Older Home Research Articles

Finnish telehomecare workers' satisfaction with the inclusion of telehomecare in older adults' home care and factors associated with it

AbstractBackgroundTelehomecare in older adults' home care in Finland is mainly video‐mediated check‐up and reminder calls with home care clients. Home care workers have reported mixed attitudes and feelings towards utilisation of technologies and remote services in their work.ObjectivesThe aim of this cross‐sectional study was to investigate Finnish telehomecare workers' satisfaction with the inclusion of telehomecare in older adults' home care. Another aim was to examine what factors are associated with this satisfaction.MethodsThe data were collected with an electronic quantitative email survey. Five Finnish older adults' home care organisations participated as the target organisations of the study. Two of the organisations were located in large cities, one in a medium‐sized provincial centre and two in rural municipalities. Three organisations provided telehomecare services with centralised service models and two with decentralised service models. In total, the organisations had 103 telehomecare workers to whom the survey was directed.ResultsThe telehomecare workers were mostly satisfied with (55.8%) or felt neutral about (20.9%) the inclusion of telehomecare in older adults' home care. Satisfaction was strongly related to the workers' experience of telehomecare making their work easier, improving interaction and enhancing relationships of trust with clients as well as decreasing workload. Application of telehomecare to overcome the workers' physical restrictions, and also their perceptions of being able to influence whether to start working in telehomecare, were strongly related to their satisfaction with the inclusion of telehomecare in home care.ConclusionsThe results confirm that telehomecare job positions function well as relocated job positions in home care when workers have musculoskeletal problems or injuries. However, it is important that workers' willingness to work in telehomecare is also respected. From the telehomecare workers' perspective, good interaction and trustful relationships with clients are important factors that produce good care and increase satisfaction with telehomecare.Implications for practiceTelehomecare may have a positive impact on the home care workers’ job satisfaction. The homecare workers need training in the use of new technologies. In addition, they need to be able to decide themselves whether they start working in telehomecare or not.

1895 Three-year nationwide analysis of falls risk prescribing for over 65 care home and non-care home patients

Abstract Introduction In 2021 the NHS Business Services Authority Data Science team openly published the first comprehensive nationwide analysis of over 65 care home versus non-care home prescribing (https://nhsbsa-data-analytics.shinyapps.io/estimated-prescribing-patterns-for-care-home-patients/). The analysis has been expanded to include three years of prescribing data and key falls risk prescribing metrics, offering new insight into falls risk prescribing for the over 65s in England. Method Patient address information from 800m prescription forms was matched against 35m Ordnance Survey Address Base addresses. Patient addresses from prescription forms were classified as belonging to a care home or otherwise. Prescribing metrics around volume, cost, polypharmacy and falls risk were generated, with falls risk metrics informed by the STOPPFall study drug groups (https://www.prescqipp.info/umbraco/surface/authorisedmediasurface/index?url=%2fmedia%2f6019%2f300-medication-and-falls-20.pdf). These metrics were the mean number of falls risk medicines and proportion of patients prescribed three or more falls risk medicines within a given month. Results Over 65 care home patients received more prescribing of falls risk drugs than non-care home patients, whilst the proportion of care home patients on three or more falls risk drugs within a given month was double that of non-care home patients. Nearly 40% of care home patients aged 65-69 were prescribed three of more falls risk drugs within a given month, far more than both older care home patients and non-care home patients. Falls risk prescribing metrics displayed a great deal of variation by ICS and Local Authority. Conclusion Aside from headline figures and key findings, the analysis (due for public release in September 2023) allows granular analysis of over 65 falls risk prescribing, by patient age band, gender, geography and care home setting. The exploratory nature of the analysis lends itself to further investigation by healthcare analysts and clinicians, with the aim to gather feedback, iterate and expand the content annually.

Communication support in care homes for older adults: Views and reported practices of speech and language therapists and care home activities staff in the UK.

Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID-19. Results were analysed using descriptive statistics and qualitative content analysis. A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%-87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%-89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles.

Pharmacist-led intervention for older people with atrial fibrillation in long-term care (PIVOTALL study): a randomised pilot and feasibility study

BackgroundOlder care home residents are a vulnerable group of people with atrial fibrillation (AF) at high risk of adverse health events. The Atrial Fibrillation Better Care (ABC: Avoid stroke; Better symptom management; Cardiovascular and other comorbidity management) pathway is the gold-standard approach toward integrated AF care, and pharmacists are a potential resource with regards to its’ implementation. The aim of this study was to determine the feasibility of pharmacist-led medicines optimisation in care home residents, based on the ABC pathway compared to usual care.MethodsIndividually randomised, prospective pilot and feasibility study of older (aged ≥ 65 years) care home residents with AF (ISRCTN14747952); residents randomised to ABC pathway optimised care versus usual care. The primary outcome was a description of study feasibility (resident and care home recruitment and retention). Secondary outcomes included the number and type of pharmacist medication recommendations and general practitioner (GP) implementation.ResultsTwenty-one residents were recruited and 11 (mean age [standard deviation] 85.0 [6.5] years, 63.6% female) were randomised to receive pharmacist-led medicines optimisation. Only 3/11 residents were adherent to all three components of the ABC pathway. Adherence was higher to ‘A’ (9/11 residents) and ‘B’ (9/11 residents) components compared to ‘C’ (3/11 residents). Four ABC-specific medicines recommendations were made for three residents, and two were implemented by residents’ GPs. Overall ABC adherence rates did not change after pharmacist medication review, but adherence to ‘A’ increased (from 9/11 to 10/11 residents). Other ABC recommendations were inappropriate given residents’ co-morbidities and risk of medication-related adverse effects.ConclusionsThe ABC pathway as a framework was feasible to implement for pharmacist medication review, but most residents’ medications were already optimised. Low rates of adherence to guideline-recommended therapy were a result of active decisions not to treat after assessment of the net risk–benefit.

Activity provider-facilitated patient and public involvement with care home residents

BackgroundIn care home research, residents are rarely included in patient and public involvement and engagement (PPIE) despite their lived experiences of day-to-day care. This paper reports on a novel approach to PPIE, developed in response to Covid-19, and utilised in a large UK-based study focused on care homes. PPIE sessions were facilitated on behalf of the research team by Activity Providers (APs) already working within the care homes. This paper provides an account of how PPIE with care home residents can be achieved.MethodsAn exploratory design was used to see if it was possible to support “in-house” PPIE, with researchers working at a distance in partnership with care home staff. The National Activity Providers Association recruited five APs working in care homes. A series of optional discussion or activity sessions were developed by the research team in partnership with APs, tailored to reflect the research topics of interest and to make sessions accessible to residents with differing needs.ResultsAPs facilitated four rounds of PPIE with up to 56 residents per topic, including individuals living with cognitive and communication impairments. Topics discussed included residents’ views on data use, measuring quality of life and the prioritisation of care-related data for study collection. Feedback from the residents was observed to have unexpected and positive changes to participating care homes’ practice. APs valued participation and working with researchers. They identified acquisition of new skills and insights into residents’ thoughts and preferences as direct benefits. Challenges included time pressures on APs and managing emotive feedback. APs were able to approach residents at times convenient to them and in ways that best suited their individual needs. PPIE with residents provided different perspectives, particularly with respect to the importance of different types of data, and constructive challenge about some of the research team’s assumptions.ConclusionsPPIE with APs as research partners is a promising approach to working in an inclusive and participatory way with care home residents. The voices of older care home residents, including those living with cognitive or communicative impairments, are important for the successful and meaningful completion of research.

Perspectives on elder mistreatment screening and responding in emergency departments: A qualitative study with survivors.

Elder Mistreatment (EM) occurs in approximately 10% of older adults and is associated with trauma-related outcomes including depression, anxiety, posttraumatic stress disorder, and early mortality. Low screening and older adult self-reporting, especially within emergency departments, represent missed opportunities for identify and mitigate future EM occurrences and consequences. To date, no studies have obtained EM survivors' perspectives on EM screening and response practices in emergency departments. Semi-structured interviews with 19 EM survivors of those with Adult Protective Services validated EM were completed in older adults' homes. The Elder Mistreatment Emergency Department Screening and Response Tool (EM-SART) was used to guide the interview questions. All interviews were recorded, transcribed, and analyzed using qualitative thematic analyses. The participants were mostly female (63%) and white (58%) with an average age of 74 years. Physical abuse accounted for 67% of the EM incidents. Three themes emerged indicating the survivor preference for (1) building rapport and approaching the older adult with compassion and care, (2) setting the context before asking the EM questions, and (3) allowing mutuality, collaborative work, and shared decision-making during the response. Older adults are agreeable and willing to self-report and actively engage in the EM screening and response practices in the emergency department if trauma-informed care principles are utilized.

Home Care Nurses' Knowledge and Attitudes Regarding Telehealth to Promote Medication Compliance among Older Adults.

Medication noncompliance among older adults is a persistent problem resulting in morbidity, hospital readmissions, and decreased quality of life. Home care nurses are in a key position to assist older adults to employ medication compliance strategies that are tailor-made to fit their individual needs and abilities. The purpose of this study was to understand the knowledge and attitudes of home care nurses regarding telehealth practices to promote medication compliance of older adult patients and their perceived readiness to do so. We employed a qualitative research approach using semi-structured interviews. Individual interviews were conducted via Teams platform for a maximum of 60 minutes. Participants were home care nurses who use telehealth technology to advance medication compliance strategies. Ten interviews were conducted. Several themes emerged from the data which suggested home care nurses accept telehealth technology, are supportive of its continued use, and are willing to be educated on future advances in this technology to assist older adults with medication compliance strategies. Universities and home care agencies must provide opportunities to prepare nurses to utilize telehealth technologies to promote medication compliance among older adult home care patients.

Evaluation of Pharmacists' Active Intervention to Reduce Potentially Inappropriate Medications in Special Older Adult Nursing Home

Currently, elderly care facilities that do not offer long-term care are not required to employ pharmacists, and duties such as the dispensing and distribution of medicines are entrusted to external pharmacies. Pharmacists seldom spend sufficient time at the facilities for elderly people requiring special care. Thus, in many cases, the pharmacists have insufficient knowledge of the residents' medication status, leading to their inability in determining whether the residents are receiving a suitable drug therapy. We previously documented various problems in the practices adopted by nursing staff (with negligible intervention by pharmacists) for assisting residents in taking their medications. In the present pilot study, we attempted to eliminate the use of potentially inappropriate medications by stationing a pharmacist at a nursing home for 24 h every week (3 d/week). We proactively collected information from nurses and other nursing staff and observed the residents' actual living conditions and medication use. As a result of this intervention, 56 prescriptions were changed. However, only two of these were changed exclusively based on the prescription information. Most prescriptions were able to change based on the information obtained by the pharmacist present at the facility. Therefore, pharmacists' presence at the facility (at least for a few hours) is necessary, as they can actively intervene and collaborate with other staff to prevent the use of potentially inappropriate medications.

A novel application of a self-report comprehensive assessment: Where do telephone assessments fit in home care practice?

Introduction: In Canada, long-stay home care patients are a prevalent group of frail older adults living in the community. Home care patients have a high emergency department visit rate compared to those living independently without formal home care services. In March 2020, concerted efforts were put into place to reduce COVID-19 transmission and spread in health sectors, including older adult home care populations.
 Description: The interRAI home care (HC) assessment is the practice standard for face-to-face comprehensive assessments in home care. The interRAI Check Up is a comprehensive self-report assessment that can be completed in-person, by video call or telephone. Check Up assessment items are consistent with the content items of interRAI HC. During pandemic mandated restrictions, care coordinators used the Check Up to assess new and existing patients over the phone or by video call to ensure continuity of care. Feasibility and utility of the Check Up was evaluated through a staff survey and focus groups in two distinct regions of Ontario.
 Discussion: A total of 48 care coordinators completed the survey, of which 7 consented to provide feedback in the focus groups. Care coordinators found the Check Up easy to pivot to during the pandemic, citing familiarity with questions and risk algorithms. The Check Up results were helpful in gaining an understanding of the patient’s medical issues, functional status, mood, and informal supports, while telephone and video assessments saved travel time. According to the care coordinators, patients and informal care givers were comfortable answering the questions over the phone and appreciative of interaction with a health professional. Although care coordinators were accustomed to telephone check ins, language barriers, hearing impairment, and inability to see the home environment were limitations. Care coordinators found telephone assessments, using the Check Up, most beneficial in the absence of cognitive impairment and with patients previously known and assessed by the care coordinator. 
 Conclusion: The interRAI Check Up was an efficient method of completing a comprehensive assessment over the phone. Care coordinators found the Check Up to be best suited for reassessments and as a new assessment with stable, cognitively intact patients. Our findings support use of the interRAI Check Up as a promising and feasible addition to the suite of tools for home care coordination.

MEASURING ANKLE FLEXIBILITY IN OLDER HOME CARE RECIPIENTS WITH DISABILITIES IN THEIR HOME SETTING

Abstract Ankle flexibility is critical for daily activities, such as climbing stairs. Ankle range of motion (AROM), or the range through which the ankle joint can bend up and down, decreases with age. Thus, interventions to improve or maintain AROM is an important goal in geriatric rehabilitation. Evaluating the outcome of such interventions requires AROM measures. However, existing measures either require large equipment or for the participant to stand and lunge, and so are not appropriate nor practical for home-bound older adults. This paper aims to (1) describe how we developed an AROM measure for frail, older adults as part of the Promoting Seniors’ Health with Home Care Aides (Pro-Home) Study, and (2) examine the convergent and discriminant validity of the AROM measure. Data came from the baseline assessment of older home care participants’ physical function (N=115). AROM was moderately correlated with lower extremity function as measured by the Short Physical Performance Battery, r(113) = 0.30, p< 0.01 and the gait speed component scores, r(113) = 0.33, p< 0.01, and AROM was not correlated with self-reported upper extremity function. Results from the robust regression analyses are that 1 standard error unit greater averaged AROM is associated with 0.06 points higher SPPB score (p< 0.00) and 0.06 greater Gait Speed Score (p< 0.00), after adjusting for age, gender, and ambulatory device use. The significant associations between AROM and SPPB and AROM and gait speed indicate that the AROM measure has convergent validity, while the nonsignificant associations among AROM and upper extremity function show its discriminant validity.

Using participatory research to co-produce an education and training e-resource to support care home staff to meet the sexuality, intimacy and relationship needs of care home residents with and without dementia.

To present the methodological approach and research methods chosen in a research study designed to enable the collaborative creation of an education and training e-resource designed to facilitate and support care home staff to address the sexuality, intimacy and relationship needs of older care home residents. Co-production using community-based participatory approach. Four participatory workshops with care home staff, residents and their significant others. Workshops 1 and 2 identified and developed real-world case scenarios related to sexuality, intimacy and relationship needs and identified care staff training needs in this area. Then workshop 3 provided valuable feedback on the prototype training e-resource, and the final workshop identified care home staff engagement with and implementation of the e-resource in practice. The findings provide evidence that using participatory approaches, such as co-production, to develop education and training resources in a sensitive subject area with care home residents, significant others, carers and care home staff, was a useful approach in engaging a vulnerable population group, in a sensitive area. However, this approach is not without challenges in care home communities.

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 study biobank, available for use by researchers. Over 70,000 individuals from 346 care homes were included in the data linkage cohort (1st March 2020–31st March 2023). 4975 samples from 2268 individuals (1419 staff, 827 residents) collected between 29th October 2020 and 10th March 2023 are stored. Amongst these samples, there was a maximum of seven per participant however, 217 (26.2%) residents and 555 (39.1%) 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.

The prevalence of malnutrition (MUST and MNA-SF), frailty and physical function and relationship with mortality in older care home residents

The prevalence of malnutrition (MUST and MNA-SF), frailty and physical function and relationship with mortality in older care home residents

Staff perceptions towards virtual reality-motivated treadmill exercise for care home residents: a qualitative feedback study with key stakeholders and follow-up interview with technology developer

ObjectivesHealth and care resources are under increasing pressure, partly due to the ageing population. Physical activity supports healthy ageing, but motivating exercise is challenging. We aimed to explore staff perceptions...

When a home is no longer the best place – older adults’ use of health and care services in the context of a major healthcare reform

Abstract This study investigates the association between insufficient home care and the use of health and social care services among older adults. Data was collected from the Resident Assessment Instrument (RAI) home care register linked to registers for health care and primary health care (N = 33,493). The results show that one in six respondents felt that they would be better off living elsewhere than at home with home care, and these respondents used more hospital, emergency, and home care services than those who preferred living at home. The findings suggest that when older adults perceive their home care to be insufficient, they are more likely to utilize a range of health and social care services. Improved service integration could potentially mitigate the increased use of health and social care services by older adults who perceive their home care as inadequate. Furthermore, the ongoing healthcare reform in Finland aims to promote the integration of health and social services, which could lead to improved care outcomes for older adults. The study's findings can inform policymakers and healthcare providers on the importance of identifying and addressing the needs of older home care clients, particularly in the context of the ongoing healthcare reform in Finland.

The role of functioning in predicting nursing home placement or death among older home care patients

Objective There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. Design A prospective one-year follow-up study. Settings and subjects Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). Main outcome measures Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). Results Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62–0.86), IADL (0.75, 0.65–0.87) MMSE (0.92, 0.87–0.96), and TUG (1.02, 1.01–1.03). NHP alone was predicted by BADL (0.62, 0.50–0.78), IADL (0.57, 0.45–0.73), and MMSE (0.88, 0.82–0.94) and mortality by TUG (1.02, 1.01–1.03). Conclusion Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.

A duoethnography about musicking at an older adult care home during COVID-19

Loneliness during the COVID-19 pandemic has been a global problem. Older adults, who are considered high-risk individuals, have been particularly impacted and have experienced increased isolation and loneliness. Musicians also experienced loneliness during the lockdown period. Therefore, the purpose of this duoethnography is to explore the culturally situated meanings two research participants ascribe to musicking at an older adult care home during the COVID-19 pandemic. The research participants are two community musicians who have facilitated weekly musicking sessions at an older adult care home for the past five years. During the hard lockdown, we serenaded the older adults in the street in front of the care home. Our data collection was stimulated by photos, session plans, song choices, diary reflections, and individual accounts. To explore our dialogical understanding, we used storytelling and Pinar’s (1975) four step method of currere, namely regressive, progressive, synthesis and analysis. The findings indicated that musicking during the COVID-19 pandemic allowed us to share and express compassion and care towards the older adult residents and each other. We, therefore, argue that musicking, with the necessary hygienic precautions, should be encouraged as a form of reciprocal care during a global pandemic.

A novel smart somatosensory wearable assistive device for older adults' home rehabilitation during the COVID-19 pandemic.

Due to the Coronavirus disease 19 (COVID-19) related social distancing measures and health service suspension, physical activity has declined, leading to increased falling risk and disability, and consequently, compromising the older adult health. How to improve the quality of older adult life has become a crucial social issue. In traditional rehabilitation, manual and repetitive muscle training cannot identify the patient's rehabilitation effect, and increasing the willingness to use it is not easy. Therefore, based on the usability perspective, this study aims to develop a novel smart somatosensory wearable assistive device (called SSWAD) combined with wireless surface electromyography (sEMG) and exergame software and hardware technology. The older adult can do knee extension, ankle dorsiflexion, and ankle plantar flexion rehabilitation exercises at home. Meanwhile, sEMG values can be digitally recorded to assist physicians (or professionals) in judgment, treatment, or diagnosis. To explore whether the novel SSWAD could improve the older adult willingness to use and motivation for home rehabilitation, 25 frail older adult (12 males and 13 females with an average age of 69.3) perform the rehabilitation program with the SSWAD, followed by completing the system usability scale (SUS) questionnaire and the semi-structured interview for the quantitative and qualitative analyses. In addition, we further investigate whether the factor of gender or prior rehabilitation experience would affect the home rehabilitation willingness or not. According to the overall SUS score, the novel SSWAD has good overall usability performance (77.70), meaning that the SSWAD makes older adult feel interested and improves their willingness for continuous rehabilitation at home. In addition, the individual item scores of SUS are shown that female older adult with prior rehabilitation experience perform better in "Learnability" (t = 2.35, p = 0.03) and "Confidence" (t = -3.24, p = 0.01). On the contrary, male older adult without rehabilitation experience are more willing to adopt new technologies (t = -2.73, p = 0.02), and perform better in "Learnability" (t = 2.18, p = 0.04) and "Confidence" (t = -3.75, p < 0.001) with the SSWAD. In addition, the result of the semi-structured interview shows that the operation of the SSWAD is highly flexible, thus reducing older adult burden during the rehabilitation exercise and using them long-term. This novel SSWAD receives consistently positive feedback regardless of the gender or prior rehabilitation experience of elders. The SSWAD could be used as a novel way of home rehabilitation for elders, especially during the COVID-19 pandemic. Older adult can do rehabilitation exercises at home, and physicians could make proper judgments or adjust suitable treatments online according to the sEMG data, which older adult can know their rehabilitation progress at the same time. Most importantly, older adult do not have to go to the hospital every time for rehabilitation, which significantly reduces time and the risk of infection.

The prevalence of malnutrition (MUST and MNA-SF), frailty and physical disability and relationship with mortality in older care home residents

The prevalence of malnutrition (MUST and MNA-SF), frailty and physical disability and relationship with mortality in older care home residents

Close relatives’ perspectives of everyday activities at home for older adults repeatedly readmitted to hospital: A qualitative study

Introduction: Relatives are important when older adults return home after a hospital stay. The aim of this study was to describe close relatives’ perspectives of the everyday activities of older adults who are repeatedly readmitted to hospital and discharged to home. Methods: A semi-structured interview was performed to collect data from twenty relatives (aged 45–82 years). Data were analysed using a deductive qualitative content analysis based on the results of a previous study within this field. Results: The overall theme ‘In need of support to manage an unpredictable everyday life’ shows that the older adults often needed support in everyday activities. In the two categories ‘Difficulties in dealing with an unstable day’ and ‘Managing an unstable day’ and the 10 subcategories, close relatives described that the older adults needed support in various ways from relatives or other individuals. Close contact was important for how everyday activities worked at home and in maintaining social contacts and contact with healthcare. Conclusion: It was found that social needs, such as social contacts/activities, are just as important to assess at discharge as medical and functional needs.