Long-term Care Institutions Research Articles

Deprescribing antipsychotics in long term care patients with dementia

ObjectiveTo develop a clinical protocol for the use of antipsychotic drugs in dementia patients with behavioral disturbances that includes prescribing and deprescribing criteria and to assess its applicability in long-term care institutions. MethodThe protocol was developed from an interdisciplinary perspective based on a literature search of the published proposals on antipsychotic drug use in dementia patients. Its applicability to the antipsychotic deprescribing process was assessed in a single center in a prospective before-after study with a follow-up of 6 months after the intervention study. ResultsA protocol was developed that includes prescribing and deprescribing criteria. The intervention was performed in 35 patients (21 [60%] female). Antipsychotic treatment was completely withdrawn in 28 patients (80%) and was reduced to the minimum effective dose in 7 (20%). Treatment was resumed in 2 patients due to worsening symptoms. The pre- and 6-month post-test results showed that there were no significant changes in neuropsychiatric symptoms (12.91 ± 12.80 vs 13.76 ± 16.68; P = 0.124). ConclusionsThe establishment of a protocol that includes prescribing and deprescribing criteria, in combination with the incorporation of a pharmacist in the multidisciplinary team, can be effective in improving the use of these drugs in elderly dementia patients in long-term care institutions.

Factors Associated with Oral Health and Oral Hygiene Status in Long Term Care Facilities

<p>The objective of this study is to determine whether oral health assessment factors commonly used in long-term care institutions are related to important physical and mental examination factors, including the daily life function assessment scale, physical health assessment sheet, mini nutritional assessment MNA, simple mental state assessment form, social adaptation, and psychological assessment form. </p> <p>Materials and Methods: This is a retrospective study that involved residents living in four long-term care service institutions in Xindian, Taiwan. A total of 233 residents who resided in these institutions before March 2021 were included in the study, and 110 residents with complete data were analyzed. Oral care assessments include halitosis severity and tongue coating de-gree. Severity of bad breath was classified into five grades, while degree of tongue coating was divided into three grades. Relevant factors were selected from routine physical and men¬tal examinations, such as history of hospitalization for pneumonia, eating or feeding duration, presence of dysphagia, cognitive function status, depression severity, functional status, nutri¬tional status, and body mass index. Chi-square and Fisher’s exact tests were used for analysis, with the prevalence ratio calculated for each independent variable in relation to the outcome at a 95% confidence level. </p> <p>Results: The study found no significant relationship between the severity of halitosis/ tongue coating accumulation and several variables, including hospitalization history of pneumonia, duration of eating or feeding, type of food eaten, denture wearing, cognitive function status, severity of depression, functional status, nutritional status, and body mass index. </p> <p>Conclusion: In conclusion, while our study did not find significant associations between halito¬sis/tongue coating accumulation and various potential risk factors in nursing home residents. Study with more participants more comprehensive oral examinations may be conducted in the future to better understand the underlying causes of halitosis in this population.</p> <p> </p>

Local Implementation of the Symbiotic Community Model to Achieve Aging in Place

<p>進入高齡社會的臺灣，偏鄉與原住民族應如何在諸多不利因素影響下，回應在地社區高齡者的生活照顧和醫養需求，成為落實在地老化高齡社會保障政策的重要一環。本文透過余尚儒以臺東都蘭診所推動的共生社區與在宅醫療模式，以及林依瑩在臺中和平區達觀部落伯拉罕長照機構的共生型照顧服務模式與地域營造方案，來檢視高齡社會下，透過在地組織連結資源、以特色服務解決高齡醫養困境的可能性；同時也檢視目前長照2.0在原鄉的執行困境及可能的解決方向。</p> <p> </p><p>In response to Taiwan’s aged society, rural and indigenous communities experience various challenges and unfavorable conditions while attempting to meet the caregiving and healthcare needs of older residents. Attending to such needs has become a crucial constituent of policy implementation aimed at ensuring social security in an aged society to achieve aging in place. This study explored two models to examine the feasibility of addressing the aforesaid problem by integrating local organizational resources and providing specialized services. The first model was the symbiotic community and home-based care model promoted at the Home Clinic Dulan in Taitung. The second model was the symbiotic care service model and place-making program promoted at the Plahan Long-term Care Institution in L’olu Tribe, which is located in Heping District, Taichung. Additionally, this study delved into existing challenges concerning the local implementation of Long-Term Care Plan 2.0 in indigenous communities, proposing possible solutions to these challenges.</p> <p> </p>

Older persons' expressed perceptions on exercise programs in long-term care institutions: Influence of professionals and institutions

ObjectiveTo explore the perceptions of institutionalised older people about the professionals and institutions regarding exercise programs in long-term care institutions Design, setting, and participantsA qualitative study was carried out using focus group discussions. Forty-seven institutionalised participants (≥ 65 years old) with a score of > 23 in the Mini-Mental State Examination (MMSE) were recruited. ResultsMost participants believed that the frequency of the exercise sessions could be increased by enhancing the number of staff assisting them and by adapting the facilities to their needs. They also suggested using outdoor spaces and avoiding childish activities and treatment. Participants’ beliefs were grouped into three major themes (i) Perceptions about the health professionals delivering the exercise programs (ii) Perceptions about the institution or centre regarding exercise programs; (iii) Perceptions about the exercise programs. ConclusionParticipants proposed certain changes that could take place in the institutions to promote engagement with exercise programs: tailored exercise programs, avoiding puerile treatment, increasing the number of staff members, and the creation of well-equipped spaces to perform the exercise. Practical implicationsProfessionals should spend time designing tailored exercise programs and avoid puerile treatment. Institutions must review the need for spaces and the personnel assigned.

Promoting activity and mobility in long-term care environments: A photo-elicitation study with older adults and nurses.

The aim of this research study is to collaboratively generate insights in the current institutional long-term care environment for activity and mobility of older adults, and of solutions that could be used to increase the activity and improve the mobility of the older adults. This research constitutes a qualitative study with a critical approach. Data were collected using photo-elicitation in four long-term care units in Finland during the spring of 2022. Older adults participated in individual data collection sessions which combined photographing and discussion. Staff members individually took photographs and later participated in a group discussion based on the photographs. Reflexive thematic analysis was used to analyse all data together. Ten older adults and 12 staff members participated in the research study. Four themes were identified: (1) facilities should be designed and equipped for their users, (2) moving in the institutional environment, (3) passivity as a norm, and (4) nurses should act differently and have the resources to do so. To increase the activity and improve the mobility of older adults, improvements are needed in terms of the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources. Increased attention to the support of activity and mobility could benefit older adults in institutional long-term care. Physical activity promotion should be incorporated as an integral part of nursing practice. Directors of units were consulted when planning the study. Older adults and nurses contributed to the data collection and interpretation of data. (ADDRESSING): What problem did the study address? ○Older adults have recurrently been reported as living inactive lives in institutional long-term care. ○There is evidence of the relationship between the environment and the activity and mobility of older adults, but there seems to be a research-practice gap in terms of implementing activity- and mobility-promoting environments. ○Older adults and staff members are important in developing practice and change-oriented knowledge that can be used to increase the activity and improve the mobility of older adults in institutional long-term care. What were the main findings? ○Various environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long-term care settings. ○Improvements for the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources for activity support would benefit older adults' activity and mobility. Where and on whom will the research have an impact? ○Increasing the activity of older adults requires better activity promotion and mobility support by nurses in institutional care. Sufficient education and resources should be organized for activity promotion, in addition to a care and organizational culture that values activity. ○Environmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities. ○Policymakers and care organizers should consider evidence of the harms and benefits of different institutional living environments when making decisions on organizing care. The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Exploring experiences of times without care and encounters in dementia: protocol for a living and adaptive evidence map

IntroductionIndividuals with dementia spend most of the day without care, without encounters, and usually without activity. Although this has been proven in studies, there is a knowledge gap on how...

자기효능감이 노인 장기요양기관 이용자의 삶의 질에 미치는 영향

The purpose of this study is to find out the effect of self-efficacy of users of long-term care institutions for the elderly on the quality of life. This study surveyed and analyzed a total of 374 elderly people at elderly care institutions located in Seoul, Gyeonggi, and Chungcheong from October 2021 to April 2022. The results of the study on the effect of self-efficacy on life are as follows. First, self-acceptance (β=) among the sub-factors of self-efficacy of physical satisfaction.363, p<.001) and social efficacy (β=.136, p<.05) was statistically significant. Second, among the sub-factors of self-efficacy of psychological satisfaction, self-fulfillment (β=).247, p<.001), social efficacy (β=.203, p<.01), self-acceptance (β=.190, p<.01) was statistically significant. Third, among the sub-factors of self-efficacy of social satisfaction, social efficacy (β=.376, p<.001) and self-acceptance (β=.233, p<.001) was statistically significant. Fourth, self-acceptance (β=) among the sub-factors of self-efficacy of indoor living environment satisfaction.159, p<.05) and self-fulfillment (β=.150, p<.05) and outdoor living environment and self-acceptance (β=.159, p<.05) and self-fulfillment (β=.150, p<.05) was statistically significant. These results suggest that self-efficacy plays an important role in improving the quality of life of users of long-term care institutions for the elderly.

Vietnam's Responses to Dementia - An Assessment of Service Delivery.

This study was conducted to assess Vietnam's dementia service delivery. Using WHO methodology, website searches of key organisations focused on three aspects of Vietnam's healthcare system: (1) Health and social workforce; (2) Services, supports and treatment programs; and (3) Promotion of awareness and understanding. Data were analysed using content analysis. While key members of the healthcare workforce receive some education in dementia competencies during their training, the skill-mix of staff in the current workforce appears inadequate to address the complex needs of people with dementia. Although Vietnam's general healthcare system comprises a good variety of service types, there is a lack of dementia-specific services. Available diagnosis and treatment services are concentrated in the hospital system and are mainly located in metropolitan areas, impacting their accessibility. While both community-based and institutional long-term care is available, institutional care is not universally accessible and home-based care is mainly provided by family carers who don't have access to dementia care training. There is no active dementia prevention or public awareness campaign. To improve the ability of Vietnam's service delivery to meet the needs of people with dementia and their carers, the skill-mix of the healthcare workforce should be strengthened by ensuring that dementia core competencies are embedded within undergraduate and graduate education programs and making post-qualification dementia care training available. The capacity of existing community-level health and social services should be expanded to ensure that integrated, specialised and comprehensive health and social services are accessible to all people with dementia. Expanding access to institutional long-term care and making dementia education available to family and other informal carers could increase choice and improve quality of care. Finally, Vietnam could look to other countries in the region with regards to the development of a dementia prevention and public awareness campaign.

Economic Evidence for Home and Community Care Investment: The Case for Ontario Personal Support Workers' Wage Parity.

The home and community care (HCC) sector is in a health human resource crisis. Particularly concerning is the shortage of personal support workers (PSWs) who provide the majority of HCC. This paper outlines a strategy to mitigate the HCC PSW shortage by applying appropriate funding to HCC and focusing on equal pay between HCC and institutional long-term care facilities' PSWs. Using publicly available data, our calculations estimate substantial government cost-savings from investing in HCC PSWs to increase HCC capacity. Beyond the economic evidence, how such investments would benefit those seeking care are also highlighted.

Long-Term Impairment in Activities of Daily Living Following COVID-19 in Residents of Long-Term Care Facilities.

BACKGROUND Long-term care facilities were severely impacted during the COVID-19 (Coronavirus Disease 2019) pandemic. Residents surviving the disease might continue to suffer from the post-COVID syndrome, similar to community-dwelling persons. This study aimed to characterize the longitudinal evolution of activities of daily living in COVID-19 survivors from long-term institutional care. MATERIAL AND METHODS This was a retrospective study with prospective follow-up of consecutive COVID-19 survivors living in long-term care facilities. The Barthel Index was used to assess changes in functional independence before the disease, right after recovery, and 3 months later. RESULTS The study enrolled 201 residents of long-term care facilities, median age 79 years old, who survived 3 months after recovery from COVID-19. The disease caused hospitalization in 47% of cases. Early after COVID-19, deterioration in activities of daily living was higher in older, hospitalized patients with cardiovascular comorbidity. However, in the long-term follow-up, these factors did not predict functioning. Independence was severely affected in hospitalized and non-hospitalized COVID-19 patients. This had implications for post-COVID care and rehabilitation since these interventions were mainly offered after hospitalization. CONCLUSIONS The findings support that residents of long-term care facilities who had COVID-19, even with a mild clinical course, may have persistent impairment in function and ability to perform activities of daily living that require support and rehabilitation.

Integrating Artificial Intelligence and Wearable IoT System in Long-Term Care Environments

With the rapid advancement of information and communication technology (ICT), big data, and artificial intelligence (AI), intelligent healthcare systems have emerged, including the integration of healthcare systems with capital, the introduction of healthcare systems into long-term care institutions, and the integration of measurement data for care or exposure. These systems provide comprehensive communication and home exposure reports and enable the involvement of rehabilitation specialists and other experts. Silver technology enables the realization of health management in long-term care services, workplace care, and health applications, facilitating disease prevention and control, improving disease management, reducing home isolation, alleviating family burden in terms of nursing, and promoting health and disease control. Research and development efforts in forward-looking cross-domain precision health technology, system construction, testing, and integration are carried out. This integrated project consists of two main components. The Integrated Intelligent Long-Term Care Service Management System focuses on building a personalized care service system for the elderly, encompassing health, nutrition, diet, and health education aspects. The Wearable Internet of Things Care System primarily supports the development of portable physiological signal detection devices and electronic fences.

Optimizing Weekend Schedules in Home Health Care: The Essential Care on Weekends for Personal Support Quality Improvement Project

The availability of personal support workers (PSWs) is a limiting factor for home care system capacity, as this workforce provides 70% to 80% paid care in this sector. Without sufficient support to live at home, many seniors and people with disabilities experience poorer outcomes and require care in more expensive and less preferred institutional long-term care or hospital settings. Insufficient PSW availability is limiting access to necessary care in the community. Capacity challenges are particularly pronounced on weekends. The Essential Care on Weekends (ECoW) program was co-developed as one solution to adapt current PSW scheduling practices to increase the number of clients with high-intensity care needs who can be served within the constraints of PSW availability. ECoW focused on increasing weekend capacity and care consistency, particularly for clients with the highest care needs, through prioritizing essential care and moving less time sensitive tasks to weekdays. ECoW was operationalized through 4 activities: communication and engagement, clinical care plan review, geographic review of PSW schedules and the creation of the ECoW schedule. Implementation of ECoW demonstrated success in increasing access to and consistency of care for clients with the highest care needs: weekend capacity increased, access to care improved for clients requiring daily or near-daily care and missed care rates decreased both on weekends and weekdays. This strategy represents a change in scheduling practices that organizations can use to provide consistent service to a growing number of clients with high-intensity care needs in the context of increasingly limited health human resource capacity.

The work status of nurses in long-term care institutions in elderly care: A qualitative descriptive study.

To understand the work status of nurses in long-term care institutions in China for elderly care to provide a reference for further formulating management strategies and promoting the development of long-term care teams. Using qualitative descriptive research methods, 31 nurses from three long-term care institutions were selected through purposive sampling for in-depth interviews, and a three-week participatory observation was conducted on the daily work of nurses in the above three long-term care institutions. Content analysis was used to analyse data. In our sample, nurses in long-term care institutions had insufficient manpower, generally had low academic qualifications, and lacked professional ability. Their work enthusiasm and initiative need to be further improved. Long-term care nurses were moderately paid, and their salary satisfaction was lower than in other trades. At the same time, the social understanding of the long-term care industry was insufficient, and the social identity of nurses in long-term care institutions was low. The development of long-term care requires the joint efforts of nurses, medical institutions, and society. By improving the system, cultivating talents and building a harmonious atmosphere, we aim to enhance the work enthusiasm of long-term care nurses and promote the stable and orderly development of the long-term care team. Nurses in long-term care institutions are at the core of the ageing age and play a vital role in coping with the ageing problem, meeting long-term care needs, improving the quality of life of old people and reducing the cost of long-term care. The training and management of nurses in long-term care institutions and the construction of the entire long-term care system should be based on China's national conditions and actual needs.

Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study.

Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans' needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. DERR1-10.2196/46156.

The Institutionalisation of Brazilian Older Abused Adults: A Qualitative Study among Victims and Formal Carers.

Abuse against elders is acknowledged as a severe and pervasive problem in society. If support services are not tailored to the victims' knowledge or perceived needs, the intervention is likely to be unsuccessful. This study aimed to explore the experience of institutionalisation of abused older people from the perspective of the victims and their formal carers in a Brazilian social shelter. A qualitative descriptive study was performed with 18 participants, including formal carers and older abused persons admitted to a long-term care institution in the south of Brazil. Qualitative thematic analysis was used to analyse the transcripts of semi-structured qualitative interviews. Three themes were identified: (1) personal, relational, and social bonds: broken or weakened; (2) denial of the violence suffered; and (3) from imposed protection to compassionate care. Our findings provide insights for effective prevention and intervention measures in elder abuse. From a socio-ecological standpoint, vulnerability and abuse might be averted at the community and societal levels (e.g., education and awareness of elder abuse) by creating a minimum standard for the care of older individuals (e.g., law or economic incentives). Further study is needed to facilitate recognition and raise awareness among individuals in need and those offering assistance and support.

The Dedication

In 2020, the COVID-19 pandemic exploded and nursing homes rapidly became overwhelmed with disease, death, and despair. During this time, I learned Sylvia, an old woman with dementia I had befriended, was one of the many old and disabled people confined in nursing homes who did not survive. In this reflective and part personal, part scholarly essay, I leave evidence of and for Sylvia and the nearly 200,000 old and disabled people and care workers who contracted COVID-19 and died within the confines of neoliberal, profit-driven long-term care institutions. Disability justice activist Mia Mingus writes, "We must leave evidence. Evidence that we were here, that we existed, that we survived and loved and ached." Leaving evidence is a political act, a form of resistance in an ableist word. And yet leaving evidence is particularly challenging in the context of dementia, care, confinement, and death—making it even more important, more urgent. Building on Ellen Samuels’ assertion, "Crip time is grief time," I consider how mourning Sylvia and countless other nursing home deaths, interwoven with my own experiences of distress, yet also solidified my need to survive, might leave evidence and keep working toward an abolitionist future—one in which old and disabled women like Sylvia, like my future self, might thrive.

PROMJENA RELATIVNE EFIKASNOSTI SUSTAVA DUGOTRAJNE SKRBI U ODABRANIM ZEMLJAMA OECD-A

The population is ageing, which has many social and economic implications, and one of them is an increase in demand for institutional long-term care for the elderly. Therefore, the aim of this paper is to analyse the change and to detect whether there are differences between twelve selected OECD countries in the period 2014-2019 in regard to the values of total factor productivity of long-term care system for the population aged 65 and over these countries. The Malmquist – DEA performance measure, under the assumption of the variable returns to scale (BCC model) and by using the input-oriented model, has been used to obtain the patterns of productivity change. The number of long-term workers and the number of beds in residential long-term care facilities are selected as input variables, while the number of long-term care recipients has been used as an output variable. According to obtained results, the total factor productivity in selected OECD countries increased by 1.023% in the analysed period. The increase is mainly a consequence of a 1.018% increase in technical efficiency, which emphasises an increase in managerial relative efficiency. Results obtained for Turkey indicate the highest productivity increase, accompanied by both a rise in technical efficiency and in technological change. Additionally, an increase in technical change that reflects a catch-up effect and a modest increase in technological change, indicating a lack of innovation altogether, resulted in an average productivity increase of 1.02% over the analysed period.

고령사회 돌봄인력 확보방안에 관한 소고

The purpose of this study is to explore the possibility of using foreign caregivers as an alternative to stably securing care workers for the elderly that Korea, which has entered an aged society in the shortest period of time, will face in near future. To this end, we conducted in-depth interviews with 4 current foreign caregivers working in long-term care institutions for the elderly after obtaining a caregiver license. We also conducted analysis based on the phenomenological research method of Giorgi (1997). As a result of the analysis, a general structure of care for the elderly by foreign caregivers in long-term care institutions was derived for the purpose of strengthening the influx of foreign caregivers as certified care workers, early labor experience in unequal working conditions and working environments, and pride as an essential workforce providing care services, and the value of care work. Through this analysis, several policy implications were suggested as follows: (1) active job promotion with access to nursing care worker job, (2) strengthening of public intervention to improve service quality, and (3) the enhancement of professionalism through education and promotion system.

텍스트 마이닝 기법을 활용한 노인장기요양기관 부당청구 판례 분석 연구

The increasing number of unfair claims in long-term care facilities has emerged as a risk factor for threatening the finances of the Korean national health insurance and increasing medical expenses, considering the imminent danger to super-aged society, since the implementation of the Long-term Care Insurance Act for the Elderly. Therefore, we aim to provide alternatives for unfair claim prevention and recidivism. The court's precedents and text-mining analysis were used to identify issues and factors in unfair claims to meet our research goals. Ninety-one cases (i.e., eighty-five elderly care facilities and six elderly care communal homes) were collected from January 1, 2013, to December 31, 2020. Our results revealed that fourty-four were fined, seventy-two received probation, and eighteen were sentenced to imprisonment, of the first verdicts by trial courts for senior medical welfare facilities. Among the defendants (n = 146), ninety-nine were top managers; thirteen were care workers; and five were social workers. The indictments consisted of seven violations, and of three most representative contents were violations of the Long-Term Care Insurance Act for the Elderly, of the Act on the Aggravated Punishment of Specific Economic Crimes (fraud), fraud, violations of the Elderly Welfare Act, business embezzlement and forgery of private documents. In the first trial, TF-IDF analysis indicated four keywords, 'regulations and announcements,' 'working hours,' 'additions,' 'competition,' and mandatory personnel, such as physical therapists, social workers, and nursing assistants. In the second trial, 'field investigation,' 'sanitation,' and 'resident' were the main words. Topic Modeling of the first trial showed that 'nursing care workers & sanitation center,' 'nursing care staff assignment standards,' 'social worker & physical therapist,' 'notifications and laws,' 'working hours & exploitation,' 'defendants & victim.' In the second trial, 'accused & supreme unjust (heavy),' 'placement criteria & deception (acts),' 'long-term care benefit & breach of working hours,' 'victim's claim & crime of fraud,' 'false service,' 'staff assignment standards & deceiving (acting),' and 'defendant's working rules & field investigation.' Thus, we explored causes and issues with unfair claims. Finally, we proposed several preventative solutions: ①. change in the perception of operators and works of long-term care institutions, ②. transparent management, ③. a thorough understanding of relevant regulations, such as laws and public announcements, and prevention of errors in interpretation, and lastly ④. active countermeasures focused on improving unfair claims instead of punishment.

Prevalence of Suicidal Behaviors in Residents of Long-Term Care Facilities: A Systematic Review and Meta-Analysis.

Long-term care facilities (LTC) plays a pivotal role in caring for geriatric population. However, the risk of suicide in long-term care institutions among older individuals is little understood (e.g., nursing homes, assisted living facilities). The purpose of this systematic review is to pool and meta-analyze the data on prevalence of suicidal behaviors in geriatric population residing in long-term care facilities. We have conducted the systematic review in accordance with the PRISMA guidelines. The utilized databases are Pubmed, Medline, Google scholar and Scopus. The Meta-analysis was done using OpenMeta [analyst] software. Subgroup analysis was also performed. After running an analysis on pooled data from twenty cross-sectional studies with 3,023,224 participants, the prevalence of suicidal behavior is 6.4% (95% CI = 5.7-7) in LTC. This meta-analysis shows pooled prevalence of suicidal behavior among geriatric residents of LTC was found to be moderately high all over the world.