Long-term Care Facilities Research Articles

Optimized Edge-Cloud System for Activity Monitoring Using Knowledge Distillation

Driven by the increasing care needs of residents in long-term care facilities, Ambient Assisted Living paradigms have become very popular, offering new solutions to alleviate this burden. This work proposes an efficient edge-cloud system for indoor activity monitoring in long-term care institutions. Action recognition from video streams is implemented via Deep Learning networks running at edge nodes. Edge Computing stands out for its power efficiency, reduction in data transmission bandwidth, and inherent protection of residents’ sensitive data. To implement Artificial Intelligence models on these resource-limited edge nodes, complex Deep Learning networks are first distilled. Knowledge distillation allows for more accurate and efficient neural networks, boosting recognition performance of the solution by up to 8% without impacting resource usage. Finally, the central server runs a Quality and Resource Management (QRM) tool that monitors hardware qualities and recognition performance. This QRM tool performs runtime resource load balancing among the local processing devices ensuring real-time operation and optimized energy consumption. Also, the QRM module conducts runtime reconfiguration switching the running neural network to optimize the use of resources at the node and to improve the overall recognition, especially for critical situations such as falls. As part of our contributions, we also release the manually curated Indoor Action Dataset.

Validity of Pharmaceutical Claims Data for Determining Medication Exposure in Long-Term Care Facilities.

To compare the accuracy of pharmaceutical claims with medication administration chart data for individuals in long-term care facilities (LTCFs). Secondary analyses of a prospective cohort study (n = 279 residents, 5 LTCFs) were conducted. Details of medications charted for regular administration at study enrollment were extracted from administration charts and coded using Anatomical Therapeutic Chemical (ATC) classification codes. Pharmaceutical claims for government-subsidized medications dispensed in the 0-30, 0-60, 0-90, 0-120, and 0-180 days before study enrollment were compared to medication chart data (reference standard). Sensitivity, specificity, and positive predictive value (PPV) and 95% CIs were determined at the 3- and 7-digit ATC levels. 149 (53.4% of total) residents with both medication chart and claims data available were included. The proportion of PPVs ≥ 75% for 3-digit ATC level medications was 89.4% and 86.1% using exposure windows of 30 and 180-days for claims, respectively. Using a 120-day exposure window for claims, sensitivity was highest for diabetes agents, beta-blocking agents, calcium channel blockers, agents acting on the renin-angiotensin system, anti-Parkinson drugs, psychoanaleptics, and airways disease agents (all ≥ 90%) and was lowest for vitamins (1.4%, 95% CI 0-7.7) and mineral supplements (10.3%, 95% CI 2.9-24.2). Specificity was ≥ 85% for all 3-digit level medications within each exposure window other than antibacterials and analgesics. Pharmaceutical claims data has good accuracy for determining prescription medication exposure in LTCFs. Exposure windows of 90-120-days are generally sufficient for determining exposure although longer periods may be required for large pack sizes.

Empowering Palliative Wound Care in Long-Term Care Facilities: A Comprehensive Nursing Competency for Palliative Wound Care

Purpose: The importance of wound care as a part of end-of-life care is rising due to aging populations and increased chronic disease prevalence. This study developed a comprehensive competency framework on palliative wound care for nursing staff within long-term care facilities (LTCFs). Methods: The study utilized a three-phased exploratory methods approach involving topic modeling, expert interviews, and a Delphi survey. Results: Four key competencies emerged regarding nursing competency for palliative wound care in LTCFs: (1) building partnerships with patients and caregivers, (2) an individual approach to wound treatment based on understanding the patient's situation, (3) a holistic approach through shared information and cooperative decision-making, and (4) integration of wound management knowledge within end-of-life care. Conclusion: This framework supports developing targeted training programs for nurses to improve the quality of life for terminally ill patients in LTCFs.

Translation, psychometric testing and implementation of the perineal assessment tool for assessing incontinence-associated dermatitis risk in semi-intensive care patients

Skin injury is a growing issue among older adults, especially when admitted to an intensive care unit or long-term care facility. Skin prevention is a key point in dealing with this issue, and prompt and effective screening instruments should be used to identify risks and start preventive interventions and care. This descriptive study aimed to translate and examine the psychometric property and implement the Perineal Assessment Tool for incontinence associated dermatitis risk assessment. The English version was translated into Thai following the international guidelines from the World Health Organization by the bilinguals. From May to June 2023, 119 patients from the semi-intensive care unit were included using a consecutive sampling method. The research instruments included the demographic questionnaires, the original English version, and the translated Thai version. The Thai Version had a content validity index, an index of item-objective congruence, a Pearson correlation coefficient of percent agreement, the Pearson correlation coefficient of the interrater reliability, the Kappa coefficient of interrater reliability, the Pearson correlation coefficient of the intra-rater reliability, and the Kappa coefficient of intra-rater reliability ranked from 0.75 to 1.00. The 21.95% had a high risk of developing incontinence-associated dermatitis, which was associated with females, the length of stay in hospital and semi-intensive care unit longer than or equal to four days, receiving antibiotics, disease severity greater than or equal to 20 points, the albumin level less than 3.8 g/dl, and neuropathy and brain disorders. In conclusion, this instrument has high validity and reliability and can assess patients at risk of incontinence-associated dermatitis. This tool will help with early risk detection and guide for planning to manage various risk conditions to prevent dermatitis instead of taking care of them after the skin has already been damaged.

Healthy ageing in long-term care? Lessons learned from the COVID-19 pandemic: a position paper.

This position paper focuses on healthy ageing for the frailest and institutionalized older adults in the context of the recent pandemic. The paper aims to identify and discuss hindering and promoting factors for healthy ageing in this context, taking both health safety and a meaningful social life into account, in a pandemic situation and beyond. The recent COVID-19 pandemic has highlighted the vulnerability of frail older adults residing in long-term care institutions. This is a segment of the older population that does not seem to align well with the recent policy trend of healthy and active ageing. The need for healthy ageing in this population has been voiced by professionals and interest organizations alike, alluding to inadequate support systems during the pandemic, conditioned by both previous and newly emerging contextual factors. Supporting healthy ageing in older adults in nursing homes and other residential care settings calls for attending to meaningful social life as well as to disease control. Findings and early conclusions leading up to the position paper were presented with peer discussions involving healthcare professionals and researchers at two joint EFPC PRIMORE workshops 2021 and 2022, as well as other international research seminars on long-term care. The following aspects of long-term care and COVID-19 were systematically discussed in those events, with reference to relevant research literature: 1. Long-term care policies, 2. pre-COVID state of long-term care facilities and vulnerability to the pandemic, 3. factors influencing the extent of spread of infection in long-term care facilities, and 4. the challenge of balancing between strict measures for infection control and maintaining a meaningful social life for residents and their significant others. A policy shift towards ageing at home and supporting the healthiest of older adults seems to have had unwarranted effects both for frail older adults, their significant others, and professional care staff attending to their needs. Resulting insufficient investment in primary health care staff and in the built environment for frail older adults in nursing homes were detrimental both for the older adults living in nursing homes, their significant others, and staff. More investment in staff and in physical surroundings might improve the quality of care and the social life of older adults in nursing homes in a non-pandemic situation and be a resource for primary health care staff ensuring both protection from health hazards and a meaningful social life for frail older adults in a pandemic or epidemic situation. As for investing in the physical surroundings, smaller nursing homes are advantageous, with singular resident rooms and for developing out-and indoor spaces for socializing and for meeting with families and other visitors. Regarding investment in staff, there is a documented need for educated staff in full-time positions. Use of part-time or temporary staff should be limited.

Mortality rate in patients in a long-term psychiatric care facility in Johannesburg

Background: Limited research exists on mortality rates and contributing factors among individuals with severe mental illness (SMI) in long-term psychiatric care, especially in low- and middle-income countries (LMICs).Aim: To analyse mortality rates and associated factors at Solomon Stix Morewa Memorial Hospital (SSMMH), a long-term psychiatric care facility in Johannesburg, South Africa.Setting: SSMMH, a private facility in Selby Park, Johannesburg, has been contracted by the Gauteng Department of Health since March 2017 to provide inpatient care for SMI patients.Methods: A retrospective analysis was conducted on records of 406 SMI patients admitted to SSMMH from March 2017 to February 2022. Mortality rates were calculated, and associated factors were analysed using descriptive statistics and logistic regression.Results: Of the 406 participants, 34 (8%) died over five years, yielding a standardised mortality ratio (SMR) of 1.28 (95% CI: 0.85–1.71). Mortality was highest in the 60–69 years age group (SMR 2.7), with most deaths occurring in 2020–2021, likely due to COVID-19. Cardiovascular conditions were the leading cause of death (53%). Age at admission (OR: 2.35, 95% CI: 1.55–3.58) and transfer site (OR: 0.58, 95% CI: 0.42–0.81) were significant predictors of mortality.Conclusion: Individuals with SMI face elevated mortality rates, with age, diagnosis, and comorbidities as key factors.Contribution: This study provides insights into the comprehensive management of people with SMI to reduce mortality. Further research is needed to guide psychosocial and palliative care approaches.

Nurses' and Nursing Assistants' Experiences With Teleconsultation in Small Rural Long-Term Care Facilities: Semistructured Interview Pilot Study.

In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers ("Centres d'hébergement et de soins de longue durée"; CHSLDs) located in rural areas. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers of Quebec's Ministère de la Santé et des Services sociaux has rolled out a teleconsultation pilot project. This study aims to explore nurses' and nursing assistants' experience of integrating teleconsultation during night shifts in rural CHSLDs with ≤50 residents. The 6-month pilot project was rolled out sequentially in 3 rural CHSLDs located in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 18 semistructured interviews were conducted with 9 nurses and nursing assistants between February and July 2023. Participants' experiences revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. The leadership played a significant role in clarifying professionals' roles and in supporting effective adaptation to teleconsultation. This pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts but also optimizes professional practices while ensuring the safety and quality of care provided to residents.

The development and effects of a social constructivist approach in an interprofessional discomfort care online education program

BackgroundThe importance of interprofessional education (IPE) programs is increasing due to the complexity and multidimensional aspects of discomfort in long-term care facilities (LTCFs). The social constructivist approach, which is helpful in IPE, has received considerable attention in education. This study aimed to develop and identify the effects of an interprofessional discomfort management online education program using a social constructivist approach.MethodsUsing the Network-Based Instructional System Design model, five steps were employed for online educational program development: analysis, design, production, implementation, and evaluation. We modified the framework of interprofessional discomfort care and a C3 (case-based, collaborative, and contextual learning) instructional model to construct the program. The study used a non-equivalent control group pre-post-test design with 54 interprofessional participants from four LTCFs.ResultsThe pre-post outcomes were statistically significant for proactivity in problem-solving (t = − 2.244, p = 0.030), team outcomes (t = − 2.457, p = 0.017), and transactive memory system (t = − 3.229, p = 0.002). The results of the learners’ educational program-related satisfaction were as follows: overall degree of satisfaction, 3.67 ± 0.67; difficulty, 3.56 ± 0.82; suitability for practice, 3.83 ± 0.64, content, 3.69 ± 0.75; and educational method, 3.46 ± 0.86.ConclusionsThese findings support the effectiveness of the social constructivist approach education program for the awareness of discomfort care in LTCF healthcare professionals and can contribute to the improvement of IPE.

Quality of life and associated characteristics in long-term care residents with advanced dementia in Macao: a cross-sectional study

BackgroundThe quality of life (QoL) of long-term care residents with advanced dementia represents a critical concern. However, empirical data on this topic especially within Chinese society remains relatively scarce.AimsThis study aimed to investigate the QoL in this population and identify the key factors affecting it.MethodsA cross-sectional study employing cluster sampling methodology was carried out in three long-term care facilities in Macao, involving a sample of 81 residents. The participants were assessed using the Functional Assessment Staging Test (FAST) and the Quality of Life in Late-Stage Dementia (QUALID) scale. Other variables recorded included Behavioral and Psychological Symptoms of Dementia (BPSD), comorbidities, PAINAD scores, and Waterlow scores.ResultsThe majority of participants were female (65.4%), and 70.1% were classified at Stage 7 on the FAST scale. The mean score on the QUALID was 23.94 ± 7.58, suggesting a relatively lower QoL in Macao, particularly in items of smiling, interaction, and touch. Multiple linear regression analysis indicated that higher PAINAD scores, presence of BPSD, and higher FAST stage were significantly associated with lower quality of life among long-term care residents with advanced dementia, explaining 65.9% of the total variance (F = 36.639, p < 0.001).ConclusionsThe findings indicated that residents with advanced dementia in Macao experience relatively lower quality of life, particularly in aspects such as smiling, interaction, and touch. Pain, BPSD, and advanced dementia stage are the three major associated factors of QoL among long-term care residents with advanced dementia. Comprehensive and individually tailored care strategies focusing on pain management and interventions targeting BPSD are suggested to enhance QoL in this population.

Effect of a Hydration Game-Based Learning Program in Improving Fluid Intake and Hydration Status in Institutional Residents.

Approximately 50% of residents living in institutions have insufficient fluid intake, and 20%-30% experience dehydration. Implementing strategies that effectively increase fluid intake is crucial to preventing dehydration-related complications and reducing complications and comorbidities in this population. This study was designed to explore the effects on fluid intake and hydration status of a hydration game-based learning program in institutional residents. A single-blind, cluster, randomized controlled trial was conducted. Sixty-four subjects from five long-term care facilities in northern Taiwan were randomly assigned to either an experimental or control group. The experimental group received a 40-minute game-based hydration care program intervention twice weekly for 8 weeks. The control group received routine care. The data obtained were analyzed using generalized estimating equation analysis to verify changes in observed variables in the two groups at 4 and 8 weeks (during and immediately after the intervention). The results showed a significant improvement in fluid intake in the experimental group at 4 and 8 weeks (p = .002 and p < .001, respectively). In terms of dehydration-related indicators, although total body water was significantly improved at 8 weeks in the experimental group (p = .009), no significant improvement was found in urine-specific gravity. In terms of signs of possible urinary tract infection, the experimental group showed significant improvement in urine leukocytes (p = .029) and nitrites (p = .004) at 8 weeks. The findings of this study support the positive effects of applying the concept of uncertain rewards and game-based learning in institutional group activities. Specifically, the interventions increased social interaction and enhanced enjoyment of drinking. The findings call for nursing professionals at institutions to offer similar hydration game-based learning programs as part of residents' daily activities to improve fluid intake.

Prevalence of Dementia in the Geriatric Population Residing in a Long-term Care Facility: An Updated Systematic Review and Meta-Analysis

Background: The global rise in the geriatric population is increasing dementia cases, imposing significant burdens on families and society, making long-term care facilities (LTCFs) essential. Thus, updated dementia prevalence data are crucial for effective health-care planning and policy-making. Methodology: A systematic review and meta-analysis, updating Fagundes et al. (2021), included articles post-August 2, 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were selected based on predefined criteria, and data extraction was independently performed by two reviewers, focusing on dementia prevalence rates, assessment tools used, and regional variations. Meta-analytic techniques estimated pooled dementia prevalence rates and assessed study heterogeneity, focusing on assessment tools and regional variations. Results: The review included 38 studies, with 18 new ones since the previous review. The pooled dementia prevalence in LTCFs was 57.8% (confidence interval 51.63–63.98; P &lt; 0.01), up from 53%. Europe had the highest rate, while other regions showed variability. High heterogeneity suggests diverse factors, such as diagnostic criteria and population characteristics, influence prevalence estimates. Discussion: The rising dementia prevalence in LTCFs highlights the need for specialized care, improved health policies, and resource allocation. Regional prevalence variations may be due to differences in diagnostic criteria, health-care infrastructure, and societal factors, with high heterogeneity reflecting diverse methodologies and populations. Increased public awareness and ongoing research are essential for developing innovative, tailored care models for dementia patients in LTCFs. Conclusion: This updated review shows a higher dementia prevalence in LTCFs, highlighting the need for targeted interventions and policy adjustments to improve care quality and outcomes. Further research is needed to explore regional prevalence factors and develop standardized care practices.

Cognitive function and its determinants in elderly Indonesians residing in long-term care: Insights from a cross-sectional study

Background Multiple medical conditions arising from reduced physical and physiological functioning, including cognitive decline, manifest in older persons. This study aims to examine the relationship between cognitive function and associated risk factors in older persons living in long-term care facilities in Indonesia. Methods This study involved 350 elderly individuals residing in long-term care institutions. A cross-sectional design utilizing an analytical survey methodology was implemented. Data were gathered via interviews employing a demographic questionnaire and the Montreal Cognitive Assessment (MoCA). Statistical analysis was conducted using SPSS (version 23). Results Univariate analysis demonstrated significant correlations between cognitive performance and gender, ethnicity, level of education, medical history, subjective memory issues, smoking habits, alcohol consumption, dietary intake of fruits and vegetables, and employment history (p &lt; 0.05). Higher education (OR = 0.69, 95% CI: 0.56–0.84) and reduced subjective memory complaints (OR = 0.29, 95% CI: 0.20–0.44) correlated positively with enhanced cognitive function, but alcohol intake (OR = 6.79, 95% CI: 2.42–19.1) correlated with impaired cognitive function. Conclusions the level of education, subjective memory complaints, and alcohol intake are substantially correlated with cognitive performance in older persons residing in long-term care facilities. Evaluating demographic characteristics in elderly individuals can assist healthcare professionals in the early detection of cognitive impairment, facilitating prompt interventions in long-term care environments.

Exploring Post-Fall Management Interventions in Long-Term Care Facilities and Hospitals for Older Adults: A Scoping Review.

The population is rapidly growing, significantly impacting healthcare settings such as hospitals and long-term care. Falls are a major concern, being a leading cause of hospitalisations and injuries especially among adults aged 60 and above. Despite extensive research on falls prevention and risk factors, there is limited study on effective post-fall management strategies, making it crucial to review and develop interventions to improve care and safety for older adults in healthcare settings. To explore the interventions implemented for post-fall management for residents and patients within healthcare settings, including hospitals and long-term care facilities. A scoping literature review. We used the Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR). Eligible articles included hospital and long-term care post-fall management interventions. Data were manually extracted by two independent reviewers using the AACTT (Actor, Action, Context, Target and Time) Framework to detail intervention characteristics and guide the data charting process, allowing for thematic analysis and narrative synthesis of key findings. Medline, CINAHL, PsychINFO and Scopus were searched from inception until 30th September 2024. Eighteen articles were included. Over half the studies (55.5%) focused on post-fall interventions in LTCFs, testing assessment tools (50%), structured protocols (27.7%), huddles (11.1%) or multifactorial approaches (11.1%), with varied effectiveness. While assessment tools and huddles showed mixed results, structured protocols showed encouraging results with reduced unnecessary hospital transfers and hospitalisations. This scoping review identified a variety of interventions used after falls in healthcare settings. However, there is inconclusive evidence about the effectiveness of interventions to reduce hospitalisation and injuries. This review identified areas for research that may help to inform post-fall management, including the need for further research into various interventions (e.g., standardised toolkit) to enhance care immediately following a fall. No Patient or Public Contribution.

The Functional Profile, Depressive Symptomatology, and Quality of Life of Older People in the Central Alentejo Region: A Cross-Sectional Study.

Background: Europe's aging population presents challenges such as a shrinking labor force, pressure on health services, and increased demand for long-term care. This study assesses the functional profile, depressive symptoms, and quality of life of older adults in the Central Alentejo region of Portugal. Methods: A cross-sectional, descriptive study was conducted with a convenience sample of 868 older adults in Portuguese long-term care facilities across the Évora district. A structured questionnaire collected sociodemographic data, elderly nursing core set patient information, a health questionnaire with nine responses, and WHO Quality of Life Assessment (short version) scores. Results: Nearly half of the participants needed assistance with care. Women (OR = 1.46) and those with cognitive impairment (OR = 10.83) had higher impaired functionality, while education (OR = 0.52) and being overweight (OR = 0.52) were inversely related to functional dependence. Quality of life scores ranged from 56.4 (physical) to 66.6 (environmental). Moderate depressive symptoms were found in 17.1% of participants, with 9% having moderately severe to severe symptoms. Higher dependence doubled the likelihood of depressive symptoms (OR = 2.18). Discussion and Conclusions: High rates of depression and functional dependence correlate with a low perception of quality of life, highlighting the need for research to promote and protect the health of older adults.

Comparison of the oral health status of nursing home residents using the current and the newly developed interRAI oral health section (OHS-interRAI): a cross-sectional study

BackgroundRegular dental l check-ups and good oral hygiene are challenging for nursing home residents, resulting in poor oral health. The interRAI instrument for Long-Term Care Facilities (LTCF) enables caregivers to evaluate residents’ health, including oral health, and to integrate oral care into general care planning. Because the current oral heal1th section in the interRAI instruments does not accurately identify residents who need help with daily oral care or dental referral, the interRAI Oral Health Section (OHS-interRAI) was developed. The OHS-interRAI differs from the current section by including more items, response options and guidelines, photographs, instruction videos, and Collaborative Action Points to alert caregivers when oral care is needed.This study describes and compares residents’ oral health status assessed by caregivers using the current section and the OHS-interRAI.MethodsThis cross-sectional study includes baseline data of adults aged 65 years or older in Flemish and Dutch nursing homes, collected by professional caregivers (e.g., nurses, nurse aids, therapists). Assessments with the current section dated from October 2016 to January 2023, and with the OHS-interRAI from October 2020 to January 2023.ResultsInterRAI assessments of 12,476 residents from 158 nursing homes with the current section were compared with those of 1212 residents from 37 nursing homes with the OHS-interRAI.The OHS-interRAI assessments showed more missing data. A higher proportion of oral health problems was detected with the OHS-interRAI compared to the current section for chewing function (13.7% vs. 6.8%), dry mouth (9.8% vs. 7.6%), teeth (22.1% vs. 16.6% ),and gums (7.8% vs. 3.1%). There was no significant difference in the proportion of residents with discomfort or pain in the mouth.ConclusionsMore missing OHS-interRAI data may be attributed to regulatory decisions on using the interRAI LTCF instrument. Caregivers identified more oral health problems with the OHS-interRAI, which may be due to its additional features, such as photographs and extensive instructions. The Collaborative Action Points included in the OHS-interRAI support continuity of care and enable integration of oral care into general care. Further research is needed to evaluate whether the OHS-interRAI accurately identifies residents who need help with daily oral hygiene or dental referral.

The prevalence and risk factors of apathy among the Canadian long-term care residents with Alzheimer's disease and related dementias.

Apathy is a prevalent and debilitating neuropsychiatric symptom among persons living with Alzheimer's disease and related dementias, particularly those residing in long-term care facilities (LTCF). Despite its profound effects on the quality of life for both residents and their caregivers, apathy remains underrecognized and poorly understood in the context of dementia care. To investigate the prevalence and biopsychosocial characteristics of apathy among newly admitted residents with dementia in Canadian LTCF using an Apathy Index derived from the interRAI Minimum Data Set (MDS) 2.0. This cross-sectional study analyzed data from newly admitted residents with dementia from various LTCF (N = 97,789) across seven Canadian provinces between 2015 and 2019. Logistic regression analysis was performed to determine the relationship between apathy and multiple variables including sociodemographic and clinical variables. The biopsychosocial model of health was used to guide analysis. The prevalence rate of apathy among the Canadian long-term care residents with Alzheimer's disease and related dementias was 13.1%. Apathy was associated with various variables including male sex, pain, use of psychotropics, high Activity of Daily Living Self-Performance Hierarchy Scale scores, depression, aggression, severe cognitive impairment, and insomnia. Preferences for certain activities such as card games, art and craft, reading, music and exercise were inversely related to apathy while gardening was not. By shedding light on this complex phenomenon within a Canadian context, we recommend that targeted interventions and improved care strategies to enhance the well-being of persons living with dementia should be prioritized in LTCF.

Widely Integrated Services in Home (WISH) for homebound older adults: a study protocol for a randomized encouragement trial

BackgroundHome-based primary care (HBPC) is an emerging patient-centered, interprofessional healthcare service model that can address unmet medical needs and care burdens for homebound older adults. In December 2022, the Ministry of Health and Welfare in South Korea launched the Home-Based Medical Center Demonstration project to provide a new bundle payment for physician home visits. In this study, we seek to determine whether the recently introduced HBPC services in South Korea have been associated with a reduction in long-term care (LTC) facility admissions and acute hospitalizations among homebound older adults.MethodsThe study is a community-based, multicenter, two-arm, randomized encouragement design trial with a 12-month follow-up period (n = 600). Eligible study participants are community-dwelling LTC recipients with multimorbidity and functional deterioration. Study participants are recruited from five HBPC centers located in urban areas (Northeast Seoul, West Seoul, Daejeon, Wonju, and Paju). The study participants are randomly assigned to either the HBPC group or the usual care group with a 1:1 allocation ratio. Those assigned to the HBPC group receive longitudinal home visits at least once a month by an interprofessional HBPC team according to the Widely Integrated Services in Home (WISH) intervention protocol. This protocol adheres to the Integrated Care for Older People principles, which call for a person-centered assessment and broader integration of health and LTC services at the micro-, meso- and macro-levels. Primary outcomes of the trial are 1) between-group community survival days and 2) between-group potentially avoidable hospitalizations. Results of the treatment are estimated by both modified intention-to-treat and complier average causal effect analytic methods.DiscussionThis study aims to investigate the real-world effectiveness of HBPC on the reduction of LTC facility admissions and acute care hospitalizations in the community setting. The findings may inform healthcare policy decisions to expand HBPC services in South Korea and other countries.Trial RegistrationCRIS KCT0007921.

Mortality in Newly Admitted Nursing Home Older Adults with Dementia in France: A Post Hoc Analysis from an Observational Study in the Bordeaux Region.

A significant proportion of older adults with Alzheimer's disease or related disorders live in a long-term care facility. This study aimed to determine the time delay between admission and death for older adults with dementia. A post hoc analysis was conducted using data from a French observational cohort, identifying older adults with dementia who were admitted to nursing homes. This study assessed median survival times after admission to care facilities by using Kaplan-Meier models and evaluated factors potentially associated with the time until death by using Cox models. A total of 201 individuals were included. The median survival time from admission to a nursing home to death was 39 months. Being male, an older age, and having higher cognitive impairment and comorbidities were associated with decreased survival rates. This study provides survival results for institutionalised older adults with dementia in France and provides elements for the definition of future public policies.

Transmission of MRSA, ESBL E. coli, and C. difficile within a tertiary care hospital and across surrounding facilities in Japan: a molecular epidemiological study with the PCR-based Open-reading frame typing.

To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and Clostridioides difficile (C. difficile) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs). Retrospective cohort study. Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and C. difficile. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing Escherichia coli (E. coli), and C. difficile, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method. Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL E. coli (31.8%), and 32 ESBL Enterobacterales (non-E. coli) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL E. coli and C. difficile occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively. MDROs/C. difficile transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.

Protocol for a prospective, longitudinal cohort study on the incidence of dementia after the onset of delirium in patients with mild cognitive impairment: MDDCohort (Mild Cognitive Impairment Delirium Dementia)

BackgroundMild cognitive impairment (MCI) is a major risk factor for delirium. Few studies with mid- to long-term follow-up periods have examined delirium, MCI, and the conversion of MCI to dementia. This prospective, longitudinal cohort study aims to assess the incidence of dementia after delirium onset in patients with MCI and to develop an artificial intelligence algorithm for predicting the conversion of MCI to dementia.MethodsA 30-day evaluation for delirium will be performed for adults aged ≥ 65 years diagnosed with MCI who score 18–23 on the Korean Mini-Mental State Exam. Individuals exhibiting delirium at least once will be classified into the delirium group and the remainder into the non-delirium group. Over 3 years, patients will undergo follow-ups for survival and conversion to dementia at 30-day intervals to analyze risk factors for delirium and clinical outcomes. Differences between the two groups will be analyzed using the chi-square and independent t-tests. Kaplan-Meier survival and Cox proportional hazard regression will be used to assess the effects on 30-day, 60-day, 12-month, 24-month, and 36-month mortality, whereas linear regression will be used to assess the length of stay at long-term care facilities and medical costs.DiscussionThe results will emphasize the importance of preventing delirium in MCI patients, and preventive interventions can be strengthened.Trial RegistrationNCT05113446 (ClinicalTrials.gov). Registered 9 November 2021 - Retrospectively registered.