Old People's Homes Research Articles

A map of long-term care for people with dementia at the level of local communities

Long-term care for people with dementia has been studied using the Rapid Assessment of Needs and Services method, which has been used to map long-term care needs in order to stimulate the development of care that effectively meets the needs of people with dementia. In this paper, we present the results of three focus groups with key stakeholders in long-term care for people with dementia in three selected communities, involving 29 people from a variety of organisations: social work centres, homes for the older people, health centres, general and psychiatric hospitals, municipalities and non-governmental organizations. Qualitative analysis of the empirical material showed that the following problems are prevalent in the communities: (i) acute and unmet needs of informal caregivers, (ii) a multi-tiered system of long-term care that puts people in an unequal position, (iii) a lack of community-based long-term care, and inadequate responses to the needs of people with dementia. Even in communities where there are various forms of support, both institutional and community-based, available across all service sectors, long-term care for people with dementia is based on informal care. We propose the development of a national strategy for family caregivers, with special attention to informal caregivers of people with dementia. The support offered by existing facilities is inadequate, poorly accessible, or nonexistent. Homes for older people are overcrowded, and people with dementia wait months or years to be admitted to a home. Home-based assistance is not evenly distributed across communities, and its scale (20 hours per week) in particular is insufficient to meet the needs of people with dementia. There is a lack of alternative forms of care that enable people with dementia to remain in their own home environment for as long as possible, for example in the form of personal assistance. We suggest that the development of long-term care for people with dementia should be based on the proposed research methodology.

Home support for vulnerable older people: from shared decision-making to negotiation: A qualitative pilot study

Shared decision-making allows older people to discuss and change their care with informal caregivers and healthcare professionals. When opinions differ, an older person's decision-making ability can be compromised by many factors. The objective of this qualitative pilot study was to study the dynamics of shared decision-making in home care support for vulnerable older people. Observations were carried out at the older people's homes during appointments with the network's healthcare professionals. Semi structured interviews were then conducted with older people, caregivers and healthcare professionals observed. When opinions differ, negotiation dynamics then develop between older people, caregivers and healthcare professionals. Using a dedicated negotiation framework, we identified four types of negotiation between the stakeholders in home care decision-making, influenced by various articulations of individual, collective and environmental factors.

An Online, Self-Report Version of the Home Falls and Accidents Screening Tool (HOME FAST-SR) to Identify Fall-Related Hazards in the Homes of Older People

To identify the characteristics of the users of the HOME FAST-SR, to explore the common home hazards identified and to determine the opinions of older people about the usefulness of the HOME FAST-SR. Data from completed HOME FAST-SR submissions were downloaded from the website hosting the tool, and data from participants who consented to provide additional anonymized information about themselves were included for analysis (n = 250). A further link to an electronic survey was used to gather data about participants’ experience of using the HOME FAST-SR (n = 27). Data were downloaded into SPSS and analyzed. Participants had a mean of 11.37 hazards which is in the high-risk category for falls. A total of 12 hazards were identified by more than half of the participants, most of which were modifiable. Participants indicated they agreed that HOME FAST-SR was useable across the criteria, and 57.9% of participants rated the HOME FAST-SR at 4 stars and a further 21.1% rated it at 5 stars. The online HOME FAST-SR is a useable tool that provides older people with an evaluation of their home hazards and information about how to modify these hazards. It also provides a way to make home hazard evaluation more accessible for older people living in the community.

Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals

BackgroundThe connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people.MethodsThis cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture—norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff’s professions and years of work experience.ResultsThe most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience.ConclusionsThis study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety.

Enhancing healthcare at home for older people in rural and regional Australia: A protocol for co-creation to design and implement system change.

World-wide, health service providers are moving towards innovative models of clinical home-based care services as a key strategy to improve equity of access and quality of care. To optimise existing and new clinical home-based care programs, evidence informed approaches are needed that consider the complexity of the health care system across different contexts. We present a protocol for working with health services and their partners to perform rapid identification, prioritisation, and co-design of content-appropriate strategies to optimise the delivery of healthcare at home for older people in rural and regional areas. The protocol combines Systems Thinking and Implementation Science using a Consensus Mapping and Co-design (CMC) process delivered over five workshops. The protocol will be implemented with rural and regional healthcare providers to identify digital and non-digital solutions that have the potential to inform models of service delivery, improve patient experience, and optimise health outcomes. The combination of system and implementation science is a unique approach for optimising healthcare at home for older populations, especially in the rural context where need is high. This is the first protocol to integrate the use of systems and implementation science into one process and articulating these methods will help with replicating this in future practice. Results of the design phase will translate into practice through standard health service planning methods to enhance implementation and sustainability. The delivery of the protocol will include building capacity of health service workers to embed the design, implementation, and evaluation approach into normal practice. This protocol forms part of the DELIVER (Delivering Enhanced heaLthcare at home through optImising Virtual tools for oldEr people in Rural and regional Australia) Project. Funded by Australia's Medical Research Future Fund, DELIVER involves a collaboration with public health services of Western Victoria, Australia.

Narratives of Ageing and Materiality

Abstract The body is a site on which ageing occurs and is also the means by which we navigate and experience a material world. As our bodies change as we age, so too do our experiences of (and interactions with) our material environment. This article presents findings from an ethnographic study of the experiences of everyday life among residents of an older people's home in northern England. I draw on the concept of the ‘embodied life course’ (Marshall and Katz 2012) to argue that residents’ feelings about being and becoming at home were shaped by their embodied, temporal and socio-material experiences throughout their lives, and that these experiences continued throughout their time in the residential home.

Older home care clients' experiences of digitalisation: A qualitative study of experiences of the use of robot for medicines management.

Home-living older people with multiple medications are a key target group for medication robots. However, our understanding of how robots for medicines management work in older people's daily lives is limited. The aim of this study was to describe older home care clients' experiences of the implementation and use of a robot for medicines management at home. A qualitative interview study. Data were collected during spring and autumn 2021 using semi-structured individual interviews with older home care clients (n=38). The data were analysed using inductive content analysis. The older home care clients had positive experiences with the use of technology for the medication process, but they also faced challenges in their daily life activities. Implementation and use of the robot required open-mindedness, satisfaction with the implementation, and the opportunity to practice the use of the robot with a nurse. However, the current design and size of the robot for medicines management in home care still need development, given that our research participants did not feel included in the robot development process. The use of digital solutions will increase older people's home care. Therefore, there is a need to deepen our understanding of the implementation and use of digital solutions to prevent digital challenges and to provide a more comprehensive picture of this phenomenon. In addition, research focusing on whether the use of the robot affects medication administration incidents and medication adherence should be conducted to improve the safety of medicines management.

Recognising older people's individual resources and home-care-specific tasks in home care in Finland: A document analysis of care and service plans.

Comprehensive care and service planning in home care is tailored to older people's individual needs and resources in order to support them living at home. However, little is known about how these individual resources and home-care-specific tasks are recognised in older people's care and service plans. To describe the content of care and service plans in older people's home care with special attention to their individual resources and home-care-specific tasks. This was a document-based cross-sectional study with mixed-methods analysis, carried out in Eastern Finland during Spring 2018. A document analysis using the deductive Finnish Care Classification (FinCC), and an inductively developed framework of older people's care and service plans (n=71). The data were analysed with descriptive statistical methods. Altogether, 1718 notes were relevant to the FinCC main categories: 707 (41%) focused on older people's needs and 1011 (59%) on nursing interventions. We identified 1104 notes based on the 26 inductively developed main categories: the majority (n=628, 57%) focused on individual resources and the remainder (n=476, 43%) on home-care-specific tasks. Increasing age resulted in fewer notes on safety and sensory functions. There were fewer notes on resources related to sleeping and wakefulness after longer care and service periods. An increased number of home visits resulted in more documentation on tasks related to pharmaceutical issues, including repeat prescriptions. Individual resources for older people were documented, to some extent, in their care and service plans. It is necessary to review these alongside home-care-specific tasks that support older people's independence and safety at home. Individual resources need to be recognised in order to enable home-care professionals to provide tailored, high-quality home care services. Home-care-specific tasks should be supported by documentation with updated, sensitive home care classifications.

Home care professionals' experiences of successful implementation, use and competence needs of robot for medication management in Finland.

To describe home care professionals' individual experiences of the implementation, use and competence needs of a robot for medication management in older people's home care. A qualitative focus group interview study. Data were collected during spring and autumn 2021 by semi-structured focus group interviews and analysed using inductive content analysis. The participants were 62 home care professionals working in older people's home care. The successful implementation and use of the robot for medication management consisted of a timely and adequate introduction before the implementation of the robot, the fluent usability of the robot in daily work, and confidence in work competence. There is a need for the reorganization of home care professionals' use of digital solutions to make workflow fluent, prevent burnout and turnover among home care professionals. Professionals' competence should also be developed to ensure that it corresponds to digitalized healthcare. No patient or public contribution.

Establishing the places of care for the old people in The Diaries of Jane Somers by Doris Lessing

The Nobel-prize winner Doris Lessing brings forward the significance of caring for the old and dying people in her novel The Diaries of Jane Somers, which reveals that human flourishing is based on responsibility, interdependency, and trust between the carer and cared for. In this novel, Lessing mainly emphasizes the significance of caring for both close relatives and distant others who suffer from old age and sickness via the protagonist Jane Somers, who develops unconditional care for a ninety-year-old woman, Maudie Fowler. By depicting Jane's transformation into a caring and interdependent character, contrary to her earlier indifference and autonomy, Lessing proposes that the claims of the old, the sick, and the dying people could be responded to by sharing their experiences and feelings, especially in their personal places. In this respect, this study aims to explore the relationship between literature and care ethics within the scope of ageing studies. This study will embrace the claims of care ethicists and analyse how they are reflected in a literary work. Thus, the aim is to create awareness through literature about caring for older, sick, and dying people by establishing or sharing the places of care, such as older people's homes, rooms, beds, bathrooms, and even deathbeds.

Vpliv epidemije covida-19 na življenje stanovalcev domov za stare

Impact of Covid-19 epidemic on the lives of residents of homes for old people The year 2020 was marked by the Covid-19 epidemic, which had the greatest impact on socially vulnerable groups, especially old people. Based on qualitative research, the article explains the impact of measures to curb the Covid-19 epidemic on the lives of old people in the Ajdovščina Home for the Old People. During this period, social work found itself in a difficult situation and was forced to respond. In institutions for old people, it found itself in an unenviable position, as it had to adapt very quickly to new challenges - to maintain contact in a time that severely limited physical contact, and to enable communication between residents and their loved ones. The article connects homes for old people with the concept of a total institution and shows how social work in the home for old people coped with challenges during the Covid-19 epidemic. The impact of epidemiological measures and social isolation on people's mental health and everyday life is shown. The fundamental tasks of social workers in crisis situations are listed.

Odzivi socialnega dela na ukrepe za zajezitev epidemije covida-19 v domovih za stare ljudi

Responses of social work to measures for containing the Covid-19 epidemic in homes for old people The first part of the article shows how the covid-19 epidemic revived ideas about the development of social work with old people. More frequent violations of human rights, increasing discrimination of old people, and searching for answers to the increasingly severe hardships of the social isolation of the old people – these are topics that call for the establishment of specialization for social work with old people. The development of specialized knowledge also benefits the development of social work in homes for old people. Some key practices for the development of new areas of social work in homes are shown. In the central part of the paper, research with social workers in Slovenian homes is described and the results of the epidemic's impact on social work are presented. The article presents the key challenges for social work, how social work maintains its role at organizing institutional care and what are the most pressing ethical dilemmas of social work. Both the shortcomings and advantages of social work are shown in order to recognize the existing risks for social work as an opportunity for further development of the profession.

Uporaba stimulativnih aktivnosti v socialnem delu z ljudmi z demenco

Use of stimulating activities in social work with people with dementia With growing number of cases of dementia, social work with people with dementia faces new challenges in maintaining dignity in the lives of people with dementia and their families. The article discusses the importance of continuous implementation of various stimulating activities for people with dementia in homes for older people (which are also suitable for implementation in home environment), and their well-being, maintenance of self-worth and self-esteem. Stimulating activities are non-pharmacological forms of care and include various areas: daily tasks (in household and garden), physical exercise, cognitive exercises, as well as complementary activities such as: music and visual arts activities, playing with babies, incorporating modern information technologies, aromatherapy. Stimulating activities can be provided by social workers, occupational therapists and other professionals. Their goal is to maintain cognitive abilities, slow the progression of dementia, and promote well-being of people with dementia. In stimulating activities, the person with dementia, together with a professional, discovers activities that they can manage and enjoy. This leads to reduction in the behavioral and psychological symptoms of dementia.

Cabinet Stories: Curators in the Community

Cabinet Stories was a touring exhibition and research project aimed at audiences with restricted access to the arts, with a singular cabinet housing a series of small, interchangeable, displays devised, in turn, by seven curators. This traveling show enabled an intimate space for conversation between audiences and fashion curators, who stepped outside of the museum context to lead workshops, as an extension of their displays, within complex environments which are closed to the public namely: a women’s prison; a medical center for patients with borderline personality disorder; a home for older people. The final venue was public-facing with the displays presented within a charity shop in east London. This article presents the research outcomes of this year-long outreach project and reflects upon museological theory and exhibition-making practice to contextualize the contribution fashion displays can make to wellbeing. Documentation of the curators’ authorship of their displays, and the audience interpretation is recorded, alongside the work of the participants as curator through the Our Cabinet Story display. This article culminates with the public installation within a charity shop and highlights the on-going legacy of this work and the contribution fashion curation can make to care.

Multi-human Fall Detection and Localization in Videos

Context:There has been a delay in the exploration of the benefits of deep learning for human action and activity recognition applications. Within these fields, the detection of falls attracts attention due to its excellent public utility. Fall detection can be implemented in facilities such as nursing homes, areas with public cameras, and the homes of older people who live alone, as the vast majority of fatalities related to falls occur in these locations. Goal:The YOLO object detection algorithm is combined with temporal classification models and the Kalman filter tracking algorithm, which are used to detect falls individually on video streams. Method:The following steps are taken when the proposed approach is used: (i) the region of the image in which the fall occurred is located; (ii) the features that comprise the fall in a temporal sequence of images are tracked and extracted, and a series of actions associated with a given person are formed; and (iii) a model is built to classify the consecutive sequence of images and aggregate the temporal information. Based on these steps, two versions of the proposed approach, YOLOK+3DCNN and YOLOK+2DCNN+LSTM, are created. Result:The proposed model is compared with other methods in the literature using well-known metrics. Experimental simulations using a custom dataset and state-of-the-art models show that the best results in most evaluated metrics are achieved using the proposed approach.

The shift from old age to very old age: an analysis of the perception of aging among older people

BackgroundThe oldest-old (individuals over 90 years) are a fast-growing population. Understanding the perceptions of older people about very old age is the first step towards developing optimal geriatric care for an aging population. This study aimed to explore the potential shift from old age to very old age through the exploration of older people’s perception of aging.MethodsQualitative study conducted through individual interviews in the homes of older people. We voluntarily chose to include persons a decade under and above 90 years old to explore other factors than age that could participate in the shift from old age to very old age. The sampling was theoretical. We carried out the analyses using an inductive approach based on the phases of grounded theory. The researchers used triangulation. Collection was concluded when theoretical saturation was reached.ResultsFourteen participants were interviewed. The shift from old age to very old age was not based on age but occurred when participants became conscious of the irreversibility of aging and its effects, and when they started living day-by-day, renouncing to any plan in a near future. The transition to very old age seemed to be preceded by a progressive disengagement from non-essentials activities. Participants reported a sensation of progressive social exclusion due to the loss of contemporaries or spouse, the difficulty to connect with younger generations or the absence of relationships in their neighborhood. The last step of life was feared, not because of the idea of death itself but because of the associated suffering and loss of autonomy.ConclusionPrecipitating and slowing factors of the shift to very old age were identified to help general practitioners support older patients throughout their life trajectories.

Situation Analysis of Healthcare Standards and Criteria That Contribute to the Care of Residents in Homes for Older People in Tanzania.

Problems experienced in homes for older people in Tanzania highlighted the need for a situation analysis of healthcare standards to identify the baseline of care provided to residents in these homes. This study conducted a situation analysis of structure healthcare standards and associated criteria with the aim of contributing to improved quality of care for residents in homes for older people in Tanzania. Thirty-two homes for older people in Tanzania were audited using an audit instrument that included seven fields, 26 structure standards, and 262 associated criteria. The analysis showed that overall, the homes were non-compliant with healthcare structure standards and associated criteria. The Tanzanian Government should urgently introduce measures to address the missing standards and associated criteria.

An open and private-by-design Active and Healthy Ageing smart home platform

The increasing trend in the percentage of older people among the European population, and in the number of older people living alone, poses a number of challenges, some of which can be addressed from digital solutions monitoring and supporting comfort, physical activity and health. Nowadays, research efforts seek to ensure, through technology-based solutions, the quality of life as people age and the needs that arise during the process. The home environment can host modern home-automation solutions supporting information gathering, monitoring and early intervention to prevent risks to lead to major consequences. Smart homes can thus make a positive contribution to the Active and Healthy Ageing paradigm. However, one of the biggest limitations preventing smart homes from being a reality is the lack of interoperability among different-vendor devices or the fact that most of the commer-tial solutions rely on cloud-based solutions. This work faces these limitations and proposes an architecture that, based on the use of commercial sensors, ensures that information is gathered and processed locally, independently of the commercial solution provided by the manufacturer of the device. The architecture has been experimentally validated by implementing a monitoring system based on environmental and security sensors interconnected by means of the ZigBee wireless communication protocol. The proposed system also supports caregivers caring for their older people who will be granted access to collected data. Thus, the system offers a remote monitoring system based on an information storage and visualisation solution. This system is intended to provide a solution that improves the quality of life and extends the time of independent living at home for older people.

Piora da fragilidade em pessoas idosas comunitárias com hipertensão e fatores associados

Abstract Objective To estimate the prevalence and factors associated with the worsening of frailty in older people with arterial hypertension. Methods Quantitative, longitudinal, prospective and analytical study. Carried out in community-dwelling hypertensive older people from Minas Gerais. Sampling was probabilistic, by clusters in two stages. Data collection took place at the older people's homes in two moments. Demographic, socioeconomic and clinical-assistance variables were analyzed. Frailty was measured by the Edmonton Frailty Scale. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios. Results 281 older people participated in the study, 23.1% showed a worsening of their state of frailty. The prevalence of frailty increased from 38.0% in the base year to 31.2% in the first wave. The worsening of frailty was associated with negative self-perception of health, polypharmacy and hospitalization in the last 12 months. Conclusion There was a transition between states of frailty. An important contingent of the older people showed worsening frailty.

Medication management in Swedish nursing homes: an ethnographic study of resistance, negotiation and control

ABSTRACT Medication management in elderly care has become a considerable part of the care work. It involves health care professionals, such as registered nurses, formally delegating their tasks to non-professionals, typically care workers. The aim of this article is to explore the medication management in nursing homes for older people. The focus lies on how care workers and residents interact in relation to the medication management routines. Participant observations were made in seven nursing homes, and the analysis of the empirical material applied the theoretical concepts of local routine culture and materiality. The nursing home residents may try to resist or negotiate the medication management routines, express their reluctance in words or actions, ask questions or make demands. While routines produce institutional bodies, acts of resistance and negotiation may strengthen a person’s sense of self. Medication management affect the relationship between care workers and residents, by enabling interaction. Looking at medication management as a social phenomenon deepens the understanding of how it affects care work and illustrates that in the context of nursing home care, health care and social care are not separate but rather intertwined.