People In Aged Care Facilities Research Articles

Infection control and COVID-19 outbreak training at elderly care facilities.

Fatalities caused by pneumonia and underlying diseases from COVID-19 infection show the highest relative frequency among elderly people. Long-term care facilities for elderly people have continued to be the areas most vulnerable to COVID-19. We examined the effectiveness of training for infection control and COVID-19 at elderly care facilities. After sending questionnaires to all long-term elderly care facilities in Ibaraki prefecture, Japan during January 18-29, 2022, we received useful responses from 98 facilities. Using logistic regression, we regressed a dummy variable for outbreak experience to dummy variables representing routine but partial training, routine training for all staff members, long-term care facilities for elderly people, numbers of nurses, and numbers of residents. Outbreak experiences of two types were inferred, as represented by a dummy variable for a COVID-19 outbreak at the facility, and by a dummy variable for outbreak experience at the facility before COVID-19 was found. Multivariate analysis indicated routine training for all staff members as the most effective, in fact the only effective, countermeasure against COVID-19 outbreak.

Equity in walking access to community home care facility resources for elderly with different mobility: A case study of Lianhu District, Xi'an.

As the aging of China's population continues to deepen, a number of elderly care facilities relying on community platforms to provide home care services have been established in urban communities, effectively alleviating the problem of difficult community elderly care, while a spatial mismatch between the facilities and the elderly population has also emerged. To solve this problem, this paper analyzes the equity in walking access to community home care facilities for elderly people with different mobility abilities in Lianhu District of Xi'an City, taking the resources of community home care facilities as the research object. Firstly, the coverage rate of the facilities was calculated based on the 15-minute walking range of the elderly with different mobility, and the accessibility of the facilities was measured using the Kernel Density-type two-step moving search method. Then, Gini coefficient, Lorenz curve and location entropy were used to analyze the spatial matching pattern of facilities and elderly population. The results show that there is a serious spatial mismatch between the resources of community home care facilities and the elderly population with mobility restriction. In addition, the available facility area per capita is low for more than 80% of the elderly with mobility restriction, and the road network density has a significant impact on the access of the elderly with mobility restriction to the community home care facility resources. These research results indicate that the spatial layout and configuration of community home care facilities are unfair to the elderly with poor mobility, and that these elderly care facility configurations do not favor the disadvantaged groups.

Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study.

Falls are a major public health issue, given their prevalence and social impact. Older adults living in long-term care facilities (LTCF) are at greater risk of injury resulting from a fall due to multiple factors, such as nutritional, functional/cognitive impairment, postural instability, polypharmacy, and the presence of potentially inappropriate medications (PIMs). Medication management in LTCF is complex and often sub-optimal and might be crucial for falls. Pharmacist intervention is important, since they have a unique knowledge of medication. However, studies mapping the impact of pharmaceutical activities in Portuguese LTC settings are scarce. This study aims to assess the characteristics of older adult fallers living in LTFCs and examine the relationship between falling and several factors in this population. We also intend to explore the prevalence of PIMs and their relationship with the occurrence of falls. The study was conducted in two long-term care facilities for elderly people, in the central region of Portugal. We included patients aged 65 and older with no reduced mobility or physical weakness and with the ability to understand spoken and written Portuguese. The following information was assessed: sociodemographic characteristics, comorbidities, polypharmacy, fear of falling, functional, nutritional and cognitive status. PIMs were evaluated according to the Beers criteria (2019). A total of 69 institutionalised older adults, 45 women and 24 men, with a mean age of 83.14 ± 8.87 years were included. The prevalence of falls was 21.74% Out of these, 46.67% (n=7) fell once, 13.33% (n=2) fell twice, and 40% (n=6) fell 3 or more times. Fallers were mainly women, had lower levels of education, were well nourished, had moderate to severe levels of dependence, and displayed moderate cognitive impairment. All adult fallers had a fear of falling. The main comorbidities of this population were related to the cardiovascular system. Polypharmacy was present in every patient, and at least one PIM was identified in 88.41% of the subjects. Fear of falling (FOF) and cognitive impairment (in subjects with 1 to 11 years of education) showed statistically significant associations with the occurrence of falls (p=0.005 and p=0.05, respectively). No significant differences were found between fallers and non-fallers for any other factors. This present study is a preliminary contribution to characterise a group of older adult fallers living in Portuguese LTCFs and demonstrated that fear of falling and cognitive impairment are associated with the occurrence of falls in this population. The high prevalence of polypharmacy and PIMs emphasises the need for tailored interventions featuring the collaboration of a pharmacist to optimise medication management in this population.

Correctional nurse education and training to care for and support prisoners with dementia: a systematic review of text and opinion.

The objective of this review was to synthesize the best available evidence on the training required for correctional nurses to care for and support prisoners with dementia. Nurses caring for people in aged care facilities receive training related to aging and dementia; however, this has not carried across to training for the increasing aging population within correctional settings. Most research related to dementia care is focused on the aged and acute care sectors, and there is an absence of research in the correctional setting. Therefore, this systematic review was based on expert opinion and synthesizes information related to correctional nurse training for the support and care of prisoners with dementia. Articles focusing on correctional nurses, regardless of gender, who were responsible for the health care of adult prisoners were considered for this review. The primary phenomenon of interest was the training needs and requirements for correctional nurses to support prisoners with dementia. The secondary phenomenon of interest was how the delivery of the training could be facilitated. The context of this review was the adult correctional setting. The sources of information considered for this review included text and narratives describing expert opinion, expert opinion-based guidelines, expert consensus, published discussion papers, unpublished dissertations, reports accessed from professional organization websites, and government policy documents. A three-step search strategy was employed to look for both published and unpublished articles as recommended by JBI. The search was conducted for English-only articles, and from database inception to November 2020. All included articles were assessed by two independent reviewers for methodological quality. The data were extracted and pooled. Categories were developed and assigned based on similarity of meaning, and a set of synthesized conclusions was developed after subjecting the categories to meta-synthesis. Sixteen papers met the inclusion criteria and underwent critical appraisal and data extraction. Five synthesized findings were generated from 103 findings, which were aggregated into 15 categories. As expected, the rating was very low due to the nature of the included papers (ie, non-research), and the mix of unequivocal, credible, and unsupported findings. The review highlighted gaps in correctional nurse training related to caring for prisoners with dementia. Training for correctional nurses should incorporate information on general aging, alterations in aging, and dementia screening and management. Other findings included the need for policy and procedures related to training nurses to become dementia experts, and the development of partnerships with experts in the community to adapt training to the correctional setting.

Comparing the care environment at farm-based and regular day care for people with dementia in Norway-An observational study.

People with dementia should be able to live in the community, and day care services are recommended as a means for people to live in their own homes for as long as possible. In this study we wanted to compare the quality of care at one type of small-scale day care situated at community farms to regular day care provided in connection with residential care facilities for elderly people. A total of 42 participants from 10 farm-based day care offers and 46 participants from seven regular day care offers were included. A qualitative observational design using the validated Maastricht Electronic Daily Life Observation tool was used. The data were collected between March and June 2018. Ecological momentary assessments of the activities taking place, level of engagement, physical effort, location, social interaction and mood were conducted while the participants attended their day care offer. The results showed that familiar daily activities were common at farm-based day care, and a linear mixed model analysis showed that farm-based day care attendees used more physical effort, spent more time outdoors, had more social interaction and experienced more positive mood compared to regular day care attendees. These findings contribute with valuable information about care provided at different types of day care services, and indicate that farm-based day care has more activities with the potential to meet the social and activity needs of people with dementia compared to regular day care. There are two main implication of this study. First, regular day care services should focus on including more familiar daily activities found to be important for attendees' sense of identity and feelings of contributing. Second, regular day care services should utilise the potential of available outdoor areas as time spent outdoors has been found to facilitate physical activity, relaxation, health and well-being.

Evacuation Ability of Residents and General Capability of Disaster Response System at Care Facilities for Elderly People

Evacuation Ability of Residents and General Capability of Disaster Response System at Care Facilities for Elderly People

Impact of medication reviews on inappropriate prescribing in aged care

Background: Inappropriate prescribing (IP) is prevalent among elderly people in aged care facilities. Little has been published on the effect of pharmacists performing residential medication management reviews (RMMRs) in aged care on the appropriateness of prescribing. RMMRs represents a key strategy for achieving quality use of medicines, by assisting residents in aged care facilities and their carers to better manage their medicines. However, the structure of RMMR has moved from annual to every two years for each resident.Objectives: The primary objective of this study was to investigate the impact of pharmacists performing RMMRs on medication use appropriateness, as measured by the Medication Appropriateness Index (MAI).Methods: Retrospective analysis of RMMRs pertaining to 223 aged care residents aged ≥65 years in Sydney, Australia. The MAI was applied on two RMMR cohorts; newer cohort (n = 111, 2015) i.e. following the recent changes to the RMMR funding and older cohort (n = 112, 2012) at baseline, after pharmacists’ recommendations (assuming all pharmacists’ recommendations were accepted by the General Practitioner [GP]), and after the actual uptake of pharmacists’ recommendations by the GP. Differences in inappropriate prescribing were measured using the Wilcoxon sign rank test.Results: Overall, all patients in the study (n = 223) had at least one inappropriate rating at baseline (median MAI score of 26 for the old cohort and 27 for the newer cohort). The median cumulative MAI scores were significantly lower after the RMMRs by pharmacists (15.5 and 20 for the old and new cohort respectively, p < .001) and following the uptake of recommendations by the GP, indicating an increased appropriateness of drug regimen after the medication review (20 and 22 for the old and new cohort respectively, p < .001).Conclusion: This study shows that pharmacist-led medication reviews are effective in reducing inappropriate prescribing among aged care residents, as demonstrated by the reduction in MAI scores. Future studies should focus on the impact of such a decrease on patient outcomes.

The role of urban green spaces in care facilities for elderly people across European cities

Urban green spaces (UGS) are increasingly acknowledged for their importance for the well-being of urban populations. However, studies are lacking the consideration of the demand and use of UGS by different population groups and connecting UGS with social infrastructure. In an era of worldwide urbanization and ageing, this European study sheds light on the role of UGS for care facilities for elderly. 126 care facilities from 17 cities in Austria, Germany, Norway, Poland, Romania and Slovenia took part in an online survey. Administrations of care facilities gave insights on the (1) importance of gardens related to care facilities for the quality of life for the seniors, (2) importance of UGS outside of care facilities for the quality of life for the seniors and (3) the consideration of natural and age-friendly designs and management of ecosystem disservices of UGS. The results emphasize not only the importance of UGS for the quality of life of seniors residing in care facilities, but also for the staff and visitors. UGS contribute to physical activities, recreation, and social interactions. The study found that in particular facilities with an own garden are highly aware of the benefits UGS provide. The study holds important lessons for UGS planning, management and design not only to focus on the quantitative supply of UGS, but also to consider age-sensitive amenities in and access to UGS of high quality for seniors.

Turnover élevé du personnel soignant dans les EHPAD privés en France : impact de l’environnement local et du salaire

The high turnover among nursing staff working in nursing homes for dependent elderly people (EHPADs) in France has negative consequences in terms both of cost and of quality of care for the residents. We study the causes of this staff turnover using the estimate from a probit model estimated on two samples, one of 5,478 nurses and the other of 13,444 nursing auxiliaries working in private EHPADs under open-ended contracts. The probability of the nurses and nursing auxiliaries leaving is significantly influenced by factors t related to the environment around the employee’s place of residence, computed at a highly disaggregated geographical level, including closeness to a hospital, competition between residential care facilities for elderly people, shortage of nursing staff, and attractiveness of the self-employed professional sector for nurses. The wage level, corrected for endogeneity, has a positive effect on the retention of nursing auxiliaries working in EHPADs, but it does not seem to have an influence in the case of nurses.

Robotic Seals as Therapeutic Tools in an Aged Care Facility: A Qualitative Study.

Robots, including robotic seals, have been used as an alternative to therapies such as animal assisted therapy in the promotion of health and social wellbeing of older people in aged care facilities. There is limited research available that evaluates the effectiveness of robot therapies in these settings. The aim of this study was to identify, explore, and describe the impact of the use of Paro robotic seals in an aged care facility in a regional Australian city. A qualitative, descriptive, exploratory design was employed. Data were gathered through interviews with the three recreational therapists employed at the facility who were also asked to maintain logs of their interactions with the Paro and residents. Data were transcribed and thematically analysed. Three major themes were identified from the analyses of these data: “a therapeutic tool that's not for everybody,” “every interaction is powerful,” and “keeping the momentum.” Findings support the use of Paro as a therapeutic tool, revealing improvement in emotional state, reduction of challenging behaviours, and improvement in social interactions of residents. The potential benefits justify the investment in Paro, with clear evidence that these tools can have a positive impact that warrants further exploration.

Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia. More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth. INCLUSION CRITERIA Types of participants This review will consider studies that include residents with a formal diagnosis of dementia currently residing in permanent care in Residential Aged Care Facilities. This review will exclude participants that have not received a formal diagnosis of dementia as well as those who are not living as a permanent admission in Residential Aged Care Facilities. Studies conducted on community dwelling individuals with a formal diagnosis of dementia will be excluded. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the efficacy of professional oral health care performed by a dental hygienist. These studies involve professional oral health care performed by a dental hygienist using a toothbrush, interdental brushes, floss and hand scalers if necessary to remove plaque and food debris and in some instances hardened calculus or tartar. If there are studies involving the professional oral health care being performed by dentists or a combination of dentists and dental hygienists they will be included in the analysis. This review will exclude interventions involving staff training interventions and interventions performed by nurses/assistant nurses. TRUNCATED AT 250 WORDS

高齢者介護・療養施設に適応する機能評価表の検討

目的： 一人の理学療法士（PT）が多数の患者の訓練指導を行うタキザワ式リハビリテーションを実施してきた。実施施設には、入所者・患者には身体機能低下の著しい人，重度の痴呆を有する人が多かったが，評価は個別に記述してきた。一療法士対入所者・患者多数で実施するため、実施しているPT は評価表作成のための負担が大きかった。複数施設において実施することになり、またPT の負担を減らす必要があったので、各施設で利用する機能評価表が必要になった。方法： 実施状況の後方視による現状分析を行い，運動種類及び回数等で表す事が出来るよう定型化を行った。結果： 定型化しチェック式で対応可能に作成した。身体機能経過記録として，頭部、体幹、下肢、移乗・移動に区分し、定型的に評価出来るよう作成し、図示した。拘縮、失認の有無、立位・歩行の状況,トレーニングと部位、回数を記録出来るようにした。考察： 問題点をあげ短期，長期の目標を立てる事が可能になり、複数施設で利用できるようになった。評価記録の省力化が図れた。

Clostridium difficile infection in elderly nursing home residents

Age-related changes in intestinal flora and host defences, the receipt of antibiotic treatment, and the presence of underlying diseases are some of the most common risk factors associated with Clostridium difficile infection. Therefore, retirement care facilities for elderly people have been pinpointed as frequent sources of contamination. There is only limited data regarding the presence and epidemiology of C. difficile in nursing homes, and this gap in the current literature emphasises the need to gain a better understanding of the situation in order to prevent the emergence of new outbreaks among this population group.

Assessment of the validity and internal consistency of a performance evaluation tool based on the Japanese version of the modified barthel index for elderly people living at home.

[Purpose] This study aimed to examine the validity and internal consistency of the Japanese version of a performance evaluation tool for activities of daily living (ADL) based on the modified Barthel Index (PET-MBI) among elderly people at home. [Subjects] The subjects were elderly people living at home in Japan. [Methods] A cross-sectional study was performed at five home care facilities for elderly people in Japan. ADL performance was evaluated for 128 participants using the PET-MBI, which included 10 self-care items. We used confirmatory factor analysis to estimate the factorial validity. We assessed data model fitness with the χ2 statistic, the Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), and Root Mean Square Error of Approximation (RMSEA). Cronbach’s alpha coefficient was used to determine the internal consistency. [Results] The mean age of the participants was 79.1±8.9 years. Among the 126 participants included in the analysis, 67 were women (53.2%). The single-factor model demonstrated a fair fit to the data, with the χ2 statistic = 74.9 (df =35), GFI = 0.88, AGFI = 0.81, and RMSEA = 0.096, and the path coefficients of each item ranged from 0.44 to 0.95. The alpha coefficient of the 10-item scale was 0.93. [Conclusion] The PET-MBI for elderly people at home was well validated.

Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial

Sophisticated approaches are needed to improve the quality of care for elderly people living in residential care facilities. We determined the effects of multidisciplinary integrated care on the quality of care and quality of life for elderly people in residential care facilities. We performed a cluster randomized controlled trial involving 10 residential care facilities in the Netherlands that included 340 participating residents with physical or cognitive disabilities. Five of the facilities applied multidisciplinary integrated care, and five provided usual care. The intervention, inspired by the disease management model, consisted of a geriatric assessment of functional health every three months. The assessment included use of the Long-term Care Facility version of the Resident Assessment Instrument by trained nurse-assistants to guide the design of an individualized care plan; discussion of outcomes and care priorities with the family physician, the resident and his or her family; and monthly multidisciplinary meetings with the nurse-assistant, family physician, psychologist and geriatrician to discuss residents with complex needs. The primary outcome was the sum score of 32 risk-adjusted quality-of-care indicators. Compared with the facilities that provided usual care, the intervention facilities had a significantly higher sum score of the 32 quality-of-care indicators (mean difference - 6.7, p = 0.009; a medium effect size of 0.72). They also had significantly higher scores for 11 of the 32 indicators of good care in the areas of communication, delirium, behaviour, continence, pain and use of antipsychotic agents. Multidisciplinary integrated care resulted in improved quality of care for elderly people in residential care facilities compared with usual care. www.controlled-trials.com trial register no. ISRCTN11076857.

Examination of Practicability of Communication Robot-Assisted Activity Program for Elderly People

We have developed a Robot Assisted Activity (RAA) program for recreational use in health care facilities for elderly people. The RAA program has been evaluated in such a facility to assess its usefulness. The program applies a standard classroom model, starting with homeroom and including lessons in the Japanese language, music, gymnastics, arithmetic, and other subjects. At the end of the program, there is a graduation ceremony. We use a video camera to record each scene. Each behavior and utterance of the participants is then analyzed. In addition, immediately upon completion of the RAA program, specialists conduct a Focus Group Interview (FGI) in which they collect comments, opinions, and requests from the participants. Ten elderly people participate in the program, two men and eight women (81.0±3.7 years old). All are residents at a health care facility in Aichi Prefecture, Japan. TheMMSE (MiniMental State Examination) score indicating the level of dementia is 24.1±3.0 points. Two participants are judged to be in a moderate stage of cognitive decline (21 points or less), six are in a mild stage (22-26 points), and the remaining two are normal. On the Geriatric Depression Scale (GDS), in which a score of 13.3±4.2 points indicates a state of depression, seven participants are judged to be depressive (11 points or more). The results of our study show that all participants have a favorable impression of the robot and nearly all have a positive opinion of the RAA program. This suggests that the program can be used for emotional and recreational therapy at health care facilities for the elderly. However, in spite of the overall success of the RAA program, we seldom observe interaction between participants and the robot.

Oral health care in long‐term care facilities for elderly people in southern Brazil: a conceptual framework

To present a theoretical model for understanding oral health care for the elderly in the context of long-term care institutions (LTCI). Open-ended individual interviews were conducted with the elderly residing in LTCI, their carers, nursing technicians and nurses, directors of care, dental surgeons and managers of public health services. A grounded theory methodological approach was adopted for data collection and analysis. The emerging core category revealed a basic social process: 'Promoting oral health care for the elderly based on the context of LTCI'. This process was composed of two contradicting yet correlated aspects: the oral health care does not minimise the poor oral epidemiological condition, and at the same time, there was a continued improvement in the oral care expressed by better care practices. These aspects were related to the: attribution of meaning to oral health, social determination of oral health, the ageing process, interactions established in the oral health care practices, oral health care management in LTCI, inclusion of oral health care into the political-organisational dimension and possibility of conjecturing better oral health care practices. The core concept of 'Promotion of oral health care for elderly people based on the context of LTCI' is capable of explaining the variations in the structure and process of LTCI, as well as in helping to understand the meaning of the oral health care practices for the institutionalised elderly.

Molecular epidemiology of Escherichia coli producing extended-spectrum β-lactamases in Lugo (Spain): dissemination of clone O25b:H4-ST131 producing CTX-M-15

Having shown that the Xeral-Calde Hospital in Lugo (Spain) has been concerned by Escherichia coli clone O25:H4-ST131 producing CTX-M-15 (Nicolas-Chanoine et al. J Antimicrob Chemother 2008; 61: 273-81), the present study was carried out to evaluate the prevalence of this clone among the extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates and also to molecularly characterize the E. coli isolates producing ESBL other than CTX-M-15. In the first part of this study, 105 ESBL-producing E. coli isolates (February 2006 to March 2007) were characterized with regard to ESBL enzymes, serotypes, virulence genes, phylogenetic groups, multilocus sequence typing (MLST) and PFGE. In the second part of this study, 249 ESBL-producing E. coli isolates (April 2007 to May 2008) were investigated only for the detection of clone O25b:H4-ST131 producing CTX-M-15 using a triplex PCR developed in this study and based on the detection of the new operon afa FM955459 and the targets rfbO25b and 3' end of the bla(CTX-M-15) gene. Of the 105 ESBL-producing E. coli isolates, 60 (57.1%) were positive for CTX-M-14, 23 (21.9%) for CTX-M-15, 10 (9.5%) for SHV-12 and 7 (6.7%) for CTX-M-32. Serotypes, virulence genes, phylogenetic groups and molecular typing by PFGE demonstrated high homogeneity within those producing CTX-M-15 and high diversity within E. coli producing CTX-M-14 and other ESBLs. By PFGE, CTX-M-15-producing E. coli isolates O25b:H4 belonging to the phylogenetic group B2 and MLST profile ST131 were grouped in the same cluster. The epidemic strain of clone O25b:H4-ST131 represented 23.1%, 22.5% and 20.0% of all ESBL-producing E. coli isolated in 2006, 2007 and 2008, respectively. CTX-M-type ESBLs, primarily CTX-M-14 and CTX-M-15, have emerged as the predominant types of ESBL produced by E. coli isolates in Lugo. In view of the reported findings, long-term care facilities for elderly people may represent a significant reservoir for E. coli clone O25b:H4-ST131 producing CTX-M-15. The triplex PCR developed in this work will be useful for rapid and simple detection of this clone.

DIFFERENCES OF MANAGEMENT AND NURSING NEEDS OF SMALL SCALE CARING HOME FOR THE ELDERLY ACCORDING TO REGIONALITY

The practice of TAKUROSYO has extended. TAKUROSYO means a frame of services and facilities that has multi-service of the [Daycare (established Day-Service function)], [Staying (established Short-Staying function)], and the [Residence (established Group-Living function)]. Therefore, the senior citizen's life can be supported continuously in TAKUROUSYO. In this research, Small-scale nursing care facilities for elderly people based on day including TAKUROSYO were analyzed. In this paper, the regional difference of the management modality and nursing needs of these facilities is analyzed. It was expected that was different according to such as the aging of population, how much can the family nurse, and how many senior citizen support facilities are there at the locality. A lot of parts of the TAKUROSYO management based on fl exible service with local conditions are contradictory to a managerial vision under the new system that is uniform regulations throughout the country. Danger of destroying the senior citizen's life is involved to the system management that doesn't consider the regionality.

Incidence of falls and fall-related outcomes among people in aged-care facilities in the Lower Hunter region, NSW

This article describes the rate of falls and adverse outcomes following falls, such as fracture, hospitalisation and death, among residents of 88 aged-care facilities in the Lower Hunter region of NSW from July to December 2005. A high rate of falls was observed with a crude incidence of 171 falls per 1000 beds per month. Around 40% of the falls resulting in hospitalisation were for fractured neck of femur. Estimated 3-month survival following fractured neck of femur was low, with a rate ratio of around 1 : 3. The data indicate an urgent need for falls injury prevention in aged-care facilities.