Long-term Care Services Research Articles

An analysis of the efffects of the income level of the family caregivers for the recipients using LTC home care services on the willingness to pay : A cross-sectional study

Purpose: This study aimed to determine how income level affects the willingness to pay out-of-pocket payments for those who bear the cost of home care services to use better services. Method: We analyzed data from 1,189 family caregivers who used home care services in the Co-payment for LTC Insurance in 2021. The Chi-square and Cochran-Mantel-haenszel tests was conducted to confirm the relationship between the family caregiver’s income level and willingness to pay out-of-pocket payments. The logistic regression analysis was performed to analyze the effect of income level on willingness to pay. Result: We found that 58.6% of family caregivers in home care services were willing to pay out-of-pocket payments for better long-term care service. After adjusting home care benefit types, the higher the family caregivers’ income level , the higher the willingness to pay additional out-of-pocket payments(p<.001). In addition, as family caregivers’ income level increased, the odds ratio of the willingness to pay additional payments tended to increase(p<.001). Conclusion: Family caregivers who are responsible for the payment of home care services by recipients are willing to pay additional out-of-pocket payments for better service use by recipients. We found that the higher the income level, the higher the willingness to pay. It is necessary to consider the additional cost sharing along with introducing the new home care services and improving the quality of home care services.

Perspectives on registered nurse retention in nursing homes in Korea: A qualitative study

Purpose: This study aimed to understand the factors influencing registered nurses’ (RNs) intentions to remain employed in their current nursing homes (NHs). Methods: Data were collected through individual in-depth interviews with 10 RNs in five Korean NHs from May 1 to May 31, 2024, and analyzed using thematic analysis. Results: RNs in NHs reported that their intention to stay was influenced by “positive interactions with residents,” “cooperative relationships among staff,” and “stability from long-term employment.” Conversely, their intention to leave was influenced by “work burden from insufficient RNs,” “role conflict,” and “low salaries.” Conclusion: This study indicates that significant reforms in staffing regulations and compensation systems are required to retain RNs. Improving working conditions is crucial for healthcare systems to provide effective long-term care to older adults. These changes are essential to maintain the quality of long-term care services.

Evolution of institutional long-term care costs based on health factors

As many developed countries face the challenges of an aging population, the need to efficiently plan and finance long-term care (LTC) becomes increasingly important. Understanding the dynamics of care requirements and their associated costs is essential for sustainable healthcare systems. In this study, we employ a multi-state Markov model to analyze the transitions between care states of elderly individuals within institutional LTC in the canton of Geneva, Switzerland. Utilizing a comprehensive dataset of 21494 elderly residents, we grouped care levels into four broader categories reflecting the range from quasi-autonomy to severe dependency. Our model considers fixed covariates at admission, such as demographic details, medical diagnoses, and levels of dependence, to forecast transitions and associated costs. The main results illustrate significant variations in care trajectories and LTC costs across different health profiles, notably influenced by gender and initial care state. Females generally require longer periods with less intensive care, while conditions like severe and nervous diseases show quicker progression to more intensive care and higher initial costs. These transitions and expected length of stay in each state directly impact LTC costs, highlighting the necessity of advanced strategies to manage the financial burden. Our findings offer insights that can be utilized to optimize LTC services in response to the specific needs of institutionalized elderly people. These findings can be applied to enhance healthcare planning, the preparedness of infrastructure, and the design of insurance products.

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

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

A Regional Efficiency Assessment of Long-Term Care Services in Taiwan

Taiwan is currently an aging society and will be a super-aging society in the near future. The purpose of this research is to use two models of data envelopment analysis (DEA)—the slacks-based measurement (SBM) model and the dynamic slacks-based measurement (DSBM) model—to analyze the efficiency of long-term care (LTC) in Taiwan. This analysis aims to explore the current situation of LTC in Taiwan and provide policy recommendations for LTC. The computation empirical result on the LTC efficiency score presents that the DSBM model exhibits higher efficiency than the SBM model after considering the carry-over variable in the former model. The result from the SBM model indicates that Taiwan’s outlying islands display the worst LTC efficiency, but this result does not appear in the DSBM model. Lastly, these two models both indicate that the number of elderly people being serviced in institutions exhibits higher efficiency and lower slack than those serviced in homes in 2017 and 2018. This paper concludes that the DEA approach is a viable method for examining the performance of the LTC services system as Taiwan approaches a super-aged society.

Assessing the long-term care (LTC) service needs of older adults based on time-driven activity-based costing (TDABC)–a cross-sectional survey in central China

BackgroundThe global population’s aging has led to an increasing demand for long-term care (LTC), especially in developing countries like China. Comprehensive assessment of LTC service demands by including the time and cost analysis is crucial to inform the planning and financing of LTC resources, yet such research is lacking in China. Our research team has developed a quantitative index system of the medical and nursing services needs of older adults (QISMNSNE) based on the framework of Time-Driven Activity-Based Costing (TDABC), providing a valuable tool for measuring LTC service needs. This study aimed to assess the LTC service needs of older adults in China and the factors associated with such needs.MethodsA cross-sectional study was conducted in Changsha City, Hunan Province, China, from June 2021 to December 2022. A stratified multistage cluster sampling method was used to recruit 1,270 older adults from five nursing homes and three communities/streets in three regions of Changsha City. The LTC service needs were assessed by calculating the service time required from caregivers, nurses, and doctors and the total service time (min/d) using the QISMNSNE. Participants’ disability, activities of daily living (ADLs), mental status and social involvement (MSSI), and sensory and communication (SC) were assessed using standard scales. Generalized linear regression models were used to analyze factors associated with LTC service needs.ResultsThe participants had an average age of 76.41 ± 8.38 years, with 43.7% being female. The median service time required from caregivers, nurses, and doctors was 53.34 min/d, 3.66 min/d, and 0.33 min/d, respectively, and the total service time was 83.31 min/d. The generalized linear regression model identified the following factors that were associated with higher total service time: aged 75–84 years, living in nursing homes, income over 5000 per month, ADLs, MSSI (9 ~ 40), SC, and having 3 ~ 4 kinds of geriatric comorbidity (P < 0.05).ConclusionsOlder adults have a high need for LTC services, especially those provided by caregivers, indicating an urgent need to expand and improve LTC systems. The LTC service time needed is associated with multilevel factors encompassing socio-demographic, functional, and psychological aspects. This study offers preliminary insights into the needs, demands, and costs of LTC services for older adults and provides essential guidance for future planning and financing of LTC resources.

“Transported to a Better Place”: The Influence of Virtual Reality on the Behavioural and Psychological Symptoms of Dementia

Emerging research supports that institutionalisation may contribute to the development of the behavioural and psychological symptoms of dementia. Many studies have documented that Virtual Reality can enhance symptom management in people diagnosed with dementia. We design a Virtual Reality system to improve the symptom management of people diagnosed with dementia residing in long-term care services. Twenty people with dementia were enrolled in the study to evaluate the developed solution. Following semi-structured interviews and observations, a thematic analysis was conducted to analyse the results of the system. Heart Rate and Eye-tracking data were recorded to enhance the reliability of the findings. Our findings indicate that Virtual Reality might be able to improve the quality of life of people diagnosed with dementia, as it is highly effective in reducing behavioral and psychological symptoms associated with dementia, including aggression, agitation, anxiety, apathy, and depression. Additionally, Virtual Reality was found to be a possible solution for pain management, reminiscence therapy, and dementia diagnosis.

Unpacking Family Caregiving Types for Older Adults in South Korea: Insights from Time Use Indicators

Population aging has led to an increase in the amount of time families spend providing unpaid care to older members of Korean society. However, there is limited understanding of these caregivers’ daily time allocation and their perceptions of time use. To address these limitations and gain insight into caregivers’ daily lives, we examine the family caregivers’ daily experience by analyzing six objective and subjective indicators related to time use. The data on caregiving for older adults was retrieved from the 2018 South Korean Family Caring Survey ( N = 501). We applied Latent Profile Analysis (LPA) to develop family caregiving types. The study identified five distinct family caregiving types based on six different time-use indicators. These types illustrate variations in socioeconomic status, available social resources, and support utilization among family caregivers. The research delineates both ‘manageable’ and ‘unfavorable’ caregiving types and compares the differences. Through analysis and discussion, the study delves into the policy implications of these findings for formal long-term care services and to empower family caregivers.

Pre-procedural nursing home length of stay and outcomes of transcatheter aortic valve replacement.

Older adults with severe aortic stenosis (AS) may receive care in a nursing home (NH) prior to undergoing transcatheter aortic valve replacement (TAVR). NH level of care can be used to stabilize medical conditions, to provide rehabilitation services, or for long-term care services. Our primary objective is to determine whether NH utilization pre-TAVR can be used to stratify patients at risk for higher mortality and poor disposition outcomes at 30 and 365 days post-TAVR. We conducted a retrospective cohort study among Medicare beneficiaries who spent ≥1 day in an NH 6 months before TAVR (2011-2019). The intensity of NH utilization was categorized as low users (1-30 days), medium users (31-89 days), long-stay NH residents (≥ 100 days, with no more than a 10-day gap in care), and high post-acute rehabilitation patients (≥90 days, with more than a 10-day gap in care). The probabilities of death and disposition were estimated using multinomial logistic regression, adjusting for age, sex, and race. Among 15,581 patients, 9908 (63.6%) were low users, 4312 (27.7%) were medium users, 663 (4.3%) were high post-acute care rehab users, and 698 (4.4%) were long-stay NH residents before TAVR. High post-acute care rehabilitation patients were more likely to have dementia, weight loss, falls, and extensive dependence of activities of daily living (ADLs) as compared with low NH users. Mortality was the greatest in high post-acute care rehab users: 5.5% at 30 days, and 36.4% at 365 days. In contrast, low NH users had similar mortality rates compared with long-stay NH residents: 4.8% versus 4.8% at 30 days, and 24.9% versus 27.0% at 365 days. Frequent bouts of post-acute rehabilitation before TAVR were associated with adverse outcomes, yet this metric may be helpful to determine which patients with severe AS could benefit from palliative and geriatric services.

Using Unsupervised Learning Methods to Explore the Trajectory of Long-Term Care Service in Taiwan

Abstract Background Understanding the temporal trends in long-term care (LTC) utilization enables more effective planning by government and service providers. This study employed machine learning methods to explore LTC utilization trajectories among care recipients in a southern county of Taiwan. Methods Administrative data from the government-funded LTC programme was utilized, with a total of 24,614 participants included after excluding those with less than six months of data. Daily service utilization records, mainly focusing on caregiving services, were aggregated, and the number of days each participant used LTC services within every 30-day period post-application was calculated. Utilization rates during 6 and 12 months post-application were separately analyzed. K-means clustering, an unsupervised machine learning method, was employed to select the optimal classification and identify LTC utilization trajectories using 10-fold cross validation. Temporal frequency variations of each caregiving service within each trajectory group were visualized using heatmaps. Results In the analysis of LTC utilization within the first 6 months post-application, trajectories were classified into 7 groups; while within 12 months, trajectories were divided into 4 groups. These trajectories can be categorized into 4 distinct patterns: High-Stable (6 mo: 21.3%; 12 mo: 35.7%), Low-Stable (6 mo: 33.1%; 12 mo: 37.2%), High-Decrease (6 mo: 12.8%; 12 mo: 10.7%), and Low-Increase (6 mo: 32.7%; 12 mo: 16.5%). We further explored differences in socio-demographic characteristics and needs factors among trajectory groups. Heatmaps were used to illustrate temporal variations in the utilization rates of specific service items, which played a significant role in determining the trajectories. Conclusions K-means clustering is useful in identifying distinct patterns among LTC users. Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups. Key messages • The unsupervised machine learning method distinguished various temporal dynamic patterns in LTC utilization. • Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups.

Long-term Survival After Cancer: A Scoping Review of the Health Care Landscape in Germany

Abstract Background Cancer remains a global health concern, with a significant increase in new cases projected in the coming years. Although cancer treatment and diagnosis have advanced, leading to improved survival, survivors often face complex physical, emotional, and cognitive challenges. The objective of this scoping review is to provide an overview of the current landscape of specialized long-term survivorship care services in North Rhine-Westphalia (NRW) with a focus on vulnerable groups. Methods The scoping review involves two search approaches: a manual search performed by two review authors and a systematic search performed by an information specialist following Scoping Review guidance. The protocol was published on the OSF platform. The systematic search was conducted in databases such as LIVIVIO, MEDLINE and Scopus. The manual search involves identifying key categories of survivorship services and conducting online searches based on these categories in duplicate. Data extraction and synthesis is conducted using EPPI-Reviewer software, and focuses on services characteristics, patient demographics, program format, and accessibility. Results The study has identified more than 300 survivorship care services across North Rhine-Westphalia. According to preliminary results some services offer comprehensive care, while others have significant gaps, particularly in addressing the needs of vulnerable groups. One example of these gaps is the lack of tailored services specifically designed for people with a migration background. Most of the services are not available in multiple languages or gender-specific oriented. The results will be presented on the congress in detail. Conclusions This scoping review underscores the importance of tailored survivorship care, especially for vulnerable groups. Public health actions should focus on addressing disparities in access to survivorship services, enhancing existing programs, and developing new policies to support cancer survivors. Key messages • Effective survivorship care requires attention to vulnerable groups. • The care of long-term cancer survivors should receive more attention in research.

Effects of Sitting Baduanjin Exercises on Cognitive Function, Attention, and Muscle Strength among Patients with Mild Cognitive Impairment

ABSTRACT Purpose Sitting Baduanjin exercises can be effective in treating mild cognitive impairment (MCI). However, evidence on effectiveness of sitting Baduanjin exercises is lacking. This study investigated the effects of sitting Baduanjin exercises on cognitive function, attention, and muscle strength in patients with MCI. Design Quasi-experimental. Methods The participants were assigned to the experimental (n = 12) or comparison group (n = 12). The experimental group performed sitting Baduanjin exercises three times weekly for 40–50 minutes per session for 12 weeks, while the comparison group maintained their usual routine and attended health-related education. The two groups’ cognitive function and attention were assessed through a questionnaire and their muscle strength was measured at weeks 0, 9, and 13. Findings The experimental group showed significant improvements in cognitive function, attention, and muscle strength in the right shoulder anterior flexor; however, the left shoulder anterior flexor group showed no obvious improvements. Conclusion Sitting Baduanjin exercises feature simple actions, are convenient, and have positive effects on improving cognitive function, attention, and muscle strength in patients with MCI. Clinical evidence Baduanjin exercises are suitable for long-term community frontline care services. Early intervention with this exercise program may prevent healthy older people or those with health issues from progressing to dementia.

Lifetime healthcare expenditures across socioeconomic groups

BackgroundA socioeconomic gradient affects healthcare expenditures and longevity in opposite directions as less affluent individuals have higher current healthcare expenditures but simultaneously enjoy shorter lives. Yet, it is unclear whether this cross-sectional healthcare expenditure gradient persists from a lifetime perspective. This paper analyzes lifetime healthcare expenditures across socioeconomic groups using detailed individual-level healthcare expenditure data for the entire Danish population.MethodUsing full population healthcare expenditures from Danish registries, we estimate lifetime healthcare expenditures as age-specific mean healthcare expenditures times the probability of being alive at each age. Our data enables the estimation of lifetime healthcare expenditures by sex, socioeconomic status, and by various types of healthcare expenditure.ResultsOnce we account for mortality differences and all types of healthcare expenditures, all socioeconomic groups spend an almost equal amount on healthcare throughout a lifetime. Lower socioeconomic groups incur the lowest lifetime hospital expenditures, whereas higher socioeconomic groups experience the highest lifetime expenditures on long-term care services. Our findings remain robust across various socioeconomic measures and alternative estimation methodologies.ConclusionImproving the health status of lower socioeconomic groups to align with that of higher socioeconomic groups is costly but may ultimately reduce current healthcare expenditures. Enhanced health outcomes likely increase lifespan, leading to extended periods of healthcare consumption. However, since all socioeconomic groups tend to have similar lifetime healthcare expenditures, this prolonged consumption has limited impact on overall lifetime healthcare costs. Additionally, a significant benefit is the deferment of healthcare expenditures into the future. Overall, our results diminish concerns about socially inequitable utilization of healthcare resources while socioeconomic differences in health and longevity persist, even in a universal healthcare system.

Healthcare professionals' experience with nutritional care beyond formal quality systems — A qualitative study

BackgroundNumerous formal strategies, screening tools, and interventions have been used to prevent malnutrition in long-term care patients. Despite these efforts, the proportion of screened patients is low, and a large proportion are malnourished. Previous research has revealed that healthcare professionals use a broad approach in their nutritional care but has also emphasised the need for further investigation into these approaches. ObjectiveTo explore how healthcare professionals working in long-term care experience and apply nutritional care. DesignA descriptive, exploratory, qualitative design containing 240 h of participant observation, 12 focus groups and 2 individual interviews. Setting(s)Twelve nursing homes and home care units in three Norwegian municipalities. ParticipantsParticipant observation of interactions between healthcare professionals and patients. Forty-three registered nurses participated in focus group or individual interviews. MethodsThe data were analysed using inductive thematic analysis. ResultsThe analysis identified three themes: The first theme, limited significance of nutritional screening, showed that healthcare professionals experienced the limited value of nutritional screening, as it often did not capture patients' nutritional challenges. They also perceived nutritional screening as unsuitable for patients at the end of their lives, those with overweight-related complications, or undergoing rehabilitation. In addition, nutritional screening was perceived as something healthcare professionals did for their managers or administrators, not because it was crucial to providing good nutritional care. The second theme, provision of individualised food, captures the healthcare professionals' efforts in adapting and preparing food according to the patient's preferences. Facilitation to enable patients to make individual food choices and the use of food cards or lists were two approaches to individualising nutrition care. The third theme, making meals more than about food, elucidated how healthcare professionals used meals to help patients cope with their situations and experience social belonging. Conversations about or around meals were used to provide patients with a sense of belonging to their past or present situation. The meals were also used as a diversion strategy for patients with unrest, as arenas for daily activity training, and for meaningful social interactions between patients around the tables. ConclusionsNutritional screening and prevention of malnutrition are only one part of healthcare professionals' nutritional care. Individualised food and meals that create coping, a sense of belonging, and social experiences are equally important parts of their care. Emphasising healthcare professional's person-centred approach to nutritional care would be beneficial, as it could strengthen and further develop long-term nutritional care services.

Influence of Digital Health Technologies among Healthcare Providers on Long-term Care Services Implementation for Elderly with Disabilities

Purpose: The traditional paradigm of home care in China is not up to the challenges posed by the country's increasing population's advancing age and lack of available resources. Digital monitoring technology solutions are thought to be advantageous for managing caregivers' workloads while also improving resident safety and care quality in assisted living facilities. To effectively provide the best possible services, teamwork is crucial in New Hampshire. Due to several issues such staffing shortages, rising resident expectations, and increased demands, NH are consequently embracing the use of Knowledge Management (KM) activities more and more to facilitate knowledge development, storage, transfer, and application. Method: In China, the lack of an established system for caring for the elderly is having a significant impact on society as a whole, making it imperative to establish one. The researcher examined the real impacts of their quality management system and KM efforts on service quality, as well as the KM adjustments made by two China state NH that adopted the E-Qalin management of quality model, in the qualitative research. Additionally, the researchers looked at the approaches used by two China private NH that address service quality from a knowledge management standpoint but have not implemented a certified management of quality program. There were eighty nursing professionals in the sample. Teamwork is crucial in every NH included in this study, and each participant in the researcher’s poll is a member of a team. In this work, the researchers used linear regression to analyse connections between individual variables. Results: Between the development, transmission, and application of knowledge in the state of New Hampshire regardless of the E-Qalin certificate, the researchers discovered a strong and favourable correlation. The researchers found a statistically significant and favourable association between knowledge storage and service quality, but only in New Hampshire with an E-Qalin certificate. Thus, the researcher’s study's findings highlight the necessity of learning more about quality control and knowledge management in the context of New Hampshire. Conclusion: The government, tech companies, and nursing homes need to further restructure the current system before more elderly people adopt sophisticated technology in home care settings. The study's findings, which centre on the transmission of tacit knowledge, substantially advance the field of knowledge management research in New Hampshire.

The personnel support of the long-turn care system in the Russian Federation

In Russia, over the past few years, long-term care system is developing as pilot project. Its main goal is to maintain habitual lifestyle of citizens of retirement age and the disabled who have functional impairments and who need help in household chores, sanitary hygienic procedures performance, medications intake, medical procedures execution and and physician prescriptions following in general. According to approved standard model of long-term care main sources of long-term care services are social security system, health care system, relatives and friends of service addressees. However, full-fledged and systemic implementation of program requires not only definition of these components, but also establishment of mechanism of interaction between them. For this, in most cases, elimination of normative inconsistencies impeding care and consideration of interests of elder citizens and the disabled is required. At the same time, it is necessary to foresee personnel staffing for long-term care, since this area is labor-intensive and is based on people interaction, model of person-to-person care. The problems with personnel staffing in medical and social sphere were present earlier, prior to development of long-term care system and without their elimination it is impossible to implement program in accordance with approved road-map. The training of medical specialists to working with older people, training of junior medical personnel to perform sanitary hygienic and medical procedures, provision with social and medical personnel rural areas are among tasks to be implemented. The article presents evaluation of compliance of components of long-term care system with program tasks, including medical personnel staffing and compliance of standards in force with interests of citizens.

FC26: Compassion fatigue in informal caregivers

Objectives: More than 80% of all long-term care services globally are provided by informal caregivers. However, they are often overlooked, underrecognized and insufficiently supported. This study analyses how providing informal care affects mental health and how the negative effects may be prevented or mitigated.Methods: A cross-sectional study was conducted among informal caregivers in Serbia. Compassion fatigue and compassion satisfaction (CS) were measured with the Professional Quality of Life Scale (ProQOL) version 5. Compassion fatigue is a concept from the formal care setting, a known work-related phenomenon linked to secondary trauma from prolonged work with suffering/ traumatized patients. ProQOL subscales demonstrated good reliability with a Cronbach alpha coefficient of 0.917 on the CS subscale, 0.891 on the burnout (BO) and 0.857 on the Secondary Traumatic Stress (STS) subscale.Results: A total of 187 informal caregivers participated, with an average age 56.95 ± 12.86 years. 74.9% of the participants were female; the majority married or partnered (62.6%). The median time spent in caregiving was 4 years, ranging from several months to 50 years. The majority of the sample had a moderate compassion satisfaction (72.2%) with moderate levels of compassion fatigue, represented by the BO (67.4%) and STS (64.2%) subscales. Very few participants scored high on CS (3.7%) and high on STS (5.3%). Sex based differences were found for CS and BO domains, with both CS and BO being higher among women (p = 0.002 and p = 0.026, respectively). BO was found to be higher among singles (p = 0.049). Differences were found regarding urban/rural community, with CS being higher among informal caregivers in urban community (p = 0.041) and STS being higher in rural community (p = 0.004). There was no correlation between age and years spent in caregiving and ProQoL domains.Conclusions: Over the coming decades, in the absence of a proactive approach, the increasing needs for care will significantly increase the burden of informal caregivers and intensify its consequence on mental health, by pushing moderate levels of burnout and STS towards higher values.

Older Adults in Administrative Quagmire: A Scoping Review of Policy and Program Coordination Across Six Marginalized Older Adult Populations.

Coordination of governmental action is crowded with policies and programs that are highly interdependent, sometimes operating in silos if not contradicting each other. These dilemmas, or administrative quagmires, are heightened for older adults in general, but they are particularly problematic for marginalized older adults because these groups often require public assistance and support. This scoping review studies the coordination of governmental action on aging published in social science journals, focusing on 6 groups of marginalized older adults: those with histories of immigration, individuals with severe mental health problems, those who have had experiences of homelessness, formerly incarcerated individuals, members of the LGBT (lesbian, gay, bisexual, and transgender) community, and individuals living in a rural area. A 5-stage scoping review methodology was followed, and 53 articles (published between 2000 and 2022) from 5 social science databases were analyzed. The analysis revealed a limited number of contributions with coordination as a primary focus. Understandings of coordination varied but tended to examine structure, organization, and relationships between sectors. When coordination was the primary object of a study, it was often analyzed in 1 specific policy area or within a clinical setting along the lines of facilitating care coordination. This scoping review reveals a mutual neglect on the part of public administration and policy scholars toward marginalized older adults and a lack of public administration considerations on the part of scholars studying long-term care and social service programs for these marginalized older adults.

Navigating the complexities of long-term care service delivery for older people in South Africa

Navigating the complexities of long-term care service delivery for older people in South Africa

Caregiving management needs and predictors for family caregivers of persons with dementia: a cross-sectional study

BackgroundFamily caregivers of persons with dementia are faced with complex caregiving management needs. This study had two aims: (1) to identify caregiving management needs of family caregivers of persons with dementia and (2) identify any variables that might influence these needs.MethodsThis cross-sectional study recruited family caregivers of persons with dementia (N = 250) through referrals from clinicians at a dementia outpatient clinic in Northern Taiwan. Data were collected with a 32-item researcher-developed instrument, the Caregiving Management Needs Scale (CMNS), to identify management needs specific to family caregivers of persons with dementia. The CMNS was comprised of questions about the types of assistance or support family caregivers would like to receive to facilitate caregiving.ResultsCMNS scores indicated caregivers had moderate management needs. Caregivers of relatives with a moderate severity of dementia had significantly higher scores on the CMNS compared with caregivers of persons with very mild dementia (p < 0.01). Linear regression analysis indicated significant predictors of high caregiving management needs were caregivers who were female (p < 0.01), and persons with dementia with behavioral problems (p < 0.01), low scores for Activities of Daily Living (p < 0.01), regular medication adherence (p < 0.01), and use of long-term care services (p < 0.001) were significant (F[13, 236] = 7.12; p < 0.001; R2 = 28.2%).ConclusionsUnderstanding variables and predictors of caregiving management needs for family caregivers could reduce the complexity of caregiving.Trial RegistrationClinicalTrials.gov NCT05151185