Elderly Long-term Care Research Articles

Prevalence of potentially inappropriate medications according to STOPP-Frail criteria in nursing home residents, the SHELTER study

ObjectiveThe aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less.Methods and deignThe study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment.ResultsAmong the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions.ConclusionsThis study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.

Learning integrated care from the Dutch

PurposeThis article aims to gather lessons from a research interchange between England and The Netherlands, reflecting on the countries’ delivery of integrated care across adult and elderly long-term care and how to transfer learning across contexts.Design/methodology/approachThe paper describes the Dutch health and care system, using four key components of integrated care described in the literature: person-centred, expert knowledge, continuity and coordination.FindingsThe Dutch deliver integrated care expertise in each component assessed. The weakest integrated care characteristics in England are multi-sectoral coordination and person-centred care.Originality/valueThis article develops an overview of integrated care delivery in The Netherlands and puts a spotlight on the importance of exchanging real-world experiences, not just evidence-based, to collaboratively improve integrated care in England. There is no need to reinvent the all-wheel, a lot of good is already done, tested and proved.

Intestinal microbiology and urinary tract infection associated risk in long-term aged care residents

BackgroundUrinary tract infections (UTI) are the most frequently diagnosed infection in residents of long-term care and are a major risk factor for urosepsis, hospitalisation, and death. Translocation of gut pathobionts into the urinary tract is the presumed cause of most UTIs. While specific gut microbiota characteristics have been linked to UTI risk in younger adults, their relevance in aged care residents remains uncertain.MethodsThe faecal microbiome was assessed in 54 long-term aged care residents with a history of UTIs and 69 residents without a UTI history. Further comparisons were made to microbiome characteristics in 20 younger adults without UTIs. Microbiome characteristics were examined in relation to prior and subsequent UTIs, as well as antibiotic therapy.ResultsIn long-term aged care residents, prior UTI history and exposure to UTI-exclusive antibiotics do not significantly affect microbiome composition or functional capacity. However, exposure to antibiotics unrelated to UTI treatment is associated with distinct microbiota compositional traits. Adjustment for dementia, incontinence, diabetes, and prior antibiotic use finds no microbiota characteristic linked to UTI development. However, prior UTI is identified as a predictor of future UTIs. Comparison with younger adults identifies greater within-participant dispersion in aged care residents, as well as lower microbiota diversity and altered microbiome functional potential.ConclusionsNo association between the gut microbiome and UTI incidence, as has been reported in younger individuals, is evident in long-term aged care residents. Considerable variability in gut microbiome characteristics, relating to high antibiotic exposure and age-related physiological and immunological factors, could mask such a relationship. However, it cannot be discounted that increased UTI risk in the elderly is independent of microbiome-mediated mechanisms.

Health outcomes following provision of Home Medicines Reviews for older people receiving aged care services at home

BackgroundThe impact of Home Medicines Reviews (HMRs) on long-term health outcomes among individuals receiving long-term in-home aged care services is unknown. ObjectivesTo examine associations between HMR provision and hospitalization, long-term care facility (LTCF) entry and mortality among older people receiving long-term in-home aged care services. MethodsThis retrospective cohort study included individuals aged 65–105 years from three Australian states who accessed in-home aged care services between 2013 and 2017. Using propensity score matching, HMR recipients (n = 1530) were matched to individuals who did not receive an HMR (n = 1530). Associations between HMR provision and outcomes were estimated using multivariable regression models. ResultsOver a median of 414 days (interquartile range 217–650) of follow-up, HMR provision was not associated with hospitalizations for unplanned events (subdistribution hazard ratio (sHR) 1.04, 95%CI 0.96–1.14), falls-related hospitalizations (sHR 0.97, 95%CI 0.83–1.13), LTCF entry (sHR 0.97, 95%CI 0.83–1.13), or all-cause mortality (adjusted HR 0.86, 95%CI 0.72–1.01). ConclusionsIn a cohort of older people receiving long-term in-home aged care services, no differences in unplanned hospitalizations, falls, LTCF entry or mortality were observed those with HMRs compared to those that did not receive an HMR.

Exposure to doxycycline increases risk of carrying a broad range of enteric antimicrobial resistance determinants in an elderly cohort

High rates of antibiotic prescription in residential aged care are likely to promote enteric carriage of antibiotic-resistant pathogens and increase the risk of antibiotic treatment failure. Despite their importance, relationships between antibiotic exposures and patterns of enteric resistance carriage in this population remain poorly understood. We conducted a cross-sectional metagenomic cohort analysis of stool samples from residents of five long-term aged-care facilities in South Australia. Taxonomic composition was determined, and enteric carriage of antibiotic resistance genes (ARGs) was identified and quantified against the Comprehensive Antibiotic Resistance Database. Both the detection and abundance of stool taxa and ARGs were related to antibiotic exposures up to 12 months prior. Factors associated with the abundance of ARGs of high clinical concern were identified. Stool samples were provided by 164 participants (median age: 88 years, IQR 81-93; 72% female). Sixty-one percent (n=100) of participants were prescribed antibiotics at least once in the prior 12 months (median prescriptions: 4, range: 1-52), most commonly a penicillin (n=55, 33.5%), cephalosporin (n=53, 32.3%), diaminopyrimidine (trimethoprim) (n=36, 22%), or tetracycline (doxycycline) (n=21, 12.8%). More than 1100 unique ARGs, conferring resistance to 38 antibiotic classes, were identified, including 20 ARGs of high clinical concern. Multivariate logistic regression showed doxycycline exposure to be the greatest risk factor for high ARG abundance (adjusted odds ratio [aOR]=14.8, q<0.001) and a significant contributor to inter-class selection, particularly for ARGs relating to penicillins (aOR=3.1, q=0.0004) and cephalosporins (aOR=3.4, q=0.003). High enteric ARG abundance was associated with the number of separate antibiotic exposures (aOR: 6.4, q<0.001), exposures within the prior 30 days (aOR: 4.6, q=0.008) and prior 30-100 days (aOR: 2.6, q=0.008), high duration of antibiotic exposure (aOR: 7.9, q<0.001), and exposure to 3 or more antibiotic classes (aOR: 7.4, q<0.001). Carriage of one or more ARGs of high clinical concern was identified in 99% of participants (n=162, median: 3, IQR: 2-4), involving 11 ARGs conferring resistance to aminoglycosides, four to beta-lactams, one to glycopeptides, three to fluoroquinolones, and one to oxazolidinones. Carriage of ARGs of high clinical concern was positively associated with exposure to doxycycline (aminoglycoside, fluoroquinolone, and oxazolidinone ARGs) and trimethoprim (fluoroquinolone and beta-lactam ARGs). Analysis of doxycycline impact on microbiota composition suggested that observed resistome changes arose principally through direct ARG selection, rather than through the antibiotic depletion of sensitive bacterial populations. The gut microbiome of aged care residents is a major reservoir of antibiotic resistance. As a critical antibiotic in medical practice, a comprehensive understanding of the impact of doxycycline exposure on the gut resistome is paramount for informed antibiotic use, particularly in an evolving landscape of prophylactic applications. Near-universal asymptomatic carriage of clinically critical resistance determinants is highly concerning and reinforces the urgent need for improved management of antibiotic use in long-term aged care.

“Elderly care through new eyes: Insights from Spain's future nurses” A phenomenological study

This study explores nursing students' perceptions of institutionalized elderly care, aiming to identify attitudes and biases that influence their academic and professional development in gerontological nursing. Conducted with 128 students across two campuses, this qualitative study utilized 15 focus groups for data collection. Five primary themes emerged through thematic and inductive analysis: Institutionalized Living, Stereotypes, Improvement Proposals, Exemplary Practices and Positive Observations and Educational Strategies and Person-centered Care Integration. Findings underscore the multifaceted nature of elderly long-term care settings, highlighting the prevalence of loneliness. Despite institutionalization's intent to mitigate loneliness, results suggest its effectiveness is variable, with a deficiency in social interaction opportunities. This underscores the imperative for comprehensive socialization programs. Additionally, integrating students into professional teams has been shown to foster positive interpersonal relationships significantly. Recommendations for enhancing care quality include personalizing living spaces, strengthening bonds between staff and residents, and enriching the nursing curriculum with advanced professional training.

Care quality and safety in long-term aged care settings: A systematic review and narrative analysis of missed care measurements.

To critically evaluate missed care measurement approaches and their application in long-term aged care (LTAC) settings. Systematic review using Tawfik's guideline. PubMed, Scopus, Web of Science, CINAHL and ProQuest were searched. Supplemental searching was from reference lists of retrieved records, first authors' ORCID homepages and Google advanced search for grey literature. Search limitations were English language, published between 1 January 2001 and 31 December 2022. COVIDENCE was utilized for screening, data extraction and quality appraisal. JBI Critical Appraisal Tools and COSMIN Risk of Bias Tool were used for quality appraisal. Data were summarized and synthesized using narrative analysis. Twenty-four publications across 11 regions were included, with two principal methods of missed care measurement: modified standard scales and tailored specific approaches. They were applied inconsistently and generated diverse measurement outcomes. There were challenges even with the most commonly used tool, the BERNCA-NH, including absence of high-quality verification through comparative analysis against an established 'gold standard', reliance on self-administration, incomplete assessment of constructs and inadequate exploration of psychometric properties. Globally, there are deficiencies in the effectiveness and comprehensiveness of the instruments measuring missed care in LTAC settings. Further research on theoretical and practical perspectives is required. Findings highlighted a critical need to establish a standardized, validated approach to measure missed care in LTAC settings. This review calls for collaborative efforts by researchers, clinical staff and policymakers to develop and implement evidence-based practices as a way of safeguarding the well-being of older clients living in LTAC settings. Measurements of missed care in LTAC settings rely on adapting acute care tools. There is a critical gap in measuring missed care in LTAC settings. Developing a new tool could improve care quality and safety in LTAC settings globally. Adhered to PRISMA guideline. No patient or public contribution.

Implementing a gerontological nursing competencies programme in aged care: Participant experiences.

To explore the experience of registered nurses and their mentors in the implementation of the Gerontological Nursing Competencies in long-term aged care and the perceived effectiveness and suitability of the programme to support nurse development. The global population is ageing and needs a reliable aged-care nursing workforce. Opportunities for education and mentorship for newly qualified and experienced aged-care nurses warrant investigation. Qualitative evaluation using semi-structured focus groups was conducted following the implementation of the programme into five not-for-profit long-term aged-care organisations and analysed by a reflexive qualitative thematic approach and reported according to COREQ criteria. A total of 21 nurses (7 mentors and 14 mentees) participated in six focus groups. Five themes were generated: (1) nurses gained confidence and competence through the programme; (2) the facilitation of suitable mentoring activities and approaches was crucial to success; (3) the programme helps nurses recognise gerontology as a specialty; (4) the programme contributes to building a strategy of recruitment/retention/quality improvement in the sector; (5) barriers, challenges, changes and recommendations were identified. The Gerontological Nursing Competency model, which combined adaptive mentoring supported by reflective practice embedded in a gerontological nursing competencies framework, was perceived to improve nurse confidence and competence to lead and improve nursing standards of care. The evidence-based competencies are an acceptable and effective method for supporting gerontological nurse development. Expansion of, and accessibility to, the programme may aid global responses to aged-care reform, by building the recognition of gerontological nursing as a specialty and contributing towards recruitment, retention and quality care improvements.

A Discussion on the Constitutional Issues of Low Birth Rate, Aging Society and the Elderly Long-Term Care Insurance Act ― Focusing on the Constitutional Court Decision ―

A Discussion on the Constitutional Issues of Low Birth Rate, Aging Society and the Elderly Long-Term Care Insurance Act ― Focusing on the Constitutional Court Decision ―

A Study on the Burden on Primary Guardian of Elderly Long-Term Care Patients

A Study on the Burden on Primary Guardian of Elderly Long-Term Care Patients

Building Medication Profiles in the Elderly: a Qualitative Study Based on Medication Information Literacy in a Long-Term Care Facility.

Long-term care facilities are increasingly challenged with meeting the diverse healthcare needs of the elderly population, particularly concerning medication management. Understanding medication information literacy and behavior among this demographic is imperative. Therefore, this qualitative study aims to explore medication information literacy and develop distinct medication profiles among elderly long-term care residents. In this study, we conducted in-depth semi-structured interviews with 32 participants aged 65 or older residing in a long-term care facility. The interviews were designed to explore participants' understanding of medication information, medication management practices, and experiences with healthcare providers. Thematic analysis was employed to analyze the interview data, allowing for the identification of common patterns and themes related to medication-taking behavior among the elderly residents. The thematic analysis revealed four distinct medication behavior profiles among the elderly long-term care residents: (1) Proactive Health Self-Managers, (2) Medication Information Adherents, (3) Experience-Based Medication Users, and (4) Nonadherent Medication Users. These findings provide valuable insights into the diverse approaches to medication management within long-term care facilities and underscore the importance of tailored interventions to support the specific needs of each profile. This study highlights the necessity for tailored medication education and support to optimize medication management for the elderly. With the aging population expansion, addressing the unique medication challenges within long-term care facilities becomes increasingly critical. This research contributes to ongoing endeavors to enhance healthcare services for the elderly, striving for safer and more effective medication-taking behavior.

Footwear and Falls in Long-Term Residential Aged Care Facilities: An Analysis of Video Capture Data

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

Swallowing Difficulties, Oral Symptoms, and Nutrition in Long-Term Care Elderly Residents – A Secondary Publication

Oral health is often impaired in people living in residential care. In older people, poor oral health is associated with functional deficits, multiple sclerosis, and memory disorders. Keeping one’s teeth healthy throughout life would promote both oral health and general health. Biting and swallowing problems in older people are also linked to oral health, limiting eating activities and requiring diet changes to softer foods that are easy to chew and swallow. This may limit dietary diversity and adequate nutrient intake. Although eating-related chewing and swallowing problems are common in institutionalized residents, they are often addressed too late, when the resident is already malnourished. Nutrition in nursing and retirement homes has been the subject of various studies since the 2000s. However, studies on swallowing and chewing difficulties are scarce and their link to adequate nutrient intake has received lesser attention [6,7].

Utilization of the Intimacy and Sexuality Expression Preference tool in long-term care: a case study.

Sexual wellness plays a crucial role in an individual's quality of life, interpersonal relationships, and self-concept, particularly among older adults residing in residential aged care facilities, including those with dementia. However, there is currently a limited person-centered approach to understanding the unique preferences of each older person regarding their intimate and sexual behaviors. To address this gap, the Intimacy and Sexuality Expression Preference (ISEP) tool was developed to facilitate meaningful discussions between healthcare professionals or workers and older individuals about their intimacy and sexuality needs and preferences. This paper explores the use of the ISEP tool with residents in long-term aged care, including those with dementia via a user-centric case study. ISEP tool interviews were conducted with 14 residents in a single residential aged care facility in Queensland, Australia. The study presented valuable insights and contextual information from using the ISEP tool, including an example of a resident's response, which provided recommendations for better supporting the resident. This involves engaging in supportive conversations to facilitate the exploration, implementation, and assessment of practical and actionable strategies to meet intimacy and sexuality needs and preferences. The ISEP tool shows promise in improving care practices and addressing the intimacy and sexuality needs of older individuals in aged care facilities. However, it is important to acknowledge that the study was conducted in a single aged care facility with a small group of residents, potentially limiting the generalisability of the findings. Further large-scale studies are necessary to establish the tool's broader applicability across different care settings.

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

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

Caring Connections: Immigrant Caregivers and Long-Term Elderly Care in Italy

Caring Connections: Immigrant Caregivers and Long-Term Elderly Care in Italy

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia.

Objective The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8-43.3], vs 37.8% [37.6-38.0]), unplanned hospitalisation (39.8% [39.6-40.1] vs 33.4% [33.2-33.6]) and potentially preventable hospitalisation (11.8% [11.6-12.0] vs 8.2% [8.1-8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency.

Market characteristics and entry strategy decision making: The market perspective of Croatian elderly care homes

Background: Socio-demographic changes increase the need for long-term elderly care. Consequently, providing formal institutional service in elderly care homes is an interesting opportunity for entrepreneurs. However, the entry strategy decision is influenced by numerous external variables. Purpose: The main goal is to answer what determines market concentration as one of the most important market entry determinants. Study design/methodology/approach: A linear regression model has been formed and tested on the Croatian elderly care home market, observed on a county level, using data for 2021. Further, a cluster analysis, as a decision-support tool, has been made to assess market characteristics that are more likely to attract new entrants to the elderly care home market. Findings/conclusions: Results indicate that demand for long-term care services plays a significant role, and the market with more elderly will attract more competitors. When the level of GDP per capita and the unemployment rate are observed together, markets with stronger economies tend to attract entrepreneurs. In other words, it is more likely that someone will open an elderly care home in a densely populated county with individuals that can afford formal institutional long-term care for themselves or family members. Limitations/future research: The shortcomings are mainly related to the lack of data on prices and quality measures. Further, information on the number of beds in each elderly care home would enable an alternative calculation of the Herfindahl-Hirschman index, while data on service prices and structure of employees as a proxy for quality (medical and non-medical staff) would enable a more reliable comparative analysis of obtained results. Future studies on this subject include variables related to the portion of unemployed females in the market since female family members more often provide informal care, and at the same time, they are more likely to be employed in formal long-term care institutions.

Integrated institutional care based on comprehensive assessment – a case study of Yanda Long-term Care Centre in China

Introduction: Long-term elderly care institutions in China usually solely provide care for daily living to the residents. In response to the multiple needs of the elderly and the policies of integrating health and care by the government, some elderly care institutions started exploring new care models.Yanda Long-term Care Centre is a private institution with more than 5000 beds participating in the interRAI initiative in China. Partnering with a built-in community health care center, it explored integrated institutional care based on interRAI assessment.&#x0D; Practice change implemented: The Centre has established a service model of ""integrated multidisciplinary care based on comprehensive assessment"" to provide integrated health and social care for the elderly. The main concept of the model is to provide comprehensive and effective care through care management and multi-professional teamwork. This care model started its official operation in 2010 and the development is ongoing.&#x0D; Targeted population and stakeholders:The targeted population is all residents in the center especially those with disability or other chronic conditions. Key stakeholders include the management team of the facility, the case managers, the multi-disciplinary care team, the interRAI company in China and the residents’ families. &#x0D; Highlights&#x0D; &#x0D; Yanda Long-term Care Centre adopted a three-tier assessment model. A basic ADL assessment was conducted as initial screening, with disabled residents entering into the next comprehensive assessment which used Long Term Care Facility Assessment Scale (InterRAI-LTCF) as the tool. Specialist assessment scales measuring functional, cognitive, nutritional, spiritual and other dimensions will be employed for specific conditions, such as mini nutritional assessment (MNA), Braden scale for predicting pressure score risk etc.&#x0D; The case managers are responsible for assessing the needs of the elderly and the quality of long-term care services, developing and guiding the implementation of integrated long-term care plans, integrating care resources.&#x0D; Multi-disciplinary care team supported by the built-in community health center，include physician, nurse, therapist, nutritionist, pharmacist, physical and occupational therapist , social worker and so on. They provide comprehensive services, including medical, nursing and rehabilitation services, health management upon needed.&#x0D; &#x0D; &#x0D; Comments on sustainability and transfer-ability: The service model could be sustainable if the current management team of the facility remains stable. The service procedures, assessment methods, case management and multidisciplinary team formation based on the built-in health care center all provide valuable experiences for other elderly care facilities to learn and practice in China.&#x0D; Discussion: Despite progress made, there are still some barriers, including the lack of training systems for professional assessors, underdevelopment of the insurance system for integrated long-term care services.&#x0D; Conclusion: The model develops individualised service plans based on comprehensive assessment and establishes a case management system, providing integrated interventions and services to high-needs residents. It reduces the incidence of risk, improves residents’ quality of life and acquires high satisfaction from both residents and their families. Attention should be given to a more standardised implementation pathway for comprehensive assessment, cultivation of professional talents and further development of financing and payment systems for integrated long-term care services.&#x0D; &#x0D;

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

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