Residents Of Long-term Care Facilities Research Articles

Sequencing analysis of SARS-CoV-2 cases in Slovenian long-term care facilities to support outbreak control

IntroductionResidents of long-term care facilities (LTCFs) are at high risk of morbidity and mortality due to COVID-19, especially when new variants of concern (VOC) emerge. To provide intradisciplinary data in order to tailor public health interventions during future epidemics, available epidemiologic and genomic data from Slovenian LTCFs during the initial phases of the COVID-19 pandemic was analyzed.MethodsThe first part of the study included SARS-CoV-2 reverse-transcription Real-Time PCR (rtRT-PCR) positive LTCF residents, from 21 facilities with COVID-19 outbreaks occurring in October 2020. The second part of the study included SARS-CoV-2 rtRT-PCR positive LTCF residents and staff between January and April 2021, when VOC Alpha emerged in Slovenia. Next-generation sequencing (NGS) was used to acquire SARS-CoV-2 genomes, and lineage determination. In-depth phylogenetic and mutational profile analysis were performed and coupled with available field epidemiological data to assess the dynamics of SARS-CoV-2 introduction and transmission.Results370/498 SARS-CoV-2 positive residents as well as 558/699 SARS-CoV-2 positive residents and 301/358 staff were successfully sequenced in the first and second part of the study, respectively. In October 2020, COVID-19 outbreaks in the 21 LTCFs were caused by intra-facility transmission as well as multiple independent SARS-CoV-2 introductions. The Alpha variant was confirmed in the first LTCF resident approximately 1.5 months after the first Alpha case was identified in Slovenia. The data also showed a slower replacement of existing variants by Alpha in residents compared to staff and the general population.DiscussionMultiple SARS CoV-2 introductions as well as intra-facility spreading impacted disease transmission in Slovenian LTCFs. Timely implementation of control measures aimed at limiting new introductions while controlling in-facility transmission are of paramount importance, especially as new VOCs emerge. Sequencing, in conjunction with epidemiological data, can facilitate the determination of the need for future improvements in control measures to protect LTCF residents from COVID-19 or other respiratory infections.

Dietary Inflammatory Potential and its Association with Sleep Complaints in Institutionalized Older Adults: A Pilot Study

Abstract Objective To evaluate the inflammatory potential of diets, the specific dietary contributors to said inflammatory potential, the nutritional adequacy of these diets, and the association between the dietary inflammatory potential and sleep complaints among residents of long-term care facilities. Materials and Methods The present is a cross-sectional, quantitative, and exploratory study, with a convenience pilot sample from two long-term care facilities. To assess sleep complaints, the sleep domain of the Nottingham Health Profile was applied, as well as a question about daytime napping. To evaluate the inflammatory potential of the diet, the Dietary Inflammatory Index (DII) was calculated. Results The participants presented energy and protein intakes below the recommendation. The intake of saturated fatty acids, omega 6, dietary fiber, vitamins D, E, B6, and magnesium were inadequate in some of the participants. The mean score on the DII was of 1.6, representing a more proinflammatory potential, due to insufficient intake of anti-inflammatory components. The foods with the most significant inflammatory effect consumed were whole milk and butter. On the other hand, those with less inflammatory potential were beans, beets, coffee, and sweet potatoes. No significant association was observed between the sleep complaints and the DII. Conclusion The data showed inadequacy of many nutrients and a proinflammatory potential regarding the diet in the long-term care facilities. However, the DII was not significantly associated with sleep complaints in our sample. The present study highlights the need for greater attention to meal planning in these institutions.

Long term care facilities in England during the COVID-19 pandemic—a scoping review of guidelines, policy and recommendations

BackgroundThe disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area.AimsTo identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes.MethodA scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes.ResultsThirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication.DiscussionLTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing.

Changes in Psychiatric Medication Use During the COVID-19 Pandemic in a Pediatric Long-Term Care Facility.

Background: Coronavirus disease 2019 (COVID-19) caused a global pandemic that dramatically altered infection control procedures in long-term care facilities. Mental health decline among residents of geriatric facilities during the pandemic has been described (Ferro Uriguen et al., 2022). Our study aims to evaluate psychological effects of the pandemic on residents of a pediatric long-term care facility, a population comprised of medically complex children. To characterize this, we compared patterns of psychotropic medication use during the COVID-19 pandemic to those of the prepandemic period among residents of a 76-bed pediatric long-term care facility. Methods: We conducted a retrospective study of psychotropic medication use from January 2019 to August 2022 using de-identified monthly facility medication refill data. Linear multivariable regression models were used to estimate the level and trends in the monthly rates of medication refills per 10,000 bed days among resident children before and after the pandemic onset. Six classes of psychotropic medications were analyzed including antipsychotics, antidepressants and anxiety medications, trazodone, clonidine, mood stabilizers, and gabapentin. Results: The pandemic onset was associated with a significant increase in the monthly prescribing rates of antidepressant and anxiety medications (20.83; 95% CI, 3.96-37.71; p = 0.017), mood stabilizers (10.44; 95% CI, 5.79-15.09; p < 0.001), and trazodone (-27.66; 95% CI, -40.44 to 14.88; p < 0.001) above those expected by prepandemic trends. The trend in trazodone use changed significantly during the pandemic from decreasing prepandemic to increasing (2.21; 95% CI, 1.28-3.14; p < 0.001). Antidepressant, anxiety medication, and gabapentin use increased throughout the study. Antidepressant and anxiety medication use surged early in the pandemic, but then continued growth at their prior rates of use. Discussion: Increased use of antidepressant and anxiety medications and trazodone suggests a possible impact of the COVID-19 pandemic on rates of anxiety, depression, sleep disturbance, and agitation among children with severe intellectual and developmental disabilities living in long-term care.

Pharmacist-guided deprescribing for frail older adults in nursing homes using STOPPFrail

Abstract Introduction Frail older adults in nursing homes are often prescribed inappropriate medications. Whilst STOPPFrail can aid deprescribing in such persons with limited life expectancy, there has been insufficient research showing pharmacists’ application of this tool.[1,2] Aim To evaluate the impact of pharmacist-led application of STOPPFrail to frail older nursing home residents. Methods Nursing home residents aged ≥65 years with advanced frailty and a poor one-year survival prognosis were eligible to partake.[1] A convenience sample of nursing homes was recruited via nursing home GPs within the research team’s professional network. After recruitment by their general practitioner (GP), a research pharmacist (EH) reviewed participants using STOPPFrail to identify potentially inappropriate medications (PIMs). Deprescribing recommendations for each participant were provided to GPs via email and discussed via videoconference, whereby recommendations were implemented if GPs perceived they were clinically appropriate. Outcome measures were recorded at baseline, post intervention, and at six months. Descriptive and inferential statistics were performed, where p&amp;lt;0.05 represents a statistically significant difference from baseline. Results Ninety-nine patients from six nursing homes were recruited (76% female). The mean age was 86 years (standard deviation [SD]: 6.9), and the mean number of comorbidities was 15 (SD: 5.3). Nearly all patients (94%) were prescribed ≥1 PIM at baseline. From 349 clinically relevant STOPPFrail recommendations to deprescribe 329 PIMs, 58% were accepted (n=203) and 55% were implemented (n=193), resulting in 176/329 PIMs (53%) being deprescribed – with 167/176 (95%) persisting at six months. Recommendations most commonly concerned medications without a clear indication (29.5%), vitamin D (16.9%), antipsychotics (8.9%), memantine (7.2%), and proton pump inhibitors (7.2%). Relating to baseline, post intervention, and at six months: i)the mean ± SD number of prescribed medications was 16.0±6.1, 14.6±5.7 (p&amp;lt;0.01), and 15.4±5.5 (p=0.03); ii)the monthly mean ± SD cost of patients’ medications was €186.8±123.7, €172.7±119.0 (p&amp;lt;0.01), and €186.4±121.2 (p=0.949); iii)the mean ± SD Modified Medication Appropriateness Index (MMAI) was 2.19±0.73, 2.11±0.74 (p&amp;lt;0.01), and 2.08±0.71 (p&amp;lt;0.01); iv)the median [interquartile range] Drug Burden Index (DBI) was 1.03 [0.50-2.00], 0.93 [0.50-1.80] (p&amp;lt;0.01), and 0.93 [0.50-1.80] (p&amp;lt;0.01); v)the mean ± SD Anticholinergic Cognitive Burden (ACB) was 4.27±2.45, 3.86±2.54 (p&amp;lt;0.01), and 3.94±2.70 (p=0.03). The mean ± SD EQ-5D-5L QoL summary score was 0.183±0.286 at baseline and 0.159±0.312 (p=0.18) at six months. The mean ± SD EQ-5D-5L visual analogue score was 60.3±22.8 at baseline and 61.8±19.9 (p=0.45) at six months. Over two-thirds of residents (70/99) were alive at six months. There were 36 falls, one emergency department visit, and eight non-elective hospitalisations six months prior to baseline compared to 31, four, and seven respectively in the six months post intervention. Conclusion To the authors’ knowledge, this is the first study to apply STOPPFrail to residents of long-term care facilities and also the first to have a pharmacist do so. Although this study lacked a control group, the intervention significantly reduced PIMs, medication costs (initially, but not maintained at follow-up), and both the anticholinergic and sedative burden. The intervention maintained QoL and reduced fall frequency. Given these results, policymakers, nursing home facilities, and clinicians should consider the wider implementation of pharmacist-led STOPPFrail-guided reviews to optimise the medications of frail older adults.

The impact of the COVID-19 pandemic, and care home closures on timing of mortality in residents of English LTCFs

Background In the UK, mortality incidence of residents in long-term care facilities (LTCFs) was high during the first two waves of the COVID-19 pandemic. Prior to the pandemic, mortality risk was greater amongst new LTCFs admissions compared to longer term residents. Following the re-opening of these facilities to new residents after the second wave of the pandemic, we hypothesised that this difference would be more pronounced. We aimed to establish whether this occurred by comparing mortality risk in new admissions with existing residents. Methods Data were accessed from the VIVALDI study, a prospective cohort study set up to investigate COVID-19 in English LTCFs. Residents aged over 65 were included and analysis performed over the Delta (16th May 2021-19th December 2021) and Omicron (19th December 2021-31st March 2022) waves of the pandemic. Classification into new and existing residents was based on presence in the LTCF before or after 24th April 2021. Mixed effects Cox regression models were used, with separate hazard ratios associated for existing vs new residents estimated for each calendar month. Results 11,532 residents were observed during the Delta wave and 9,801 during the Omicron wave. Mortality hazard ratios for existing care home residents compared to new care home residents stabilised after September 2021, following a period of reduced risk between May (HR: 0.23 95% CI: 0.11-0.47) and August (HR: 0.37, CI:0.29-0.47) 2021. No mortality displacement was observed in the Omicron wave. Conclusions Mortality rates amongst existing residents were lower than anticipated between May and August 2021 but increased and stabilised by September 2021, providing evidence for mortality displacement within this population. Improved monitoring of infection outcomes for LTCF residents that consider time since admission would help improve our understanding of the dynamics and composition of LTCF populations in non-pandemic periods.

Validation of the Delirium Observation Screening Scale in long-term care facilities in Flanders.

The aim of this study was to validate the Delirium Observation Screening Scale (DOSS) in a population of long-term care facility (LTCF) residents in Flanders. Currently there is no validated screening tool for delirium available for the population in this setting in Flanders. A multisite, cross-sectional study was conducted in six LTCFs. A total of 338 residents aged 65 years and older were included. Sociodemographic and clinical data, including data from the Montreal Cognitive Assessment (MoCA), Confusion Assessment Method (CAM) and DOSS, were obtained by three trained nurse researchers. For the DOSS, internal consistency was determined, and inter-rater reliability was calculated. To validate the DOSS, the sensitivity, specificity, and positive and negative predictive value of the DOSS relative to the CAM were determined through receiver operating characteristic analysis. This article adheres to the Strengthening the Reporting of Observational Studies (STROBE) checklist for observational research. For 338 residents, delirium assessments were completed during an early or late shift. The prevalence of delirium was 14.2% as measured with the DOSS. The reliability (α) for the CAM and DOSS was assessed, as was the inter-rater reliability (κ) and the area under the curve. The sensitivity and specificity for a cut-off value of 3 on the DOSS by Youden's index were very high, as was the negative predictive value. The positive predictive value was good. This study showed that the DOSS is a reliable and valid instrument to screen for delirium in LTCF residents in Flanders. Geriatr Gerontol Int 2024; ••: ••-••.

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 falls characteristics (proposed mechanism and fall direction). Results: There were 300 falls experienced by 118 older adults aged 58 years to 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.

A systematic review of reasons and risks for acute service use by older adult residents of long-term care.

To identify the reasons and/or risk factors for hospital admission and/or emergency department attendance for older (≥60 years) residents of long-term care facilities. Older adults' use of acute services is associated with significant financial and social costs. A global understanding of the reasons for the use of acute services may allow for early identification and intervention, avoid clinical deterioration, reduce the demand for health services and improve quality of life. Systematic review registered in PROSPERO (CRD42022326964) and reported following PRISMA guidelines. The search strategy was developed in consultation with an academic librarian. The strategy used MeSH terms and relevant keywords. Articles published since 2017 in English were eligible for inclusion. CINAHL, MEDLINE, Scopus and Web of Science Core Collection were searched (11/08/22). Title, abstract, and full texts were screened against the inclusion/exclusion criteria; data extraction was performed two blinded reviewers. Quality of evidence was assessed using the NewCastle Ottawa Scale (NOS). Thirty-nine articles were eligible and included in this review; included research was assessed as high-quality with a low risk of bias. Hospital admission was reported as most likely to occur during the first year of residence in long-term care. Respiratory and cardiovascular diagnoses were frequently associated with acute services use. Frailty, hypotensive medications, falls and inadequate nutrition were associated with unplanned service use. Modifiable risks have been identified that may act as a trigger for assessment and be amenable to early intervention. Coordinated intervention may have significant individual, social and economic benefits. This review has identified several modifiable reasons for acute service use by older adults. Early and coordinated intervention may reduce the risk of hospital admission and/or emergency department. This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. No patient or public contribution.

Meditation Moderates the Relationship between Insecure Attachment and Loneliness: A Study of Long-Term Care Residents in Thailand.

Background and Objectives: Loneliness is prevalent among residents of long-term care settings, posing significant challenges to their mental wellbeing. Insecure attachment has been identified as a contributing factor to loneliness in this population. Previous research has suggested that meditation may have beneficial effects on mental health outcomes. This study aimed to examine the relationship between meditation, insecure attachment, and loneliness among residents of long-term care facilities in Thailand. Specifically, the study sought to investigate the moderating effect of meditation on the association between insecure attachment (both avoidance and anxiety) and loneliness. Materials and Methods: A cross-sectional study was conducted involving 236 residents living in long-term care homes in Thailand. Participants completed self-report measures including the 18-item Revised Experience of Close Relationship questionnaire (to assess attachment anxiety and avoidance), the Inner Strength-Based Inventory (to measure meditation practice), and the 6-item Revised Version of the University of California Los Angeles Loneliness Scale. Moderation analyses were performed to explore the role of meditation in the relationship between insecure attachment and loneliness. Results: The mean age of participants was 73.52 years, with females accounting for 57.6% of the sample. Among the participants, 58.4% reported engaging in meditation, with practice frequency ranging from often to daily. The mean meditation score was 2.92 out of 5, indicating regular but not daily practice. Meditation was found to moderate the relationship between insecure attachment (both avoidance and anxiety) and loneliness. Specifically, the moderation effect between attachment anxiety and loneliness was significant (B = 0.44, SE = 0.21, 95% CI [0.30, 0.86]), as was the interaction effect between attachment anxiety and loneliness (B = -0.34, SE = 0.17, 95% CI [-0.67, -0.02]). Conclusions: The findings suggest that the impact of meditation practice on loneliness is influenced by an individual's attachment dimension. Meditation demonstrates a moderating effect on attachment avoidance, anxiety, and loneliness, with variations observed in the direction of these effects. The clinical implications of these findings and recommendations for further research are discussed.

Depression and anxiety between nurses and nursing assistants working in long-term care facilities during the COVID-19 pandemic.

This study investigated the levels of depression and anxiety in nurses and nursing assistants working in long-term care facilities during the COVID-19 pandemic. We also explored the potential causes of depression and anxiety in nurses and nursing assistants working in long-term care facilities during the pandemic. The COVID-19 pandemic has had a considerable impact on long-term care facilities. The high infection and mortality rates for COVID-19 have resulted in an increased workload for caregivers. The COVID-19 pandemic exposedcaregivers working in long-term care facilities to higher risks of anxiety and depression. Additionally, the high risk of infection in the work environment and concerns about spreading COVID-19 to family members and long-term care facility residents led to various forms of stress among caregivers. The present study was a cross-sectional study. Questionnaires were used to investigate depression and anxiety among regarding nurses and nursing assistants working in long-term care facilities during the pandemic. The depression and anxiety levels of the nurses were higher than nursing assistants, but had no statistically significant difference (p=0.551). The factors influencing levels of depression and anxiety in nurses contained facility affiliation and experience working. In terms of nursing assistants, age, marital status, and facility affiliation were correlated with the levels of depression and anxiety. The pandemic has severely impacted caregivers. In the process of implementing pandemic prevention measures and providing care for COVID-19 patients, safeguarding the psychological health of caregivers is also essential. The levels of depression and anxiety in nurses were higher than in nursing assistants working in long-term care facilities during the pandemic. Long-term care facilities managers are recommended to enhance the education and training process for caregivers. Managers are also recommended to ensure provision of sufficient amounts of pandemic prevention equipment and resources.

Post-discharge surveillance of urinary tract infections in patients following hip and knee arthroplasty: Identifying targets for infection prevention and control

This population-based study aimed to evaluate the incidence of urinary tract infections (UTIs) following hip and knee arthroplasty (HPRO and KPRO) and to identify UTI risk factors among Polish patients. Analysis included data from 83,525 patients, with incidence rates of 0.7% and 0.49% after HPRO and KPRO, respectively. We identified women, individuals over 65 years old, residents of long-term care facilities, patients with chronic circulatory, endocrine, or digestive diseases, and those operated on due to trauma as targets for infection prevention and control.

Spiritual Needs of Older Residents in Long-Term Care Facilities: A Concept Analysis

The aim of this study was to explore and define the spiritual needs of older residents in long-term care facilities (LTCFs) using the Walker and Avant (2019) approach. In this regard, the keywords “spiritual needs”, “old adults” and “long-term care facilities” were searched through PubMed, EBSCOhost, and Google Scholar electronic databases between the years 2000 and 2023 along with hand searching of reference lists extracted from more than 135 articles. Finally, 11 articles that had inclusion criteria were examined based on the eight stages mentioned in Walker and Avant’s concept analysis approach. Through the systematic application of Walker and Avant's eight stages concept analysis approach, this paper provides a nuanced understanding of the spiritual needs of elderly residents in long-term care facilities. The results are serves as a valuable tool for guiding caregivers, healthcare professionals, and policymakers in developing strategies that cater to the spiritual well-being of this demographic, ultimately fostering a more holistic and compassionate caregiving environment.

Individual and organizational interventions to promote staff health and well-being in residential long-term care: a systematic review of randomized controlled trials over the past 20 years

BackgroundStaff in residential long-term care (RLTC) experience significant physical and mental work demands. However, research on specific interventions to promote staff health and well-being in RLTC facilities is limited. This systematic review aimed to synthesize the current evidence on health promotion interventions among RLTC staff.MethodsA comprehensive systematic literature review was conducted on studies published between January 2000 and April 2023. Four electronic databases were searched, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PsychArticles via EBSCO. The review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The methodological quality of the included studies was assessed using the Risk of Bias Assessment tool (RoB 2).ResultsA total of 26 publications, referring to 23 different interventions with a randomized controlled design were included. Among these interventions, ten used training/educational approaches, six used behavioral approaches, and seven employed a multimodal approach. Significant improvements in health and well-being outcomes were found in four interventions using a training/educational approach, three interventions using a behavioral approach, and four interventions using a multimodal approach. Within the interventions studied, twelve specifically targeted the reduction of job demands, while only one intervention exclusively addressed job resources among RLTC staff. Furthermore, ten interventions addressed primary outcomes that encompassed both job demands and job resources.ConclusionCurrent evidence for health promotion interventions among RLTC staff is still limited, but research suggests that there is potential to improve certain outcomes related to RLTC staff health and well-being. Future research is recommended to contemplate a tailored intervention design that encompasses both individual-level and organizational-level approaches, and gender-specific physiological and sociological characteristics of RLTC staff. Moreover, detailed reporting of the development process, and research on the interaction between job demands and resources of RLTC staff are also recommended.

Validation of the prevalence to incidence conversion method for healthcare associated infections in long-term care facilities.

Residents of long-term care facilities (LTCFs) are a population at high risk of developing severe healthcare associated infections (HAIs). In the assessment of HAIs in acute-care hospitals, selection bias can occur due to cases being over-represented: patients developing HAIs usually have longer lengths of stays compared to controls, and therefore have an increased probability of being sampled in PPS, leading to an overestimation of HAI prevalence. Our hypothesis was that in LTCFs, the opposite may occur: residents developing HAIs either may have a greater chance of being transferred to acute-care facilities or of dying, and therefore could be under-represented in PPS, leading to an underestimation of HAI prevalence. Our aim was to test this hypothesis by comparing HAI rates obtained through longitudinal and cross-sectional studies. Results from two studies conducted simultaneously in four LTCFs in Italy were compared: a longitudinal study promoted by the European Centre for Disease Prevention and Control (ECDC, HALT4 longitudinal study, H4LS), and a PPS. Prevalence was estimated from the PPS and converted into incidence per year using an adapted version of the Rhame and Sudderth formula proposed by the ECDC. Differences between incidence rates calculated from the PPS results and obtained from H4LS were investigated using the Byar method for rate ratio (RR). On the day of the PPS, HAI prevalence was 1.47% (95% confidence interval, CI 0.38-3.97), whereas the H4LS incidence rate was 3.53 per 1000 patient-days (PDs, 95% CI 2.99-4.08). Conversion of prevalence rates obtained through the PPS into incidence using the ECDC formula resulted in a rate of 0.86 per 1000 PDs (95% CI 0-2.68). Comparing the two rates, a RR of 0.24 (95% CI 0.03-2.03, p 0.1649) was found. This study did not find significant differences between HAI incidence estimates obtained from a longitudinal study and through conversion from PPS data. Results of this study support the validity of the ECDC method.

Social Activity and Cognitive Decline in Older Residents of Long-Term Care Facilities: A Cohort Study.

Cognitive decline is a major reason for dependence and resource use in long-term care. We explored whether social activities may prevent cognitive decline of older residents of long-term care facilities. In a routine care cohort, 3,603 residents of long-term care facilities were assessed on average 4.4 times using the interRAI-Long-Term-Care-Facilities instrument which includes frequency of participation in social activities of long standing interest over the last 30 days and the Cognitive Performance Scale. Linear mixed models repeated measures analyses were performed corrected for age, sex, physical activity, Activities of Daily Living, mood, and health indicators. Social activity was associated with cognitive preservation over time. This association was stronger in those with no or mild cognitive impairment at baseline, relative to those with moderate to severe impairment. Participation in specific social activities such as conversing and helping others showed a similar positive association. The relation between social activity and cognitive impairment appeared to be bi-directional. The protective effects of social activity offer a window of opportunity to preserve cognitive functioning in long-term care residents.

Cluttered spaces, strained bonds: Examining the correlation between hoarding symptoms and social functioning among long-term care facilities older adult residents

BackgroundSymptoms of hoarding, such as the inability to part with possessions, leading to significant clutter, are commonly observed among residents in long-term care facilities in Egypt. This behavior significantly impacts their social interactions and functioning. Therefore, this study examined the relationship between hoarding symptoms and social functioning among older adult residents in long-term care facilities. MethodsThe study employed a cross-sectional survey on a purposive sample of 300 older adults. ToolsSaving Inventory-Revised and Functional Idiographic Assessment Template-Questionnaire-Short Form were used. ResultsThe findings revealed a significant positive correlation between hoarding symptoms and social functioning (r = 0.682, p < 0.000). A linear regression analysis supported this correlation, establishing hoarding symptoms as a significant predictor of social functioning (adjusted R2 = 0.32). ConclusionThe current study highlighted that a significant proportion of long-term care older adult residents displayed moderate hoarding symptoms and compromised social functioning. A noticeable positive association was observed between hoarding symptoms and social functioning. These results underscore the potential impact of hoarding symptoms on various aspects of social functioning. Given these findings, long-term care nurses should comprehend the various facets of compulsive hoarding behavior and devise effective strategies for assessment and intervention. Establishing support groups within these facilities could provide a platform for these residents to share their experiences and coping strategies. This could reduce interpersonal conflicts and argumentativeness and foster emotional expression and intimacy.

Development of a multidisciplinary medication management program in nursing homes: protocol for a randomized controlled trial

BackgroundPolypharmacy and the use of potentially inappropriate medications are common among nursing home residents and are associated with negative outcomes. Although deprescribing has been proposed as a way to curtail these problems, the best way to implement multidisciplinary comprehensive medication review and deprescribing and its real impact in specific high-risk populations, such as nursing home residents, is still unclear. This multicenter randomized controlled clinical trial aims to assess the effects of a multidisciplinary mediation management program on medication use and health problems.MethodsA total of 1,672 residents aged ≥ 65 years from 22 nursing homes in South Korea who meet the targeted criteria, such as the use of ≥ 10 medications, are eligible to participate. The experimental group will receive a comprehensive medication review, deprescription, and multidisciplinary case conference with the help of platform. Outcomes will be measured at baseline, at the end of the intervention, as well as at 3, 6, 9, and 12 months after the end of the intervention. The primary endpoints will be the rate of adverse drug events, number of potentially inappropriate medications/potentially inappropriate medication users/two or more central nervous system drug/ central nervous system drug users, delirium, emergency department visits, hospitalization, and falls. The secondary endpoint will be the number of medications taken and polypharmacy users.DiscussionOur trial design is unique in that it aims to introduce a structured operationalized clinical program focused on reducing polypharmacy and potentially inappropriate medications in a nursing home setting with large samples.Trial registrationEthical approval was granted by the public institutional review board of the Ministry of Health and Welfare (2022-1092-009). The study is also registered with the Clinical Research Information Service (Identifier: KCT0008157, Development and evaluation of a multidisciplinary medication management program in long-term care facility residents Status: Approved First Submitted Date: 2023/01/18 Registered Date: 2023/02/03 Last Updated Date: 2023/01/18 (nih.go.kr) https://cris.nih.go.kr/), which includes all items from the World Health Organization Trial Registration Dataset.

We need a radical change to take place now´–The potential of integrated healthcare for rural long-term care facilities

This study explores healthcare professionals' perceptions in rural German long-term care facilities, focusing on integrated health systems. The aim is to understand experiences, challenges, and preferences. Twenty nurses and paramedics participated in in-depth interviews. Thematic analysis was applied to transcripts, revealing key themes: acute healthcare provision, interdisciplinary collaboration, telemedicine use, and preferences for the future healthcare landscape. Themes highlighted factors influencing acute care situations and the crucial role of interdisciplinary collaboration. Integrated care was infrequently encountered despite high demand in rural long-term care facilities. Though uncommon, integrated healthcare remains crucial in addressing long-term care facility residents' complex needs. Healthcare professionals express a strong demand for integrated care in rural areas, citing potential benefits for resident wellbeing, healthcare effectiveness, and job satisfaction. The findings guide healthcare organizations in developing institutional-level strategies for integrated care integration, emphasizing its importance in rural settings.

Development and validation of the resident safety activity questionnaire for long-term care facility staff

This study developed and tested a questionnaire to evaluate the safety activities supporting older adult residents’ quality of care among long-term care facility staff. The process included item construction, expert review and pilot testing, testing of reliability and validation with 268 staff from 12 targeted facilities in South Korea. The final questionnaire yielded 28 items across six domains: proactive activities for emergency situations, comfort management, prevention of infections, staff training and communication, sufficient goods and equipment, and adequate personnel. These factors explained 73.48 % of the total variance. The fit indices in the confirmatory factor analysis were acceptable, and the total Cronbach's ⍺ was 0.952 (sub-domains: 0.823 – .895), indicating high reliability. The findings suggest the reliability and validity of the newly-developed Resident Safety Activity Questionnaire, enabling an accurate evaluation of the safety of long-term care facility residents and serving as an indicator for improving care quality in such establishments.