Long-term Care Residents Research Articles

Antihypertensive Deprescribing and Cardiovascular Events Among Long-Term Care Residents

The practice of deprescribing antihypertensive medications is common among long-term care residents, yet the effect on cardiovascular outcomes is unclear. To compare the incidence of hospitalization for myocardial infarction (MI) or stroke among long-term care residents who are deprescribed or continue antihypertensive therapy. This comparative effectiveness research study used target trial emulation with observational electronic health record data from long-term care residents aged 65 years or older admitted to US Department of Veterans Affairs community living centers between October 1, 2006, and September 30, 2019, and taking at least 1 antihypertensive medication. Analyses were conducted between August 2023 and August 2024. A reduction in the number of antihypertensive medications or dose (by ≥30%), assessed using barcode medication administration data. Incidence of MI and stroke hospitalization up to 2 years was assessed using International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. A pooled logistic regression model with inverse probability of treatment weighting (IPTW) and inverse probability of censoring weighting (IPCW) was used to estimate per-protocol effects. Of 13 096 long-term care residents (97.4% men; median age, 77 years [IQR, 70-84 years]) taking antihypertensive medication, 17.8% were deprescribed antihypertensive medication over a period of 12 weeks. The estimated unadjusted cumulative incidence of stroke or MI hospitalization over 2 years was similar among residents who were and were not deprescribed antihypertensives in per-protocol analyses (11.2% vs 8.8%; difference, 2.4 percentage points [95% CI, -2.3 to 7.1 percentage points]). Participant characteristics were balanced after applying IPTW and IPCW; all standardized mean differences were less than 0.05. After full adjustment for confounding and informative censoring, the per-protocol analysis results showed no association of antihypertensive deprescribing with MI or stroke hospitalization (hazard ratio, 0.93; 95% CI, 0.70-1.26). In this comparative effectiveness research study, deprescribing antihypertensive medication was not associated with risk of hospitalization for MI or stroke in long-term care residents. These findings may be informative for long-term care residents and clinicians who are considering deprescribing antihypertensive medications.

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.

System Dynamics Modeling of Caries Severity States in Long-Term Care.

Dental caries among long-term care (LTC) residents is a persistent and complex problem driven by social and structural factors. Systems thinking may be useful in considering novel approaches to reducing disease. This study aimed to develop a system dynamics model to simulate the progression of dentate older adults in LTC through caries severity states and estimate the effects of 3 intervention scenarios on the progression of caries: preventive topical fluoride (TF), arrest of caries with silver diamine fluoride (SDF), and a combination of TF and SDF. Dentate older adults in LTC were categorized into 4 caries severity states by their number of untreated carious lesions. The model assumed that changes in severity states were consistent with incidence rates reported in the literature and available billing data for dental care and that individuals move in and out of the system by entering and exiting the facility or experiencing edentulism. For all scenarios, the proportion of dentate older adults in LTC with 1 or more untreated lesions stays stable, the distribution of disease shifts from a high severity state, and the system approaches equilibrium after 4 y. The TF intervention predicts minimal impacts on decreasing the proportion of dentate older adults with 1 or more untreated lesions (2.5% decrease), while the SDF intervention and the combination interventions were most disruptive. There was a 29.6% and 33.6% decrease, respectively. Given the specific population dynamics in LTC, these findings suggest that long-term (greater than 4 y) interventions should be designed to address both the management of existing lesions and their incidence. This system dynamics model allows researchers to render institution-specific data points from LTCs to estimate the effects of proposed interventions at the respective site.

Food-Related Control and Person-Centered Care: Influences on Life Satisfaction in Long-Term Care Residents

Upon entering long-term care (LTC) homes, residents relinquish control over their daily life choices, which may influence life satisfaction. This study explored hypothesized relationships among the concepts of person-centered care, locus of control (LOC), and life satisfaction of LTC residents. Survey data were collected and analyzed from 154 residents of 16 skilled nursing facilities in the Midwest. Data were analyzed using structural equation modeling to examine relationships among person-centered care, life satisfaction, food-related life satisfaction, health LOC and food-related control. Results indicated food-related life satisfaction was influenced by perceived person-centered care and life satisfaction. Health LOC and person-centered care affected life satisfaction. Support for the use of person-centered care practices was demonstrated in LTC. The results suggest that older adults in LTC should be encouraged to participate in food-related decision-making to support life satisfaction.

Long-Term Residential Care and the Built Environment: Improving Quality of Life and Resilience Through a Universal Design Approach.

This paper draws on a series of transdisciplinary research projects examining the role of the built environment in supporting quality of life in long-term residential care settings (LTRC) in Ireland. Acknowledging the impact of COVID-19, these projects include airborne infection control as a key theme. Moreover, considering the wide spectrum of needs, impairment, and health conditions experienced by people living in these settings, along with the diversity of residents, staff, and visitors who occupy LTRC buildings, the research is underpinned by a Universal Design (UD) approach. Finally, climate change is examined as emerging challenge, particularly for older people living in LTRC. Starting with these major concerns, this exploratory paper examines how UD can act as a bridging concept to bring together inclusion, quality of life, health and wellbeing, and climate resilience in the context of long-term residential care in Ireland and beyond.

Universal Designed Homes: Social Value and Economic Benefits.

This paper examines the social value and economic benefits of Universal Design (UD) Homes, with a focus on assessing the potential financial savings arising in various areas of expenditure due to investment in UD Homes. Investment in the provision of UD Homes can result in a win-win outcome, leading to improved quality of life and more cost-effective forms of investment. UD Homes are found to be particularly cost-effective in the context of age friendly housing due to the potential to reduce the need for costlier forms of long-term residential care and the avoidance of injurious falls.

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.

Denosumab for osteoporosis in older adults in long-term care: A randomized trial.

In long-term care (LTC), the incidence of hip or vertebral fractures are eight times that in the community. Despite the wide availability of osteoporosis therapy, LTC residents are omitted from pivotal trials and not treated. Denosumab is a relatively new, monoclonal antibody therapy for osteoporosis treatment. Via a randomized trial, we sought to determine the safety and efficacy of denosumab in LTC residents. We conducted a 2-year, double-blind, placebo-controlled, randomized clinical trial in 201 osteoporotic men and women aged ≥ 65 years, living in LTC communities. Participants with multimorbidity, dysmobility, and cognitive impairment were not excluded. The intervention was denosumab 60 mg subcutaneous every 6 months or placebo. Our primary outcome measures were hip and spine bone mineral density (BMD) improvement at 24 months. Secondary outcomes included BMD at other skeletal sites, function, and safety. We included 123 women and 78 men with a mean ± standard error age of 81.5 ± 0.6. Overall, 83% and 71% completed 12 and 24 months, respectively. Compared with placebo, the women receiving denosumab had a greater 24-month percent increase in spine (7.41 ± 0.93 vs. 2.15 + 0.56; p = 0.014), and total hip BMD (4.62 ± 0.62 vs. -0.19 ± 0.79; p = 0.007); and men in spine (7.91 ± 0.96 vs. 1.12 ± 1.13; p = 0.002) and total hip (3.74 ± 0.55 vs. 0.48 ± 0.74; p = 0.018). There were no significant differences in safety metrics. Denosumab was a safe and effective therapy for improving BMD in osteoporotic older men and women with multiple comorbidities in LTC.

"More Than Just Holding the iPad": Family Members' Perspectives on the Work of Video Calling in Aged Care

Video calls are increasingly being adopted to enable older adults living in long-term residential care (aged care homes) to remain socially connected with friends and family. However, care home residents often require extensive support to participate effectively in video calls. Despite growing interest in examining the work involved in facilitating technology use in care homes, the role of caregivers---comprising family members and staff---in facilitating video calls has received limited attention. Drawing on data from a study of family members' experiences in Australia, we analysed the essential work activities required to make video calls function in residential aged care. We show how video calling is underpinned by the development of relationships between families and staff, and how video calling requires considerable work in preparation, facilitation, and troubleshooting. We discuss how video calling systems for care homes might be designed to alleviate unwanted work, lowering the burden of call participation for residents, families, and care staff.

Association of oral frailty with falls in long-term care residents.

We investigated the relationship between oral frailty (OFr) and falls among long-term care residents. Residents (N = 254, mean age 84 y, 79% women) participated in this longitudinal cohort study in 2018-2021. OFr was defined by six signs. Demographics, diagnoses, and medications were retrieved from the medical records. Frailty phenotype, sarcopenia and disability were assessed. Number of falls was collected from medical records over 12months following baseline assessment. Of participants, 35% fell during follow-up. Of the fallers, 28% were bedridden or needed a wheelchair; among non-fallers, this figure was 73%. In logistic regression analysis after adjusting for age, sex, BMI, stroke, dementia, diabetes, coronary heart disease, number of medications, mobility, walking speed and sarcopenia, OFr did not predict falls (OR for severe OFr 0.13 (95% CI 0.01-1.27). Male sex predicted falls. No association was found between severe OFr and falls over a 12-month follow-up.

How the COVID-19 pandemic shaped Canadians' preferences for setting of dying: Comparison of two panel surveys.

The purpose of this article is to assess whether COVID-19 shaped Canadians' preferred settings of dying. We compared data collected using the same survey from two independent but comparable sets of panel respondents, prior to and after the onset of the pandemic. A vignette methodology was used to assess preferences for dying in each of four settings: home, acute/intensive care, palliative care, and long-term residential care. Although preferences for dying at home, in acute/intensive care and palliative care units did not change, preferences for dying in nursing homes significantly declined. In the pandemic's first and second waves, the spread of knowledge about problems of poor care, visitation restrictions, and fears of contagion in Canadian long-term residential care may have shaped public perceptions of and preferences for dying these settings. If this change persists, it may influence advance care planning decisions. That preferences for dying at home did not shift is, however, noteworthy.

Supporting resident-centred decision-making about transitions from long-term care homes to hospital: a qualitative study protocol

IntroductionBurdensome care transitions may occur despite clinicians’ engagement in care planning discussions with residents and their family/friend care partners. Conversations about potential hospital transfers can better prepare long-term care (LTC)...

Effectiveness of physical rehabilitation for physical functioning and quality of life in long-term care residents with dementia.

Effectiveness of physical rehabilitation for physical functioning and quality of life in long-term care residents with dementia.

The impact of patient-facility language discordance on potentially inappropriate prescribing of antipsychotics in long-term care home in Ontario, Canada: a retrospective population health cohort study

BackgroundAppropriate use of medication is a key indicator of the quality of care provided in long-term care (LTC). The objective of this study was to determine whether resident-facility language concordance/discordance is associated with the odds of potentially inappropriate prescribing of antipsychotics (PIP-AP) in LTC.MethodsWe conducted a population-based, retrospective cohort study of LTC residents in Ontario, Canada from 2010 to 2019. We obtained resident language from standardized resident assessments, and derived facility language by determining the proportion of residents belonging to each linguistic group within individual LTC homes. Using linked administrative databases, we identified all instances of PIP-AP during a 1-year follow-up period. PIP-AP was defined using the STOPP-START criteria, which have previously been shown to predict adverse clinical events such as emergency department (ED) visits and hospitalizations. The association between linguistic factors and PIP-AP was assessed using adjusted multivariable logistic regression analysis.ResultsWe identified 198,729 LTC residents consisting of 162,814 Anglophones (81.9%), 6,230 Francophones (3.1%), and 29,685 Allophones (14.9%). The odds of PIP-AP of were higher for both Francophones (aOR 1.15, 95% CI 1.08–1.23) and Allophones (aOR 1.11, 95% CI 1.08–1.15) when compared to Anglophones. When compared to English LTC homes, French LTC homes had greater odds of PIP-AP (aOR 1.12, 95% CI 1.05–1.20), while Allophone homes had lower odds of PIP-AP (aOR 0.82, 95% CI 0.77–0.86). Residents living in language-discordant LTC homes had higher odds of PIP-AP when compared to LTC residents living in language-concordant LTC homes (aOR 1.07, 95% CI 1.04–1.10).ConclusionThis study identified linguistic factors related to the odds of PIP-AP in LTC, suggesting that the linguistic environment may have an impact on the quality of care provided to residents.

Does staffing impact health and work conditions of staff in long-term care homes?: a scoping review

Abstract Background Long-Term Care (LTC) homes are highly regulated and task oriented, with demanding work and insufficient resources. Chronic underfunding of the sector, coupled with increased complexity of care, has deteriorated working conditions, resulting in precarious employment, intensified and stressful work, and decreased job satisfaction. These work conditions have contributed to severe staffing shortages of healthcare workers globally. To meet increased labour demands, OECD countries on average will need to increase the proportion of overall employment dedicated to LTC by 32% over the next decade. While reviews of literature have examined the association between staffing and care outcomes for residents in LTC, they have not examined how staffing structures affect the healthcare staff themselves. This scoping review asks: How does staffing impact the health of staff and working conditions in LTC? Methods A scoping review of empirical peer reviewed and grey literature was conducted to examine the association between LTC staffing practices and how they impact working conditions and the health and well-being of staff. PubMed, CINHAL, and Scopus databases were searched for relevant articles published within the past 10 years. Results Searches yielded 3994 unique articles, which were independently screened by pairs of reviewers. Preliminary results highlight that staffing levels are not optimized for healthy, sustainable work conditions. The level of staff, their skill mix, and ratios all impact the ability to provide care. In circumstances where there is inadequate staffing, care workers are more likely to experience stress, burnout, job dissatisfaction, and increased injury and illness. Conclusions Staffing practices shape working conditions which impact healthcare workers own health outcomes. To facilitate a strong LTC workforce, working conditions and occupational health need to be a priority in improvement initiatives. Key messages • With extreme staffing shortages challenging the healthcare sector, this review highlights the need for heightened attention to the impact of staffing practices on the healthcare workforce. • Improving working conditions and attuning to the needs of the workforce, ultimately improves quality of care.

Wellbeing, career satisfaction, and educational requirements in healthcare assistants in Ireland

Abstract Background The long-term residential care (LTRC) sector in Ireland relies heavily on Health Care Assistants and Carers (HCAs). This workforce has become increasingly diverse in recent years, often relying on non-national temporary workers with varying levels of education. In 2022, of 22,495 HCAs and 5,289 Healthcare Support Assistants working in 563 nursing homes caring for some 30,000 residents, 22% were non-national. Their plight became evident during COVID-19 which had profound consequences in the LTRC sector. Objectives In this study, we investigate the recruitment, training, employment terms and conditions of HCAs in Ireland, as well as their general well-being and career satisfaction. Methods A cross-sectional study of members of ‘Care Assistance Ireland’, for which ethics approval was granted for an estimated sample of 1,052, is conducted. Validated instruments used are: the Maastricht Instrument for Sustainable Employability (MAISE); Utrecht Work Engagement Scale (UWES); General Wellbeing Schedule (GWBS) and Minnesota Career Satisfaction Survey (MCSS). Results The internal consistency reliability (Cronbach’s alpha) of GWBS and MCSS instruments were high. The response rate in the selected sample is estimated circa 60%, the majority being female and qualified. General well-being status will be investigated once all responses are submitted. Spearman correlation is predicated to show moderate to strong positive correlations (0.2-0.9) for all GWBS and MCSS questionnaires questions. While MAISE and UWES are still under investigation. It is predicted that there is variability in the requirements for, and terms and conditions of, employment among HCAs in Ireland, while job security remains a concern. Conclusions These findings reinforce the importance of ensuring standards for recruitment, training, job security and well-being for the LRTC workforce. The lack of educational requirements for HCAs in some settings is a critical consideration. Key messages • Findings will impel a more agreeable, consistent entry award in the healthcare system. • It profiles career needs of HCAs outlining the long-term shortfalls preventable with health policy enactments.

Incidence, predictors and outcomes of non-home discharge following transcatheter aortic valve implantation: a multicentre Australian experience. The NHD TAVI study

Abstract Background Patients undergoing transcatheter aortic valve implantation (TAVI) commonly experience non-home discharge (NHD), a phenomenon associated with increased health-care expenditure and possibly poorer outcomes. Despite its relevance to patients, post-TAVI NHD remains poorly explored in the literature. Purpose To characterise the incidence and predictors of NHD following TAVI, understand its impact on quality of life, and identify the proportion of patients that require long-term residential care following initial NHD. Methods Retrospective analysis of prospectively collected data of 2229 patients undergoing TAVI from 2010–2023 included in an Australian TAVI Registry. Results Median age was 82 (IQR: 78-86) years and 41% were female. 257 (11.5%) patients were not discharged home following TAVI, with incidence falling over time (R2=0.636, p&amp;lt;0.001). Multivariable logistic regression modelling for NHD prediction was developed with excellent calibration and discrimination (C-Statistic 0.835). Independent predictors of NHD were post-procedural stroke (adjusted odds ratio [aOR] 11.1), procedure at a private hospital (aOR 3.0), living alone (aOR 2.4), vascular access site complications (aOR 2.1), frailty (aOR 1.9), age&amp;gt;80 (aOR 1.8), hypoalbuminemia (aOR 1.8), NYHA III-IV (aOR 1.7) and hospital length of stay (aOR 1.1) (all p&amp;lt;0.05). NHD was not associated with mortality at 30-days and less than one percent of all patients required longer-term residential care. Conclusion While common following TAVI, NHD does not predict short-term mortality and most patients successfully return home within 30-days. When used appropriately, NHD may serve as a brief and effective method of optimising functional status without compromising long-term independence.Predictors of Non Home Discharge

Association Between Modifiable Structural and Process Factors and the Quality Indicator Pain in Nursing Home Residents: A MultiCentre Cross-Sectional Survey.

The aim of this study is to examine the association between modifiable structural and process factors and self-reported as well as observed pain in Swiss residential long-term care residents. Sub-study of a multicentre cross-sectional survey. Institution, unit, and staff data were collected from September 2018 to October 2019 in 118 residential long-term care institutions in Switzerland's German- and French-speaking regions using paper questionnaires. Resident data were exported during the same period from routine data sets. In this study, 6213 residents from 86 residential long-term care institutions were included. Modifiable structural factors such as institutions having access to geriatricians, nursing experts and a palliative care team, the presence of a pain guideline on the unit and good teamwork among care workers were associated to less pain in residents. It is possible for residential long-term care institutions to improve pain in residents and to optimise the quality of care by providing access to geriatricians, nursing experts and a palliative care team, working with a pain guideline and fostering teamwork. Residential long-term care institutions can modify and implement modifiable structural factors which can reduce pain in residents to optimise residents' quality of life and quality of care. Improved pain management in residential long-term care institutions can lead to optimised quality of care and quality of life for individual residents. STROBE checklist. No patient or public contribution.

Social connection in long-term care homes: a qualitative study of barriers and facilitators

BackgroundSocial connection is a basic human need and is essential to quality of life. It is associated with better mental and physical health outcomes for long-term care (LTC) home residents and is a key aspect of quality of care and person-centred care. There are considerations for LTC homes that may present obstacles to and opportunities for social connection. It is therefore important to understand what restricts or enables good social connection in LTC homes, to guide better quality care and future interventions in this population. This qualitative study aims to identify barriers and facilitators to social connection for LTC residents.MethodsWe used thematic analysis to describe themes derived from individual and group qualitative interviews from 67 participants (18 residents, 17 staff members and clinicians, 32 family members and friends) recruited from LTC homes in the United Kingdom and Canada.ResultsThemes were grouped into four categories: (1) becoming familiar with life in the LTC home to support social connection; (2) physical and virtual access beyond the LTC home as strategies to maintain contact; (3) getting to know residents to deepen relationships; (4) person-centred approaches to build social connection. ‘Becoming familiar with life in the LTC home to support social connection’ described the benefits of counteracting the institutionalized feel of LTC homes, enabling LTC residents to spend time in meaningful ways, and increasing freedom of mobility around the home. ‘Physical and virtual access beyond the LTC home as strategies to maintain contact’ related to the benefits of outings, providing support with technology, and involving family and friends in LTC home life. ‘Getting to know residents to deepen relationships’ related to the benefits of using routine care and interactions as opportunities for social contact, using family and friend knowledge as a resource, and fostering resident relationships. ‘Person-centred approaches to build social connection’ included considering physical, mental, cognitive, and sensory impairments, accounting for adjustment and sociability, using communal spaces well, and prioritizing psychosocial needs.ConclusionsThis study identifies barriers and facilitators to social connection for LTC residents which can be addressed in care policies, staff selection and training, and can inform policies and interventions to build and maintain social connection in LTC homes.Clinical trial numberclinicaltrials.gov ID NCT05315960.

Having to ‘go beyond’: Staff perspectives on activity programs for older people living in nursing homes

Activity programs are run by many nursing homes (also known as residential aged care facilities or long-term care facilities) however little is known about how activities are chosen or how well they meet the needs of residents. The aim of this study was to learn more about activity programs currently offered to older people living in nursing homes in Victoria, Australia. Interviews were undertaken with 13 activities/lifestyle staff working across six nursing homes. Staff were asked about their role and training; how activities were chosen, run, and evaluated; and barriers to providing social participation opportunities for residents. Thematic analysis of interview transcripts revealed six main themes: the role of the activities staff is to make people happy and meet their needs; activities staff largely choose (group based) activities; evaluation of activity programs is mostly informal; activity programs are poorly resourced; staff are often required to ‘go beyond’; and catering to the unique needs of residents is challenging. Given the established importance of social interaction to physical and psychosocial health, it is essential that activity programs and staff are viewed as integral to resident wellbeing; that staff are trained and supported; and that programs are funded and resourced adequately to deliver programs that are person-centred and meet the needs and preferences of residents.