Older Adults In Care Homes Research Articles

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study

BackgroundLow physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes.MethodsParticipants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention.ResultsAn average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme.ConclusionsThe digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary.Trial registrationThe trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.

Capturing Home Care Information Management and Communication Processes Among Caregivers of Older Adults: Qualitative Study to Inform Technology Design.

The demand for complex home care is increasing with the growing aging population and the ongoing COVID-19 pandemic. Family and hired caregivers play a critical role in providing care for individuals with complex home care needs. However, there are significant gaps in research informing the design of complex home care technologies that consider the experiences of family and hired caregivers collectively. The objective of this study was to explore the health documentation and communication experiences of family and hired caregivers to inform the design and adoption of new technologies for complex home care. The research involved semistructured interviews with 15 caregivers, including family and hired caregivers, each of whom was caring for an older adult with complex medical needs in their home in Ontario, Canada. Due to COVID-19-related protection measures, the interviews were conducted via Teams (Microsoft Corp). The interview guide was informed by the cognitive work analysis framework, and the interview was conducted using storytelling principles of narrative medicine to enhance knowledge. Inductive thematic analysis was used to code the data and develop themes. Three main themes were developed. The first theme described how participants were continually updating the caregiver team, which captured how health information, including their communication motivations and intentions, was shared among family and hired caregiver participants. The subthemes included binder-based health documentation, digital health documentation, and communication practices beyond the binder. The second theme described how participants were learning to improve care and decision-making, which captured how they acted on information from various sources to provide care. The subthemes included developing expertise as a family caregiver and tailoring expertise as a hired caregiver. The third theme described how participants experienced conflicts within caregiver teams, which captured the different struggles arising from, and the causes of, breakdowns in communication and coordination between family and hired caregiver participants. The subthemes included 2-way communication and trusting the caregiver team. This study highlights the health information communication and coordination challenges and experiences that family and hired caregivers face in complex home care settings for older adults. Given the challenges of this work domain, there is an opportunity for appropriate digital technology design to improve complex home care. When designing complex home care technologies, it will be critical to include the overlapping and disparate perspectives of family and hired caregivers collectively providing home care for older adults with complex needs to support all caregivers in their vital roles.

Assessing family function: older adults vs. care nurses: a cross-sectional comparative study.

This study aimed to assess family function in home care for older adults. Understanding family dynamics is essential for providing quality care to older adults choosing to age in place. In a cross-sectional study, 53 patients aged 65 or older receiving home care were evaluated, along with four home care nurses. The General Function of Family Assessment Device (FAD-GF) was used for self-assessment to examine family resources. Only 5.7% of older adults reported good family function. Strong correlations were found between assessments by nurses and older adults. Among the six aspects of family function, "problem solving," "communication," "affective responsiveness," and the overall results showed no disparities between the evaluations of older adults and nurses. Home care nurses can effectively assess family function using the FAD-GF, particularly after six months of care. This assessment can help identify family issues and enhance home care quality through nurse training in FAD-GF application.

Reduced Anxiety and Depression and Improved Mood in Older Adults Living in Care Homes After Participating in Chair Yoga.

Providing opportunities for older adults to engage in physical and mental activity is important to support healthy aging. The present preliminary study investigated the feasibility of accessible chair yoga for older adults in care homes. Chair yoga participants (n = 17) were assessed before and after attending twice weekly chair yoga sessions for 8weeks, while control participants (n = 16) underwent the assessments only. Participant ages ranged from 80 to 101years and included those living with mild to severe dementia. Anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS), and negative affect measured by the Positive and Negative Affect Schedule (PANAS), improved in the chair yoga but not the control group. Balance confidence (Modified Falls Efficacy Scale) and Health-related Quality of Life (EQ-5D-3L) were unchanged. Chair yoga is a feasible activity for older care home residents, including those living with dementia, with the potential to improve mental well-being.

Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography

BackgroundCase managers play a vital role in integrating the necessary services to optimise health-related goals and outcomes. Studies suggest that in home care, case managers encounter tensions in their day-to-day work, that is, disjuncture between what they should do, in theory, and what they actually do, in practice. However, direct exploration of these tensions is lacking. As such, this study aimed to describe the tensions encountered by case managers in public home care for older adults in Quebec and their influence on day-to-day work.MethodsAn institutional ethnography was conducted through observations of work, interviews and a survey with case managers working in home care in Quebec. Data were analysed using institutional ethnography first-level analysis procedures. This included mapping the work sequences as well as identifying the tensions experienced by case managers through the words they used.ResultsThree main tensions were identified. First, case managers perceive that, despite working to return hospitalised older adults at home safely, their work also aims to help free up hospital beds. Thus, they often find themselves needing to respond quickly to hospital-related inquiries or expedite requests for home care services. Second, they are supposed to delegate the care to “partners” (e.g., private organisations). However, they feel that they are in effect managing the quality of the services provided by the “partners.” Consequently, they go to great lengths to ensure that good care will be provided. Finally, they must choose between meeting organisational requirements (e.g., reporting statistics about the work, documenting information in the older adults’ file, doing mandatory assessments) and spending time providing direct care. This often leads to prioritising direct care provision over administrative tasks, resulting in minimal reporting of essential information.ConclusionThe results are discussed using the three lenses of professional practice context analyses (i.e., accountability, ethics, and professional-as-worker) to formulate recommendations for practice and research. They suggest that, despite their important role, case managers have limited power in home care (e.g., with partners, with the hospital).

Experiences regarding Home Care for Older Adults from the Viewpoint of Family, Paid Caregivers, Nurses, and Experts: A Qualitative Study

Home care (HC) is recommended for older adults who want to live at home as long as possible despite life-limiting conditions. It is more convenient and cost-effective than institutionalization and hospitalization. However, HC for older adults in Iran faces many challenges. The purpose of this study was to explore the perspectives of different stakeholders involved in HC for older adults about their experiences and suggestions for HC improvement. This qualitative study was conducted based on the explorative content analysis approach between 2021 and 2022 in Tabriz, Iran. The participants were selected using the purposeful sampling method, and the data were collected through in-depth semistructured personal interviews. A total of 27 individuals who participated in individual interviews were family members, HC workers (including nurses and unqualified paid caregivers), heads of counseling and nursing care at home centers, and experts who had clinical or research experience in the field of geriatric care. Collected data were categorized into three main themes: defects in home care governance, concern about the efficiency of home care, and caregivers’ job security concerns. These themes reflected the problems of HC, such as conflicts between multiple trustees, lack of evaluation and monitoring, inadequate competence and financial barriers of families and caregivers, and poor integration and coordination of services. Therefore, it is recommended to develop a national model for HC for Iranian older adults and allocation of different financial resources for HC, implementing quality improvement and evaluation tools, enhancing the training of caregivers, providing them with adequate compensation and benefits, and ensuring the safety and quality of services. These findings can inform the policymakers and planners of care services about the needs and challenges of this population and facilitate the collaboration among different stakeholders to provide better HC for older adults.

Home care for older adults: perspectives of nurses under the Family Health Strategy

Home care for older adults: perspectives of nurses under the Family Health Strategy

Implementation of a New Integrated Healthcare Model; Quality Aspects to Support the Complex Home Care of Older Adults with Multiple Needs.

This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people's homes. Open-ended group interviews with personnel were carried out, three of the group interviews pre-implementations of the model, and three of the group interviews post-implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis. The quality of the integrated care model was based on care-chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person-centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants' experiences of the post-implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting. Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question.

Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff

BackgroundCare home residents often experience polypharmacy (defined as taking five or more regular medicines). Therefore, we need to ensure that residents only take the medications that are appropriate or provide value (also known as medicines optimisation). To achieve this, deprescribing, or the reduction or stopping of prescription medicines that may no longer be providing benefit, can help manage polypharmacy and improve outcomes. Various tools, guides, and approaches have been developed to help support health professionals to deprescribe in regular practice. Little evaluation of these tools has been conducted and no work has been done in the care home setting. ObjectiveThis qualitative study aimed to assess distinct types of deprescribing tools for acceptability, feasibility, and suitability for the care home setting. MethodsCognitive (think-aloud) interviews with care home staff in England were conducted (from December 2021 to June 2022) to assess five different deprescribing tools. The tools included a general deprescribing guidance, a generic (non-drug specific) deprescribing framework, a drug-specific deprescribing guideline/guide, a tool for identifying potentially inappropriate medications, and an electronic clinical decision support tool. Participants were recruited via their participation in another deprescribing study. The Consolidated Framework for Implementation Research informed the data collection and analysis. ResultsEight care home staff from 7 different care homes were interviewed. The five deprescribing tools were reviewed and assessed as not acceptable, feasible, or suitable for the care home setting. All would require significant modifications for use in the care home setting (e.g., language, design, and its function or use with different stakeholders). ConclusionsAs none of the tools were deemed acceptable, feasible, and suitable, future work is warranted to develop and tailor deprescribing tools for the care home setting, considering its specific context and users. Deprescribing implemented safely and successfully in care homes can benefit residents and the wider health economy.

Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care.

Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. PRR1-10.2196/53150.

Determinants of implementing deprescribing for older adults in English care homes: a qualitative interview study

ObjectivesTo explore the factors that may help or hinder deprescribing practice for older people within care homes.DesignQualitative semistructured interviews using framework analysis informed by the Consolidated Framework for Implementation Research...

How did providers of home care for older adults manage the early phase of the Covid-19 pandemic? A qualitative case study of managers’ experiences in Region Stockholm

BackgroundIn the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff.MethodA descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis.ResultsThree themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions.ConclusionSocial care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.

“Caregiving is teamwork…” Information sharing in home care for older adults with disabilities living in the community

AimWe examined information sharing between direct care workers, family caregivers, and clinicians involved in the care of older adults with disabilities. MethodsSemi-structured interviews with N = 11 representatives of home care agencies (“residential service agencies” in Maryland). ResultsWork system and process characteristics relevant to information sharing included: (1) using electronic management systems and patient portals to communicate within agencies and with clinicians, (2) implementing tools to gather information about client goals, preferences, and routines, and (3) relying on family members for information about clients’ needs. Participants did not report differences in dementia-related care coordination; however, dementia-related adaptations involved additional considerations for navigating relationships with family and standardizing processes to communicate with clinicians. ConclusionFindings highlight care demands experienced by direct care workers and support calls to better coordinate information sharing between interdisciplinary care teams.

Microenterprise and home care for older adults in England and Wales: A partial revolution?

Paid carers play an important role in helping older adults with care needs to remain living in their own homes. This paper examines changes in the home care field, specifically the emergence of self-employed care entrepreneurs ('microentrepreneurs'). To do this, it employs Bourdieu's concepts of field, capital and habitus. Drawing on 105 semi-structured interviews with stakeholders working in home care, the paper describes how the interaction of changes to field structures, and altered practices of care have challenged the taken-for-granted acceptance of traditional, transactional forms of care provision. This process has been highly dependent on local state actors, their ability to mobilise relevant forms of capital and the factors which shaped their habitus. It should be seen within the context of changes to local field structures and the hierarchical classification processes which underpin them. These changes threaten the distribution of capital in the home care field in ways that are beneficial to microentrepreneurs. Bourdieu might categorise these developments as 'partial revolutions', which do not challenge the fundamental axioms of the field. However, for care entrepreneurs, formerly employed as low-paid home-care workers, a revolution that is only partial may be better than none at all.

Improving Medication Reconciliation for Older Adults in Home Care

<p>目的：「提升用藥整合」列為醫療品質及病人安全工作目標之一，隨著進入高齡社會併多重慢性病，顯見整合用藥之重要性。材料與方法：實施對象為居家老年人，本專案期間為2020年1月1日至2021年3月31日。統計2020年1月至3月居家老年人用藥整合率僅11.8%，分析用藥整合不良原因：缺乏用藥整合指導工具、沒有窗口諮詢、缺乏居家用藥整合流程、住院期間無法得知用藥整合訊息，予介入策略：一、制定用藥整合宣導影片及衛教單張；二、提供地段專責護理師聯繫名片；三、建置用藥整合作業標準；四、制定用藥整合查檢表；五、辦理單位出院準備專責教育訓練。結果：經專案實施後，居家老年人用藥整合率由11.8%提升至84.6%，目標達成率151%。結論：專案持續執行策略6個月，效果維持期仍有82.3%。</p> <p> </p><p>Purpose: Improving medication reconciliation is listed as one of the goals for quality of care and patient safety, particularly in an aging society with multiple chronic diseases. Materials and Methods: This study enrolled older adults in home care, and the study period was January 1, 2020, to March 31, 2021. From January 1, 2020, to March 31, 2020, the medication reconciliation rate for older adults in home care was only 11.8%. After the collection of up-to-date data, Pareto charts and cause-and-effect diagrams were used to identify the following causes underlying the low reconciliation rate: lack of medication reconciliation guidance tools, lack of primary contact information, lack of implementation of home medication reconciliation procedures, and a lack of medication reconciliation information available during hospitalization. The following intervention strategies were implemented: (1) development of promotional videos on medication reconciliation and health education leaflets, (2) provision of contact cards for designated nurses in the region, (3) establishment of working standards for medication reconciliation, and (4) formulation of edication reconciliation lists. Results: By the end of the study period, the medication reconciliation rate for older adults in home care had increased from 11.8% to 84.6%. The goal achievement rate was 151%. Conclusion: At the 6-month follow-up after the end of the study, the reconciliation rate remained at 82.3%.</p> <p> </p>

A study on the quality evaluation index system of smart home care for older adults in the community ——based on Delphi and AHP

BackgroundIn the context of the “silver wave” and “technology wave”, smart home care for older adults in the community provide new ways for China and other countries to support ageing in place. Yet, only very few studies have focused on developing a quality index system of smart care. This study attempted to draw on the SERVQUAL model to establish a quality evaluation index system for smart senior care for older adults in the community.MethodsOn the basis of the service quality model, this paper has integrated qualitative and quantitative analyses using the Delphi and Analytic Hierarchy Process (AHP) methods to construct the index system of smart home care in the community and obtain the weights. These were based on literature research and field interviews in Guangzhou and Shenzhen pilot districts.ResultsA quality evaluation indexes system of smart home care for older adults in the community was developed, with 5 primary indices and 33 secondary indices. The weights of the 5 stair indices from high to low were smart emergency assistance 0.332, smart meal assistance 0.272, smart medical assistance 0.229, smart cleaning assistance 0.110 and smart amusement assistance 0.057.ConclusionThe results from the weight allocation revealed smart emergency assistance, smart meal assistance, and smart medical care assistance were the most important and crucial aspects of community-based smart home care. The study also suggested that “timeliness”, “reliability”, and “ease of use” should be given more attention. It is recommended to use this index system as a regulatory benchmark to guide the government bodies, senior care enterprises and communities to take measures to enhance the quality.

Analysing the Quality of Life of Older Adults: Heterogeneity, COVID-19 Lockdown, and Residential Stability.

This study aims to, first, investigate the quality of life (QOL) of older adults in Taiwan, from the perspective of heterogeneity and, second, clarify the social isolation affecting their QOL during the pandemic. Additionally, it explores the residential stability of older adults. Our empirical model, a Generalized Ordered Probit Model, uses secondary data from the 2019 Taiwan Social Change Survey for people aged 65 and above, with a total sampling size of 417. The results show that the self-assessed physical health of older adults is a significantly heterogeneous variable affecting their QOL, and has a varying impact on the probability of them being satisfied with their QOL. Results suggest that better financial plans and staying healthy are the main determinants of their QOL. Social isolation during the COVID-19 pandemic significantly hampered their QOL, which was not compensated by the use of the internet. Furthermore, older adults’ residential stability significantly influences their QOL. Family members and relevant social work units should contribute to in-person home care for older adults to reduce their social isolation, with a focus on improving their living environments and to ensure that they age in a safe and healthy place.

Augmented video consultations in care homes during the COVID-19 pandemic: a qualitative study.

The COVID-19 pandemic necessitated an unprecedented implementation of remote consultations in UK primary care services. Specifically, older adults in care homes had a high need for infection prevention owing to their existing health conditions. GP practices in the East Midlands incorporated augmented video consultations (AVC) with the potential to support remote healthcare assessments for older adults at care homes. To explore GPs' and care home staff's experiences of the use of AVC as a mechanism to perform remote examinations of older adults in care homes. Qualitative interviews were conducted with GPs and care home staff in the East Midlands, UK, during May-August 2020. A convenience sample of GPs (n = 5), nurses (n = 12), and senior healthcare assistants (n = 3) were recruited using a purposive approach. Data were collected through semi-structured telephone interviews and analysed using framework analysis. Findings from participants indicated that AVC enabled real-time patient examinations to aid diagnosis and promoted person-centred care in meeting the needs of older adults. The participants also discussed the challenges of video consultations for patients with cognitive impairment and those receiving end-of-life care. AVCs show great potential in terms of GPs providing primary care services for care homes. However, healthcare staff must be involved in the development of the technology, and consideration should be given to the needs of older adults with cognitive impairment and those receiving end-of-life care. It is also vital that training is available to encourage confidence and competency in implementing the technology.

Venerable vulnerability or remarkable resilience? A prospective study of the impact of the first wave of the COVID-19 pandemic and quarantine measures on loneliness in Swedish older adults with home care

ObjectivesTo examine the early impact of the pandemic and of quarantine measures targeting older adults introduced in March 2020 on loneliness among older adults in Sweden.Design Prospective pretest–posttest and controlled...

Technology in the Home Care of Older People: Views from Finland and Ireland.

Optimistic expectations of technology can be identified in policy documents, academic centres and businesses that aim to create and promote a variety of technologies so that older people can age at home. This article draws on recent data from Ireland and Finland, two countries at different stages of technological development, to examine the role of technology in the home care for older adults. Research participants (service providers and care recipients) agreed that technology could play an important role by improving communications, enabling social contact, and connecting the 'lone worker' and 'isolated patient' to other stakeholders in home care services. However, participants also had serious concerns around technology. Care was conceptualised as relational and participants expressed apprehension about technology replacing face-to-face contact. Service providers expressed trepidation about the digital divide and technology driving further inequalities in the future. It is important that attempts to develop technology for older adults consider the concerns identified in this study, in order for home care technology to be successfully implemented, widely adopted and meaningfully used.