Elderly Long-term Care Research Articles

Long-Term Care Needs of the Elderly in Korea and Elderly Long-Term Care Insurance

Korea is one of the fastest-aging societies in the world. According to the Korea National Statistical Office, the number of those aged 65 years and older will dramatically increase from 9.1% in 2005 to 37.3% in 2050. It is very evident that Korea must urgently prepare itself for new times. The government insurance policy for elderly people, now called long-term care insurance, is ultimately designed for providing home- and facility-based supports to seniors with geriatric diseases and dementia, as well as for reducing the support burden on other family members. This article is to introduce the long-term care insurance of Korea and thereby to advocates the necessity of international discussion of the prospects for developing health care for aging populations; its aim is to encourage the sharing of differing national experiences concerning care for the elderly.

老老介護の現状と主介護者の介護負担感に関連する要因

【目的】深刻な問題である老老介護の現状と, 老老介護世帯の主介護者の介護負担感と関連要因を明らかにする. 【方法】茨城県南西部において65歳以上の高齢者のみで世帯形成し, 介護認定を受けた高齢者が同居している93世帯の主介護者を対象として半構造化面接調査を実施. 主介護者の生活状況, 要介護者の状態, 介護負担感を調査し, 介護負担感との関連について分析を行った. 【結果】老老介護を行っている主介護者の8割以上が配偶者であり, 約4割が別居家族からの支援の無い世帯であった. また, 主介護者の介護負担感と睡眠時間や主観的健康感, 1日の介護時間, 別居家族からの支援, 要介護者のADL状況, 認知症の周辺症状に関連が認められた. 【結論】老老介護世帯の主介護者が在宅介護を継続できるよう, 主介護者を対象とした健康促進, 介護時間の軽減や睡眠時間の確保, 要介護者の排泄動作の介助量軽減に繋がる支援の必要性が示唆された.

A 5‐year follow‐up of older adults residing in long‐term care facilities: utilisation of a comprehensive dental programme

This study will compare the clinical outcomes of 139 elders residing in long-term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years. Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care. A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition. Eighty-three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70-73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56-72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, chi(2) = 7.9, df = 2). Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.

Nutritional status and nutritional rehabilitation of elderly living in long-term care

We review our studies on the most important factors related to feeding and nutrition in long-term care institutions, as well as we present the nutritional status of elderly people living in social homes, and, based on our results, we make recommendations concerning nutritional rehabilitation. We aimed to assess the following: nutritional status of people older than sixty years (elderly) living in long-term care institutions; changes in the body mass index of elderly living in long-term care institutions; changes in the nutritional status of elderly living in long-term care institutions during the last half decade; relations and correlations between acute and chronic diseases and nutritional status; the sip feed provision for elderly living in long-term care institutions; relationship between the discovered potential influencing factors and nutritional status screened by Malnutrition Universal Screening Tool (MUST). We screened the nutritional status of altogether 4774 (men: 28.9-30.9%, women: 69.1-71.19%; mean age: 77.8+/-8.9 years) elderly long-term care residents who volunteered to participate. In 2004 and 2006 the MUST and our questionnaire, in 2008 the nutritionDay questionnaire was used. Risk of malnutrition is high (26.8-77.0%) in elderly residents of social homes. Assessment of nutritional status is done four times a year or even more rarely in 29.5% of the residents. Nutritional status is multifactorial; it is influenced by immobility, fever, etc. Loss of appetite and swallowing difficulties are 2.5-fold, limited mobility, dementia and missing teeth are almost two-fold (1.6-1.7) more frequent in the group of high risk elderly than in the elderly living in social homes. Neurological diseases are in a significant correlation with nutritional status. Incidence of neurological diseases increased significantly in the last years. Nutritional rehabilitation does not end with screening the nutritional status, moreover, it begins with that. Individual diet has to follow the determination of personal nutritional guidelines.

Workforce Issues in Residential Care Facilities in Rural China

This study examined contemporary frontline workforce issues related to residential care for elders in rural China. Residential facilities in rural China are in transition from exclusively providing shelter to childless elders to providing long-term care for frail elders. These facilities are also under pressure to improve the quality of services that they provide. The study is based on in-depth interviews with administrators and field observations of facilities. The study focused on the following issues related to the workforce: recruitment and retention, training, work environment, workforce organization, regulations, compensation, and career ladders. The implications of resident characteristics for demands on the work force were examined. The study found that lack of skilled personnel is one of the major reasons that the overwhelming majority of facilities deny admission to frail and demented elders. Improving workers’ skill is critical if these facilities are to meet the increasing demand for institutional long-term care needs.

Analysis of the North Carolina Long-Term Care Polypharmacy Initiative: A multiple-cohort approach using propensity-score matching for both evaluation and targeting

Background: The high cost and undesirable consequences of polypharmacy are well-recognized problems among elderly long-term care (LTC) residents. Despite the implementation of the 1987 Omnibus Budget Reconciliation Act, which requires pharmacist review of drug regimens in this setting, medical and drug costs for LTC residents have continued to increase. Objective: This study evaluates the North Carolina Long-Term Care Polypharmacy Initiative, a large-scale medication therapy management program (MTMP) that combined drug utilization review activities with drug regimen review techniques. Methods: This was a prospective records-based study that used a difference-in-difference model with both historical and nonintervention group controls. To ensure equivalence among subjects, propensity scoring was used to match study subjects from participating LTC facilities with comparison subjects from nonparticipating facilities. Residents with interventions were grouped for analysis by intervention type—retrospective only, prospective only, or dual type (residents with both prospective and retrospective interventions)—and by intervention stage—review, recommendation, and drug change—plus an all-inclusive “all types” grouping that aggregated groups by intervention type, for a total of 10 total cohorts. Results: In the overall population of 5255 study subjects identified, a US $21.63 per member per month drug-cost savings was observed. Although only 1 of 10 cohorts had a change in the number of drug fills, substantial reductions in 2 of 5 types of drug alerts were observed in all 10 cohorts. A reduction in the relative risk for hospitalization (0.84 [95% CI, 0.71–1.00]) was observed in the cohort of residents receiving a retrospective review. Conclusions: This Initiative suggests that an MTMP can be quickly launched in a large number of LTC facility residents to produce monetary drug-cost savings and improved health outcomes. Additionally, the evaluation of this program illustrates the utility of using propensity scoring techniques to target future intervention groups in a cost-effective manner.

Prevalence of hypomagnesemia (HM) in a geriatric long-term care (LTC) setting

Electrolyte abnormalities are frequently observed in elderly long-term care (LTC) patients. Magnesium is a trace mineral, but is the second most abundant intracellular cation and the fourth most abundant cation in the body. This was a cross-sectional study to assess the prevalence of hypomagnesemia (HM) in non-selected elderly LTC patients. A total of 159 patients aged 65 years and older were included in the study. The attributes and variables related to the patients’ hospital course were used to compare the two groups. We used univariate and multivariate analyses to correlate magnesium levels with demographic, clinical factors and laboratory data. HM was found in 36% of the patients, of whom 35% presented with moderate HM (0.8–0.9 μequiv./l) and 18% with severe HM (≤0.7 μequiv./l). Patients with HM had a higher number of comorbid diseases per patient ( p = 0.038), low body mass index (BMI) ( p = 0.044) and more of them presented with laboratory markers of malnutrition, such as low total cholesterol (TC) and serum albumin (SA) levels. Coexistence with other electrolyte abnormalities was higher among patients with HM than without ( p = 0.006), predominantly hypocalcemia and hypokalemia ( p = 0.023 and 0.032, respectively). Using regression analysis, independent variables significantly associated with serum magnesium levels were serum albumin, calcium, potassium, urea levels, chronic renal failure (CRF), chronic heart failure (CHF), diabetes mellitus (DM) and diuretic drugs ( R 2 = 0.877). Both early (up to 30 days) and late rate of death were higher in patients with HM. The incidence of HM in LTC elderly patients is high and multifactorial. Understanding the causes of HM, correction of magnesium level, and definitive and effective treatment of the cause leading to HM is important to improve patient prognosis.

Transitions of Elders Between Long-Term Care and Hospitals

Elderly long-term care recipients who require acute hospitalizations must navigate a fragmented system with poor "handoffs," often resulting in negative outcomes. This article makes the case that reducing preventable hospitalizations and improving transitions to and from hospitals will enhance health care quality and outcomes among these elders. Immediate action targeting diffusion of evidence-based care is recommended to decrease avoidable rehospitalizations and achieve cost savings. Policy changes are needed to address barriers to high-quality transitional care, including deficits in health professionals' and caregivers' knowledge and resources, regulatory obstacles, and inadequate financial incentives and clinical information systems.

Development and initial testing of the Person-centered Care Assessment Tool (P-CAT)

Person-centered care is increasingly regarded as being synonymous with best quality care. However, the concept and its precise meaning is a subject of debate and reliable and valid measurement tools are lacking. This article describes the development and initial testing of a new self-report assessment scale, the Person-centered Care Assessment Tool (P-CAT), which measures the extent to which long-term aged care staff rate their settings to be person-centered. A preliminary 39-item tool generated from research literature, expert consultations and research interviews with aged care staff (n = 37), people with early onset dementia (n = 11), and family members (n = 19) was distributed to a sample of Australian aged care staff (n = 220) and subjected to item analysis and reduction. Psychometric evaluation of the final 13-item tool was conducted using statistical estimates of validity and reliability. The results showed that the P-CAT was shown to be valid and homogeneous by factor, item and content analyses. Cronbach's alpha was satisfactory for the total scale (0.84), and the three subscales had values of 0.81, 0.77, and 0.31 respectively. Test-retest reliability were evaluated (n = 26) and all analyses indicated satisfactory estimates. This study provides preliminary evidence in support of the psychometric properties of the P-CAT when used in an Australian sample of long-term aged care staff. The tool contributes to the literature by making it possible to study person-centered care in relation to health outcomes, organizational models, characteristics and levels of staffing, degrees of care needs among residents, and impact of interventions.

Dining experience, foodservices and staffing are associated with quality of life in elderly nursing home residents.

Few studies have quantitatively investigated potential relationships between quality of life (QOL) in long term care (LTC) and foodservices. To investigate if dining experiences, and food and nutritional services affect elderly nursing home residents' QOL. A total of 395 residents in 38 nursing homes participated in this cross-sectional study. Information on dining experiences and QOL was gathered by face-to-face interviews with cognitively intact residents; primary institutional caregivers completed a questionnaire for cognitively impaired residents. Additional data were also obtained from participants' medical charts and from administrators and foodservice managers. Multivariate ordinary least squares (OLS) regression was used to determine which institutional characteristics were related to QOL. Number of dining companions, autonomy in relation to food, tray meal delivery service, and ratio of residents per resident assistant were significantly related to QOL in both cognitively intact and cognitively impaired residents. For cognitively intact residents, number of medical conditions, therapeutic menus, and use of china dishes were also related to QOL. For cognitively impaired residents, independence with eating and frequency of menu revision were also related to QOL. Modifying certain aspects of food and nutritional services, as well as residents' dining experience, may improve QOL of elderly LTC residents.

The Difference of Calf Circumferences between the Mid-Calf and Tibial Tuberosity and the Relationship between the Difference and Mobility in Long-Term Care Elderly Patients

The Difference of Calf Circumferences between the Mid-Calf and Tibial Tuberosity and the Relationship between the Difference and Mobility in Long-Term Care Elderly Patients

Management of hypertension in elderly long-term care residents

To determine the adequacy of hypertension management in institutionalized elderly patients. Retrospective chart review of all patients with a physician-documented diagnosis of hypertension at 15 long-term care facilities in Edmonton, Alberta. Of 2063 long-term care residents, 733 (36%) were diagnosed with hypertension (mean age 84 years), and 566 (77%) of this cohort were receiving antihypertensive medication. The most frequently prescribed antihypertensive drugs were angiotensin-converting enzyme inhibitors (341 patients [60%]). Of the long-term residents prescribed antihypertensive therapy, 274 (48%) were on one medication, 203 (36%) were on two and 89 (16%) received three or more agents. Blood pressure readings were taken every 14 days on average (interquartile range two to 31 days). Overall, 467 (64%) of these residents with a diagnosis of hypertension achieved target blood pressure. Hypertension treatment and control rates are better in elderly patients who are institutionalized than those reported in studies of patients who reside in the community. Determining the reasons for this discrepancy will be important for the design of strategies to improve hypertension control rates in the community.

Evaluation of the Benefits of Enteral Nutrition in Long-Term Care Elderly Patients

Demented patients may refuse to eat as they come closer to the end of their lives. We evaluated the effectiveness of enteral nutrition in the improvement of survival and nutritional and functional status in very dependent and demented long-term care (LTC) elderly patients and its correlation with the nutritional parameters. Fifty-seven elderly patients, aged 60 years and older, who received nutrition by the enteral route (enteral nutrition group, ENG), were compared with 110 age-, sex-, comorbibity-, cognitive-, and dependent-matched subjects (control group, CG). Indications for enteral nutrition, type of tube; weight status subsequent to enteral nutrition; cognitive, functional, and pressure sore status; and complete clinical, complete blood count, and biochemical profile were recorded for each subject on initiation and conclusion of the study. Enteral nutrition was associated with improvement in blood count (hemoglobin and lymphocyte count), in renal function tests and electrolytes (BUN, creatinine, BUN/creatinine ratio, sodium and potassium), hydration status, serum osmolarity, and in serum proteins (total protein, albumin, and transferrin), but not in serum cholesterol and CRP levels. Decline in functional and in cognitive status was higher in CG than in ENG (Delta changes; respectively P = .24 and P < .001). ENG had a higher Norton scale than CG (Delta changes; P < .001). Mortality rate was higher in ENG (42%) than in CG (27%, P > .05). Complication rate related to nutrition was higher in ENG than in CG (61% and 34%, respectively; P < .001). Enteral nutrition does not have an advantage over oral nutrition in prolonging life or preventing pressure sore development in an LTC setting.

Future of Long-Term Care Financing for the Elderly in Korea

ABSTRACT With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly long-term care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.

Poorhouse to Warehouse: Institutional Long-Term Care in the United States

Nursing homes in the United States are a product of American federalism and reflect the complexities and variabilities of that system. Over time, institutional long-term care for frail elders has shifted from local government funding and administration to state-level oversight and support to a shared federal-state concern. The unsystematic American approach produces haphazard results in terms of quality, equity, and efficiency. The graying of the American population will increase the demand for long-term care, resulting in pressure for a more coherent policy response.

Health Illiteracy Challenges Long-Term Care

Health Illiteracy Challenges Long-Term Care

Nutrient Inadequacies Among Elderly Residents Of Long-term Care Facilities

Regular, non-therapeutic diets were examined in long-term care (LTC) residents to determine whether these residents consumed adequate nutrients according to current recommendations. Elderly (88 +/- 8 years) residents (31 female, 17 male) in five Saskatoon LTC centres participated. All were receiving regular diets. Dietary intakes were collected for three days at breakfast, lunch, and dinner, by using simultaneous weighed and observation methods. Snacks provided and eaten were also recorded. Observed intakes provided more complete data on nutrient intake than did weighed intakes. Inadequacy was most prevalent (in 70% or more of participants) for folate (according to prefortification intake levels), magnesium, zinc, vitamin E, and vitamin B6; inadequacy prevalence was below 50% for protein, vitamin C, and thiamine. Mean intakes of calcium, vitamin D, and dietary fibre were well below their respective Adequate Intake (AI) values. Energy consumed at meals and with snacks was 16% less than that offered at meals alone; other nutrients ingested ranged from 0% to 32% below energy offered. To model nutrient planning, target usual intake distributions were calculated where possible. These data suggest that nutrient-dense foods alone may not allow elderly LTC residents to meet intake requirements for many nutrients. Assessment of dietary adequacy in institutionalized elderly people allows for the development of realistic nutrition goals.

A Novel Solution is Needed to Correct Low Nutrient Intakes in Elderly Long-Term Care Residents

Currently, there is no consensus about how to best treat malnutrition in elderly long-term care residents. A recent study found that the traditional treatment method of serving small, frequent meals was not effective at increasing energy intake. This review describes strategies to treat malnutrition in this vulnerable population.

Seeking What's Best During the Transition to Adult Day Health Services

Family caregivers provide more than 80% of the long-term care for elders in the United States and experience a variety of transitions that are intertwined with those of their elders. Previous research on health care transitions documents problems elders and family caregivers encountered following hospitalization, following nursing home admission, and in adjusting to home health care. Little is known about the transition to adult day health services (ADHS). The purpose of this study was (a) to examine family caregivers' perspectives on the transition to ADHS and (b) to develop a situation-specific theory to guide interventions for elders and their family caregivers during the transition. Semistructured interviews were conducted with 16 family caregivers 1 month and 3 months following the elder's enrollment in ADHS. The constant comparative method was used in analyzing the data. The findings indicate that family caregivers consistently sought what was best for elders throughout the transition.

Is that all there is? The concept of care and the dialectic of critique

Recognition of the usefulness of critical social analysis for gerontology has been increasing just as a range of new problems, ranging from globalization to the anti-aging movement, are posing fresh questions about ideology, legitimation and inequality for the study of aging. Such problems and questions represent the negative moment of critique in the theory–practice dialectic. As is generally true of critical theory, in critical gerontology it is rare to find research that reflects a positive movement toward emancipatory change. Yet gerontology is one of the fields that offers special opportunities for critiquing the status quo of aging and elders in society, envisioning new possibilities for aging and developing practices that produce positive change. This paper describes the movement of our own thinking and work, away from a primary focus on analysis and critique and toward an embrace of the possibilities of generating and sustaining change in organizational care settings. We argue that principles of critical developmental and social theory can be used to reframe the concept of care, and we describe briefly how the methodology of action research can be applied in efforts to create new opportunities and possibilities in the everyday experience of elders in long-term care. In our work, we are learning how a constructive theory–practice dialectic can be initiated when critical principles are applied to a practical and urgent domain — the domain of interpersonal care within long-term care institutions for elders.