, comprehensive and can be completed within minutes. Data from wearable devices are obtained 24/7 at high frequency. All data are displayed on a dashboard to the corresponding physician with only a few minutes delay. The system captures vital signs (blood pressure, temperature, pulse, breathing rate, oxygen saturation, etc.) and GvHD related symptoms such as skin rash including body surface area affected, and frequency/volume of bowel movements. It provides information based on the patient's physical activity, food intake, fluid intake, sleeping patterns in a structured fashion. The physician's dashboard displays all transplant relevant static information like HLA match, conditioning regimen, type of immunosuppression, ABO incompatibility, serologies of patient and donor. It displays all data reported longitudinally and allows physicians to observe trends and developments providing interactive graphs on each metrics. It provides a medication plan that captures daily dosage, duration of treatment and calculates cumulative doses. Changes in medication and dosing will alert the patient on the mobile phone application. All data can be obtained in a structured fashion for research purposes by the participating institution. Conclusion: This mobile phone application in combination with a wearable device allows for remote monitoring of patients after aHSCT. Its function is comprehensive and not only provides structured data, but allows for monitoring success of medical treatment. It is developed in a modular fashion that can be easily adapted to specific requirements in other cell therapies such CAR CD19, AML induction therapies or autologous SCT.

In-Line Aerosol Therapy via Nasal Cannula during Adult and Paediatric Normal, Obstructive, and Restrictive Breathing.

High-flow nasal oxygen therapy is being increasingly adopted in intensive and home care settings. The concurrent delivery of aerosolised therapeutics allows for the targeted treatment of respiratory illnesses. This study examined in-line aerosol therapy via a nasal cannula to simulated adult and paediatric models with healthy, obstructive and restrictive lung types. The Aerogen Solo vibrating mesh nebuliser was used in combination with the InspiredTM O2FLO high-flow therapy system. Representative adult and paediatric head models were connected to a breathing simulator, which replicated several different states of lung health. The aerosol delivery was quantified at the tracheal level using UV-spectrophotometry. Testing was performed at a range of supplemental gas flow rates applicable to both models. Positive end-expiratory pressure was measured pre-, during and post-nebulisation. The increases in supplemental gas flow rates resulted in a decrease in aerosol delivery, irrespective of lung health. Large tidal volumes and extended inspiratory phases were associated with the greatest aerosol delivery. Gas flow to inspiratory flow ratios of 0.29-0.5 were found to be optimum for aerosol delivery. To enhance aerosol delivery to patients receiving high-flow nasal oxygen therapy, respiratory therapists should keep supplemental gas-flow rates below the inspiratory flow of the patient.

Evidence for Criterion-Related Validity of Pressure-Mediated Reflection Spectroscopy for Approximating Fruit and Vegetable Consumption among Preschool Children

BackgroundSkin carotenoids are a valid biomarker for approximating fruit and vegetable consumption (FVC). Veggie Meter® (VM®, Longevity Link Corp.) is a pressure-mediated reflection spectroscopy (RS)-based device that allows for noninvasive and rapid assessment of skin-carotenoid score (SCS) in adults and children. Although VM® is established as a valid tool to measure FVC in adults, there is limited research supporting the validity evidence of the VM® to approximate FVC among preschool children. ObjectiveThe current study aims to assess evidence supporting the criterion-related validity of RS-based SCS for approximating FVC among preschool children (3–5-y old). MethodsWe collected cross-sectional data from typically developing preschool children (n = 136) attending the Child and Adult Care Food Program-participating family child care home settings (FCCHs) (n = 46) in Nebraska. Research team members collected children’s height and weight to calculate body mass index; and measured children’s SCS using the VM®. Children’s FVC in FCCHs were collected using dietary observation. In addition, parents (n = 89) completed a shortened food frequency questionnaire to report children’s FVC at home. Kendall’s Tau (τ) correlation tests were conducted to measure the association between children’s SCS with FVC in FCCHs and with parent-reported total fruit and vegetable (FV) frequency scores. ResultsChildren’s SCS were significantly correlated with their mean FVC in FCCHs, τ = 0.14 (P = 0.02), total provitamin A carotenoids intake in FCCHs, τ = 0.19 (P < 0.001), and with parent-reported total FV frequency score, τ = 0.16 (P = 0.04). ConclusionThe correlation coefficients in this study are comparable with results from a meta-analysis examining associations between FVC and SCS in 7–10-y-old children (r = 0.20). Thus, evidence suggests that RS offers a potentially valid, objective, and feasible method to assess preschool children’s total FVC in multiple settings, especially in conjunction with other dietary assessment tools.

SIOG2023-4-P-281 - Feasibility of administering azacitidine in a home care setting with telemedicine support

SIOG2023-4-P-281 - Feasibility of administering azacitidine in a home care setting with telemedicine support

National service is free, not cancer disease: Financial toxicity in a public universal coverage healthcare system.

32 Background: Italian National Health Service provide regional control on clinical pathways to be cost-free. ASL Napoli 1 centralized model of Palliative Care Unit ensure free multidisciplinary medical and nursing assistance, beyond aids and devices. Since healthcare costs are rising and private spending is becoming necessary, our aim is screening financial toxicity in the most densely populated area in Europe. Methods: From January to April 2023 we performed simple random sampling to select 27 home care patients. From the richest neighborhoods to poorest ones, patients answered the COST-FACIT questionnaire. We collected information about medical history, sociodemographic characteristics (employment status or retired, family composition, if benefiting from state allowances) and, above all, out-of-pocket costs. Results: Data highlight that wealthiest and middle-class patients are afraid about out of control medical expenses and their satisfaction about economic status is declining. Patients from a lower socioeconomic background are deeply concerned about not being able to work and not being of financial support to often single income families. Score analysis reveals significant variation among the different items, and the average score is 12.4. Highest scores count 28 and 29, respectively, suggesting that these patients are more able to manage the costs of treatment or access financial resources to cope with medical expenses. Three scores of 0 suggest higher financial toxicity in the realm of palliative oncology care. These patients face greater difficulty in handling treatment costs, encounter barriers in accessing financial resources, or experience high expenses. Patients have highlighted that purchase of non-reimbursable drugs is the most onerous out-of-pocket cost in home care setting. Conclusions: Our centralized Palliative Care Unit organizational model coordinates by adapting purchasing and providing holistic sanitary approach beyond patients' economic abilities. Our centralized Palliative Care Unit provides health services to endure equity across all the city. However, score analysis suggests a range financial suffering for home care patients. Low average score 12.4 suggests how much financial suffering in palliative care impacts, even in a model of centralization of health care with global coverage. So, screening for financial toxicity plays a key role in directing health policies on pharmaceutical expenditure.

Subcutaneous Levetiracetam Administration in Latino Patients on Home Care.

Background: Levetiracetam has a favorable pharmacology profile to be used subcutaneously. However, its subcutaneous use is still considered off-label as this is beyond its license. The evidence base for its safety, tolerability, and efficacy is limited to observational studies. Objectives: To report the safety and efficacy of subcutaneous levetiracetam in Latino patients on home care. Design: Observational retrospective case series study. Subjects: Consecutive sample of Latino adults with life-limiting illnesses. Methods: A case series framework with 4 domains (selection, ascertainment, causality, and reporting) to ensure reporting quality was used. Additionally, 8 relevant outcomes established in a previous comprehensive review, were collected and reported. Adverse reactions were documented using the Common Terminology Criteria for Adverse Events. Results: Fifteen Latino patients with oncological and non-oncological diagnoses received subcutaneous levetiracetam for a mean of 21days on home care. Levetiracetam was most frequently initiated subcutaneously due to loss of the oral route. The average dosage of subcutaneous levetiracetam was 1200mg. Only 1 patient required a dose adjustment, and only 2 patients experienced a total of 5 seizures during the therapy trial. No adverse reactions were reported. Conclusions: Subcutaneous levetiracetam appears to be effective and safe. This case series of Latino patients in home care expands the evidence of its use in the home care setting. The preliminary data reported by now on multiple case series warrants robust trials.

Older peoples' lived experiences of personalised care in care homes: A meta-ethnography.

Guidance and policy on personalised (or person-centred) care of older people living in care homes advocates that all residents must have their preferences considered, and that all care provided must be reasonably adjusted to meet the person's specific needs. Despite this, research that considers what matters to residents in terms of the care they receive is limited. Our review aims to explore care home residents' lived experiences of personalised care and understand what really matters to them. Six electronic databases (CINHAL, Medline (Ovid), Embase, PubMed, Web of Science & PsychInfo) and Google Scholar (grey literature) were searched to identify qualitative studies relating to personalised care in care home settings, which also included resident (voices) quotes. The literature review and synthesis are reported using eMERGe guidance. Fifteen studies met the inclusion criteria for our meta-ethnography. Four conceptual categories (the challenge of fitting into institutional care, the passing of time, holding onto a sense of self and a desire to feel at home) and two key concepts (creating a culture of purposeful living and caring and forming and maintaining meaningful & empowering relationships) were identified. Finally, a conceptual framework of understanding represents what personally matters to residents in terms of their care. Our meta-ethnography, guided by residents' lived experiences of personalised care, offers a new perspective of what personally matters to residents in terms of the care they receive. The conceptual framework of understanding highlights the importance of moving from an institutional position of doing for residents to a person-centred position of doing with residents. Our findings highlight the importance of understanding the differences between personalised and person-centred care for policy and practice. Further considerations are required on how this might be applied through nurse and care home professionals' education and work practices.

Digital denture scanning and 3D printing for residents in care homes: A feasibility study for pre-empting denture loss.

The aim of this study was to assess the feasibility of digitally scanning dentures and 3D printing replica dentures for care home residents. The study also investigated whether the process and replacement denture was acceptable to the resident. Denture loss is a significant issue for people living in care homes and impacts on nutrition, quality of life and dignity. Denture loss is underreported, and care home residents have barriers to accessing dental care. The conventional process for remaking a denture can often take approximately 2 months with multiple clinical stages, often not feasible in adults with frailty and cognitive impairment. Scanning and 3D (3 dimensional) printing are increasingly used in dentistry, this rapidly evolving technology may provide an innovative solution to denture loss. A digital workflow was established using a handheld scanner and 3D printing technology. Care home residents wearing functional acrylic dentures were recruited. Dentures were scanned within the care home, and the scan was sent to a dental laboratory for 3D printing. The dentures were fitted at a subsequent visit, and semi-structured interviews were undertaken with the resident. Using thematic analysis, the feasibility of this pathway was assessed, and the use of digital scanning technology was explored. Eight residents successfully had dentures scanned and replicated to a satisfactory standard. It took, on average, 10 minutes to scan a denture and 20 minutes to print the denture. All replica dentures were satisfactory to the resident. Qualitative data from semi-structured interviews showed that study participants were satisfied with denture replacements and the process. The 3 main themes that emerged were: the significance of dentures to the individual, satisfaction with the scanning process and general low self-esteem and fatigue. This study has established a workflow for digitally storing dentures and replicating them satisfactorily. In the context of a care home setting, a scan of a denture can be used to provide a replacement denture if lost or broken. A large-scale study could follow now that the feasibility of this pathway has been demonstrated.

Reducing restraint on residents in Hong Kong care home settings

Reducing restraint on residents in Hong Kong care home settings Individuals from the Jockey Club Centre for Positive Ageing discuss reducing using restraint on residents in Hong Kong care home settings. Restraint use among residents in care home settings could be significantly reduced by implementing a multi-component restraint reduction programme, a research study conducted by Jockey Club Centre for Positive Ageing (JCCPA) said. (1) The study involved the implementation of a comprehensive programme over 12 months. The programme included staff training, examination of current care practices, environmental design modifications, monthly case conferences, and support from multidisciplinary experts. Implemented in two care homes, the programme demonstrated a significant 30% reduction in restraints. One of the primary reasons for employing restraints, fall prevention from chairs, was also significantly reduced following the implementation of the restraint reduction programme.

An effective AI model for automatically detecting arteriovenous fistula stenosis

In this study, a novel artificial intelligence (AI) model is proposed to detect stenosis in arteriovenous fistulas (AVFs) using inexpensive and non-invasive audio recordings. The proposed model is a combination of two new input features based on short-time Fourier transform (STFT) and sample entropy, as well as two associated classification models (ResNet50 and ANN). The model’s hyper-parameters were optimized through the use of the design of the experiment (DOE). The proposed AI model demonstrates high performance with all essential metrics, including sensitivity, specificity, accuracy, precision, and F1-score, exceeding 0.90 at detecting stenosis greater than 50%. These promising results suggest that our approach can lead to new insights and knowledge in this field. Moreover, the robust performance of our model, combined with the affordability of the audio recording device, makes it a valuable tool for detecting AVF stenosis in home-care settings.

Usability assessment of the MoliCare absorbent continence products by nursing specialists.

Incontinence is a common disorder among older adults with a higher prevalence in nursing home settings than in community dwellings. There is a wide variety of absorbent continence products on the market used to manage continence. The study aimed to investigate the experience of caregivers of residents with incontinence in care home settings using the new MoliCare Premium Form design and to compare some of the product features with the previous design. A questionnaire focusing on the key performance characteristics of the product was developed and administered to 74 nurses in Germany to obtain their opinions on the use of MoliCare Premium Form products. More than 90% of respondents rated each key performance aspect of the new product design as 'good' and 'OK'. More than 60% of the caregivers found the new product design to be better performing and 93% preferred the new design to the previous version. The newly redesigned continence pad performed very well on each of the individual performance features, indicating the high quality and optimised design of the product. The new design was found to be suitable and effective for individuals with incontinence.

Fundamentals of end-of-life communication as part of advance care planning from the perspective of nursing staff, older people, and family caregivers: a scoping review

BackgroundNursing staff is ideally positioned to play a central role in end-of-life communication as part of advance care planning for older people. However, this requires specific skills and competences. Only fragmented knowledge is available concerning important fundamentals in end-of-life communication performed by nursing staff.ObjectiveThis review aimed to explore the fundamentals of end-of-life communication as part of advance care planning in the hospital, nursing home and home care setting, from the perspective of the nursing staff, the older person, and the family caregiver.DesignScoping review.MethodsA literature search in PubMed, PsycINFO, CINAHL and Google (Scholar) was conducted on August 20, 2022. The search strategy followed the sequential steps as described in the Joanna Briggs Institute Manual. Peer-reviewed articles of empirical research and gray literature written in English or Dutch and published from 2010 containing fundamentals of end-of-life communication as part of advance care planning from the perspective of nursing staff, older people, and family caregivers in the hospital nursing home or home care setting were considered eligible for review.ResultsNine studies were included, and four themes were composed, reflecting 11 categories. Nursing staff attunes end-of-life communication to the values and needs of older people to approach the process in a person-centered manner. This approach requires additional fundamentals: building a relationship, assessing readiness, timing and methods to start the conversation, communication based on information needs, attention to family relationships, a professional attitude, improving communication skills, listening and non-verbal observation skills, and verbal communication skills.ConclusionsThis review is the first to compile an overview of the fundamentals of end-of-life communication performed by nursing staff. Building a nursing staff-older-person relationship is the most important foundation for engaging in a person-centered end-of-life communication process. Knowing each other enables nursing staff to have a sense of older people’s readiness, determine the right timing to initiate an end-of-life conversation, identify specific needs, and accurately apply (non-)verbal observation skills. end-of-life communication is not a one-time conversation, but a complex process that takes time, effort, and genuine interest in each other.

Flow of information contributing to medication incidents in home care-An analysis considering incident reporters' perspectives.

To describe the contributing factors and types of reported medication incidents in home care related to the flow of information in different phases of the medication process, as reported by multi-professional healthcare groups. This descriptive, qualitative study used retrospective data. An incident-reporting database was used to collect 14,289 incident reports from 2017 to 2019 in a city in Finland. We used this data to select medication incidents (n = 1027) related to the flow of information in home care and between home care and hospitals. Data were divided into five groups based on the medication phase: (1) prescribing, (2) dispensing, (3) administration, (4) documentation and (5) self-administration. In addition, the types of medication-related incidents were described. The data were examined using abductive content analysis. The EQUATOR SRQR checklist was used in this report. Four main categories were identified from the data: (1) issues related to information management, (2) cooperation issues between different actors, (3) work environment and lack of resources and (4) factors related to healthcare workers. Cooperation issues contributed to medication-related incidents during each phase. Incomplete communication was a contributing factor to medication incidents. This occurred between home care, remote care, hospital, the client and the client's relatives. Specifically, a lack of information-sharing occurred in repatriation situations, where care transitioned between different healthcare professionals. Healthcare professionals, organisations, clients and their relatives should focus on the efficient and safe acquisition of medications. Specifically, the use of electronic communication systems, together with oral reports and checklists for discharge situations, and timely cooperation with pharmacists should be developed to manage information flows. These findings demonstrate that healthcare professionals require uniform models and strategies to accurately and safely prescribe, dispense and administer medications in home care settings. No patient or public contributions.

Emotions, action strategies and expectations of health professionals and people with dementia regarding COVID-19 in different care settings in Switzerland: a mixed methods study

BackgroundMore than 55 million people are currently affected by dementia worldwide and over 144 thousand in Switzerland. In Swiss nursing homes, 47.6% of the residents had a medical diagnosis of dementia in 2014. Due to cognitive impairment, they have difficulties remembering hygiene measures or placing them in the epidemic context. This results in a higher infection risk. There are COVID-19-associated recommendations focused on dementia care management but studies simultaneously surveying and correlating perspectives of health professionals as well as people with dementia across care settings are largely lacking. This study is focused on COVID-19-associated perspectives and needs of health professionals and people with dementia across different care settings. Lessons learned from the pandemic shall be pointed out.MethodsWe conducted a mixed-methods approach based on an exploratory sequential design. Two qualitative interview rounds (n = 15 participants) and a quantitative online survey (n = 148 participants) with people with dementia, caring relatives, Advanced Practice Nurses and nursing home managers (health professionals) were performed. Data collected was performed in nursing home and home-care settings. The SQRQ checklist was used.ResultsFear and uncertainty were highest at the beginning of the pandemic among the interviewed nursing professionals and nursing home managers. As a positive side effect of the pandemic, increased cohesion in care teams was reported. Some people with dementia experienced the decelerated outside world as pleasant and less challenging to master. Particularly during the first wave, nursing home managers rated political decision-making processes as being too slow, partly non-transparent, inconsistent, and sometimes inappropriate for people with dementia.ConclusionsAlthough the identified emotional and physical consequences of the COVID-19 pandemic are mostly negative for health professionals and people with dementia, research should also investigate potential positive side effects. Furthermore, political decisions should be passed on to care institutions as promptly, transparently, and comprehensibly as possible. The results provide guidance on dementia-focused COVID-19 management interventions incorporating lessons learned and considering the emotional impact of the pandemic in Switzerland and beyond.

The role of functioning in predicting nursing home placement or death among older home care patients

Objective There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. Design A prospective one-year follow-up study. Settings and subjects Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). Main outcome measures Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). Results Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62–0.86), IADL (0.75, 0.65–0.87) MMSE (0.92, 0.87–0.96), and TUG (1.02, 1.01–1.03). NHP alone was predicted by BADL (0.62, 0.50–0.78), IADL (0.57, 0.45–0.73), and MMSE (0.88, 0.82–0.94) and mortality by TUG (1.02, 1.01–1.03). Conclusion Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.

Supporting registered nurses to complete their revalidation in a care home setting

Adrian Ashurst discusses how care home managers can support nurses to successfully complete the revalidation process.