Residential Care Facilities Research Articles

Sense of belonging and its positive association with physical activity levels and negative association with sedentary behaviors in residential aged care facilities in COVID-19 pandemic: a longitudinal study

IntroductionThe COVID-19 pandemic reduced physical activity levels and increased sedentary behavior among older adults in residential care facilities. Another effect of this crisis was that facilitating a sense of social belonging through in-person social activities, such as group exercises or communal meals, became difficult. This study examines the relationship between physical activity, sedentary behavior, and sense of social belonging in older adults.MethodsThis longitudinal study, which lasted 10 months, involved 57 older adults in residential care facilities. Participants completed the Échelle de mesure du Sentiment d’Appartenance Sociale (ESAS) questionnaire three times and wore an accelerometer on their waists for 1 week each time to measure sedentary time and physical activity levels. The ESAS questionnaire, a validated tool for evaluating social belonging in older adults, measures social belonging through a series of questions that assess an individual’s feelings of acceptance and intimacy within their social group.ResultsParticipants were predominantly sedentary (7.30 h/day) and engaged in low-intensity physical activities (2.9 h/day). They did not meet the recommended 150 min/week of moderate-to-vigorous physical activity. The sense of social belonging was high, with mean scores of 6.75 (ESAS), 7.08 (Acceptance), and 6.43 (Intimacy). Light physical activity was negatively associated with sedentary time. The sense of social belonging was positively associated with light physical activity and negatively correlated to sedentary time.ConclusionThis study underscores the importance of light physical activity and a sense of social belonging in reducing sedentary behavior among older adults in residential care facilities. By promoting social interactions and light physical activity, we can enhance the well-being of this population, especially during pandemic conditions. The study’s findings should inspire future interventions to focus on these aspects, thereby improving health outcomes in residential care facilities for older adults.

The experiences and roles of infection prevention and control professionals working in residential care facilities during global outbreaks: An integrative review.

The escalating threat of global infectious disease outbreaks has underscored the imperative for robust infection prevention and control (IPC) measures, particularly within the high-risk context of residential care facilities. This research aimed to investigate the experiences and roles of IPC professionals (IPCPs) in such settings during global outbreaks. Utilising an integrative review methodology, four electronic databases - Medline, CINAHL, Embase, and Scopus - were searched from 2003 onwards for relevant papers. A two-tiered independent screening approach was employed to select eligible articles, followed by a consensus-based appraisal and thematic analysis of included studies. The final review encompassed eight articles. IPCPs faced systemic organisational and ground-level operational hurdles, including inequitable access to resources, and lack of training and outbreak preparedness. External and internal variables impacted the effectiveness ofoutbreak responses, affecting resident and occupational health, and perceptions of IPC overtime. The review identified systemic challenges IPCPs face in residential care during outbreaks, including resource inequity and lack of standardised training. Centralised resources and standardised educational benchmarks may help to mitigate these issues. Policy changes are required to enhance healthcare readiness, quality, and research in residential care settings.

Differing risk factors for potentially preventable and fall-related injury readmissions of older residents in long-term care facilities after hip fracture

Differing risk factors for potentially preventable and fall-related injury readmissions of older residents in long-term care facilities after hip fracture

Challenges of Dementia Care in a Regional Australian Hospital: Exploring Interventions to Minimise Length of Stay for Dementia Patients.

There are significant difficulties associated with the management of dementia patients in hospitals, leading to adverse patient outcomes, prolonged length of stay (LOS), strain on resources and high readmission rates. This study aimed to investigate these factors in the context of a regional hospital. This study retrospectively reviewed all dementia admissions in a publicly funded Australian regional hospital from January 2022 to December 2022. All admissions including an ICD-10 coded dementia diagnosis were assessed, and data extracted using the integrated electronic medical record. Overall, 257 bed Australian regional hospital in an area with a Modified Monash Model rating of 2. There were 105 dementia patients admitted within the study period. Dementia severity, LOS, consultation liaison (CL) psychiatry involvement, readmission rates, and discharge destinations. The LOS in patients with dementia was 23.3 (± 35.2) days compared to age-matched patients without dementia admitted in the same period with a LOS of 8.2 (± 4.7) days. Dementia patients who died in hospital had the longest acute LOS at 14.4 (± 8.8) days. Dementia patients who were admitted from their usual residential aged care facility had the longest maintenance LOS at 69 (± 83.3) days. This research contributes information to the current knowledge gap of dementia care in regional hospitals. Data from this study may help to inform the development of strategies for effective hospital-based dementia care and interventions.

Promoting aged care COVID-19 and influenza vaccination through education of Australian residential aged care staff: A mixed methods project evaluation.

Vaccination coverage against COVID-19 and influenza among Australian aged care residents remains suboptimal, placing this vulnerable population at heightened risk of severe illness, frailty, and death. Health care professionals' recommendations significantly influence vaccination uptake. Aged care staff, with their unique proximity to residents, play a pivotal role in promoting vaccination. The aims of this study were to evaluate the acceptance of a vaccine education project and determine the impact on vaccine conversation confidence. This quality improvement project aimed to enhance aged care staff's knowledge and confidence in discussing vaccination with residents and their families. It included a 30-min face-to-face educational session for staff members of residential aged care facilities. The session featured a didactic component on COVID-19 and influenza vaccines, an interactive question and answer component, and role-play exercises to demonstrate effective vaccine conversation skills. Evaluation of the project involved participant survey data collected immediately after the sessions and then again at a delayed timepoint. Project developers, co-ordinators, and facilitators also provided feedback on their experience which was analysed through qualitative thematic analysis. The educational program was delivered to 27 facilities across 32 sessions, with 316 staff members attending (median session attendance: 9, IQR 8-13). 95.4% of attendees reported improved knowledge and skills, 95.8% reported increased confidence in vaccine conversations, and 94.2% would recommend the session to others. Qualitative feedback was positive, highlighting the adequacy of content and improved confidence in discussing vaccines. In-house, face-to-face education is a well-received method of delivering education to residential aged care staff. However, facilities in most need of education may be less proactive in seeking it out. Further research is needed to understand barriers to uptake of staff education and strategies for fostering a culture of quality improvement and ongoing learning within facilities.

By Their Side, Not on Their Chest: Ethical Arguments to Allow Residential Aged Care Admission Policies to Forego Full Cardiac Resuscitation.

We argue that Aged Residential Care (ARC) facilities should be allowed to create and adopt an informed "No Chest Compression" (NCC) policy. Potential residents are informed before admission that staff will not provide chest compressions to a pulseless resident. All residents would receive standard choking care, and a fully discussed advance directive would be utilized to determine if the resident wanted a one-minute trial of rescue breaths (to clear their airway) or utilization of the automatic defibrillator in case of arrest. The benefits of chest compressions for residents in ARC are dubious, and the burdens are high. For frail elderly people without a pulse, chest compressions are arguably unethical because the chance of benefit is minuscule, the procedure is violent, painful, and challenging to perform correctly, and procedures detract from a peaceful end of life. These burdens fall on residents, their families, ARC facilities providers, and society. We further argue that limitations on universal invasive resuscitation, such as advance directives, need to be more consistently sought and applied. The goals of an informed NCC policy are twofold: removing added suffering from a person's end-of-life experience and increasing ARC residents' understanding of the burdens of ineffective treatments for pulselessness.

Association of Self-Perceived Fatigue, Muscle Fatigue, and Sleep Disorders With Cognitive Function in Older Adults: A Cross-Sectional Study.

Fatigue and sleep disorders are common geriatric conditions and are associated with an increased risk of cognitive decline. This study aimed to examine the relationships among self-perceived fatigue, objective muscle fatigue, sleep apnea risk, insomnia, and cognitive function, focusing on their associations with mild cognitive impairment (MCI). Cross-sectional study. The study involved 217 older adults (median age: 80years, 65.6% women) from 2 residential care facilities in Vienna, Austria. Cognitive function was assessed with the Mini-Mental State Examination. Sleep quality and disturbances were evaluated using the Athens Insomnia Scale (AIS) and STOP-BANG questionnaire. Subjective fatigue was measured with the Multidimensional Fatigue Inventory, and objective muscle fatigue through 2 rounds of 10 maximal handgrip strength tests, separated by a 1-hour rest. Multivariable regression models adjusted for age, sex, comorbidities, sleep medication, and total number of medications were used to analyze associations among fatigue, sleep disturbance, and MCI. Participants with MCI (n= 72) had significantly lower handgrip strength (median Fmax1: 18.75kg vs 23.44kg), higher muscle fatigue ratios (median: 1.40 vs 1.19), and poorer recovery ratios (median: 0.85 vs 1.01) compared with those without MCI (n= 145). Sleep disorders and fatigue measures were more common in those with MCI, with 80.6% reporting insomnia (AIS ≥6) compared with 21.4% in the cognitively intact group. Logistic regression showed that muscle fatigue combined with sleep apnea risk was associated with the highest odds of cognitive impairment (odds ratio [OR], 6.12; 95% CI, 2.77-13.51; adjusted OR, 3.02; 95% CI, 1.15-7.92). Recovery capacity showed a positive association with cognitive function (β= 0.150, P < .05). Sleep apnea, muscle fatigue, and reduced recovery capacity are significantly associated with cognitive decline in older adults. Assessing these factors may help in identifying individuals at risk of cognitive impairment.

Resonances of Feeling Alone: A Systematic Review Unveiling Older Persons' Loneliness and Its Mechanisms in Residential Care Facilities.

To review older persons' lived experiences and perceptions of loneliness in residential care facilities and characterise mechanisms underlying their experiences through a comprehensive loneliness model. A systematic review synthesising qualitative research on the experiences of loneliness among older people living in residential care facilities. This review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines with quality appraisal conducted using the Critical Appraisal Skills Programme checklist. Articles published in English (2014-2024) from CINAHL, PubMed, PsycINFO and Web of Science. Sixteen articles met inclusion criteria, representing 357 participants across 10 countries and regions. Three core themes of loneliness were identified: relational and individualised loneliness experiences, perception and emotional distress and the influence of context and cognitive processes in modulating loneliness. A conceptual model delineating the mechanisms of older residents' loneliness in residential settings was developed. This review highlights the influence of older persons' residential context and cognitive processes, particularly their perceptions, in triggering loneliness. The perceptions of reduced social control and insufficient social connections in residential settings exacerbate older persons' loneliness, precipitating distressing emotional responses and diminished quality of life. Residential care facilities have a crucial responsibility in establishing a supportive atmosphere conducive to positive social engagement for older residents. Future research must explore strategic transformations of older persons' perceptions through mechanistic targets and tailored care plans to reshape their social expectations within the context of residential care facilities, potentially mitigating loneliness. This review addresses the problem of understanding the mechanisms and experiences of loneliness among older persons in residential care facilities. The findings highlight the critical need for supportive social environments and targeted interventions in residential care settings to improve residents' well-being and quality of life globally. Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. No patient or public contribution.

Evaluation of the effect of dental caries, oral hygiene, and treatment need on oral health-related quality of life among Turkish orphan children and adolescents

BackgroundThe oral and dental health and related quality of life of orphan children and adolescents—who are considered a vulnerable population—are critical for both individual and public health.ObjectivesThis study aimed to investigate the status of the dental caries, oral hygiene, and dental treatment needs among a group of Turkish male orphan children and adolescents, as well as their impact on oral health-related quality of life.MethodsA total of 112 orphan children and adolescents aged between 9 and 17 years living in a residential care facility in Istanbul, Türkiye, were involved in this cross-sectional study. A comprehensive examination was conducted on each individual, encompassing the assessment of dental caries using the decayed, missing, and filled teeth (DMFT/dft) index, oral hygiene using the debris (DI-S), calculus (CI-S), and simplified oral hygiene (OHI-S) indices, and dental treatment need using the treatment need index (TNI). Oral health-related quality of life was evaluated using the validated Turkish version of the Child Oral Health Impact Profile-Short Form (COHIP-SF-19). The relationship between oral health-related quality of life and explanatory variables was evaluated using a multivariable linear regression model.ResultsThe mean age of the participants was 12 ± 1.79 years. The mean DMFT score was 4.57 ± 3.42, and the mean OHI-S score was 1.4 ± 0.52. Participants had a mean COHIP-SF-19 score of 57.79 ± 14.11, with 25% requiring at least one tooth to undergo radical treatment. Multivariable linear regression analysis indicated that the DMFT score (p = 0.009) and the need for radical treatment (TNI code 6) (p < 0.001) had a statistically significant impact on oral health-related quality of life among orphan children and adolescents aged 13–17.ConclusionsThis study underscores that dental caries and the need for radical treatment significantly impact the oral health-related quality of life of orphan children and adolescents.

Faith motifs in the constructions of family meanings by adults with care experience in Zimbabwe

PurposeAdults with care experience often struggle to make sense of their family relationships owing to adverse childhood experiences (ACES). This study analysed motifs of faith and spirituality in how care leavers made sense of the concept of “family” in their lives.Design/methodology/approachQualitative semi-structured interviews were used to collect data from 45 adult care leavers Harare, Zimbabwe. A thematic analysis brought out recurring ideas of faith and spirituality that influenced participants’ family constructions.FindingsThe Church played a functional role in care leavers’ lives providing support and care. Faith-based residential care facilities engaged in group spiritual practices, such as going to Church together, praying and worshiping together, which fall within the contemporary concept of “family practices” and allowed care leavers to view unrelated caregivers as “family” based on shared experiences. Finally having faith in God was described as an anchoring force when dealing with the hardships of adulthood in the absence of biological family and state support. These findings have implications for social policy around the role of faith-based institutions in child welfare.Originality/valueThe investigation of the role of faith and spirituality in care-experienced lives is an emerging area of study. This study explores the role of faith and spirituality in care leavers interpersonal lives, which contributes to studies of care leavers’ personal lives. As a marginalized group of young people, their voices are crucial in informing social policy around their care after leaving public state care.

Shared Decision-Making on Tobacco Smoking by Older Adults Living in Residential Care Facilities: Care Professionals' Perspectives.

Older adults with physical or cognitive disabilities may need to move to residential care facilities (RCFs). Some older adults smoke tobacco and become dependent on their care professionals to continue smoking. Care professionals need to balance an individual resident's quality of life and well-being with the health and safety of all residents and staff. Shared decision-making (SDM) could support care professionals in these dilemmas. This study assesses multiple factors that could affect care professionals' behavior and degree of SDM regarding residents' tobacco use. We conducted quantitative cross-sectional research. We included care professionals working in psychogeriatric and somatic units in Dutch RCFs. Data were collected with an online or hard copy survey and analyzed with t-tests and regression analyses using SPSS. Care professionals' positive attitudes toward residents' tobacco use are significantly associated with a lower degree of SDM concerning this use and enabling residents to smoke more often. The degree of SDM regarding residents' tobacco use is significantly positively associated with limiting residents' tobacco use and the degree of person-centered care (PCC). Care professionals working in somatic units report a significantly higher degree of SDM regarding residents' tobacco use compared with those working in psychogeriatric units. Residents' wish to smoke tobacco is a complex matter within RCFs. Care professionals' attitudes cause inconsistencies in their behavior and the degree of SDM. Moreover, care professionals tend to use SDM more often when they need to limit residents' use and cannot fulfill residents' unhealthy habits, such as smoking tobacco. SDM could support care professionals to deal with dilemmas regarding residents' tobacco use by including residents in decisions, regardless of the outcome. However, multiple factors affect care professionals' behavior and the degree of SDM. Especially, their attitudes need to be addressed. SDM is further complicated by national acts and organizational policies.

Genotyped cluster investigations versus standard contact tracing: comparative impact on latent tuberculosis infection cascade of care in a low-incidence region

BackgroundCluster and contact investigations aim to identify and treat individuals with tuberculosis (TB) and latent TB infection (LTBI). Although genotyped cluster investigations may be superior to contact investigations in generating additional epidemiological links, this may not necessarily translate into reducing infections. Here, we investigated the impact of genotyped cluster investigations compared to standard contact investigations on the LTBI care cascade in a low incidence setting.MethodsA matched case-control study nested within a cohort of 6,921 TB cases from Florida (2009–2023) was conducted. Cases (n = 670) underwent genotyped cluster investigations, while controls (n = 670) received standard contact investigations and were matched 1:1 by age. The LTBI care cascade outcomes were compared using Pearson’s chi-square tests.ResultsOf the 5,767 identified contacts, 3,230 (56.0%) were associated with the case group, while 2,537 (44.0%) were identified in the control group. A higher proportion of contacts were evaluated in the control group (85.5%) than in the case group (81.5%, p < 0.001). While the proportion of evaluated contacts diagnosed with LTBI did not significantly differ between the groups (case: 20.4%, control: 21.5%, p = 0.088), a higher percentage of LTBI-diagnosed contacts initiated TB preventive treatment (TPT) in the control group (95.9%) than the case group (92.9%, p = 0.029). TPT completion rates were similar, with 65.2% in the case group and 66.3% in the control group (p = 0.055). TB patients in the case group were more likely to be males, U.S.-born, Asians, residents of long-term care or correctional facilities, with past year histories of alcohol use, homelessness, and drug use.ConclusionDespite the demographic and epidemiological differences between cases and controls, cluster investigations identified more contacts, with no significant difference in contacts diagnosed with LTBI, but were less effective than standard contact investigations in evaluating contacts, initiating LTBI treatment, and ensuring completion.

Integrating Dental Professionals Into Aged Care With Focus on Australia: A Scoping Review.

To summarise the current evidence on the involvement of dental hygienists (DHs) in residential aged care facilities (RACFs) with respect to the feasibility of integration improved oral health for residents with dementia and multidisciplinary collaboration. The oral health of RACF residents with dementia is reported to be poor. However, little is known about how DHs can be integrated into RACFs to improve oral health, particularly as part of a multidisciplinary team. A scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) method. Multiple databases were searched for peer-reviewed articles and grey literature that included a DH working in a RACF with dementia patients, or as part of a multidisciplinary team. Data were charted using a modified version of the JBI source of evidence template. Fifty-eight studies were identified for inclusion. Integration strategies were categorised as support-focused or service-focused, but there was little evaluation of their feasibility. Five key facilitators to multidisciplinary collaboration were identified: using multiple strategies; clearly defining roles; changes to existing administrative systems; fostering multidisciplinary collaboration skills; and encouraging innovation. However, no examples of collaboration within RACFs were identified. There has been limited effort in multidisciplinary collaboration or integration of DHs into RACFs with some evidence that both support-focused and service-focused strategies can improve the oral health of residents with dementia.

'I've heard of it but had nothing… not much to do with it': The experience of older people and their families with the Resident of the Day (ROD) process in Victorian aged care facilities.

To explore the experiences of older people living in Australian residential aged care facilities (RACFs) and families of older people living in RACFs, regarding the process of Resident of the Day (ROD; sometimes referred to as a resident review) and their knowledge of how these assessments inform care planning. Semi-structured interviews were used to engage residents and families in conversations about their experiences and knowledge of the assessment associated with ROD and subsequent care planning. A reflexive thematic analysis was used to generate findings. Twenty-six interviews were conducted in four RACFs across Victoria, diverse in terms of geographic location and provider type. Those residents who had some awareness of the ROD described the process only in superficial terms. Connections between ROD and care planning were unable to be made by most residents. Family members had a greater level of awareness of the ROD, although they were unable to describe the process or purpose and did not connect it to care planning. Despite being undertaken in all Victorian RACFs, residents and families have little or no knowledge of the ROD process, purpose or what happens to the information collected.

Pneumococcal Vaccination Coverage Among Adults at Risk in the Russian Federation

Relevance. Pneumococcal infection remains one of the most significant health problems worldwide. Vaccination of adults against it has been carried out in the Russian Federation for over 10 years. During this time, more than 9 million people have been vaccinated. However, data on the level of coverage among adults of certain risk categories are not routinely collected. Our study in 2019 showed that it was low in most groups. Given the significant increase in the volume of vaccination over the past five years, it seems appropriate to conduct a study to assess changes in the level of coverage.Aim. To study the level of vaccination coverage against pneumococcal infection in adult risk groups in the Russian Federation.Materials and methods. An observational descriptive retrospective epidemiological study was conducted. Information on the number and contingents of people vaccinated against pneumococcal infection was collected by sending a request to the executive authorities of the constituent entities of the Russian Federation in the field of healthcare. The depth of data collection was 8 years (from 2015 to 2023 inclusive), information was received from 74 out of 89 regions. In addition, federal statistical observation forms were used: No. 5 «Information on preventive vaccinations» and No. 6 «Information on the contingents of children and adults vaccinated against infectious diseases», data from the Unified Interdepartmental Information and Statistical System. The results obtained were compared with the indicators obtained in the 2019 study, which was conducted according to a similar design. The analysis was carried out using descriptive statistics methods.Results. The coverage rate of vaccination against pneumococcal infection among the adult population in the Russian Federation increased from 1.5% in 2018 to 7.7% in 2023. The most significant coverage rates were achieved among persons subject to conscription for military service (78.5%) and persons over 60 years old, living in residential care facilities (87.7%). By 2023, vaccination coverage has increased among the following risk categories: individuals with chronic bronchopulmonary diseases (from 15.1% in 2018 to 47.9% in 2023), chronic heart diseases (from 3.8% to 17.0%), patients with endocrine diseases (from 1.1% to 17.6%), liver diseases (from 4.0% to 12.0%), healthcare workers (from 4.9% to 19.7%), school and preschool employees (from 3.1% to 12.9%), employees of residential care facilities (homes for elderly, nursing homes, ect.) (from 0.1% to 26.9%), the elderly population as a whole (from 1.4% to 12.7%), and working-age men (from 1.4% to 7.0%). There was virtually no increase in coverage among all groups of immunocompromised patients (1.0% in 2018, 6.2% in 2023), the working population with risk factors harmful to the respiratory system (0.9% in 2018, 5.0% in 2023), workers in the oil and gas and chemical industries (1.3% in 2018, 1.8% in 2023).Conclusion. The obtained results indicate the need to develop a strategy of measures to promote increased vaccination coverage in risk groups that are insufficiently covered by vaccination against pneumococcal infection.

Equipping residential aged care facilities for acute respiratory illness: The Western Sydney experience of improving outbreak management.

Acute respiratory illnesses have a disproportionate impact on older people, and especially those living in residential aged care facilities where transmission risks are heightened. Additionally, staff in these facilities have been working under challenging conditions, often ill-equipped in terms of both training and resources to successfully manage the outbreaks of these illnesses. This paper examines the actions of an Australian public health unit to improve influenza outbreak management in residential aged care facilities and critiques the outcomes through a contemporary lens. A naturalistic case study using critical thematic analysis was used to study the Western Sydney Public Health Unit's work with the residential aged care facilities under their jurisdiction in the management of influenza outbreaks during 2014-2019. Key to the Public Health Unit's approach to improving outbreak management in residential aged care facilities was their sustained engagement with aged care stakeholders, activities to build outbreak management capacity in this setting, and an investment in research to inform ongoing action. This engagement was mutually beneficial, as the Public Health Unit and residential aged care facilities became more attuned to each other's needs and challenges. Supporting facility staff in difficult situations resulted in a timelier public health response and improved outbreak management. In Australia, Public Health Units are important partners in the cumulative development of outbreak management capacity and responsiveness in the residential aged care setting; particularly considering the challenges posed by novel pathogens and in establishing an evidence base for best practice and future preparedness.

Protective factors promoting participatory rights for early childhood children in residential care facilities in Harare, Zimbabwe

ABSTRACT This qualitative study explored protective factors in implementing participatory rights for six-to-seven-year-old children living in seven residential care facilities in Harare, Zimbabwe. The study consisted of seven semi- structured interviews using open-ended questions with seven directors. The residential care facilities were purposefully sampled based on the style they adopted, namely five homes adopted the household unit and two the dormitory style. Through thematic data analysis, four themes were identified that promoted protective factors for implementing participatory rights of children in the early years of development residing at the homes, namely: the use of an open-door policy, the household unit style, foster care intervention programmes, and the availability of mass media. Based on the findings several recommendations are made on how to further protect the participatory rights of the children. Although the study was conducted in Zimbabwe, it has global value because there are residential care facilities in all countries.

Social Participation of the Elderly Living in Residential Care Facilities in Malaysia

Social participation plays a crucial role in the overall well-being and quality of life of elderly, especially those residing in residential care facilities. In Malaysia, the aging population has increased, and many elderly individuals now live in institutional settings due to various socio-economic factors. This study explores the level of social participation among elderly residents in Malaysian residential care facilities, identifying key barriers and enablers to active involvement in social activities. A quantitative approach was employed to assess participation levels of elderly residents. The findings suggest that while some elderly individuals actively engage in recreational, social, and cultural activities, others face challenges such as physical limitations, lack of stimulating activities, and limited interaction with external communities. Factors such as staff support, facility infrastructure, and family involvement were found to significantly impact the extent of social participation. The study emphasizes the importance of designing inclusive and engaging environments within residential care facilities to promote social participation and improve the mental, emotional, and social well-being of the elderly. Recommendations for policy, practice, and future research are provided to address the identified gaps and enhance the social integration of elderly residents in Malaysian care settings.

Shifting Student Attitudes of Gerontology Nursing: A Quasi-Experimental Evaluation of a Clinical Educator Programme.

Enduring shortages in the gerontology nursing workforce are projected to increase as demand for services for older persons grows. Recruitment of Registered Nurses in gerontology is further hindered by negative perceptions held by students towards nursing older people. To determine whether a professional development activity designed to assist clinical supervisors to build the mentorship capacity of care staff in residential aged care facilities could positively improve their clinical learning environment and improve student attitudes towards working with older adults. A quasi-experimental, non-equivalent pretest-posttest control group design. Clinical settings in which participants were undertaking an older person-focused clinical placement. A purposive sample of 466 first-year undergraduate nursing students. Forty-seven students responded to both the pre- and post-placement surveys. The intervention comprised four professional development sessions delivered to clinical supervisors supervising nursing students during clinical placement across three residential aged care facilities. Pre- and post-placement surveys measured Student Perceptions of Working with Older People (SPWOP). The modified Clinical Learning Environment Inventory (CLEI) was included in the post-placement survey to measure student perceptions of the clinical placement learning environment. Control group participants reported higher pre-placement SPWOP scores yet showed no significant improvement in score post-placement; however, the intervention group reported a statistically significant increase in SPWOP score post-placement. Modified CLEI results revealed the control group reported higher levels of engagement in the learning environment, yet the intervention group reported greater motivation to learn. An intervention designed to build staff mentorship capacity in gerontology care settings can positively influence student perceptions of working in gerontology. Despite these positive gains, results indicated that students who undertook placement at the intervention sites were less engaged. This disparity illuminates the need for continued efforts to build staff mentorship capacity in older person-focused clinical learning environments to improve student experiences and perceptions of gerontology nursing. Further research that engages directly with unregulated healthcare workers in geronotological care settings could provide new insights into what this cohort need to become effective mentors and shift student nurse attitudes towards caring for older adults.

Experiences of Eldercare Staff Working With Older People With Severe Mental Illness

In Sweden, older persons living with severe mental illnesses (SMI) increasingly live independently in the community with support from informal and formal carers and welfare services. A proportion of this group is older people with SMI who, due to age or disability, receive municipal eldercare services such as home care in their ordinary housing, or in residential care. The situation and needs of this group demand that eldercare staff have an understanding for the older person’s situation and the tools to provide appropriate care. The aim of this present study is to explore the experiences of eldercare staff working with older people with SMI. Focus group interviews were conducted with staff from three residential care facilities and two home care teams in one mid‐sized Swedish municipality. To analyse the interviews, qualitative content analysis was used. The overarching theme from the analysis was “Doing the best they can,” which was unpacked in two categories: “Working with fragmentary knowledge” and “Finding the right approach.” We could also see differences between the experiences of staff in residential care and in home care. The eldercare staff in our interviews faced lack of formal training, insufficient information and skills concerning mental illness and its treatment. Nevertheless, they tried to make the situation of the older people with SMI as good as possible using experiential and tacit knowledge. Our results also point to system level barriers that hinder effective care for older people with SMI.