Long-term Care Research Articles

Aging in place or aging out of place? Family caregivers' perspectives on care for older Pakistani migrants in Norway.

The aging population in Europe is increasing, with growing ethnic diversity among older individuals due to migration. Public policies emphasize 'aging in place' to address financial challenges and reduce the burden on the healthcare system. However, research often overlooks the heterogeneity among older people, especially non-European migrants. Also, research on family caregivers' role in enabling 'aging in place' for older relatives with migrant backgrounds is limited, despite many older non-European migrants' preference for family care in comparison to long-term institutional care. This study aims to explore the experiences and perspectives of family caregivers in the context of formal and informal care and their preferences regarding the place of care for older family members with migrant backgrounds, particularly the Pakistani Ahmadiyya community in Norway. Eighteen semi-structured individual interviews and two group interviews were conducted in Urdu and English with nineteen female family caregivers of older relatives, ages 25-62, residing in Norway. The analysis yielded three main themes: (1) "Nursing homes are not for the ones who love their parents", (2) Preferences for home with the possibility of sharing care, and (3) Mismatch between family care needs and formal care. Family caregivers' perception of health services has a decisive impact on their older relatives' demand and use of formal health services, emphasizing the need for trust. Even though home care services were seen as a viable option, they should be adapted so that the family caregivers can use them and feel supported in enabling 'aging in place' for older migrants.

Evidence pointing toward invalidity of the SF-8 physical and mental scales: a fusion validity assessment.

The SF-8™ Short Form Health Survey creates physical and mental health scale scores from responses to eight survey questions. These widely used scales demonstrate reasonable reliablity, and some forms of validity but have not been assessed for fusion validity. We assess the fusion validity of the SF-8 physical and mental health scales, and provide comments assisting fusion validity assessment of other scales. Checking the fusion validity of a scale requires including the scale and its constituent indicators in a structural equation model that has at least one variable causally downstream from the scale. We assessed fusion validity of the SF-8 physical and mental health scales in the context of work-related variables for care aides working in Canadian long-term care homes. Variables causally downstream from physical and mental health, such as work burnout, permit checking whether the SF-8 indicator items fuse to form cogent physical and mental scales, irrespective of whether those indicators share common-factor foundations. We found that the SF-8 physical and mental health scales did not function appropriately. The scales inappropriately claimed effects for several items that had no effects and provided biased estimates of other effects. These deficiencies seem grounded in the scales' developmental history, which implicitly bolstered selection of some causally ambiguous items and paid insufficient attention to component factor model testing. Our observations of causal incongruities question whether the SF-8 can provide valid assessments of physical and mental health. However, it would be imprudent to discontinue SF-8 use on the basis of a single study suggesting invalidity. This uncomfortable conclusion can be rechecked by re-analyzing data from any project that employed the SF-8 and recorded even one causal consequence of physical or mental health. The power of fusion validity assessment comes from connecting the recorded consequences simultaneously to both the scale and the items from which that scale is calculated.

Association Between Sarcopenia and Acupressure Testing in Older Adults Requiring Long-Term Care

Background and Objectives: This study analyzed the relationship between pressure pain test outcomes and sarcopenia in elderly patients and explored possible clinical applications. Materials and Methods: The participants included 143 older adults requiring long-term care who could be diagnosed with sarcopenia. Along with sarcopenia diagnosis, the participants underwent acupressure testing symmetrically at nine sites (occiput, lower cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteus, greater trochanter, and knee), totaling 18 sites. The analyses included comparisons of sarcopenia status and total tender points between the groups and a multivariable analysis. The association between sarcopenia and the number of tender points were examined based on correlations between the number of tender points and grip strength, walking speed, and skeletal muscle mass index (SMI). Intergroup comparisons and multivariable analysis of tender points with and without sarcopenia were performed to investigate specific tender points associated with sarcopenia. Results: An independent association was observed between sarcopenia and the number of tender points (p = 0.001). Furthermore, the number of tender points was correlated with grip strength (ρ = −0.536, p < 0.001), walking speed (ρ = −0.200, p = 0.028), and SMI (ρ = −0.394, p < 0.001). The supraspinatus (p = 0.029, 95% confidence interval: 1.221–35.573) and lower cervical (p = 0.039, 95% confidence interval: 1.050–7.245) regions were identified as specific tender points. Conclusions: In older adult patients requiring long-term care, sarcopenia is associated with an increased number of tender points throughout the body, with the supraspinatus and lower cervical regions potentially being specific tender points. Acupressure testing for tenderness may be a useful assessment parameter in sarcopenia patients.

Transmission of MRSA, ESBL E. coli, and C. difficile within a tertiary care hospital and across surrounding facilities in Japan: a molecular epidemiological study with the PCR-based Open-reading frame typing.

To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and Clostridioides difficile (C. difficile) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs). Retrospective cohort study. Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and C. difficile. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing Escherichia coli (E. coli), and C. difficile, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method. Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL E. coli (31.8%), and 32 ESBL Enterobacterales (non-E. coli) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL E. coli and C. difficile occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively. MDROs/C. difficile transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.

Denosumab for osteoporosis in older adults in long-term care: A randomized trial.

In long-term care (LTC), the incidence of hip or vertebral fractures are eight times that in the community. Despite the wide availability of osteoporosis therapy, LTC residents are omitted from pivotal trials and not treated. Denosumab is a relatively new, monoclonal antibody therapy for osteoporosis treatment. Via a randomized trial, we sought to determine the safety and efficacy of denosumab in LTC residents. We conducted a 2-year, double-blind, placebo-controlled, randomized clinical trial in 201 osteoporotic men and women aged ≥ 65 years, living in LTC communities. Participants with multimorbidity, dysmobility, and cognitive impairment were not excluded. The intervention was denosumab 60 mg subcutaneous every 6 months or placebo. Our primary outcome measures were hip and spine bone mineral density (BMD) improvement at 24 months. Secondary outcomes included BMD at other skeletal sites, function, and safety. We included 123 women and 78 men with a mean ± standard error age of 81.5 ± 0.6. Overall, 83% and 71% completed 12 and 24 months, respectively. Compared with placebo, the women receiving denosumab had a greater 24-month percent increase in spine (7.41 ± 0.93 vs. 2.15 + 0.56; p = 0.014), and total hip BMD (4.62 ± 0.62 vs. -0.19 ± 0.79; p = 0.007); and men in spine (7.91 ± 0.96 vs. 1.12 ± 1.13; p = 0.002) and total hip (3.74 ± 0.55 vs. 0.48 ± 0.74; p = 0.018). There were no significant differences in safety metrics. Denosumab was a safe and effective therapy for improving BMD in osteoporotic older men and women with multiple comorbidities in LTC.

Regional disparities in home health care utilization for older adults and their associated factors at the secondary medical area level: A Nationwide study in Japan.

As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors. We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long-term-care (LTC) resources, adjusted for the older adult population; proportion of single-person households; and regional factors. We performed a multivariate negative binomial distribution analysis. A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home-visit rates. Beds in LTC welfare facilities (coefficient, -0.10 [95% CI, -0.19 to -0.01]) and beds in LTC health facilities (coefficient, -0.09 [95% CI, -0.17 to 0.00]) were negatively associated. Policies to promote home health care have led to high home-visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; ••: ••-••.

Classification of Mild, Very Mild, Moderate, and Non-Demented Alzheimer’s Disease MRI Scans with SVM

Over 55 million people worldwide are affected by Alzheimer's disease (AD), which causes a substantial financial impact on society. The estimated expenses of health care and long-term care for individuals with forms of dementia are expected to approach around $360 billion in 2024. Recent developments in neuroimaging have yielded important insights into AD. Machine learning (ML) methods have become widely available as effective instruments for interpreting complex neuroimaging data. Previous studies on classifying magnetic resonance imaging (MRI) images found significant success in identifying neurological disorders. In this study, supervised learning is employed to investigate if ML models can distinguish between mild dementia, moderate dementia, very mild Dementia, and non-demented MRI images. The dataset was sourced from the Open Access Series of Imaging Studies (OASIS), a publicly available dataset that provides cross-sectional and longitudinal MRI data of the brain. We trained a linear support vector machine (SVM) classifier with stochastic gradient descent (SGD) on 75% of the dataset. To evaluate performance, we calculated the accuracy level from the testing data. This model produced an accuracy of 74.21%, demonstrating that SVM classification is a promising avenue to classify MRI images.

Becoming Eligible for Long-Term Care Insurance in China Brought More Ageing at Home: Evidence from a Pilot City.

Person-centered long-term care systems, integral to healthy ageing, should empower older people to achieve ageing in place. Yet evidence on the impact of the design of long-term care systems on older people's choice of places of ageing, especially that from developing countries, is limited. Taking the introduction of Long-Term Care Insurance (LTCI) in City X of China as a policy shock, we examined the impact of becoming eligible for LTCI on program beneficiaries' choice of places of ageing-institution or home-before they started to receive any actual benefit. Based on our analysis of the administrative data of all LTCI applicants between July 2017 and September 2020 from City X, we found that becoming eligible for LTCI increased an older-person's probability of choosing home as her place of ageing even before she received any benefit by around 16 percentage points, and this positive impact was larger for those insured of higher education level or of higher disability grade. By bring more ageing in place, the LTCI in City X promoted healthy ageing. Our study suggests that the specifics of the LTCI program like who could receive subsidies, family values, and family members' engagement in labor market could all work together to shape the substitution pattern between home and institutional care.

Epilepsy care pathway: The Finnish model.

Integrated care pathways are essential for consistent, effective epilepsy care, offering equal access and quality regardless of socioeconomic status. They must align with the WHO Global Action Plan on Epilepsy, ensuring best practices and cost-effective management. We describe the Finnish national epilepsy care pathway, which includes multiple levels of care, from initial diagnosis to long-term care for all types of epilepsy, with a specific focus on rare and complex cases integrated with the European Reference Network (ERN) for Rare and Complex Epilepsies EpiCARE. In 2017, the Finnish government nominated Kuopio University Hospital to coordinate diagnostics and care for severe epilepsy in Finland. A national multidisciplinary consensus panel, including specialists from both adult and pediatric neurology departments across all five Finnish university hospitals and from the patient organization, was established. The resulting pathway was adopted into the current Finnish evidence-based current care guidelines for epilepsy. The Finnish epilepsy care pathway focuses on timely referrals, continuity of care and enhanced communication between healthcare providers at different levels of care. Patient involvement is assured with an individualized digital application offering secure online messaging, a seizure calendar, and remote visits. The pathway enhances virtual consultations and includes regular national diagnostic multidisciplinary meetings for severe epilepsies before selected cases are consulted in ERN EpiCARE meetings. This Finnish model for epilepsy care provides a streamlined, multidisciplinary approach to diagnosis and treatment and combines modern digital tools, data sharing, and peer support. This pathway can serve to model how integrated healthcare systems can effectively manage complex conditions. We describe the Finnish national epilepsy care pathway, which includes multiple levels of care, from initial diagnosis to long-term care for all types of epilepsy, with a specific focus on rare and complex cases integrated with the European Reference Network (ERN) for Rare and Complex Epilepsies EpiCARE. Finnish model for epilepsy care provides a streamlined, multidisciplinary approach to diagnosis and long-term treatment of epilepsy. The pathway enhances virtual consultations and includes national and European-level diagnostic multidisciplinary meetings for severe epilepsies. To improve outcomes, we emphasize the use of modern digital tools, data sharing, and peer support.

Assessing the long-term care (LTC) service needs of older adults based on time-driven activity-based costing (TDABC)–a cross-sectional survey in central China

BackgroundThe global population’s aging has led to an increasing demand for long-term care (LTC), especially in developing countries like China. Comprehensive assessment of LTC service demands by including the time and cost analysis is crucial to inform the planning and financing of LTC resources, yet such research is lacking in China. Our research team has developed a quantitative index system of the medical and nursing services needs of older adults (QISMNSNE) based on the framework of Time-Driven Activity-Based Costing (TDABC), providing a valuable tool for measuring LTC service needs. This study aimed to assess the LTC service needs of older adults in China and the factors associated with such needs.MethodsA cross-sectional study was conducted in Changsha City, Hunan Province, China, from June 2021 to December 2022. A stratified multistage cluster sampling method was used to recruit 1,270 older adults from five nursing homes and three communities/streets in three regions of Changsha City. The LTC service needs were assessed by calculating the service time required from caregivers, nurses, and doctors and the total service time (min/d) using the QISMNSNE. Participants’ disability, activities of daily living (ADLs), mental status and social involvement (MSSI), and sensory and communication (SC) were assessed using standard scales. Generalized linear regression models were used to analyze factors associated with LTC service needs.ResultsThe participants had an average age of 76.41 ± 8.38 years, with 43.7% being female. The median service time required from caregivers, nurses, and doctors was 53.34 min/d, 3.66 min/d, and 0.33 min/d, respectively, and the total service time was 83.31 min/d. The generalized linear regression model identified the following factors that were associated with higher total service time: aged 75–84 years, living in nursing homes, income over 5000 per month, ADLs, MSSI (9 ~ 40), SC, and having 3 ~ 4 kinds of geriatric comorbidity (P < 0.05).ConclusionsOlder adults have a high need for LTC services, especially those provided by caregivers, indicating an urgent need to expand and improve LTC systems. The LTC service time needed is associated with multilevel factors encompassing socio-demographic, functional, and psychological aspects. This study offers preliminary insights into the needs, demands, and costs of LTC services for older adults and provides essential guidance for future planning and financing of LTC resources.

Changing patterns of social services for the elderly as innovative technologies for preserving social capital

The article examines the main problems faced by older people and suggests innovative practices and technologies of social care at home in order to preserve their social capital. Due to age and health conditions, many older people are limited in their ability to leave home and perform daily tasks and functions. Senile problems represent negative changes that affect people’s lives and are associated with poor health. The key problems of the elderly have been identified. The article notes that senior citizens need timely and long-term care to preserve their social capital, which is best provided at home and with the support of their loved ones. To implement such care, it is necessary to create long-term care centres for the elderly and the disabled. The authors of the article propose to develop services for the elderly at home, introduce innovative technologies and improve the quality of services provided. Social services play a special role in this, which is confirmed by the experience of public service centers. The introduction of innovative service practices and technologies, and the expansion of the number of social services are promising areas for preserving the social capital of the elderly.

Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework

BackgroundLanguage and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians.MethodsIn this exploratory-descriptive qualitative study, semi-structured interviews (1-h) were conducted virtually between July and November 2023. We interviewed 16 family physicians with experience providing linguistic and/or culturally discordant palliative/EoL care in various urban, suburban, and rural regions of Ontario, who practiced at community and hospital outpatient clinics, home-based care, or long-term care homes. We used reflexive thematic analysis to identify themes across the interviews guided by the intersectionality theoretical framework.ResultsWe identified three themes 1) Visible barriers to care access due to the inability to communicate accurate information and insufficient time spent during appointments with patients; 2) Invisible barriers to care access, shaped by the Eurocentric approach to palliative care and physicians’ lack of awareness on cultural discordance; 3) Workplace supports that currently exist and interventions that physicians would like to see. Community physicians following fee-for-service models were less likely to have access to professional interpreter services. Physicians in long-term care emphasized resource limitations to providing culturally-appropriate care environments.ConclusionCultural discordance required awareness of personal biases, while language discordance hindered basic communication. These findings will be useful in informing clinical practice guidelines and mobilizing policy-level change to improve palliative/EoL care for patients from linguistic and cultural minority groups.

Unpaid caregivers' process of collaborating with others during older adult hospital-to-home transitions: A grounded theory study.

Unpaid/family caregivers provide support critical to older adult hospital-to-home transitions, but lack time and preparation. There is limited evidence regarding important collaboration for caregivers during the transition. The objective was to examine caregivers' process of collaborating with others, including other family members, healthcare professionals, and community, social, and professional networks, during older adult hospital-to-home transitions. This study utilized grounded theory methodology. One-on-one interviews were conducted with unpaid/family caregivers of an older adult during a hospital-to-home transition. Data were analyzed using open, axial, and selective coding. Participants (N = 16) relationship to the older adult included: partners (n = 8), friends (n = 4), children (n = 3), and siblings (n = 1). Most were female (n = 14) and living with the older adult (n = 10). A conceptual model was developed which illustrates participants' process through 3 stages: 1) identifying and learning the caregiver role, 2) collaborating with others to provide care and support to the older adult, while supporting themselves, during the hospital-to-home transition, and 3) supporting the older adult's progress in recovering independence or planning to provide long-term care and support. Participants described multiple approaches to collaborating with others: caring on own, caring in network, caring with healthcare professionals, and caring with social and professional networks. Implications include the need to recognize and promote utilization of care networks, as it may help address negative outcomes associated with caregiving. We also identified opportunities to further leverage caregivers' social/professional networks and increase focus on caregiver needs in healthcare encounters.

Nursing Home Administrators' Experiences of Work Stress and Intention to Quit during the COVID-19 Pandemic.

The COVID-19 pandemic negatively impacted nursing home administrators (NHAs). This study explores licensed and employed NHA's perceptions about what work stress events would drive their turnover intentions (TI) in year three of the pandemic. As part of a larger survey-based research project collecting numerical and textual data, this study conducted content analysis with qualitative data. Narrative data from 3,859 discrete responses of 1,139 NHAs, from 50 states and Washington D.C, on two open-ended electronic survey questions asking about their work stress and TI were collected February - March 2022. Categories and subcategories were counted and discussed in context as themes. We identified 4 main narrative categories with subcategories about NHA's stress about the regulatory system (e.g., excessive, conflicting, changing regulations), staffing (e.g., insufficient, agency staff), organizational pressures (e.g., work overload), and macro system stressors (e.g. media representation of nursing homes). Three main TI categories with subcategories were identified: the LTC setting and system (e.g., regulatory demands, staffing, facility surveys); personal factors (e.g. stress, career opportunities), and others (e.g., "I would never quit," or "I already decided to quit"). Whole community disaster planning, person-centered surveyor training, improved regulatory guidance, simplified reporting, adequate guidance assistance, and adequate staff could mitigate NHA stress and TI during crises. Administrator resilience should be recognized. Solutions for supporting NHAs can include long-term care industry participation in public health disaster preparedness coalitions, consistent regulatory guidelines with established communication channels, and ongoing crisis leadership training for administrators.

Projecting Long-Term Care Costs Among Older Adults With ADL Disabilities and Cognitive Impairment in China.

Mounting evidence suggests that cognitive impairment is strongly associated with disability in activities of daily living (ADL disability) and long-term care (LTC) costs. However, studies forecasting future LTC costs often overlook these relationships. Consequently, this study aims to more accurately project future LTC costs in China over the next 20 years by considering the intertwined association between disability and cognitive impairment on future LTC costs. Data were from 10 959 adults ≥65 years from the 2005-2018 waves of the Chinese Longitudinal Healthy Longevity Surveys. We used the Markov model to project the population of China and track the transition of older adults in the next 20 years between 4 disability-cognition states. We employed a 2-part model to estimate LTC costs (direct and indirect LTC costs) per capita. The proportion of disabled older adults with cognitive impairment was projected to increase from 1.4% in 2021 to 3.4% in 2040, while that of those without cognitive impairment was projected to decrease from 4.7% in 2021 to 4.5% in 2040. The direct and indirect LTC costs were projected to increase from 0.3% and 0.2% of gross domestic product (GDP) in 2021 to 1.4% and 0.7% in 2040 for disabled persons without cognitive impairment and from 0.1% and 0.1% of GDP in 2021 to 1.3% and 1.3% in 2040 for those with cognitive impairment, respectively. Policy-makers could include the assessment of cognition in the LTC needs assessment and allocate more compensation to LTC insurance participants with cognitive impairment.

"More Than Just Holding the iPad": Family Members' Perspectives on the Work of Video Calling in Aged Care

Video calls are increasingly being adopted to enable older adults living in long-term residential care (aged care homes) to remain socially connected with friends and family. However, care home residents often require extensive support to participate effectively in video calls. Despite growing interest in examining the work involved in facilitating technology use in care homes, the role of caregivers---comprising family members and staff---in facilitating video calls has received limited attention. Drawing on data from a study of family members' experiences in Australia, we analysed the essential work activities required to make video calls function in residential aged care. We show how video calling is underpinned by the development of relationships between families and staff, and how video calling requires considerable work in preparation, facilitation, and troubleshooting. We discuss how video calling systems for care homes might be designed to alleviate unwanted work, lowering the burden of call participation for residents, families, and care staff.

Protocol for a prospective, longitudinal cohort study on the incidence of dementia after the onset of delirium in patients with mild cognitive impairment: MDDCohort (Mild Cognitive Impairment Delirium Dementia)

BackgroundMild cognitive impairment (MCI) is a major risk factor for delirium. Few studies with mid- to long-term follow-up periods have examined delirium, MCI, and the conversion of MCI to dementia. This prospective, longitudinal cohort study aims to assess the incidence of dementia after delirium onset in patients with MCI and to develop an artificial intelligence algorithm for predicting the conversion of MCI to dementia.MethodsA 30-day evaluation for delirium will be performed for adults aged ≥ 65 years diagnosed with MCI who score 18–23 on the Korean Mini-Mental State Exam. Individuals exhibiting delirium at least once will be classified into the delirium group and the remainder into the non-delirium group. Over 3 years, patients will undergo follow-ups for survival and conversion to dementia at 30-day intervals to analyze risk factors for delirium and clinical outcomes. Differences between the two groups will be analyzed using the chi-square and independent t-tests. Kaplan-Meier survival and Cox proportional hazard regression will be used to assess the effects on 30-day, 60-day, 12-month, 24-month, and 36-month mortality, whereas linear regression will be used to assess the length of stay at long-term care facilities and medical costs.DiscussionThe results will emphasize the importance of preventing delirium in MCI patients, and preventive interventions can be strengthened.Trial RegistrationNCT05113446 (ClinicalTrials.gov). Registered 9 November 2021 - Retrospectively registered.

How the COVID-19 pandemic shaped Canadians' preferences for setting of dying: Comparison of two panel surveys.

The purpose of this article is to assess whether COVID-19 shaped Canadians' preferred settings of dying. We compared data collected using the same survey from two independent but comparable sets of panel respondents, prior to and after the onset of the pandemic. A vignette methodology was used to assess preferences for dying in each of four settings: home, acute/intensive care, palliative care, and long-term residential care. Although preferences for dying at home, in acute/intensive care and palliative care units did not change, preferences for dying in nursing homes significantly declined. In the pandemic's first and second waves, the spread of knowledge about problems of poor care, visitation restrictions, and fears of contagion in Canadian long-term residential care may have shaped public perceptions of and preferences for dying these settings. If this change persists, it may influence advance care planning decisions. That preferences for dying at home did not shift is, however, noteworthy.

Forecasting Financial Expenditures for Long Term Care Insurance Evidence from the Typical Pilot Cities in C

Purpose: This study aims to provide decision-makers with a reference by predicting the financial expenditures and trends of long-term care insurance in China over the next thirty years. Approach/Methodology/Design: This study employs Markov chains and overall simulation model to forecast the extent of financial expenditures on long-term care for employees and residents. It examines the financial outlay levels under various entitlement payment scenarios and estimates the discrepancies in financial expenditures between employees and residents from 2021 to 2050. Findings: The results show that (1) The number of disabled elderly employees aged 60 and above will be about 14,288 thousand, and the number of disabled elderly residents will be about 68,176 thousand in 2050. (2) Under the low scenario, the financial expenditures of elderly employees and residents in 2050 will reach 29,636.87 million yuan and 17,597.92 million yuan respectively, which are 2.86 and 10.24 times as much as those in 2021. The total financial expenditures under the medium and high scenarios will be 2.38 and 5.51 times as much as those under the low scenario respectively. (3) The scale of financial expenditure on long-term care insurance for residents far exceeds that of employees, and the trend is expanding. Practical Implications: This study may provide theoretical support for the full implementation of long-term care insurance policies. Originality/value: This study uses Markov models and overall simulation models, along with typical representative plans from pilot areas in China, to differentiate the insurance identity of elderly employees and residents and to estimate the scale and trend of financial expenditures for long-term care insurance in China from 2021 to 2050.

Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

Few studies have investigated the association between COVID-19 and autoimmune and autoinflammatory connective tissue disorders; however, research with long-term observation remains insufficient. To investigate the long-term risk of autoimmune and autoinflammatory diseases after COVID-19 over an extended observation period. This retrospective nationwide population-based study investigated the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service (K-COV-N) cohort. Individuals with confirmed COVID-19 from October 8, 2020, to December 31, 2022, and controls identified among individuals who participated in the general health examination in 2018 were included in the analysis. Confirmed COVID-19. Incidence and risk of autoimmune and autoinflammatory connective tissue disorders in patients after COVID-19. Various covariates, such as demographic characteristics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting. A total of 6 912 427 participants (53.6% male; mean [SD] age, 53.39 [20.13] years) consisting of 3 145 388 with COVID-19 and 3 767 039 controls with an observational period of more than 180 days were included. Alopecia areata (adjusted hazard ratio [AHR], 1.11 [95% CI, 1.07-1.15]), alopecia totalis (AHR, 1.24 [95% CI, 1.09-1.42]), vitiligo (AHR, 1.11 [95% CI, 1.04-1.19]), Behçet disease (AHR, 1.45 [95% CI, 1.20-1.74]), Crohn disease (AHR, 1.35 [95% CI, 1.14-1.60]), ulcerative colitis (AHR, 1.15 [95% CI, 1.04-1.28]), rheumatoid arthritis (AHR, 1.09 [95% CI, 1.06-1.12]), systemic lupus erythematosus (AHR, 1.14 [95% CI, 1.01-1.28]), Sjögren syndrome (AHR, 1.13 [95% CI, 1.03-1.25]), ankylosing spondylitis (AHR, 1.11 [95% CI, 1.02-1.20]), and bullous pemphigoid (AHR, 1.62 [95% CI, 1.07-2.45]) were associated with higher risk in the COVID-19 group. Subgroup analyses revealed that demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, exhibited diverse associations with the risk of autoimmune and autoinflammatory outcomes. In addition, severe COVID-19 infection requiring intensive care unit admission, the Delta period, and not being vaccinated were associated with higher risk. This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks.