Long-term Care Institutions Research Articles

Government Policies and Programs for Rapid Ageing in China: Review of Recent Developments in System Integration and Digital Services

Background: China is facing the challenge of an increasingly ageing population. The proportion of people aged 60 and above increased from 10% to 21.1% between 1999 and 2023 and is projected to reach 28% by 2040. In response to this demographic shift, the Chinese central government has implemented a series of policies that have evolved over time. The rapid advancement of information technology and science has accelerated these changes. However, there is still a research gap in understanding the digital service policies for elderly care. Methodology: Based on research literature and policy texts, this study specifically focuses on policy development between January 2019 and January 2024. Seventy traceable national policy texts were categorized and analyzed, gathered from the State Council's policy document database and the official websites of national ministries. Result: The 70 policies were interpreted and categorized into three major aspects. Firstly, the policies on the improvement of traditional elderly care aimed to meet diverse needs by focusing on health and medical care, the management and standards of serving institutions, service improvements and standardization, and the development of the service workforce. Secondly, the policies on system integration between elderly care and other industries included the integration of finance and elderly care, the construction of the insurance system, long-term care institutions and insurance, hospice care, and the silver economy. Thirdly, the policies on digital services comprised the smart healthcare industry, information accessibility, elderly-friendly digital technology and empowerment, and the creation of elderly-friendly communities and societies. Conclusion: The development concepts and contents of China's elderly care policy have evolved. The acceleration of transformation and promotion of the silver economy has become a new comprehensive and universal measure. Despite recent policy developments indicating a growing trend towards integration, there remains considerable room for improvement in actual implementation. This should focus on the uneven development of the "three pillars" of the pension system, insufficient innovation in financial products, and inadequate industry financing channels. It is important to be alert to the persistent problems and obstacles, which widen the gap in elderly welfare, create new forms of social inequality and exclusion, and hinder the development of a friendly information society. Methodology: Based on research literature and policy texts, this study specifically focuses on policy development between January 2019 and January 2024. Seventy traceable national policy texts were categorized and analyzed, gathered from the State Council's policy document database and the official websites of national ministries. Result: The 70 policies were interpreted and categorized into three major aspects. Firstly, the policies on the improvement of traditional elderly care aimed to meet diverse needs by focusing on health and medical care, the management and standards of serving institutions, service improvements and standardization, and the development of the service workforce. Secondly, the policies on system integration between elderly care and other industries included the integration of finance and elderly care, the construction of the insurance system, long-term care institutions and insurance, hospice care, and the silver economy. Thirdly, the policies on digital services comprised the smart healthcare industry, information accessibility, elderly-friendly digital technology and empowerment, and the creation of elderly-friendly communities and societies.

Percepção de estresse, síndrome de Burnout e estratégias de enfrentamento em cuidadores de pessoas idosas institucionalizadas: estudo de correlação

Abstract Introduction Acting as a caregiver for institutionalized elderly people has been shown to be susceptible to stress, which in a chronic and adaptive way can lead to Burnout syndrome. In this context, coping strategies can mitigate or delay the negative impact of organizational factors. Objectives To analyze the perception of stress and burnout syndrome in formal caregivers of institutionalized elderly people and to verify their correlation with coping strategies. Method A cross-sectional study conducted with 54 professionals who provide care to elderly people living in three long-term care institutions. A sociodemographic, labor and health characterization questionnaire was used; the Perceived Stress Scale; the Maslach Burnout Inventory - Human Services Survey (MBI-HSS); and the Occupational Coping Scale were also used. The correlation between the values obtained by the instruments was verified using the LOESS statistical method. All ethical precepts were followed. Results There was a predominance of female participants, aged between 36 and 51 years, completed high school, married and with children, with a monthly family income between 1 and 3 minimum wages. Statistical analysis revealed a significant correlation between the perception of stress and burnout, as well as a trend in which higher levels of coping strategies exert a negative correlation on the perception of stress, regardless of the syndrome. Conclusion Screening for stress and burnout syndrome in professionals who provide care to institutionalized elderly people is important to implement preventive actions aimed at this population, and can mitigate physical, emotional, and psychological disorders.

Working Experiences of Care Aides in Long-Term Care Institutions Following the Relaxation of COVID-19 Regulations in Taiwan: A Qualitative Study

Working Experiences of Care Aides in Long-Term Care Institutions Following the Relaxation of COVID-19 Regulations in Taiwan: A Qualitative Study

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

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

장기요양기관 사회복지직의 임금공정성 인식 영향요인

The purpose of this study was to explore factors affecting perceived fairness of wages among social workers in long-term care institutions and to determine what could positively affect perceived fairness of wages of these workers. The 2017 social welfare workers' remuneration levels and working environment survey data conducted by the Korea Institute of Health and Social Affairs were used for analysis. Study subjects were 1,441 social workers in long-term care institutions. This study was conducted by dividing subjects into three categories: personal characteristics, work environment characteristics, and organizational characteristics. The analysis method used was the rank regression analysis. Results of analysis showed that, in terms of personal characteristics, age and education level were statistically significant in the perception of fairness of wages. In terms of work environment characteristics, working hours, number of overtime hours, level of dangerous experiences (such as violence, job satisfaction, satisfaction with promotion opportunities, and satisfaction with welfare) were statistically related to perceived fairness of wages. In terms of organizational characteristics, the type of organization and monthly salary showed associations with perceived fairness of wages. Based on results of this research, this study recommends that policy interventions should comprehensively take into account characteristics of the work environment, such as promotion opportunities that are useful for positively evaluating the value of work, strengthening staff welfare, preparing measures to prevent violent experiences, and increasing total wages to reduce turnover and stabilize retention of social workers working in long-term care institutions.

Mental Health Status among Individuals with Spouses Residing in Long-term Care Facilities: Using Propensity Score Matching

Purpose: The number of older adults with dementia who reside in long-term care institutions has significantly grown. When older adults with dementia are institutionalized, their spouses, who were providing care at home, may experience chronic mental health conditions. This study examined and compared the mental health status of older adults who institutionalized their spouses with dementia in long-term care institutions versus that of older adults who reside with their spouses in their homes.Methods: The analysis included 95 spouses of institutionalized individuals and 285 control group participants, drawn from 63,617 participants of the 2018 Korean Community Health Survey.Results: The results showed that the spouses of institutionalized individuals with dementia had more depressive symptoms, poorer sleep quality, and experienced greater stress than those in the control group.Conclusion: It is necessary to provide supportive care, for alleviating depressive symptoms, poor sleep quality, and stress, to individuals whose spouses are residing in long-term care facilities. For a spouse caregiver, navigation help and education on the changing roles after an older adult’s admission to a long-term care facility would be necessary.

노인 장기요양기관 이용자의 일상스트레스가 삶의 질에 미치는 영향

The purpose of this study was to investigate the impact of daily stress on the quality of life of users of long-term care facilities for the elderly from October 2021 to April 2022, surveying and analyzing a total of 374 elderly care facilities in Seoul, Gyeonggi, and Chungcheong, and the results of the study are as follows. As for the impact of daily stress on quality of life, it can be seen that physical satisfaction decreases as health problems (=-.320) and economic problems (=-.287) increase. It can be seen that psychological satisfaction decreases as economic problems (=-.277) and health problems (=-.215) increase. It can be seen that social satisfaction decreases as family problems (=-.328) and health problems (=-.166) increase. In terms of satisfaction with the indoor living environment, it can be seen that the higher the economic problems (=-.160) and family problems (=-.146), the lower the satisfaction. In terms of satisfaction with the outdoor living environment, it can be seen that the higher the family problems (=-.194) and economic problems (=-.149), the lower the satisfaction. In this study, it was found that family problems affect social satisfaction, indoor and outdoor satisfaction, and economic problems affect physical satisfaction, psychological satisfaction, and indoor living environment satisfaction in order. Health problems affect physical satisfaction, psychological satisfaction, and social satisfaction, so efforts are needed to solve health problems. Therefore, in order to improve the quality of life of the elderly who use long-term care institutions, efforts to improve family relationships and opportunities for social participation can be expanded so that the elderly are not isolated or alienated.

Long-Term and Institutional Care: A Global Perspective and Imperative

This study provides an overview of the legal aspects of long-term care (LTC) and institutional care for the elderly. It investigates whether LTC services for seniors could be recognized as a distinct human right, possibly through a United Nations convention. The study explores the existence and core components of the right to LTC and examines the minimum standards for its investigation, implementation, and enforcement. Additionally, it analyzes the specific rights of seniors that contribute to the right to care for dependent persons while also considering the intersectionality of this right and its relationship with other human rights. The study investigates the legal frameworks for protecting the right to LTC in various countries and assesses legal solutions derived from general legal instruments and special standards, particularly those concerning individuals with disabilities. Furthermore, it discusses proposed laws aimed at preserving the dignity of seniors and preventing unnecessary examinations and abuse. The study ultimately evaluates whether the right to LTC is an independent right or an extension of the rights to healthcare and social security.

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

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

Population segmentation of older adults with a hip fracture based on hospital and community care trajectories: Who waits, gets prioritized or returns home and where are the inequities?

The care trajectories of older adults with hip fracture can vary widely both during their hospital stay and afterwards upon return to the community. Understanding which care trajectory result in better outcomes for which patients is an essential approach to population health management. We learned from patients with a past hip fracture and their caregivers that there can be significant challenges faced along the care trajectory due to: long wait times, strict inclusion criteria for rehab programs and issues with care transitions from acute care to rehab and to the community. These challenges with access to care along the care trajectory may be associated with adverse outcomes including poor patient experience, extended hospital stays, unplanned readmissions and death.
 To gain insights into the characteristics of sub-groups (population segments) of older adults that share similar care trajectories we performed a retrospective cohort study of all older adults (65 years and older) with a hip fracture who were admitted over the past three fiscal years (April 2019-March 2022) to acute care at a large community hospital in Mississauga, Ontario -- one of the most ethnically diverse cities of Canada where half of the population is foreign born. We used comprehensive population-based administrative health care data inclusive of acute and post-acute hospitals, institutional and home-based long-term care, physicians, and medication records. Following a methodology that we implemented as part of the International Collaborative on Costs Outcomes and Needs In Care (ICCONIC) published in 2021, we created care trajectories for hip fracture patients that included the sequential care settings within the hospital stay: emergency room, surgery, post operation; and after the hospital stay: rehabilitation, institutional and community-based care.
 We have extracted the cohort (N=1421, mean age 80.7 years, 63% female, mean length of stay in acute care 14.9 days). Just over 7% of patients died within initial acute hospitalization; 47% were discharged to inpatient rehabilitation; 24% discharged to rehabilitation at home. 7% were transferred to nursing homes and 13% discharged to home with no formal nursing or rehabilitation care. Considering annual trends there was a marked increase in the proportion who experienced a delayed discharge from hospital that doubled from 21% in 2019 to 45% in 2021 coincident with COVID19 and subsequent challenges in transferring patients. We report on overall outcomes and discuss challenges and opportunities to improve care for older adults who experience a hip fracture. 
 As a next step, we will present our findings to patients, caregivers, health care providers to validate the results and gain insights into their experiences receiving and providing care along these care trajectories. These results describe the current care practices which will serve to identify care gaps and opportunities to improve the care experience and reduce inequities for older adults.

THE ROLE OF OUTDOOR LIGHT EXPOSURE ON SLEEP QUALITY IN OLDER INDIVIDUALS WITH FRAILTY OF DIFFERENT LIVING TYPES

Abstract The study investigates the relationship between outdoor light exposure and sleep quality in older individuals with frailty in institutions and the community, where sleep disorders are common, and outdoor light exposure is inadequate.The study includes older individuals with frailty in community and institutions in Taiwan. Participants must be aged 65 or above and have a Clinical Frailty Scale score between 4 to 8. We collect sleep quality and outdoor light exposure data using questionnaires and actigraphy.The study includes 77 older individuals: 29 from day-care centers, 22 from conventional long-term care institutions, and 26 from unit care institutions. The average outdoor light exposure is 15 minutes per day, with an average Pittsburgh Sleep Quality Index (PSQI) score of 8, 74% sleep efficiency, and 125.8 minutes of wake after sleep onset. After controlling for multiple variables. Outdoor light exposure shows no relationship with PSQI, sleep efficiency, and wake after sleep onset.The average PSQI score is > 5, indicating poor subjective sleep quality. Additionally, Wake After Sleep Onset > 60 minutes, and sleep efficiency < 75%, suggesting poor objective sleep quality. The average outdoor light exposure time < 20 minutes, indicating a lack of outdoor light exposure. However, our study does not observe the effects of light exposure, possibly because the average daily light exposure is below the 30-minutes threshold. Older individuals with frailty experience poor sleep quality. It is possible that a longer duration of outdoor light exposure may be needed to observe its impact on sleep quality.

Continuation of implementation processes in residential long-term care : Sustainability of the expert standard "Relationship management in the care of people with dementia"

Nursing institutions are facing many challenges due to evidence-based requirements. For example, they are required to introduce new interventions such as expert standards and thus adapt routine practices to new findings; however, if new interventions are continuously implemented in the facilities their sustainability is questionable. The aim was to find out how sustainably the expert standard "Relationship management in the care of people with dementia" is implemented in residential long-term care institutions. Qualitative, guideline-based interviews were conducted with persons from residential long-term care, oriented to the procedure of the problem-centered interview. The interviewees were involved in the model implementation of the expert standard "Relationship management in the care of people with dementia"'. The data were then analyzed using qualitative content analysis. The participants assessed the sustainable implementation in different ways. Some rated the sustainability of the expert standard in their institution as successful, while others see potential for improvement. According to the participants, the sustainability of continuation of implementation processes is influenced by various factors. These relate to the institution, the external context, the intervention, the implementation process, and the people involved in the implementation. On the basis of the factors identified, key needs can be derived for nursing practice, for science and research as well as for politics and legislation, so that the sustainability of expert standards and other evidence-based interventions can be ensured and, if necessary, optimized.

PREPARING FOR ADVANCING ILLNESS AND END OF LIFE WITH DEMENTIA

Abstract Dementia involves coping with advancing illness that involves cognitive and functional decline. Also decision-making capacity diminishes, which implies that preparing for a future and taking opportunities to exercise individual and relational autonomy is particularly relevant in the case of dementia. Engaging the person with dementia and family caregivers meaningfully in formal or informal advance care planning conversations may require addressing specific challenges. Health care providers often lack time or are reluctant to broach these conversations. Often conversations are delayed even in institutional long-term care settings as residents, their family caregivers and care providers may all view advance care planning as uncomfortable and difficult to initiate. Special support for health care providers to develop skills, confidence and taking initiative is needed. This symposium presents about new, large qualitative and quantitative studies with contributions from the UK and Canada, and international work. It addresses preparing for an uncertain future through advance care planning and decision making about future care and treatment which may include conversations about the end of life. We present and evaluate tools to support the process across settings.

STATE GENEROSITY IN HOME- AND COMMUNITY-BASED SERVICES (HCBS): VARIATIONS AND IMPACT ON DEMENTIA OUTCOMES

Abstract To meet the needs of community-living older adults and reduce overall medical spending, home- and community-based services (HCBS) provide assistance and care for persons with significant physical and cognitive limitations. Together, Medicaid long-term services and supports (LTSS) coverage and the Title III program under the Older Americans Act (OAA) of 1965 support the majority of the HCBS for older adults living in the U.S. with low-income and/or disabilities. We evaluated state variations in generosity of supporting HCBS in recent years and how these variations affect the healthcare outcomes of community-living older adults and socio-economic and racial disparities in dementia outcomes. State HCBS generosity from the perspectives of program participation and intensity of services was defined by the exploratory and the confirmatory factor analysis with data from multiple sources, including state reports from the National Association of State Budget Officers. State data was linked to a nationally representative sample of older adults who enrolled in the Health and Retirement Study in 2020. Analyses revealed that overall state supports for HCBS increased over time in recent years while state Medicaid expenditures for institutional long-term care remained largely stable. State supports through both Medicaid and the OAA programs for HCBS varied substantially and persisted in recent years. Discussion will focus on instrumental variable analyses that determine the causal impact of state variations in HCBS generosity on health outcomes (i.e., unmet need; hospitalization) for persons living with dementia persons.

Development of a web-based care networking system to support visiting healthcare professionals in the community

BackgroundThe role of visiting health services has been proven to be effective in promoting the health of older populations. Hence, developing a web system for nurses may help improve the quality of visiting health services for community-dwelling frail older adults. This study was conducted to develop a web application that reflects the needs of visiting nurses.MethodsVisiting nurses of public health centers and community centers in South Korea participated in the design and evaluation process. Six nurses took part in the focus group interviews, and 21 visiting nurses and community center managers participated in the satisfaction evaluation. Focus group interviews were conducted to identify the needs of visiting nurses with respect to system function. Based on the findings, a web application that can support the effective delivery of home visiting services in the community was developed. An artificial intelligence (AI) algorithm was also developed to recommend health and welfare services according to each patient’s health status. After development, a structured survey was conducted to evaluate user satisfaction with system features using Kano’s model.ResultsThe new system can be used with mobile devices to increase the mobility of visiting nurses. The system includes 13 features that support the management of patient data and enhance the efficiency of visiting services (e.g., map, navigation, scheduler, protocol archives, professional advice, and online case conferencing). The user satisfaction survey revealed that nurses showed high satisfaction with the system. Among all features, the nurses were most satisfied with the care plan, which included AI-based recommendations for community referral.ConclusionsThe system developed from the study has attractive features for visiting nurses and supports their essential tasks. The system can help with effective case management for older adults requiring in-home care and reduce nurses' workload. It can also improve communication and networking between healthcare and long-term care institutions.

A national survey on health-related quality of life for people with dementia in residential long-term care institutions

BackgroundHealth-related quality of life (HRQoL) is an essential outcome parameter in geriatric research; however, the available evidence is mixed regarding the factors associated with HRQoL among people with dementia. We aimed to identify factors that contribute to HRQoL among people with dementia in residential long-term care (LTC) institutions. MethodsWe randomly selected 299 of 1607 registered residential LTC institutions in Taiwan. A cross-sectional survey was conducted between 2019 and 2020, including items on demographic characteristics, comorbidities, the EuroQol-5 dimensions-5 levels (EQ-5D-5L; utility and visual analog scale [VAS] scores), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), behavioral and psychological symptoms of dementia, activities of daily living (ADL), and instrumental ADL (IADL). ResultsIn total, 1313 people with dementia from 267 institutions were enrolled (mean age, 76.4 ± 12.7 years). The mean EQ-5D-5L utility and VAS scores were 0.10 (standard deviation [SD] = 0.48) and 66.57 (SD = 20.67), respectively. In multivariate linear regression analysis, higher scores for ADL, IADL, and CDR sum of boxes were associated with higher utility scores. Higher VAS scores were associated with higher ADL and MMSE scores. Lower utility scores and VAS scores were associated with more frequent depressive symptoms. ConclusionADL, dementia severity, cognitive function, and depressive symptoms influenced the HRQoL of people with dementia in residential LTC institutions. Longitudinal studies should be conducted to better understand how HRQoL changes over time among people with disabilities.

Is Dementia Related to a Longer Wait Time to be Assigned a New Primary Care Provider? An Analysis of the Nova Scotia Need a Family Practice Registry Derived from the PUPPY-Study.

Access to Primary Care Providers (PCPs) is limited for many Canadians. "Unattached patients" are persons who do not have a PCP. Older adults living with dementia may face greater challenges seeking attachment. This study investigated whether older adults living with dementia experience differential wait times for PCPs compared to those without a diagnosis of dementia. This was an observational descriptive study of the centralized wait-list data from the Nova Scotia (NS) Need a Family Practice Registry (NaFPR). Time on provider wait-list by dementia diagnosis and age were compared. Number of days on the registry across these measures was estimated. Multivariable proportional hazards regression was used to compare hazards of remaining on the registry over time. Unattached older adults living with dementia were on the NaFPR for less time compared to those without dementia (381.4 vs. 428.8 days, respectively). After adjusting for age, self-reported gender, comorbidity, rurality, income quintiles, and overall deprivation, older adults with dementia had a 1.13-fold (95% CI: 1.04-1.24) increase in the likelihood of leaving the NaFPR. Potential contributors to this small difference could be placement in Long Term Care (LTC) and subsequent facility PCP attachment. Analysis of the NaFPR exhibited similarly time to PCP attachment despite a diagnosis of dementia. This represented an effective equality model of health care utilized in NS. Future studies should investigate whether an equity model with priority attachment for vulnerable patients would reduce hospitalization and LTC institutionalization.

Prevalence, and Risk Indicators of Coronal and Root Caries in Mexican Older Adults in Nursing Homes.

Several factors are associated with coronal and root caries in older persons. The purpose of this study was to determine the experience, prevalence, and risk indicators (socioeconomic, sociodemographic, and dental variables) of coronal and root caries in older persons residing in nursing homes in Mexico. A cross-sectional study was carried out in 227 dentate participants with natural teeth. Convenience sample, where all dentate residents were invited to participate. The dependent variables were coronal caries and root caries, which were determined through an oral clinical examination. The independent variables were sociodemographic factors, location, type of center, surfaces free of dental biofilm and calculus, surfaces with recession, retainers in contact with surfaces with recession, xerostomia, smoking, and the previous use of dental services. The binary logistic regression model was used in the analysis. The mean age of the participants in this study was 77.7±8.8 years, and 69.2% were women. Moreover, 71.8% live in long-term care facilities, and 48.0% live in Mexico City. The prevalence of coronal and root caries was found to be 67.8% and 50.7%, respectively. Being male and living in Mexico City were risk indicators for coronal caries, and with a 1% increase in surfaces with no biofilm, the risk decreased by 2%. Being widowed, having government or no social security, denture retainers, and coronal caries were risk indicators for root caries, while the utilization of dental services indicated lower risk. Several variables that differ in nature were found to be risk indicators for coronal and root caries. Coronal caries increases the risk of root caries. Prevention should be aimed at identifying persons at higher risk, and dental care should be improved for persons living in long-term care institutions.

Experiences of person-centered care for sundown syndrome among nurses and nurse aides in dementia special care units: a qualitative study

BackgroundTo explore the response and management experiences of nurses and nurse aides in dementia special care units when caring for residents with sundown syndrome based on the person-centered care model.MethodsFocus group interviews were conducted among nurses and nurse aides from four dementia special care units that have been accredited by the Ministry of Health and Welfare in Taiwan. Content analysis was used for data analysis.ResultsThe 29 nurses and nurse aides were recruited to participate in the study. Analysis of interview content revealed six themes, identifying the intra-individual, inter-individual, and organizational dimensions. The central topic was commitment. Under the umbrella of commitment, six themes including self-preparation, non-suppression, diversion, pacification, continuity of meeting, and collaboration, which had 18 subthemes, emerged as responsive care practices for person-centered care when supporting residents with sundown syndrome.ConclusionsThe findings provide responsive care practices based on person-centered care for people living with dementia who develop sundown syndrome. The study can inform practices for quality of care for dementia in long-term care institutions and contribute to the development of materials for nursing training and education.

The prevalence and severity of dry skin and related skin care in older adult residents in institutional long-term care: A cross-sectional study

ObjectivesTo identify possible factors associated with different severities of xerosis cutis and to describe possible associations between (skin) care dependency and application of moisturizers. DesignCross-sectional study using baseline data from a cluster-randomized controlled trial. Demographic and health characteristics, skin physiological measurements, functional abilities and application of moisturizers were compared between the participants with mild and severe dry skin. Frequency of moisturization were also compared based on the participants’ skin care dependency. ResultsThe more distal the body area, the more severe xerosis were observed. There were no or minor differences between the groups, except for the stratum corneum hydration and skin surface pH. Participants with severe xerosis received moisturizers less often. Skin care dependent residents received moisturizers frequently. ConclusionThere is under-application regarding xerosis cutis treatment in long-term care. Skin care provided by nurses, in adequate frequencies, might be helpful compared to skin care performed by the residents themselves.