Older People In Residential Care Research Articles

Not All Frailty Assessments Are Created Equal: Comparability of Electronic Health Data-Based Frailty Assessments in Assessing Older People in Residential Care.

Objectives: To evaluate the comparability of frailty assessment tools - the electronic frailty index (eFI), retrospective electronic frailty index (reFI), and clinical frailty scale (CFS) - in older residents of care facilities. Methods: Data from 813 individuals aged 65 or older, with frailty and co-morbidities, collected between 2022 and 2023, were analysed using various statistical methods. Results: The results showed significant differences in frailty classification among the tools: 78.3% were identified as moderately to severely frail by eFI, 59.6% by reFI, and 92.1% by CFS. Statistical tests confirmed significant differences (p < .05) in their assessments, indicating variability in measurement methods. Discussion: This study advances the understanding of frailty assessment within aged-care settings, highlighting the differences in the efficacy of these assessment tools. It underscores the challenges in frailty assessments and emphasizes the need for continuous refinement of assessment methods to address the diverse facets of frailty in aged care.

Cross-sectional study of prevalence and correlates of fear of falling in the older people in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

ObjectiveTo report the prevalence and risk factors for the fear of falling (FOF) among older individuals living in residential care facilities in India.DesignCross-sectional study.SettingHomes for the aged centres in Hyderabad,...

A new scale for older resident satisfaction with residential integrated care in China: Development and validation

The factors that affect resident satisfaction with emerging residential integrated care for older people in China have been unclear due to a lack of validated instruments. Based on psychometric assessment procedures, we developed a new scale for older resident satisfaction with residential integrated care (SORSRIC). The scale was developed using a two-step process and a sample of 16 Chinese institutions and 333 residents. Exploratory and confirmatory factor analysis was used to evaluate reliability and validity. Principal component analysis and maximum variance methods were used to orthogonally rotate the items to extract seven factors. These were: resident expectations, perceived quality (physical care), perceived quality (mental care), perceived value, resident satisfaction, resident complaints, and resident loyalty. The CR value of each dimension of the pre-tested, formal scale was greater than 0.80, and the AVE value was greater than 0.50. This 24-item instrument showed good reliability and structural validity and can be applied to improve the experience and outcomes for older people in residential care.

Integrating oral health assessment in the care for older people by means of the interRAI oral health section: an implementation and evaluation study.&amp;nbsp;

Background: Oral health of care-dependent older people is generally poor which can affect their general health and well-being. In nursing homes, caregivers such as nurses and nurse aids are important actors for delivering oral care and detecting oral health problems. Performing regular oral health assessments is a key element to improve oral health in older people. The interRAI instrument used in the long-term care facilities (LTCF) includes an oral health section (OHS) and holds the potential to integrate oral care in the general care planning. Since the standard OHS fails to adequately detect oral health problems, an optimized section was developed. The study evaluates the optimized OHS of the interRAI suite of instruments in order to integrate oral health assessment in the daily practice. &#x0D; Setting and participants: Care-dependent older people living in 11 nursing homes in Flanders, Belgium, who are 65 years or older. Their professional caregivers are also included in the study.&#x0D; Methods: This 2-year longitudinal cluster randomized controlled trial is set up in three parallel groups (2 test groups and 1 control group) to evaluate the effectiveness and the usability of the optimized and validated OHS for use in the interRAI-LTCF. In the intervention groups T1 and T2, trained caregivers use the interRAI-LTCF with the optimized OHS. Additionally, caregivers in T2 receive support to use new guidelines for oral care. In the control group, caregivers assess oral health using the standard OHS. The study has a longitudinal design with a mixed methods approach.&#x0D; The data collected about oral health and general health will be coupled with a national registry database on dental care consumption to analyze the outcome of the OHS regarding dental referral and actual dental care utilization. At the caregiver level, changes in knowledge and attitude regarding oral health will be evaluated using questionnaires. Interviews with older people and focus group discussions with caregivers will help to understand the usability of the optimized OHS and associated training.&#x0D; Results: The quantitative results will show whether the use of the optimized OHS enables improved oral health in care-dependent older people in residential care and improves the knowledge, attitude and perception of caregivers towards oral health and oral care. The qualitative data will show how older people and their caregivers experience the use of this OHS and to what extent daily and professional oral health care changes for the older people, being more intensively integrated in general care planning.&#x0D; Discussion: In residential care settings, prioritizing care tasks often brings neglect regarding oral care for care-dependent older people. Professional dental care is also difficult to deliver, due to mobility or lack of resources. This study evaluates whether regular oral health assessments performed by caregivers in residential care improve oral health in older people and to what extent these oral health assessments lead to better integration of oral care in general care. The results will shed light on the ongoing situation and will provide evidence to support the use of the optimized OHS and accompanying oral care guidelines in daily practice.

Clarity and adaptability of instructions preventing the spread of the COVID-19 virus and its association with individual and organisational factors regarding the psychosocial work environment: a cross-sectional study

BackgroundIn Sweden, older people in residential care had the highest mortality rates, followed by those who received home care, during the coronavirus disease 2019 (COVID-19) pandemic. Staff working in the care of older people assumed responsibility for preventing the spread of the virus despite lacking the prerequisites and training. This study aimed to investigate the psychosocial work environment during the COVID-19 pandemic among staff in the care of older people and examine the factors associated with staff’s perceptions of the clarity of instructions and the ability to follow them.MethodsA cross-sectional study design was employed using a web survey. The staff’s perceptions of their psychosocial environment were analysed using descriptive statistics. The association between organisational and individual factors, as well as the degree of clarity of the instructions and the staff’s ability to follow them, were assessed using multivariate (ordinal) regression analysis.ResultsThe main findings show that perceptions of the clarity and adaptability of the instructions were primarily correlated with organisational factors, as higher responses (positive) for the subscales focusing on role clarity, support and encouragement in leadership at work were associated with the belief that the instructions were clear. Similarly, those indicating high job demands and high individual learning demands were less likely to report that the instructions were clear. Regarding adaptability, high scores for demands on learning and psychological demands were correlated with lower adaptability, while high scores for role clarity, encouraging leadership and social support, were associated with higher adaptability.ConclusionsHigh job demands and individual learning demands were demonstrated to decrease the staff’s understanding and adoption of instructions. These findings are significant on an organisational level since the work environment must be prepared for potential future pandemics to promote quality improvement and generally increase patient safety and staff health.

The complexities of implementing an LGBT inclusion scheme in residential care: sharing knowledge, overcoming opposition and producing in- and exclusion

Abstract A growing number of organisations in residential care for older people are working towards safe and inclusive environments for LGBT residents. In the Netherlands, these efforts are supported by an LGBT inclusion scheme called ‘Pink Passkey’. Drawing on critical organisational diversity studies, the paper understands inclusion as ‘accomplished’ in interactions across difference, and as always inherently partial (i.e. exclusion-producing). Qualitative methods are used to study the implementation process of the Pink Passkey in two nursing homes during one year. In sum, the paper contributes evidence of positive change associated with the use of the Pink Passkey as an inclusion scheme characterised by a long-term, open-ended and comprehensive approach. Compared to fixed-term projects and stand-alone measures described in previous LGBT ageing literature, an inclusion scheme helps to gain sustained attention to sexual and gender diversity (despite gaps in the implementation process), to normalise it more and to overcome opposition (though this does not disappear). The inclusion accomplished is, indeed, partial: bisexual, transgender and other gender non-conforming identities are less represented than gay and lesbian identities. Also, there is an emphasis on residents' agency to disclose LGBT identities and preferences, which excludes involuntary same-sex sexual expressions caused by disinhibited behaviour. The paper ends by suggesting disinhibited behaviour in older LGBT adults as an issue of interest to the wider literature on LGBT ageing, given the increasing prevalence of dementia and Parkinson's disease. Here, the role of care professionals who are able to understand and respond to bodily cues that echo struggles with otherness merits further consideration.

Provision of domiciliary dental service to residential aged care facilities: A 3-year descriptive summary.

This cross-sectional descriptive study described the oral health status and types of domiciliary dental treatment received by residents living in residential care after an oral health assessment (OHAT). Twenty-one facilities were recruited where consenting participants received OHAT followed by a referral for further domiciliary dental treatments. Data were captured and stored as Reach-OHT database where 2017-2019 data were analyzed. Overall, 88% of residents consented. 69.1% were referred for treatment after completion of OHAT. More than half had one or more caries; 40% showed sign of periodontal disease; a higher proportion of dentate participants had an unsatisfactory level of oral cleanliness. Of those received domiciliary dental treatment, diagnostic and preventive service was the combination most frequently provided. These comprised an average of 71.9% of total treatment provided across the 3-year period. This study contributes to the understanding and knowledge around the provision of domiciliary dental services in residential care. A large number of older people in residential care can be assessed and treated through a domiciliary service pathway. As the vast majority of services provided were diagnostic, preventive, and restorative care, the feasibility of utilizing the skillset of the entire dental team should be explored.

Feasibility of self-reported health related quality of life assessment with older people in residential care: insights from the application of eye tracking technology

PurposeIncreasingly there are calls to routinely assess the health-related quality of life (HRQoL) of older people receiving aged care services, however the high prevalence of dementia and cognitive impairment remains a challenge to implementation. Eye-tracking technology facilitates detailed assessment of engagement and comprehension of visual stimuli, and may be useful in flagging individuals and populations who cannot reliably self-complete HRQoL instruments. The aim of this study was to apply eye-tracking technology to provide insights into self-reporting of HRQoL among older people in residential care with and without cognitive impairment.MethodsResidents (n = 41), recruited based on one of three cognition subgroups (no, mild, or moderate cognitive impairment), completed the EQ-5D-5L on a computer with eye tracking technology embedded. Number and length of fixations (i.e., eye gaze in seconds) for key components of the EQ-5D-5L descriptive system were calculated.ResultsFor all dimensions, participants with no cognitive impairment fixated for longer on the Area of Interest (AOI) for the response option they finally chose, relative to those with mild or moderate cognitive impairment. Participants with cognitive impairment followed similar fixation patterns to those without. There was some evidence that participants with cognitive impairment took longer to complete and spent relatively less time attending to the relevant AOIs, but these differences did not reach statistical significance generally.ConclusionsThis exploratory study applying eye tracking technology provides novel insights and evidence of the feasibility of self-reported HRQoL assessments in older people in aged care settings where cognitive impairment and dementia are highly prevalent.

Perspectives on existential loneliness. Narrations by older people in different care contexts

ABSTRACT The aim was to explore existential loneliness in different long-term care contexts as narrated by older people. A qualitative secondary analysis was performed of 22 interviews with older people in residential care, home care, and specialized palliative care. The analysis started with naive reading of interviews from each care context. As these readings showed similarity with Eriksson’s theory of the suffering human being, the three different concepts of suffering were used as an analytic grid. Our result indicates that suffering and existential loneliness are interrelated for frail older people. Some situations and circumstances that trigger existential loneliness are the same in the three care contexts while others differ. In residential and home care, unnecessary waiting, not feeling at home and not being encountered with respect and dignity can trigger existential loneliness while seeing and hearing others suffering can give rise to existential loneliness in residential care. In specialized palliative care, feelings of guilt and remorse are prominent in relation to existential loneliness. In conclusion, different healthcare contexts have various conditions for providing care that meet the existential needs of older people. Hopefully our results will be used as a basis for discussions in multi-professional teams and among managers.

Participation in vulnerable old age? Barriers and opportunities in nursing homes in Germany

Abstract Background Nursing homes in Germany are still often associated with the idea of a daily routine determined by the institution, linked to losses of self-determination and participation. Residents, as well as carers and caregivers, perceive chances for co-determination and co-creation as limited. Methods The research project PaStA (Participation in Inpatient Care for Older People) examined and analyzed opportunities and limits of improved participation in nursing homes in Germany with the help of a participatory action research design. Experiences and findings with participatory research processes in two nursing homes are presented. Results Access to people both living and working in nursing homes is demanding and time-consuming. Building a trusting cooperation requires commitment and resources. However, if a research team - including residents - is successfully installed, the participatory process enables all those involved to explore, try out and shape participation possibilities. The reflection that takes place in the process leads to learning processes that (can) result in empowerment. Discussion However, there is a danger that participatory research may primarily reach people better provided with resources for participation based on life-long circumstances (participation dilemma), highlighting the need for responsibly designed access. Likewise, the question of impact must be critically discussed. Sustainability must be considered from the beginning. Conclusions Participatory action research is a worthwhile endeavor, even in settings that are rather unfamiliar with participation, such as residential care for older people. However, researchers should not underestimate the time and commitment required, because preconditions and resistance of people and structures can compromise progress.

Optimism and subjective well-being in nursing home older adults: The mediating roles of gratitude and social support

ObjectivesTo examine the level of subjective well-being (SWB) and the mediating roles of gratitude and social support in the relationship between optimism and SWB amongst older Chinese people in nursing homes. MethodsA total of 354 older adults in Chinese nursing homes completed the World Health Organization's well-being index, Life Orientation Test-Revised, Gratitude Questionnaire-Six-Item Form, and Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to evaluate the relationships between optimism, gratitude, social support and SWB. ResultsThe mean SWB score of the older people was (63.14 ±15.31), with 21.0% of subjects reporting low SWB. Gratitude and social support in serial partially mediated the relationship of optimism with SWB (total indirect effect: Standardized β = 0.157, 95% CI [0.109,0.216], p<0.001). ConclusionThese findings provide good evidence for the inter-relationship mechanism amongst the protective factors of SWB, suggesting the need to prioritize positive psychological nursing interventions to promote SWB in older people in residential care.

COVID-19 and policies for care homes in the first wave of the pandemic in European welfare states: Too little, too late?

This article examines COVID-19 and residential care for older people during the first wave of the pandemic in 2020, comparing a range of countries – Denmark, England, Germany, Italy and Spain – to identify the policy approaches taken to the virus in care homes and set these in institutional and policy context. Pandemic policies towards care homes are compared in terms of lockdown, testing and the supply of personal protective equipment. The comparative analysis shows a clear cross-national clustering: Denmark and Germany group together by virtue of the proactive approach adopted, whereas England, Italy and Spain had major weaknesses resulting in delayed and generally inadequate responses. The article goes on to show that these outcomes and country clustering are embedded in particular long-term care (LTC) policy systems. The factors that we highlight as especially important in differentiating the countries are the resourcing of the sector, the regulation of LTC and care homes, and the degree of vertical (and to a lesser extent horizontal) coordination in the sector and between it and the health sector.

Approaching retirement: A qualitative study of older nursing assistants' experiences of work in residential care and late-career planning

In many countries, eldercare workers are approaching retirement. To remain attractive to older and experienced workers, organizations need to understand how employees nearing retirement think about and experience their work situation. This qualitative study investigated how older nursing assistants within residential care for older people experienced aging at work, their psychosocial work environment, and their late-career planning. Semi-structured interviews with eight nursing assistants (aged 55–61 years) in Sweden were analyzed using an Interpretative Phenomenological Analysis approach. The results show that the psychosocial work environment was perceived as stressful and considered a long-term health risk, and that (future) health and work ability were key factors determining nursing assistants' late-career planning. Moreover, personal resources and social support from colleagues seemed protective against job demands. Aspects considered in late-career planning also included personal finances and meaningfulness of work. While these findings may be sample-specific, they still provide insights into the experiences of an important occupational group. This means that the findings can be useful for organizations aiming at promoting successful and sustainable aging-in-workplace and encouraging extended working lives.

Nursing support for older people's autonomy in residential care: An integrative review.

Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people. The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care. An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis. The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome. Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices. The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care.

Cultivating quality awareness in corona times

The Covid-19 pandemic is a tragedy for those who have been hard hit worldwide. At the same time, it is also a test of concepts and practices of what good care is and requires, and how quality of care can be accounted for. In this paper, we present our Care-Ethical Model of Quality Enquiry (CEMQUE) and apply it to the case of residential care for older people in the Netherlands during the Covid-19 pandemic. Instead of thinking about care in healthcare and social welfare as a set of separate care acts, we think about care as a complex practice of relational caring, crossed by other practices. Instead of thinking about professional caregivers as functionaries obeying external rules, we think about them as practically wise professionals. Instead of thinking about developing external quality criteria and systems, we think about cultivating (self-)reflective quality awareness. Instead of abstracting from societal forces that make care possible but also limit it, we acknowledge them and find ways to deal with them. Based on these critical insights, the CEMQUE model can be helpful to describe, interrogate, evaluate, and improve existing care practices. It has four entries: (i) the care receiver considered from their humanness, (ii) the caregiver considered from their solicitude, (iii) the care facility considered from its habitability and (iv) the societal, institutional and scholarly context considered from the perspective of the good life, justice and decency. The crux is enabling all these different entries with all their different aspects to be taken into account. In Corona times this turns out to be more crucial than ever.

Assessments of stress of conscience, burnout and social support amongst care providers in home care and residential care for older people.

Studies points to that levels of stress of conscience and burnout among staff in healthcare contexts may seriously affect their health. To compare assessments and associations of stress of conscience, perceptions of conscience, social support and burnout amongst care providers working in home care respectively residential care for older people. This cross-sectional descriptive comparative study was performed among all care providers working in home care (n=227) and residential care of older people (n=354) in a municipality in northern Sweden. Data was collected using four different questionnaires. Analysis were performed using partial least square regression, descriptive statistics, statistical tests and effect size measures. Care providers in residential care of older people assessed higher levels of stress of conscience compared to those working in home care. Exhaustion was an important predictor for belonging to the group of care providers working in residential care of older people. The most important predictor for belonging to the group of care providers working in home care were social support from one's immediate superior and co-workers. Women assessed significantly higher levels of stress of conscience and exhaustion compared to men. Further research seems needed to investigate what the high levels of stress of conscience is caused by. A combined intervention consisting of work-directed measures against burnout and measures aiming at reducing stress of conscience is suggested.

Change agents’ experiences of implementing a new organizational culture in residential care for older people: A qualitative study

Culture change in organizations may affect employees and change agents are often a forgotten resource; their perspective is often overlooked in research. The aim of the study was to illuminate experiences of being a change agent in order to improve residential care of older people. Interviews were performed with 15 change agents who participated in a large culture transformation in residential care for older people. The study followed COREQ guidelines and content analysis was used to interpret the text. The analysis revealed that the change agents felt chosen when they accepted the challenge to become a change agent, but they also felt that transferring the message to co-workers was demanding. Conflicting demands about measuring care and aggravating circumstances to implement change were described. The results indicate that change agents benefit from preparation for the role itself as they have a great responsibility on their shoulders. In making the process more successful, all co-workers should be involved in the change process from the beginning.

Assistant Nurses' Positioned Accounts for Prioritizations in Residential Care for Older People.

Swedish eldercare is strained by an increased administrative workload, which draws time away from individual care of and interaction with older people. This study explores how eldercare staff, working closely with residents in Swedish special housing (nursing homes), make accounts for how they prioritize work tasks. Openly structured, thematic interviews were conducted with 12 permanently employed, female assistant nurses, including a group interview with 3 of them. Positioned accounts (small stories) concerning prioritizations due to insufficient resources were analyzed, using Bamberg's three-level positioning analysis. The analysis shows that the staff take a favorable position toward the older people by distinguishing between care and "the other things." They also justify prioritizations at odds with their care values. The assistant nurses present themselves as doing the best they can in organizationally restricted situations. Organizational demands limit the space for care, giving rise to an idealization of "icing on the cake." Morale is complex in residential care. A narration of "the torn carer" was found as a co-constructed storyline explaining why the staff did not perform eldercare consistent their care values. When ideals and practice differ, interaction in the peer group becomes important in order to maintain a positive professional identity. "The torn carer" is a way for the staff to escape blame for not living up to care values, but it also victimizes them. Staff could be empowered by a working environment characterized by a reflective practice.

Older people's perceived autonomy in residential care: An integrative review.

Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people’s perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher’s Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people’s individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples’ autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people’s choices. Professionals’ characteristics, such as education and attitudes, and the older people’s living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people’s perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.

Poor oral hygiene, oral microorganisms and aspiration pneumonia risk in older people in residential aged care: a systematic review.

aspiration pneumonia increases hospitalisation and mortality of older people in residential aged care. determine potentially pathogenic microorganisms in oral specimens of older people with aspiration pneumonia and the effect of professional oral care in reducing aspiration pneumonia risk. PUBMED/MEDLINE, CINAHL, EMBASE, COCHRANE, PROQUEST, Google Scholar, Web of Science. published between January 2001 and December 2019 addressing oral microorganisms, aspiration pneumonia, oral health and treatment. people 60years and older in residential aged care. the Newcastle-Ottawa Scale and the Standard Protocol Items: Recommendations for Intervention Trials checklist. twelve studies (four cross-sectional, five cohort and three intervention) reported colonisation of the oral cavity of older people by microorganisms commonly associated with respiratory infections. Aspiration pneumonia occurred less in people who received professional oral care compared with no such care. Isolation of Candida albicans, Staphylococcus aureus, methicillin-resistant S. aureus and Pseudomonas aeruginosa was related to mortality due to aspiration pneumonia. An interesting finding was isolation of Escherichia coli, a gut bacterium. more information may be present in publications about other co-morbidities that did not meet inclusion criteria. A high degree of heterogeneity prevented a meta-analysis. Issues included sampling size, no power and effect size calculations; different oral health assessments; how oral specimens were analysed and how aspiration pneumonia was diagnosed. pathogenic microorganisms colonising the oral microbiome are associated with aspiration pneumonia in older people in residential care; professional oral hygiene care is useful in reducing aspiration pneumonia risk.