Long-term Care Practitioners Research Articles

Methods for the involvement of people living with dementia in research focused on the built environment: a protocol for a scoping review

IntroductionThe positive influence of a well-designed built environment in dementia-specific care has been known for several years. Many studies focusing on the built environment have captured the perspectives of people...

Long-Term Care Research in the Context of COVID-19 Pandemic: A Bibliometric Analysis.

Despite the increasing awareness of long-term care (LTC) research after the outbreak of COVID-19 pandemic, little attention was given to quantitatively describe the evolution of the research field during this period. A total of 1024 articles retrieved from the Web of Science Core Collection database were systematically analyzed using CiteSpace visualization software. The overall characteristics analysis showed that, in the context of the pandemic, attention to LTC research increased significantly-over 800 articles were published in the past two years. The USA, Canada, Italy, and England formed the leading LTC research group, which was consistent with the conclusions of existing bibliometric studies on LTC research before the outbreak. A rigorous analysis based on a dual perspective of references and keywords was applied to reveal that, compared with previous studies, in the context of the pandemic, the focus shifted from the mental and physical health status of older adults in need of LTC to the impact of the pandemic on those of older adults in LTC facilities, from the prevention of general epidemics to the prevention and response of significant public health emergencies, from providing and paying for LTC to strategies for LTC facilities to improve the quality of LTC and well-being of their residents during the pandemic. These findings can provide help and reference for academics, civil folks, and LTC practitioners, as well as help with the sustainable development of LTC research in the context of COVID-19 pandemic.

Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems.

The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic's persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents' quality of life, while ensuring the well-being of staff and residents' families.

The characteristics of effective technology-enabled dementia education: a systematic review and mixed research synthesis

BackgroundDementia education is required to address gaps in dementia-specific knowledge among health and social care practitioners amidst increasing dementia prevalence. Harnessing technology for dementia education may remove obstacles to traditional education and empower large communities of learners. This systematic review aimed to establish the technological and pedagogical characteristics associated with effective technology-enabled dementia education for health and social care practitioners.MethodsMEDLINE, PubMed, Web of Science, CINAHL, Scopus, PsycINFO, ERIC and OVID Nursing Database were searched from January 2005 until February 2020. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Study quality was assessed with the Mixed Methods Appraisal Tool. Quantitative evidence was categorised based on Kirkpatrick’s Model. Qualitative data was synthesised thematically and integrated with quantitative findings before conclusions were drawn.ResultsTwenty-one published papers were identified. Participants were acute, primary and long-term care practitioners, or were students in higher education. Most training was internet-based; CD-ROMs, simulations and tele-mentoring were also described. Technology-enabled dementia education was predominantly associated with positive effects on learning outcomes. Case-based instruction was the most frequently described instructional strategy and videos were common modes of information delivery. Qualitative themes emerged as existing strengths and experience; knowledge gaps and uncertainty; developing core competence and expertise; involving relevant others; and optimising feasibility.DiscussionTechnology-enabled dementia education is likely to improve dementia knowledge, skills and attitudes among health and social care practitioners from multiple practice contexts. Confidence in the results from quantitative studies was undermined by multiple confounding factors that may be difficult to control in the educational research context. Convenience and flexibility are key benefits of technology-enabled instructive and simulated pedagogy that can support the application of theory into practice. More research is required to understand the role of online learning networks and provisions for equitable engagement. A future emphasis on organisational and environmental factors may elucidate the role of technology in ameliorating obstacles to traditional dementia education.Systematic review registrationPROSPERO (CRD42018115378)

New Options to Simplify the Treatment of Severe Hypoglycemia in Long-Term Care

New Options to Simplify the Treatment of Severe Hypoglycemia in Long-Term Care

Moving Toward a Post-COVID World

Moving Toward a Post-COVID World

Wit, Wisdom, and Hard Work Make a Model Medical Director of the Year

Wit, Wisdom, and Hard Work Make a Model Medical Director of the Year

Oral Care for Clients in Long-Term Care

Oral health impacts the physical and psychological comfort and the quality of life of clients in long-term care. The programs to prevent or delay disability care advocated under Taiwan's Long-Term Care Plan 2.0 address oral health care, highlighting the importance of oral health care for clients in long-term care. This article discusses three concepts of oral health care for clients who are in long-term care. These include: the relationship between oral conditions and general health, oral care and dysphagia, and oral health and hydration. In addition, oral health care strategies for long-term care facilities are discussed. It is hoped that this article will encourage long-term care practitioners to pay close attention to the issue of oral health and to implement appropriate oral health care for their long-term-care clients.

Expanding Population of Elders With HIV May Catch Nursing Homes Off Guard

Expanding Population of Elders With HIV May Catch Nursing Homes Off Guard

Expanding Population of Elders With HIV May Catch Nursing Homes Off Guard

Expanding Population of Elders With HIV May Catch Nursing Homes Off Guard

Advance Care Planning Finally Gets CMS Support

Advance Care Planning Finally Gets CMS Support

Keynoter Puts Patient Pleasure First

Keynoter Puts Patient Pleasure First

Rescheduling of combination hydrocodone products: problems for long-term care practitioners.

The Drug Enforcement Administration recently announced the final rule to reschedule hydrocodone combinations from schedule III of the Controlled Substances Act to the more restrictive schedule II category. This regulatory change will have broad operational implications for practitioners serving the health care needs of long-term care residents. Stakeholders will need to work collectively to identify possible efficiencies to counter some of the anticipated costs as well as its effect on patient care.

Scabies in the nursing home.

Scabies infection is antediluvian and ubiquitous both in developing and developed countries, yet often neglected. Scabies has a predilection to infect vulnerable subsets of population in crowding conditions, typically applicable to residents in the nursing home. The mite incites a unique immunological response from human hosts. Scabies does not manifest as a singular skin condition and may present atypically in older adults, the majority of nursing home residents, where delay has deleterious consequences. Further, pruritus or itching, the hallmark of scabies infection, is a common complaint from a variety of causes among older adults. Hence, the diagnosis is often delayed or missed. There are several pharmacological treatment options; long-term care practitioners need to understand the characteristics of each agent before selection. Even more relevant is the importance of nonpharmacological aspects of management, crucial in the success of averting spread or outbreaks in long-term care settings.

Top LTC Public-Policy Issues Spotlighted

Top LTC Public-Policy Issues Spotlighted

Coping Successfully with Aging

Aging is associated with physical decline, often accompanied by pathology and disability that can cause unhappiness and dissatisfaction. Despite this, many elders report a high level of satisfaction. This article discusses the anxiety associated with aging that some people experience, highlights research findings and models of aging, and pays particular attention to how elders compensate and cope with loss. Long-term care practitioners can help residents deflect negative stereotypes and improve their own attitudes about aging.

AMDA Is Watching Prescription, Pay Policies

AMDA Is Watching Prescription, Pay Policies

Autism and Aging: Hardly Out of the Woods

Leo Kanner first described autism in 1943, but it took the America Psychiatric Association almost 40 years to recognize it officially in 1980. It is one of five diverse pervasive developmental disorders grouped under the diagnostic category of autism spectrum disorders (ASD). Autism's core symptoms include socialization deficits, inability to understand and communicate with others, and restricted, repetitive behavioral patterns. Few children "outgrow it" or are cured. While good care and early intervention can help children develop the skills they need to deal with others in socially appropriate ways, clinicians usually see these same or similar behaviors in adults. ASD is associated with an array of problems including anxiety, depression, food allergies, and attention deficit hyperactivity disorders. Because the onset of autism occurs in early childhood, long-term care practitioners are more apt to encounter older adults who were misdiagnosed in childhood. When behavioral interventions are not fully effective, clinicians and families may look for medication. No medications are approved to treat autism's core symptoms. People with ASD have mental health disorders at rates higher than their peers, and these disorders can be treated. Long-term care practitioners need to prepare to see the people first diagnosed with autism in the 1980s who are now reaching old age with the need for long-term care facilities.

Flu Vaccine May Not Be Effective in the Elderly

CHICAGO — Trivalent inactivated influenza vaccine may not elicit a clinically adequate antibody response in elderly adults, pilot data suggest. Based on blood assays taken before and 4 weeks after administration of the Fluarix 2007/2008 formula, 88% of 71 community-dwelling older adults, mean age 85 years, failed to mount a fourfold antibody response to any of the three virus strains present in the trivalent influenza vaccine (TIV). Only two patients had a fourfold antibody response to both influenza A types, H1N1 and H3N2, and none had such a response to all three strains—H1NI, H3N2, and influenza B—Sean X. Leng, MD, PhD, said at the annual meeting of the American Geriatrics Society. A fourfold or higher vaccine antibody titer increase, also called positive seroconversion, is the criterion for a clinically adequate antibody response. In contrast, he noted that the vaccine insert reports that 444 (60%) of 745 persons, aged 18-64 years, had a fourfold antibody response to the H1N1 strain, 461 (62%) had such a response to H3N2, and 575 (77%) did so to the influenza B strain. “Obviously this is pilot data, but [it does] point out the importance of the need for comprehensive evaluation of this vaccine in older and frail populations,” said Dr. Leng of the division of geriatric medicine and gerontology at Johns Hopkins University in Baltimore. Patients had received flu vaccine for an average of 7 years prior to study entry, although this was based on self-report and subject to memory bias. Still, 25 (3.4%) participants reported signs and symptoms of flulike illness during the 2007-2008 flu season, although a laboratory diagnosis of influenza was not confirmed. No influenza-related death was reported. Dr. Leng noted that those aged 75 years and older make up a small percentage of vaccine trial cohorts, despite being the fastest growing segment of the population. In one vaccine trial, only 11% of patients were at least 75 years old (JAMA 1994;272:1661-5). The one-size-fits-all approach to influenza vaccine needs to be re-examined, as is being done with cancer screening in elderly and other high-risk groups, he suggested. Patients in the study ranged in age from 72 to 95 years, 79% were women, and 93% were white. Comorbidities included hypertension (67%), osteoarthritis (45%), and dyslipidemia (38%). Dr. Leng and associates reported no conflicts of interest. The study was sponsored by the National Institute on Aging and the American Federation for Aging Research. “While this study is interesting, it doesn't call for any action on the part of long-term care practitioners,” said David Nace, MD, MPH, director of the long-term care and flu programs at the University of Pittsburgh Institute on Aging. “It is worth noting that only 3.4% of participants reported signs or symptoms of flulike illness, and this is lower than what we would anticipate from the literature—typically one out of five older individuals per season. “This low rate of influenza illness is especially interesting given the fact that during the 2007-2008 season, strains covered by the flu vaccine didn't match the influenza that circulated through the U.S.”

LTC Physicians Detail Financial Challenges

CHARLOTTE, N.C. — Medicare payment problems continue to challenge long-term care professionals, AMDA president Charles Crecelius, MD, PhD, CMD, reported at the AMDA Annual Symposium. Eric Tangalos, MD, CMD, of the Mayo Clinic in Rochester, Minn., explained—and personally supported—long-term care practitioners' participation in Medicare's pay-for-performance program, the Physician Quality Reporting Initiative (PQRI), which offers some small bonuses. Other speakers on the topic of fiscal issues facing long-term care described other specific Medicare issues. Medicare's latest experimental strategies to address costs include bundling (paying global fees to be distributed among caregivers), gainsharing (offering health care facilities and physicians shares of savings they generate), developing the medical home model (paying incentives for coordination of care), and pay for performance (creating financial incentives for facilities to demonstrate quality and efficiency), Dr. Crecelius said. “This year I want you to embrace PQRI,” Dr. Tangalos said. “Strategically, it fits in with everything the Obama [administration] has to offer with regard to changing the way we look at medicine.” He also encouraged medical directors to adopt electronic medical records so they can take advantage of pay for performance going forward. There are 153 quality measures that can be reported by physicians under the program. Of these, 26 can be reported in nursing home settings in 2009. The measures for nursing homes include controlling hemoglobin A1c, blood pressure, and LDL cholesterol levels in residents with diabetes; beta-blocker and oral antiplatelet therapy for residents with coronary artery disease; and evaluation for age-related macular degeneration, glaucoma, and fall risk in all residents. Some measures are grouped, and, of seven groups, only diabetes is eligible to be reported in a nursing home setting. Dr. Tangalos shared PQRI-related results of AMDA's 2008 survey of members, which indicated that 16% of AMDA members participated in the program last year. In a follow-up survey, 70% of 2008 participants said that they planned to participate again in 2009–2010. But 80% of the respondents who are no longer participating in PQRI said that it was not worth the money, and 70% of all of the follow-up respondents said they felt that participation in PQRI did not improve their practices. More details about PQRI reporting are available online at www.cms.hhs.gov/pqri and through AMDA at www.amda.com/advocacy/pqri/index.cfm. Cheryl Phillips, MD, CMD, the incoming president of the American Geriatrics Society and an AMDA past president, said that the latest effort at a geriatric assessment code, the proposed Geriatric Assessment and Chronic Care Coordination Act (GACCCA), could be good news for LTC clinicians and residents. The GACCCA stalled in Congress 2 years ago, but Dr. Phillips said the bill now has bipartisan support and should be reintroduced soon. The act would create separate Medicare payments for comprehensive geriatric assessments and coordination of chronic care. Covered geriatric assessments would include medical condition, function, cognition, environmental and psychosocial needs, and availability of care. Services to be coordinated would include care planning, education of patients and their caregivers, medication management, care transitions, community and hospice services, and clinical-decision support. The GACCCA is needed because of the complexity of coordinating care for geriatric patients with multiple medical conditions, said Dr. Phillips. “There is no fee-for-service mechanism for comprehensive assessment and for the coordination activities that go across time, place, and profession,” she said. Under the GACCCA, care coordination would be paid monthly for each beneficiary who is defined as an at-risk and vulnerable elder, Dr. Phillips said. Heidi Splete is a senior writer with Elsevier Global Medical News.