Homes Of Older Adults Research Articles

Sequential multiple mediating effect of loneliness and family health on physical frailty and willingness to age at home in older adults: a national survey in China

BackgroundWith the rapid ageing of the global population, the number of older adults with physical frailty has been gradually increasing, making ageing at home a key strategy for coping with this demographic change. The opinions of older adults regarding their willingness to age at home deserve to be considered respectfully. As a result, this study aimed to investigate willingness to age at home and any associated underlying mechanisms involving physical frailty among older Chinese adults.MethodsThis study was a national cross-sectional survey. Stratified random and quota sampling were used before and after the individual level respectively. Willingness to age at home was compared between older adults with different characteristics using the Mann–Whitney U test and Kruskal–Wallis H test. A Spearman rank test was conducted to explore the correlations among physical frailty, loneliness, family health, and willingness to age at home. The path hypothesis that loneliness and family health influence the relationship between physical frailty and willingness to age at home among older adults was further tested through sequential multiple mediation analysis.ResultsA total of 3,837 older adults were included in this study. They returned a median score of 78 in terms of willingness to age at home. Physical frailty (β = − 0.044, P < 0.01) and loneliness (β = − 0.070, P < 0.001) were negatively associated, and family health (β = 0.275, P < 0.001) was positively associated with a willingness to age at home among older Chinese adults. Loneliness and family health played sequential multiple mediating role (β = − 0.018, Boot SE = 0.002, 95% CI = [–0.022, − 0.014]) between physical frailty and willingness to age at home.ConclusionsReducing physical frailty in older adults, reducing their sense of loneliness, and enhancing their family health is essential, as it can increase their levels of confidence with regard to ageing at home.

England RCT of air filtration to prevent respiratory infections (including covid-19) in care homes

Abstract Context There is evidence that portable high-efficiency-particulate-air (HEPA) filtration units remove microbial particles from the air, but it is unclear whether this is sufficient to reduce infections in care home residents. Objectives To investigate the effectiveness of portable HEPA filtration units for winter respiratory infection episode reduction in care home residents. Study design and analysis: Cluster controlled trial with intention-to-treat analysis. Setting: 90 residential care homes for older adults in England. Population: Residents expected to reside in the care home for ≥1 month. Intervention care homes: Five HEPA filtration units in communal rooms and one HEPA filtration unit in 10 to 16 bedrooms. Control care homes: Usual care. Outcome measures: The primary outcome is the number of symptomatic winter respiratory infection episodes recorded by care home staff. Secondary outcomes: other infection measures; falls /near falls; laboratory confirmed infections; hospitalisations; and staff sickness. Process evaluation to assess intervention acceptability and implementation. Results Care homes were randomised between January 2022 and February 2024, 43 to intervention and 47 to usual care. Respectively, in intervention and control group care homes: 43% and 45% provided nursing care; 87% and 87% dementia care; and median (IQR) number of communal rooms were 4 (3-5) in both groups. 1126 residents were consented, of whom 31 (3%) moved away; 151 (13%) died; and 5 stopped participating. Primary outcome data is 98% complete with 175,318 'resident days' symptom data collected. Comparing intervention and control group residents: median (IQR) age was 88 (81-92) and 88 (82-92) years; 33% and 43% were receiving nursing care; 58% and 57% had dementia; frailty scores were 6 (4-7) and 6 (5-7); 94% and 94% received influenza; and 97% and 95% COVID vaccines. Conclusions Final analytic results of this world-first RCT will be available for the conference. Key messages • This world-first RCT using HEPA filters in care homes will report the evidence of effectiveness of respiratory infection episode reduction in care home residents. • The trial will inform policy makers about the effectiveness, acceptability and implementation of HEPA filters in care homes.

Effect of group play therapy as holistic geriatric interventional modality on feelings of loneliness among older people: A randomized control trial.

Previous research has identified loneliness as a significant social stressor among the older adult population, and highlights the scarcity of empirical research on the efficacy of group play therapy as a method for addressing loneliness in this demographic. This study aimed to explore the impact of group play therapy on reducing feelings of loneliness among older individuals. A randomized clinical trial was carried out in 2018 on 60 older adult participants from two governmental health centers in Mashhad, Iran. The intervention group received adult-centered play therapy for 12 sessions over 6 weeks, with each session lasting 60 min. The therapy protocol combined traditional and modern games, structured into three stages: warm-up, working and closing. The University of California, Los Angeles (UCLA) scale was used to measure feelings of loneliness at baseline and after the intervention. Data analysis was carried out using SPSS version 21. There was a significant decrease in feelings of loneliness in the intervention group compared with the control group (P < 0.001). Additionally, a significant difference in feelings of loneliness was observed within the intervention group between baseline and follow up (P < 0.001). Group play therapy, involving a combination of traditional and modern games, can reduce feelings of loneliness among older adults. This method can promote healthy aging and improve mental health issues, such as loneliness, among older people. These findings can be utilized in healthcare centers and nursing homes for older adults. Geriatr Gerontol Int 2024; 24: 1067-1076.

Extensivist: improving the delivery of enhanced health in older people’s care homes

BackgroundOlder people living in care homes are often frail and clinically complex. The Enhanced Health in Care Homes (EHCH) framework supports organisational and clinical strategies to deliver good care, promoting...

A Novel Discharge Pathway for Older Adults presenting to the Emergency Department

Abstract Background A need was identified for an urgent therapy follow-up at home for older adults presenting to the Emergency Department (ED). The acute floor team worked together within an established therapy outreach team (for inpatients) to develop an ED outreach pathway within existing resources. The outreach team members worked within ED to ensure standardisation of assessment, practice and build strong working relationships. A trusted assessor approach was applied. The outreach team had access to the wider acute floor team including ANP for in-reach support if needed. Methods A review of the patient group who discharged home from ED using this new pathway was completed including demographics, presenting complaint, clinical frailty score (CFS) and intervention provided. Results To date, 30 patients have discharged from the ED with the therapy outreach team. Most (70%) were female and mean age 83. Presenting complaint included fall no fracture (50%, n=15), fall with fracture (26%, n=8), musculoskeletal injury (17%, n= 5) and functional decline (6%, n=2). The mean CFS was 5.1, with most (86%) living with mild to moderate frailty (CFS 4-6). All patients were offered a next clinical day home based functional and environmental assessment, continuing the assessment commenced by the acute floor team in ED. Interventions included transfers and mobility training, activities of daily living (personal/domestic/instrumental) training, carer education, environmental advice, falls education, support with care packages, liaising with other healthcare professionals and equipment provision including mobility aids, bed-levers, toilet-aids and rails. Conclusion A therapy lead team, supported by the wider acute floor team, can provide a safe alternative discharge pathway from the ED for older adults that can avoid admission with rapid therapy input at home. Future work will examine re-admission rates, re-presentation rates to ED and patient and stakeholder satisfaction.

Bezpečná domácnosť pre seniorov z pohľadu ergoterapeuta

Starting point: Preventive programs for older adults should focus on promoting aging in their place of residence. A safe household without barriers is one condition for maintaining a high quality of life and supporting self-sufficiency. The occupational therapist plays a key role in evaluating the home environment and supervising follow-up interventions. Aim: This review study aims to clarify the role of occupational therapist interventions in the home environment of older adults and describe the most common and significant risks and subsequent modifications to the environment to create a safe home and prevent falls based on best practices. Methods: This is a review of published literature between 2013 and 2024 using the PRISMA methodology. The electronic databases Web of Science, Scopus, EBSCO, and PubMed were searched. Results: Of the 198 sources, 10 studies met the analysis criteria. Risky areas in older adult homes and possible interventions to increase safety are clearly listed. The areas with the greatest security risk are the bedrooms, bathrooms with toilets, and stairs. Various obstacles, including carpets, objects placed at an inappropriate height, a low toilet, or insufficient lighting, were among the most common causes of falls. Conclusions: Studies point to the importance of promoting self-sufficiency and raising awareness regarding aging modifications to the homes of older adults.

Spatial accessibility of home visiting nursing: An exploratory ecological study.

Japan is one of the oldest societies worldwide and manages a system of care for older adults in the community. In the 2000s, a community-based integrated care system was introduced to enable older adults to live in their neighborhoods. Home visiting nursing (HVN) is a crucial component of this system; however, the current and future shortage of home visiting nurses is a concern. Thus, HVN services may not be available in some areas; however, no indicators of the accessibility of HVN services have been developed. Developing accessibility indicators will serve as a standard for considering the allocation of health care resources and supporting future nursing policies that improve regional disparities. We estimated the population-weighted spatial accessibility index (PWSAI) of HVN services in Hokkaido, using the two-step floating catchment area method (2SFCA). The 2SFCA comprised population, location of HVN agencies, number of home visiting nurses, and travel time. A multivariate regression model was run for the number of HVN users in each municipality as the objective variable to test the validity of the PWSAI; the number of home care support clinics, home care support hospitals, HVN agencies, home visiting nurses, home visiting nurses (24/7), total beds in health care facilities for older adults, and nursing homes for older adults were included as other explanatory variables. The PWSAI was median 9.0 [interquartile range: 6.2-11.8]. The distribution of the PWSAI was mapped to visualize the existence of regional differences. As a result of the conditional autoregressive model, PWSAI and home visiting nurses (24/7) were significant, Exp(β) and 95% credible interval were 1.043 [1.015-1.076] and 1.021 [1.006-1.036], respectively. The PWSAI was positively correlated with the number of HVN users in each municipality and can serve as an indicator for assessing the accessibility of HVN.

Administrative Analysis of the Home-Based Older Persons Upstreaming Prevention Physical Therapy Program: A Pilot Observational Study.

Introduction Traditionally, physical therapist (PT) services do not commence until an injury, fall, or health issue has already occurred although there is increasing evidence that preventative programs administered by PTs may decrease the fall risk among elderly individuals.The purpose of this study was to examine billing, reimbursement, and administrative outcomes of the previously established and investigated prevention-based screening and intervention HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program delivered by a physical therapist in the home of older adults after being referred by a community partner. A randomized controlled trial of the HOP-UP-PT program demonstrated an 8-fold reduction in falls for participants at moderate and high fall risk compared to those who did not participate in the program. Methods Aprospective observational study was performed to examine administrative and payment outcomes of HOP-UP-PT participation. Participants were referred into the HOP-UP-PT program via a local community center. Physician authorization for physical therapy participation was obtained for each participant as required for payment under United States' Center for Medicare and Medicaid Services (CMS)guidelines. The HOP-UP-PT program is preventative physical therapy delivered in the person's home with five in person visits (approximately one per month) followed by a monthly telehealth visit and a final in-person visit.Interventions included a balance program, home safety recommendations, health coaching, and addressing individual risks of falling or becoming homebound. A retrospective analysis was performed on the administrative andinsurance payment data from this study which was then analyzed descriptively. Results Six participants with four different insurances completed the 7-month program (mean age=77 years) in 2021. The physical therapy visits were submitted to the participants' Medicare Part B plan. One participant's physical therapy visits were not submitted for payment as the health system did not have an active agreement with that health insurer. Due to the unclear status of telehealth visits in 2021, these services were not submitted to the insurance company for payment.All other PT visits were paid by the insurance companies. The mean amount paid for the initial evaluation code was $102.83 and the mean payment for the ~15 minute treatment codes was $25.90 per unit. Initial pilot data demonstrated a potential for a4.2% positive operating margin when considering salary costs and travel.The mean delay from the initial referral into the HOP-UP-PT program until the physician provided written authorization for physical therapy was 69.7 days. Conclusion This study demonstrated initial evidence that payment for prevention-focused outpatient physical therapist services delivered in the home was feasible, however delays and costsin procuring physician authorization was a substantial barrier to prevention-focused physical therapy. A 4.2% operating margin demonstrated that, when efficiently operated, similar programs are likely to be viable. Furthermore, if telehealth services would have been paid, the operating margin was estimated to increase to 32%. Physical therapists are highly qualified to deliver efficient, effective preventative services which has the potential to reduce falls and institutionalization and subsequent healthcare cost savings.

0562 Evaluation of Habitual Sleep Duration and PAP Adherence to Quantify Effective AHI Reduction at Home in Older Adults

0562 Evaluation of Habitual Sleep Duration and PAP Adherence to Quantify Effective AHI Reduction at Home in Older Adults

Epidemiology of Accidental Injuries at Home and Related Risk Factors for Mortality among Older Adults in South Korea: A Retrospective Cohort Study.

Background and Objectives: Accidental home injuries among older adults are increasing globally, but reporting is limited. This study aims to establish foundational data for program development and policies to prevent accidental injuries at home in older adults by using data on the occurrence of accidental injuries at home and analyzing the risk factors of mortality due to accidental injuries among adults aged 65 years and older. Materials and Methods: This retrospective study used data from the community-based Severe Trauma Survey in South Korea. This study identified general, injury-related, and treatment-related characteristics of older adults who were transported to the emergency department with accidental injuries at home. Single-variable and multiple logistic regression analyses were used to identify risk factors for mortality after injury. Results: The majority of older adults in this study who experienced accidental injuries at home were aged 75 to 84 (42.8%) and female (52.8%), with 1465 injured from falls and slips (68.0%). Risk factors for mortality included older age (≥85 years) (ORs 2.25, 95% CI 1.47-3.45), male sex (ORs 1.60, 95% CI 1.15-2.20), mechanism of injury (falls or slips vs. contact injury, ORs 6.76, 95% CI 3.39-13.47; airway obstruction vs. contact injury, ORs 13.96, 95% CI 6.35-30.71), higher severity (moderate vs. mild, ORs 2.56, 95% CI 1.45-4.54; severe vs. mild, ORs 12.24, 95% CI 6.48-23.12; very severe vs. mild, ORs 67.95, 95% CI 38.86-118.81), and receiving a blood transfusion (ORs 2.14, 95% CI 1.24-3.67). Conclusions: Based on these findings, the home and community environments where older adults live should be inspected and monitored, and in-home accidental injury prevention strategies should be developed tailored to the characteristics of older adults' risk factors and their injury-related characteristics.

Experiences of health care personnel in promoting a sense of home in older adults living in residential care facilities.

Experiences of health care personnel in promoting a sense of home in older adults living in residential care facilities.

Protocol for VIVALDI social care: Pilot study to reduce infections, outbreaks and antimicrobial resistance in care homes for older adults.

Care home residents are vulnerable to severe outcomes from infections such as COVID-19 and influenza. However, measures to control outbreaks, such as care home closures to visitors and new admissions, have a detrimental impact on their quality of life. Many infections and outbreaks could be prevented but the first step is to measure them reliably. This is challenging in care homes due to the lack of data and research infrastructure. During the pandemic, the VIVALDI study measured COVID-19 infections in residents and staff by partnering with care providers and using routinely collected data. This study aims to establish sentinel surveillance and a research database to enable observational and future interventional studies in care homes. The project has been co-produced with care providers, staff, residents, relatives, and researchers. The study (October 2023 to March 2025) will explore the feasibility of establishing a network of 500-1500 care homes for older adults in England that is underpinned by a linked data platform. No data will be collected from staff. The cohort will be created by regularly extracting resident identifiers from Digital Social Care Records (DSCR), followed by pseudonymisation and linkage to routinely collected datasets. Following extensive consultation, we decided not to seek informed consent from residents for data collection, but they can 'opt out' of the study. Our goal is to be inclusive, and it is challenging to give every resident the opportunity to 'opt in' due to cognitive impairment and the requirement for consultees. The project, and all requests to use the data will be overseen by relatives, residents, staff, and care providers. The study has been approved by the Health Research Authority Confidentiality Advisory Group (23/CAG/0134&0135) and the South-West Frenchay Research Ethics Committee (23/SW/0105). It is funded by the UK Health Security Agency.

Automatic Radar-Based Step Length Measurement in the Home for Older Adults Living with Frailty.

With an aging population, numerous assistive and monitoring technologies are under development to enable older adults to age in place. To facilitate aging in place, predicting risk factors such as falls and hospitalization and providing early interventions are important. Much of the work on ambient monitoring for risk prediction has centered on gait speed analysis, utilizing privacy-preserving sensors like radar. Despite compelling evidence that monitoring step length in addition to gait speed is crucial for predicting risk, radar-based methods have not explored step length measurement in the home. Furthermore, laboratory experiments on step length measurement using radars are limited to proof-of-concept studies with few healthy subjects. To address this gap, a radar-based step length measurement system for the home is proposed based on detection and tracking using a radar point cloud followed by Doppler speed profiling of the torso to obtain step lengths in the home. The proposed method was evaluated in a clinical environment involving 35 frail older adults to establish its validity. Additionally, the method was assessed in people's homes, with 21 frail older adults who had participated in the clinical assessment. The proposed radar-based step length measurement method was compared to the gold-standard Zeno Walkway Gait Analysis System, revealing a 4.5 cm/8.3% error in a clinical setting. Furthermore, it exhibited excellent reliability (ICC(2,k) = 0.91, 95% CI 0.82 to 0.96) in uncontrolled home settings. The method also proved accurate in uncontrolled home settings, as indicated by a strong consistency (ICC(3,k) = 0.81 (95% CI 0.53 to 0.92)) between home measurements and in-clinic assessments.

Outcomes of Home Emergency Physical Readiness Education for Older Adults.

Emergency preparedness initiatives are a Medicare condition of participation in home healthcare, yet limited evidence on the impact of associated programming is available. The purpose of this exploratory pilot study was to examine the outcomes of an individualized emergency preparedness educational program provided by a physical therapist (PT) in the homes of older adults. The investigators recruited older adults (n = 30) using convenience sampling. An emergency preparedness education module was developed. Demographics, functional and environmental outcome measures, a pre- and post-education confidence survey, and learning outcomes were ascertained and analyzed. Participants reported being female (n = 23), 70 to 79 years (n = 15), and 19 individuals reported 35 different lifetime emergency events. Hearing and vision impairments, inability to change a battery or navigate stairs, and environmental deficits including clutter and poor lighting were identified. Closing bedroom doors at nighttime, functioning carbon monoxide and smoke detectors, creating an evacuation plan, and assembling first aid kits were learning outcomes. Trends toward increased confidence were identified, with statistically significant improvements in the ability to respond to a fire (P = .01), a heat wave (P = .03), and to crawl on hands and knees (P = .05) identified. This study provides emerging evidence that PTs have a role in improving an older adult's confidence to prepare for and respond to an emergency event.

Bathing Adaptations in the Homes of Older Adults (BATH-OUT-2): study protocol for a randomised controlled trial, economic evaluation and process evaluation

BackgroundThe onset of disability in bathing is particularly important for older adults as it can be rapidly followed by disability in other daily activities; this may represent a judicious time point for intervention in order to improve health, well-being and associated quality of life. An important environmental and preventative intervention is housing adaptation, but there are often lengthy waiting times for statutory provision. In this randomised controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of bathing adaptations compared to no adaptations and to explore the factors associated with routine and expedited implementation of bathing adaptations.MethodsBATH-OUT-2 is a multicentre, two-arm, parallel-group RCT. Adults aged 60 and over who are referred to their local authority for an accessible level access shower will be randomised, using pairwise randomisation, 1:1, to receive either an expedited provision of an accessible shower via the local authority or a usual care control waiting list. Participants will be followed up for a maximum of 12 months and will receive up to four follow-ups in this duration. The primary outcome will be the participant’s physical well-being, assessed by the Physical Component Summary score of the Short Form-36 (SF-36), 4 weeks after the intervention group receives the accessible shower. The secondary outcomes include the Mental Component Summary score of the SF-36, self-reported falls, health and social care resource use, health-related quality of life (EQ-5D-5L), social care-related quality of life (Adult Social Care Outcomes Toolkit (ASCOT)), fear of falling (Short Falls Efficacy Scale), independence in bathing (Barthel Index bathing question), independence in daily activities (Barthel Index) and perceived difficulty in bathing (0–100 scale). A mixed-methods process evaluation will comprise interviews with stakeholders and a survey of local authorities with social care responsibilities in England.DiscussionThe BATH-OUT-2 trial is designed so that the findings will inform future decisions regarding the provision of bathing adaptations for older adults. This trial has the potential to highlight, and then reduce, health inequalities associated with waiting times for bathing adaptations and to influence policies for older adults.Trial registrationISRCTN Registry ISRCTN48563324. Prospectively registered on 09/04/2021.

Communication support in care homes for older adults: Views and reported practices of speech and language therapists and care home activities staff in the UK.

Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID-19. Results were analysed using descriptive statistics and qualitative content analysis. A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%-87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%-89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles.

Views of medically responsible nurses and managers of care homes for older adults on communication of information on Covid-19: a case study in Greater Stockholm

This study explored the views of medically responsible nurses and managers of care homes for older adults in Greater Stockholm on communication of information during the first wave of the Covid-19 pandemic. Study participants consisted of managers of care homes for older adults (n=10) and medically responsible nurses (n=4). Semi-structured interviews were conducted between 5th and 30th November 2020. Data were analysed thematically. Findings show that both medically responsible nurses and managers of care homes experienced the information from different authorities during the first wave of the pandemic to be inconsistent and uncoordinated, which caused stress particularly among the managers. Some managers expressed that they would have wanted more assistance from the medically responsible nurse. Some managers created their own support networks to share ideas and resources. The medically responsible nurses also reported being overwhelmed by information, and that they tried to condense it and only disseminate relevant parts to the care home managers. The role of medically responsible nurses in the municipality varied locally. Some had a more managerial role within the municipal leadership, while others also to some extent worked hands-on and frequently visited local care homes. Before the pandemic their contact with care home managers was not very frequent, and for some the relationship was worsened during the first phase of the pandemic. Yet, in some cases the medically responsible nurse successfully acted as an important player linking information, guidelines and data share between authorities and care homes. In conclusion, this study suggests that there is a need for clarification of the roles and responsibilities of the different actors in the health and social care of older adults in Sweden including the role of medically responsible nurses. The findings of this study also stress that information from authorities needs to be adapted to those targeted.

Implementation of a New Integrated Healthcare Model; Quality Aspects to Support the Complex Home Care of Older Adults with Multiple Needs.

This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people's homes. Open-ended group interviews with personnel were carried out, three of the group interviews pre-implementations of the model, and three of the group interviews post-implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis. The quality of the integrated care model was based on care-chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person-centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants' experiences of the post-implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting. Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question.

Home Care Nurses' Knowledge and Attitudes Regarding Telehealth to Promote Medication Compliance among Older Adults.

Medication noncompliance among older adults is a persistent problem resulting in morbidity, hospital readmissions, and decreased quality of life. Home care nurses are in a key position to assist older adults to employ medication compliance strategies that are tailor-made to fit their individual needs and abilities. The purpose of this study was to understand the knowledge and attitudes of home care nurses regarding telehealth practices to promote medication compliance of older adult patients and their perceived readiness to do so. We employed a qualitative research approach using semi-structured interviews. Individual interviews were conducted via Teams platform for a maximum of 60 minutes. Participants were home care nurses who use telehealth technology to advance medication compliance strategies. Ten interviews were conducted. Several themes emerged from the data which suggested home care nurses accept telehealth technology, are supportive of its continued use, and are willing to be educated on future advances in this technology to assist older adults with medication compliance strategies. Universities and home care agencies must provide opportunities to prepare nurses to utilize telehealth technologies to promote medication compliance among older adult home care patients.

A novel application of a self-report comprehensive assessment: Where do telephone assessments fit in home care practice?

Introduction: In Canada, long-stay home care patients are a prevalent group of frail older adults living in the community. Home care patients have a high emergency department visit rate compared to those living independently without formal home care services. In March 2020, concerted efforts were put into place to reduce COVID-19 transmission and spread in health sectors, including older adult home care populations.&#x0D; Description: The interRAI home care (HC) assessment is the practice standard for face-to-face comprehensive assessments in home care. The interRAI Check Up is a comprehensive self-report assessment that can be completed in-person, by video call or telephone. Check Up assessment items are consistent with the content items of interRAI HC. During pandemic mandated restrictions, care coordinators used the Check Up to assess new and existing patients over the phone or by video call to ensure continuity of care. Feasibility and utility of the Check Up was evaluated through a staff survey and focus groups in two distinct regions of Ontario.&#x0D; Discussion: A total of 48 care coordinators completed the survey, of which 7 consented to provide feedback in the focus groups. Care coordinators found the Check Up easy to pivot to during the pandemic, citing familiarity with questions and risk algorithms. The Check Up results were helpful in gaining an understanding of the patient’s medical issues, functional status, mood, and informal supports, while telephone and video assessments saved travel time. According to the care coordinators, patients and informal care givers were comfortable answering the questions over the phone and appreciative of interaction with a health professional. Although care coordinators were accustomed to telephone check ins, language barriers, hearing impairment, and inability to see the home environment were limitations. Care coordinators found telephone assessments, using the Check Up, most beneficial in the absence of cognitive impairment and with patients previously known and assessed by the care coordinator. &#x0D; Conclusion: The interRAI Check Up was an efficient method of completing a comprehensive assessment over the phone. Care coordinators found the Check Up to be best suited for reassessments and as a new assessment with stable, cognitively intact patients. Our findings support use of the interRAI Check Up as a promising and feasible addition to the suite of tools for home care coordination.