Older Home Research Articles

A proof-of-concept minimum data set for older care home residents: what value does this add?

ObjectiveDeveloping resources And minimum data set for Care Homes’ Adoption (DACHA) is a four-year NIHR-funded project to establish what data need to be in place to support research, service development and innovation uptake in care homes for older people. An aspirational minimum data set (MDS) specification was identified, which included data from several sources and pilot variables. Approach767 care home residents (with a valid NHS number recorded) across three integrated care systems consented to linkage of their care home record with administrative health and social care records from NHS England. Data were linked using pseudonymised NHS number. Variables were derived to summarise healthcare utilisation. Where variables are sourced from more than one data set, expert opinion on quality across these data sets informed hierarchical selection. We reported descriptive statistics including missingness across each of the >300 variables in the MDS, with information on how these were accessed and derived, where appropriate. Descriptive summaries were informed by stakeholder engagement and cover ambulance and emergency department utilisation. An ongoing DACHA PPIE panel contributed to MDS development through sharing opinions on data access and linkage, and best sources of information across different domains. ResultsAnalysis is in progress. All results will be in pre-print publication by 31 April 2024. ConclusionsThe MDS constructed gives rich insights on healthcare utilisation and resident needs, with opportunity to understand how these interrelate. ImplicationsAs a proof-of-concept study, the findings of this research will inform national decision making on future linked care home data sets.

Virtual Coaching for Home Rehabilitation - Evidence of an Empirical Study.

Older individuals often face disabilities or diseases that lower their quality of life (QoL). While inpatient rehabilitation can initially enhance QoL, there is often a lack of continuation at home. Virtual coaches (VCs) as specific embodied conversational agents promise appropriate support for home rehabilitation. They emerge as complementary digital aids to ensure care continuity. This paper presents the results of implementing a full-featured VC for older patients' home rehabilitation in a multi-stage study, summarizing the main results regarding QoL outcomes and user experience tests. The study confirms the intervention as an engaging means for rehabilitation (mostly above user experience thresholds) and improvements of QoL (>10% between experimental and control groups).

VIVALDI Cohort Profile: Using linked, routinely collected data and longitudinal blood sampling to characterise COVID-19 infections, vaccinations, and related outcomes in care home staff and residents in England.

VIVALDI (ISRCTN14447421) is a government-funded longitudinal open observational cohort study of staff and residents in care homes for older people in England. The study aimed to describe epidemiology (including seroprevalence) and immune responses to COVID-19 in a subset of care homes, in the context of extremely high mortality in this setting, in the first 12-18 months of the pandemic. Data linkage to routine health data was undertaken for all staff and residents and a subset of individuals who consented to sequential blood sampling to investigate SARS-CoV-2 immunity. This paper aims to describe the samples stored within the VIVALDI biobank and associated linked data, available for use by researchers. Over 70,000 individuals from 346 care homes were included in the data linkage cohort (1 st March 2020-31 st March 2023). 4971 samples from 2264 individuals (1415 staff, 827 residents) collected between 29 th October 2020 and 10 th March 2023 are stored. Amongst these samples, there was a maximum of seven per participant however, 217 (26.2%) residents and 551 (38.9%) staff participated in one round only. Key study findings include high COVID-19 seroprevalence among surviving residents, exceeding rates in community-dwelling peers. COVID-19 vaccinations generated robust immune responses in staff and residents which waned, supporting the need for booster vaccination, particularly in response to new variants. Prior infection significantly improved vaccine-induced immune responses, however protection from infection declined following Omicron variant emergence. This is a unique cohort of pre- and post-infection samples linked to data on COVID-19 infections, vaccinations, and outcomes. The cohort spans host immune response evolution to infection and vaccination in this rarely sampled population of frail older care home residents who are especially vulnerable to infection and severe outcomes. These samples can be used to investigate biological mechanisms behind disparate infection responses in older people and make a valuable contribution to research into ageing.

2321 Therapeutic use of film screenings for care home residents: a scoping review

Abstract Introduction Symptoms of depression and anxiety, with and without dementia, are common in older care home residents. It is postulated that that watching films can help residents to share emotions, enhance social connectedness and engage in reminiscence. As such, films can ameliorate depression and promote well-being. This scoping review summarises the evidence for the therapeutic benefits of film-based interventions in care homes. Methods Electronic databases MEDLINE, Embase, EMCare and CINAHL were searched for quantitative and qualitative studies in English including adults aged 65 years and older in years 2005–2023. The search terms were: older adults, dementia, depression, carers, caregivers, care homes, and film. Results Five studies met our criteria: Campbell-Sills, 2006, USA; Kim, 2014, Korea; Davison et al., 2016, Australia; Bjornskov et al., 2018, Denmark; and Breckenridge et al., 2020, UK. All subjects were care home residents except for Bjornskov et al., who included 63 institutional caregivers. The number of study participants ranged from 11 to 120. There was a female predominance throughout the studies, and all residents had dementia of varying severity. Study designs included: direct comparison of participants with mood/anxiety disorder versus controls (Campbell-Sills); non-equivalent control group pretest/posttest (Kim); randomised single-blind crossover (Davison); qualitative focus-group caregiver interviews (Bjornskov); and cross-sectional observation (Breckenridge). Observation/follow up periods ranged from 6–10 weeks. Findings were as follows Campbell-Sills: residents with mood/anxiety disorders were identified by suppressing negative emotions induced by films; Kim: group reminiscence therapy using cinema increased ego integrity and reduced depression severity; Davison et al: using a personal computer platform that included films resulted in reductions in anxiety, depression and agitation; Bjornskov et al.: caregivers reported that films can evoke reminiscence; Breckenridge et al.: small-group film viewing enhanced social connectivity. Conclusions Film screenings for ageing care home residents have the potential for improving mood and encouraging social connections.

Long-term care home residents' experiences with socially assistive technologies and the effectiveness of these technologies: a mixed methods systematic review.

The objectives of this review were to determine the effectiveness of socially assistive technologies for improving depression, loneliness, and social interaction among residents of long-term care (LTC) homes, and to explore the experiences of residents of LTC homes with socially assistive technologies. Globally, the number of older adults (≥ 65 years) and the demand for LTC services are expected to increase over the next 30 years. Individuals within this population are at increased risk of experiencing depression, loneliness, and social isolation. The exploration of the extent to which socially assistive technologies may aid in improving loneliness and depression while supporting social interactions is essential to supporting a sustainable LTC sector. This mixed methods systematic review included studies on the experiences of older adults in LTC homes using socially assistive technologies, as well as studies on the effectiveness of these technologies for improving depression, loneliness, and social interaction. Older adults were defined as people 65 years of age and older. We considered studies examining socially assistive technologies, such as computers, smart phones, tablets, and associated applications. A JBI mixed methods convergent, segregated approach was used. CINAHL (EBSCOhost), MEDLINE (Ovid), Embase, APA PsycINFO (EBSCOhost), and Scopus databases were searched on January 18, 2022, to identify published studies. The search for unpublished studies and gray literature included ProQuest Dissertations and Theses Global, Open Access Theses and Dissertations, Google, and the websites of professional organizations associated with LTC. No language or geographical restrictions were placed on the search. Titles, abstracts, and full texts of included studies were screened by 2 reviewers independently. Included studies underwent quality appraisal and data extraction. Quantitative and qualitative data findings were analyzed separately and then integrated. Where possible, quantitative data were synthesized using comparative meta-analyses with a fixed-effects model. From 12,536 records identified through the search, 14 studies were included. Quantitative (n=8), mixed methods (n=3), and qualitative (n=3) approaches were used in the included studies, with half (n=7) using quasi-experimental designs. All studies received moderate to high-quality appraisal scores. Comparative meta-analyses for depression and loneliness scores did not find any significant differences, and narrative findings were mixed. Qualitative meta-aggregation identified 1 synthesized finding (Matching technology functionality to user for enhanced well-being) derived from 2 categories (Enhanced sense of well-being, and Mismatch between technology and resident ability). Residents' experiences with socially assistive technologies, such as videoconferencing, encourage a sense of well-being, although quantitative findings related to depression and loneliness reported mixed impact. Residents experienced physical and cognitive challenges in learning to use the technology and required assistance. Future work should consider the unique needs of older adults and LTC home residents in the design and use of socially assistive technologies. PROSPERO CRD42021279015.

Patterns of Multidimensional Social Exclusion Among Older Home Care Services Recipients.

The guiding principle of current aging policies has been to promote older adults to live in their private homes, but little attention has been paid to social exclusion of older adults receiving home-based care. The aim of this study is to increase understanding on different patterns of multidimensional social exclusion among older adults receiving formal home care services, and through this to shed light on the possible challenges of current aging-in-place policies. The survey data were collected in 2022 among older adults aged 65 to 102 years receiving home care services in Finland and merged with administrative data (n = 733). A latent class analysis was used to identify different types of social exclusion. Multinomial logistic regression modeling examined factors associated with different social exclusion types. Four social exclusion types were identified: (1) not excluded (16.9%), (2) homebound economically excluded (40.1%), (3) excluded from social relations (28.6%), and (4) multidimensionally excluded (14.3%). Poor self-rated health and poor functional ability significantly increase the risk of being multidimensionally excluded or homebound economically excluded. The group using home care and medical services the most are the most multidimensionally excluded. The group living in urban areas are more likely to be excluded from social relations. Different types of social exclusion should be acknowledged when addressing social exclusion among home care clients. Enhanced measures should be developed to support older adults using home and healthcare services the most, as they are at high risk of severe exclusion.

Designing Virtual Coaching Solutions

Especially older persons are prone to disabilities and chronic diseases. These chronic conditions pose a worldwide challenge, leading to deteriorating health, economic strain, loss of life, and a decline in the quality of life (QoL). Therefore, healthcare institutions seek to enhance their strategies for disease prevention and management to uphold the well-being of the community. This leads to the need to regain independence and improve QoL to properly rehabilitate the patients. Virtual Coaches (VCs) in the form of Embodied Conversational Agents are seen as a relevant digital intervention to support the continuity of care. The paper at hand reports on a Design Science Research project about implementing a VC solution to support older patients' home rehabilitation. The study underpins four pivotal design principles: Adaptivity, Coaching Strategy, Multi-user Interface, and Sustainable Infrastructure. The final artifact was tested with 80 patients which were supported in continuing their inpatient rehabilitation at home by using a VC. The evaluation shows both positive results for usability and acceptance of the intervention for four different use cases and a positive impact on the QoL. Given the comprehensive clinical evaluation, the system represents a safe and appealing solution for ensuring the continuity of medical rehabilitation care and the access to personalized cognitive and motor function treatments.

The Cooperation Between Nurses and a New Digital Colleague "AI-Driven Lifestyle Monitoring" in Long-Term Care for Older Adults: Viewpoint.

Technology has a major impact on the way nurses work. Data-driven technologies, such as artificial intelligence (AI), have particularly strong potential to support nurses in their work. However, their use also introduces ambiguities. An example of such a technology is AI-driven lifestyle monitoring in long-term care for older adults, based on data collected from ambient sensors in an older adult's home. Designing and implementing this technology in such an intimate setting requires collaboration with nurses experienced in long-term and older adult care. This viewpoint paper emphasizes the need to incorporate nurses and the nursing perspective into every stage of designing, using, and implementing AI-driven lifestyle monitoring in long-term care settings. It is argued that the technology will not replace nurses, but rather act as a new digital colleague, complementing the humane qualities of nurses and seamlessly integrating into nursing workflows. Several advantages of such a collaboration between nurses and technology are highlighted, as are potential risks such as decreased patient empowerment, depersonalization, lack of transparency, and loss of human contact. Finally, practical suggestions are offered to move forward with integrating the digital colleague.

Geographical and temporal variations in the provision of registered older people long-term care home places in Wales

Deep-seated problems facing the residential and nursing care home sector have been compounded by the impacts of the pandemic, underfunding and the cost-of-living crisis. This study aims to investigate how patterns of access to registered residential and nursing care places changed in the period spanning lockdowns and demonstrate how spatial analytical techniques can be used to examine the potential impacts of ongoing pressures on geographical patterns of access. Findings identify variations in access to provision hidden within aggregate figures that can help stakeholders monitor the current and projected availability of places as part of an overall package of care provision.

Developing the Principles of Falls Management in Care Homes: An expert Consensus Process

Context: Managing falls in care homes requires an individualised approach for each resident with involvement of staff from care homes and the wider health and social care system. A large randomised controlled trial evaluating an individualised falls management programme (Action FALLS) demonstrated positive findings. However, the delivery of the key components of such programmes is still unclear. Greater understanding of the core components of falls management programmes is needed to support future implementation research. Objective: To establish expert consensus on the core components of falls management for older care home residents. Methods: A modified Nominal Group Technique included the development of a draft set of principles through a scoping review of the grey literature (published elsewhere) and a one-off online nominal group with care home staff and clinicians. Following the group, a single online survey was circulated to gain agreement on the final principles. Findings: 10 participants (including healthcare professionals, care home managers, and care home staff) took part in the online nominal group. Thirty-five core principles of falls management were developed within the domains of theoretical approach, assessments, interventions, training, time points, wider systems, and governance and reporting. Limitations: Since a small number of experts took part in this consensus process from a large and diverse care home sector, it is important to consider the principles as providing support for future implementation work. Implications: These core principles provide a foundation to guide care homes in managing falls in care home residents. Further research is needed to develop implementation strategies and test the feasibility of embedding the principles in routine practice.

Centralized smart energy monitoring system for legacy home appliances

The increasing global population and reliance on electrical devices for daily life resulted in sharply rising energy consumption. Also, this leads to higher household electricity bills. As a result, there is a growing demand for energy monitoring systems that can accurately estimate energy usage to help save power, especially for older home appliances that are difficult or expensive to update with monitoring sensors. However, current energy monitoring systems have some drawbacks, such as the inability to detect different types of appliances and the deployment complexity. Moreover, such systems are too costly to use in older power infrastructures. To address this issue, we proposed a centralized smart energy monitoring system designed for legacy home appliances, aiming to address the limitations of current energy monitoring systems by avoiding costly infrastructure upgrades to calculate the power consumption of legacy home appliances. The proposed system employs a two-layered architecture comprising hardware (Emontx device, Analog-to-Digital Converters (ADC), and Current Transformer (CT) sensors) and a software layer that includes Artificial Intelligence (AI) predictors using a pre-defined set of rules and K Nearest Neighbours (KNN) algorithms. We conducted three experiments on real home appliances to evaluate the proposed work. The accuracy of the proposed system showed positive results after several modifications and hard tuning of several parameters in devices, specifically for Jordanian power plants.

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.

IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study

BackgroundFrailty interventions such as Comprehensive Geriatric Assessment (CGA) can provide significant benefits for older adults living with frailty. However, incorporating such proactive interventions into primary care remains a challenge. We developed an IT-assisted CGA (i-CGA) process, which includes advance care planning (ACP). We assessed if, in older care home residents, particularly those with severe frailty, i-CGA could improve access to advance care planning discussions and reduce unplanned hospitalisations.MethodAs a quality improvement project we progressively incorporated our i-CGA process into routine primary care for older care home residents, and used a quasi-experimental approach to assess its interim impact. Residents were assessed for frailty by General Practitioners. Proactive i-CGAs were completed, including consideration of traditional CGA domains, deprescribing and ACP discussions. Interim analysis was conducted at 1 year: documented completion, preferences and adherence to ACPs, unplanned hospital admissions, and mortality rates were compared for i-CGA and control (usual care) groups, 1-year post-i-CGA or post-frailty diagnosis respectively. Documented ACP preferences and place of death were compared using the Chi-Square Test. Unplanned hospital admissions and bed days were analysed using the Mann-Whitney U test. Survival was estimated using Kaplan-Meier survival curves.ResultsAt one year, the i-CGA group comprised 196 residents (severe frailty 111, 57%); the control group 100 (severe frailty 56, 56%). ACP was documented in 100% of the i-CGA group, vs. 72% of control group, p < 0.0001. 85% (94/111) of severely frail i-CGA residents preferred not to be hospitalised if they became acutely unwell. For those with severe frailty, mean unplanned admissions in the control (usual care) group increased from 0.87 (95% confidence interval ± 0.25) per person year alive to 2.05 ± 1.37, while in the i-CGA group they fell from 0.86 ± 0.24 to 0.68 ± 0.37, p = 0.22. Preferred place of death was largely adhered to in both groups, where documented. Of those with severe frailty, 55% (62/111) of the i-CGA group died, vs. 77% (43/56) of the control group, p = 0.0013.ConclusionsProactive, community-based i-CGA can improve documentation of care home residents’ ACP preferences, and may reduce unplanned hospital admissions. In severely frail residents, a mortality reduction was seen in those who received an i-CGA.

Dietary Adequacy in Older Adult Nursing Home Residents of the Northern Iberian Peninsula.

According to the latest data, Spain (19.4%) and Portugal (21.8%) are the two European countries with the highest percentage of older adults. Concerns about diet quality are increasing, especially among institutionalized older people, who are at the greatest risk of malnutrition. To assess the adequacy of dietary intake of 186 older adults (>65 y) institutionalized in public nursing homes (NH) in Galicia (Northwest Spain) and the Porto district (Northern Portugal), a cross-sectional study has been carried out. The double-weighing method and a country-specific food composition database were employed for nutritional assessment. Nutritional adequacy was assessed based on the recommendations of the EFSA and WHO. Caloric intake in Spanish NHs was higher than in Portuguese facilities; 20.3% and 35.8% of Spanish and Portuguese residents, respectively, had a protein intake below the EFSA recommendation, and 46.2% and 44.9% of residents in Portugal and Spain, respectively, had lipid intakes below the reference intake range. Further, 45.5% of the residents in Portugal and 66.9% in Spain had a carbohydrate intake within the recommended range. Salt intake was higher than the recommendation for 67.0% and 32.3% of the residents in Spain and Portugal, respectively. This study supports the notion that institutionalized older adults are prone to significant nutritional inadequacies.

Environmental hazards and likelihood of mitigation in renter-occupied housing units in Clark County, Nevada

ABSTRACT Limited research exists on the effectiveness of the NV state statutes on ensuring habitability and access to essential services, and the characteristics of environmental hazards found in Clark County, NV renter-occupied units (ROUs). We examined data from the Clark County Landlord and Tenant Hotline Study to determine which ROUs are most at-risk for hazards and what factors are associated with remediation, examining age of unit, hazard type, and tenant-initiated intervention data. Results suggest that the mean age of ROUs with essential service complaints is higher than ROUs with complaints categorized as mold or other hazards. Furthermore, a tenant’s probability of getting hazards remediated was not significantly increased if they pursued different levels of intervention (e.g., landlord letter, site inspection, legal advice). The data suggests that tenants were less likely to get their hazard remediated by landlords if they had multiple complaints, lived in an older home, or had a non-essential complaint. The results of this study can be used to enhance our ability to identify higher risk ROUs given factors related to their age, environmental hazards, and level of intervention sought by tenants in order to better understand the likelihood of remediation in Clark County, NV.

Retrospective Analysis of Circumstances of Falls and Related Injuries across Levels of Care in Older Adult Retirement Home Facilities.

Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.

Use of oral health care services among older home care clients in the context of an intervention study.

An increasing number of care-dependent older people living at home need external support to receive regular dental care. To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition. This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up. At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use. In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

From Restricted Resources to Ethical Burden-Former Home Care Workers' Reasons for Leaving Their Jobs.

The study examines former home care workers' reasons for leaving their jobs from the perspective of reforms in public services and eldercare policies impacted by New Public Management (NPM) in Finland. Written narratives from former home care workers (n = 39) were collected online and analyzed using thematic content analysis. Former home care workers' reasons for leaving their jobs were connected to four interconnecting themes: mismatch between needs and resources, measurement-driven practices, unbalancing work-life, and ethical burden. These reasons reflected critical changes in the organization of care work and the work environment in older adults' home care. Contradictions between needs, resources, and values lead to ethical dilemmas and push away from the workforce in eldercare. To improve care workers' willingness to remain in the eldercare sector, changes are needed in the resourcing and organization of home care, including managerial support in everyday care work.

Adherence and potential factors of adherence to a resistance, coordination and endurance training in older retirement home residents over 6 months.

High exercise adherence is a key factor for effective exercise programmes. However, little is known about predictors of exercise adherence to a multimodal machine-based training in older retirement home residents. To assess exercise adherence and potential predictors of adherence. Furthermore, to evaluate user acceptance of the multimodal training and the change in exercise self-efficacy. In this sub-analysis of the bestform-F study, a total of 77 retirement home residents ≥65 years (mean age: 85.6 ± 6.6 years, 77.9% female) participated in a 6-month machine-based resistance, coordination and endurance training. Attendance to the training was documented for each training session. To identify potential predictors a multiple linear regression model was fitted to the data. Analyzed predictors included age, sex, body mass index (BMI), physical function, exercise self-efficacy, and physical activity history. Different domains of user acceptance (e.g. safety aspects, infrastructure) and exercise self-efficacy were assessed by a questionnaire and the exercise self-efficacy scale (ESES), respectively. Mean exercise adherence was 67.2% (median: 74.4%). The regression model (R2 = 0.225, p = 0.033) revealed that the 6-minute walk test (6-MWT) at baseline significantly predicted exercise adherence (β: 0.074, 95% confidence interval (CI): 0.006-0.142, p = 0.033). Different user domains were rated at least as good by 83.9%-96.9% of participants, reflecting high acceptance. No statistically significant change was found for exercise self-efficacy over 6 months (mean change: 0.47 ± 3.08 points, p = 0.156). Retirement home residents attended more than two thirds of offered training sessions and physical function at baseline was the key factor for predicting adherence. User acceptance of the training devices was highly rated. These findings indicate good potential for implementation of the exercise programme.

Adherence to the Atrial fibrillation Better Care pathway and the risk of adverse health outcomes in older care home residents with atrial fibrillation: a retrospective data linkage study 2003-18.

The Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown. To examine associations between ABC pathway adherence and stroke, transient ischaemic attack, cardiovascular hospitalisation, major bleeding, mortality and a composite of all these outcomes in care home residents. A retrospective cohort study of older care home residents (≥65years) in Wales with AF was conducted between 1 January 2003 and 31 December 2018 using the Secure Anonymised Information Linkage Databank. Adherence to the ABC pathway was assessed at care home entry using pre-specified definitions. Cox proportional hazard and competing risk models were used to estimate the risk of health outcomes according to ABC adherence. From 14,493 residents (median [interquartile range] age 87.0 [82.6-91.2] years, 35.2% male) with AF, 5,531 (38.2%) were ABC pathway adherent. Pathway adherence was not significantly associated with risk of the composite outcome (adjusted hazard ratio, 95% confidence interval [CI]: 1.01 [0.97-1.05]). There was a significant independent association observed between ABC pathway adherence and a reduced risk of myocardial infarction (0.70 [0.50-0.98]), but a higher risk of haemorrhagic stroke (1.59 [1.06-2.39]). ABC pathway adherence was not significantly associated with any other individual health outcomes examined. An ABC adherent approach in care home residents was not consistently associated with improved health outcomes. Findings should be interpreted with caution owing to difficulties in defining pathway adherence using routinely collected data and an individualised approach is recommended.