Residential Facilities Research Articles

Organisational and Ethical Challenges While Caring for Older People During the COVID-19 Pandemic in Sweden: AFocus Group Study.

During the COVID-19 pandemic, older people in Sweden's residential care facilities and home care services experienced high mortality rates. Prior to the pandemic, the care of older people in Sweden was challenged by organisational and regulatory changes, an ageing population and insufficient increases in staff numbers. These issues led to high staff turnover, increased workloads, stress, burnout and a perceived inability to provide satisfactory care. The pandemic brought about increased job strain, stress, anxiety, depression and post-traumatic stress disorder among the staff who cared for older people. The aim of this study was therefore to focus on assistant nurses and care aides' experiences of their work environments when caring for older people during the pandemic in Sweden. The data were collected through four focus groups interviews and analysed using qualitative content analysis. The results showed that the care staff had to navigate organisational and ethical challenges in poor and unsafe work environments. They lacked supportive leadership in their respective organisations, were neither valued, seen nor heard and were treated as 'plain doers'. During the pandemic, they were unable to protect or communicate easily with the older people in their care, which had harsh consequences. According to the participants, the pandemic left them, their working conditions and this part of the care system in a worse situation than before the pandemic. The pandemic thus revealed more unsustainable and unethical working conditions for the staff than before it, including the vulnerability of the older people in their care. The findings highlights the need of policies that ensure adequate training and instruction on medical issues, for managers responsible for overseeing the care of older people. There are also a need of provision of sufficient support for care staff and health care professionals during crises. The findings also underscore the need of feasible and efficient strategies do disseminate care information and address the psychosocial needs of older people.

Investigation of a Norovirus GII.4Sydney[P16] outbreak in a care facility in Portugal, 2022

Abstract Background On the 29th of April 2022 the local Public Health unit was notified of 12 cases of acute gastroenteritis in residents of a long-term care facility (LTCF). A joint epidemiological investigation team was established and initiated an outbreak investigation to characterize the outbreak and implement infection control measures. Methods Epidemiological questionnaires were administered to staff (n = 44) and residents (n = 60). Case definition was LTCF residents or staff members with at least one of the following symptoms: diarrhoea, vomiting, nausea, between April 25th and May 14th, 2022. Stool or vomit samples were collected for 11 individuals. To assess environmental contamination fifteen food samples from previous meals and six surface samples from toilet faucets, wash tubs, and cutting boards were collected. Spatial distribution of cases within the LTCF was performed to guide infection control implementation. Results A total of 43 people met the case definition. Attack rates in residents and staff were 37% (23/63) and 42% (20/48), respectively. Of the total tested specimens, six (6/8) from residents and two (2/3) from staff were positive for the Norovirus (NoV) GII.4 Sydney [P16] variant by genotyping. Two (2/6) samples from surface swabs from the toilet faucet in the resident’s living room were also positive for NoV GII. Food samples were negative for major bacterial agents implicated in gastrointestinal outbreaks. Cases were distributed throughout the LTCF wards with no clear clustering. Four residents required hospital admission. Conclusions Results suggest person-to-person as well as environmental transmission of NoV. Identification of behavioural and spatial patterns of residents and staff and subsequent enactment of infection control strategies mitigated the outbreak. These findings reinforce the need for public health to maintain continuous technical support to LTCF on the implementation of infection control best practices. Key messages • Outbreak investigation in LTCF confirms Norovirus transmission, emphasizing the importance of infection control measures in long-term care facilities. • Study reveals Norovirus outbreak in LTCF, underscores the role of person-to-person and environmental transmission, highlighting the need for robust infection control protocols.

Abstract Strengths and difficulties Lithuania

Abstract Background Most mental health disorders begin before the age of 18, peaking at 14.5 years (Solmi, 2022) and manifest as emotional and behavioural difficulties that are more frequent in institutional social care (ISC): former foster care recipients have higher rates of depression and PTSD than the general population (Pecora, 2009). The rate of children living in residential care facilities in Europe and Central Asia is double the global average (UNICEF, 2024). This study aims to assess and compare the mental health of children in ISC centers and regular high schools. Methods A cross-sectional study was conducted in ISC centres and high schools in 2022-2023. The sample size consisted of children aged 11-17 living in ISC (n = 49) or in families (n = 193). Online anonymous survey was applied to assess the prevalence of endured violence, substance use and measure mental health outcomes using the Strengths and Difficulties Questionnaire (SDQ-25). Results A total of 242 respondents (age mean 14.6, SD = 2.12) in ISC and families showed similar poor mental health rates (42% and 44%, respectively). Prosocial behaviour problems were exhibited more by boys (p < 0.05), whereas emotional symptoms were more common in families (p < 0.001): 90% normal SDQ-25 scores in ISC vs 60% in families. Enduring psychological (38% vs 60.2%) violence was more prevalent among children in families (p < 0.05); smoking - in ISC, alcohol use - in families (p < 0.05). In both groups enduring physical violence was associated with smoking and alcohol use (p < 0.05), and overall poor SDQ-25 results strongly correlated (p < 0.001, r = 0.815, r = 0.610, respectively) with hyperactivity. Conclusions A significant part of study participants reported poor mental health outcomes with most problems in relationships with peers. Mental health risk factors such as violence or substance abuse are associated with poor emotional wellbeing while being more common among children living with families. Key messages • Children living in ISC and in families demonstrate similar level of mental health problems. • Varying prevalence of substance abuse among children living in different settings highlights the importance of environmental factors when addressing the issue.

Balancing power struggles: Understanding the dynamics between standards set by the government, adolescents, and staff at a therapeutic residential care facility

ABSTRACT During four days of observation at a therapeutic residential care (TRC) facility for adolescents with complex behavioral issues, we encountered a growing trend in the Norwegian child welfare system. High demand for institutional beds, along with reduced capacity in psychiatric services and the legal system, has led to increased reliance on the Duty to Assist obligation of the TRCs, administered by the Office for Children, Youth and Family Affairs (Bufetat) in Norway. This obligation is legally binding, ensuring the provision of justifiable treatment. Our observations of staff interactions and documentation analysis of an adolescent, Peter, revealed that staff’s ability to deliver appropriate care and manage high-risk situations is constrained by governmental standards set through law and regulation. Through the theoretical lens of power and discretion, we found that the combination of forced treatment at open institutions, with a strong emphasis on user involvement, creates a power struggle. Without clear practice standards, staff are left to rely on their own competencies in managing conflicts, resulting in inconsistent and unpredictable interactions. This inconsistency increases the likelihood that Peter will resist the care and treatment being offered.

Cross-country price comparison of institutional long-term care: In search of suitable data

Abstract Background In European ageing societies, the national expenditure on institutional long-term care (LTC) has been growing for decades, currently exceeding 1% of the GDP in many countries. At the same time, however, comparative analyses of (day) prices in the nursing and residential care facilities (NRCFs) are still lacking. The data reported by international databases vary substantially in the services they cover which makes cross-country comparisons very difficult. Methods We combine publicly available data from Eurostat (System of Health Accounts), OECD and national sources on the number of recipients of LTC in NRCFs, the number of beds in NRCFs and the expenditure on LTC in NRCFs in over 20 European countries. Our aim is to compute internationally comparable daily prices of LTC in NRCFs using gross-costing approach. We first validate the data by cross-checking and documenting which health care functions and providers are reported by each country. Second, based on that we identify countries with comparable data and, third, perform a cross-country comparison of the daily spending on LTC in NRCFs. Results The reported data vary substantially with respect to their coverage. For instance, while some countries include NRCFs for all disabled people at all ages, others focus only on the NRCFs for the elderly. The ways the beds and the recipients are counted also show substantial variation. Moreover, we found inconsistencies in the reported numbers not only between but also within countries. Conclusions The considerable cross-country diversity in the LTC provision within the NRCFs poses inevitable challenges to international standardised reporting. Our analysis shows, however, that at least some of the challenges can be overcome by, e.g. improving the consistency of the reported numbers at the country level. Key messages • A consistent definition application markedly improves the comparability of data on LTC in NRCFs. • Given the rising demand for and economic importance of the LTC sector standardised data on NRCF services are greatly needed.

Resuscitation of people with a do-not-resuscitate order: when does it happen and what are the outcomes?

Abstract Background Do-not-resuscitate (DNR) orders allow competent individuals to state their wishes to not receive resuscitation. Despite the existence of a DNR order, resuscitative efforts may still occur. Purpose To identify rates and outcomes of resuscitation attempts for people with DNR orders. Methods The statewide out-of-hospital cardiac arrest (OHCA) registry in Victoria, Australia (population 6.5 million) identified rates of DNR orders and resuscitative efforts in ≥60-year-olds from 2006-2021. Results Of 47,322 patients ≥60 years old with OHCA, 2,688 (5.7%) had a DNR order. DNR order was communicated to emergency call-takers in only 332 (12.4%) cases. Bystander resuscitation was commenced in 1,074 (40.0%) patients, with EMS terminating efforts in 346 (32.2%) patients on arrival but commencing resuscitation in 189 others. Strongest predictors of bystander resuscitation were shockable rhythm (OR 7.75, 95% CI 5.04-11.9) and OHCA in public location (OR 4.8, 95% CI 2.0-11.3). Predictors of EMS terminating resuscitation efforts were OHCA in residential aged care facility (OR 1.93, 95% CI 1.47-2.5) and older age (OR 1.02, 95% CI 1.00-1.04). Transfer to hospital was undertaken in 107 patients, with strongest predictors being return of spontaneous circulation (OR 91.1, 95% CI 51.7-160.7) and witnessed OHCA (OR 7.5, 95% CI 3.9-14.5). Only 7 (0.3%) transported patients survived to discharge, with 5 deceased at 12-month follow-up. Conclusion Approximately 5% of EMS-attended OHCAs in ≥60-year-olds involve a patient with a DNR order, with low rates of awareness of DNR orders. Resuscitation is commenced in 47% of patients, and 4% are transported to hospital with very poor outcomes. Strategies to communicate DNR status and respect patients’ autonomy are extremely important.

Older Adults' Needs and Wishes for Contact With the Outdoors at Residential Care Facilities: Implications for Theory and Practice.

Aim: This qualitative study aimed to explore needs and wishes of older adults concerning their perceived need for contact with outdoor environments at residential care facilities (RCFs) and what implications it has for theory and practice. Background: There is increased awareness of the importance of health-promoting everyday environments for persons with special needs. Therefore, it is important to include the experiences of older adults at RCFs in research. Methods: Twelve older adults from three Swedish RCFs participated in semistructured walking interviews. Results: Two categories were identified concerning the needs and wishes of older adults for contact with outdoor environments. The first category, Outdoor environments as part of everyday life, describes aspects of normality linked to outdoor stays at RCFs. The second category, Getting outdoors in practice, describes supportive and hindering aspects of outdoor stays, as well as accessibility regarding different body positions and access to personal support. Conclusion: It was found in this study that the needs and wishes of older adults are important to consider to increase their opportunities for outdoor stays. Their needs and wishes could also be included in briefs and programs for the design and planning of new construction or refurbishment of RCFs. The results of the study can serve as the basis for further discussions concerning older adults' outdoor stays and the accessibility of outdoor environments. Further, the results are intended to facilitate practical knowledge that is useful for care workers and managers at RCFs and to support decision makers, property developers, architects, and planners.

Public health rapid response in managing COVID-19 outbreaks in residential aged care facilities: a regional public health unit perspective.

We describe here the impact of managing coronavirus disease 2019 (COVID-19) outbreaks, during January-August 2022, in residential aged care facilities (RACFs) in Central Queensland, Australia, following the deployment of a public health rapid response team (PHRRT, comprising a medical officer, a communicable disease nurse, and an epidemiologist) from a regional public health unit (PHU). Our existing vaccine preventable diseases surveillance framework was used in identifying any symptomatic resident, triggering a PHRRT response. We found that the Hospital in the Home (HiTH) admission and death events were significantly lower after the introduction of the PHRRT than in the outbreaks that occurred before. Based on our experience with a PHRRT-led approach in mitigating the burden of outbreaks, we recommend regular reflection on optimising resources and practices in RACFs. Effective communication from PHUs can improve the RACFs' preparedness and capacity to respond, and can inform the best practice model to protect the highly susceptible elderly residents and their staff.

Functional Capacity of Institutionalized Older People and Their Quality of Life, Depressive Symptoms and Feelings of Loneliness: A Cross-Sectional Study.

The increasing number of institutionalized older individuals worldwide stresses the need to evaluate the association between the functional profile of institutionalized older adults and their quality of life (QoL), depressive symptoms and feelings of loneliness. A cross-sectional study was conducted in 19 residential facilities in Alentejo, Portugal. Between March and September 2023, all individuals aged ≥65 years were invited to complete a structured questionnaire (n = 1303). Sociodemographic and clinical data were collected, and validated scales for the Portuguese older population were used. Linear regression and unconditional binary logistic models were computed. The highest level of dependence was observed in the self-care dimension (mean (SD) = 2.93 (1.21)), with 40% of participants exhibiting levels of dependence requiring daily care or total replacement. QoL was inversely associated with functionality in all dimensions, as well as with severe or complete dependence, even after adjusting for sex, age and education. Participants with depressive symptoms and feelings of loneliness were, respectively, three and two times more likely to be dependent on care (adjusted OR = 3.69, 95% CI: 1.80-7.52; adjusted OR = 2.04, 95% CI: 1.07-3.87). Public policies and interventions should include social and emotional support strategies alongside traditional medical interventions.

“Throw Dat Hat!”: Educational Experiences, Attainment, and Aspirations of Adolescent Female Trafficking Survivors in a Residential Facility

This study addresses the gap in research on the educational experiences of adolescent human trafficking survivors, with a focus on their past, present, and future educational experiences and goals. Its objective is to inform the best practices for educational programming within female adolescent residential care centers in the United States. Drawing on a subset of data from a broader mixed-methods case study conducted at the Allasso House residential facility, this research involved 11 current residents. The data sources included case files detailing their past educational experiences, assessments of their current educational achievements, and interviews exploring their future aspirations. The findings reveal key themes related to the residents past risk factors, current educational successes and barriers, and tensions in setting future goals. Most of the residents expressed a desire to attain high school equivalency, identifying financial stability as a primary motivation. They also aspired to form healthy families, while placing significant value on material success. Unlike studies that define success primarily through survival, sobriety, and the avoidance of re-trafficking, this research highlights the broader aspirations of these adolescents, emphasizing the critical role of education in general wellbeing, risk mitigation, and future success. This study underscores the importance of prioritizing educational attainment and long-term aspirations in future research and in the design of residential programs for adolescent survivors of trafficking.

Having to ‘go beyond’: Staff perspectives on activity programs for older people living in nursing homes

Activity programs are run by many nursing homes (also known as residential aged care facilities or long-term care facilities) however little is known about how activities are chosen or how well they meet the needs of residents. The aim of this study was to learn more about activity programs currently offered to older people living in nursing homes in Victoria, Australia. Interviews were undertaken with 13 activities/lifestyle staff working across six nursing homes. Staff were asked about their role and training; how activities were chosen, run, and evaluated; and barriers to providing social participation opportunities for residents. Thematic analysis of interview transcripts revealed six main themes: the role of the activities staff is to make people happy and meet their needs; activities staff largely choose (group based) activities; evaluation of activity programs is mostly informal; activity programs are poorly resourced; staff are often required to ‘go beyond’; and catering to the unique needs of residents is challenging. Given the established importance of social interaction to physical and psychosocial health, it is essential that activity programs and staff are viewed as integral to resident wellbeing; that staff are trained and supported; and that programs are funded and resourced adequately to deliver programs that are person-centred and meet the needs and preferences of residents.

Residential Care Facilities for Users with Alzheimer’s Disease: Characterisation of Their Architectural Typology

The design and construction of residences for persons with Alzheimer’s disease (AD) have been based on the recommendations of design guides, the results of empirical tests with samples of the population, and the experience of architects and planners. The reiteration of certain patterns, criteria, and guidelines has given rise to a new type of building that has not yet been explicitly described. The aim of this paper is to determine the main characteristics of this typology. This research is based on a critical review methodology, analysing 30 care homes built over the last four decades across various global contexts. Detailed surveys of plans, projects, and buildings were carried out, allowing a comparative analysis of the architectural attributes to determine the most influential parameters for these buildings. The results indicate that environments designed with safety, accessibility, and opportunities for social interaction in mind—and, above all, those that are personalised to the needs of this collective—significantly enhance the behaviour, emotional state, and cognitive state of their residents. The main theoretical contributions include identifying and stating the key features of this type, such as small scale, basic cell housing, comprehensible organisation, and sensory stimulation of spaces, among others. The breakthrough of this study that differentiates it from other works in this field is that it provides concrete guidelines to approach the planning, design, and construction of these kinds of residences. The significance of this research lies in the definition of this unique typology, which is not characterised by its morphology, shape, or formal composition but rather focused on promoting an adequate cognitive and physiological reception of the space by the users. This building concept has important management implications, as its construction must provide for and integrate specific care services in a residential setting for people with AD.

Oral Health Assessment for Older Residents in Long-Term Care Facilities Using Video Recording by a Mobile Electronic Device.

Many older adults who require long-term care need oral health management. However, access to dental care is limited, and connecting older patients with dental professionals is a future challenge. Therefore, the development of a remote oral health assessment system is required. This study aimed to investigate the usefulness of video-based oral health assessments in older adults residing in facilities. This study comprised 60 older adults residing in facilities who consented to dental home visit treatment by the Department of Oral Function Management at Showa University Dental Hospital between July 2021 and December 2022. The Oral Health Assessment Tool (OHAT) was used to evaluate the oral health status at the facilities by one dentist. The concordance of the oral health assessments conducted by this dentist at the facilities (OHAT-B) was compared with those conducted by the same dentist (OHAT-V1) and two other dentists (OHAT-V2 and V3) using approximately 1 min video recordings of the oral cavity taken with a mobile electronic device. On the OHAT total score, the intraclass correlation coefficient (ICC [1.1]) for OHAT-B and V1 was 0.931; the ICC (2.1) was 0.889 when compared with V2 and 0.788 when compared with V3. Moreover, the comparison between V2 and V3 showed high agreement, with an ICC (2.1) of 0.750. This study revealed that the oral health assessment of older adults residing in facilities using video recordings of the oral cavity taken with a mobile electronic device may be possible, suggesting the possibility of remote oral health assessment.

The relationship between emotion regulation difficulties and eating disorder outcomes: a longitudinal examination in a residential eating disorder treatment facility

ABSTRACT Eating disorders (EDs) are associated with numerous comorbidities and deleterious outcomes (e.g. medical complications, high rates of death by suicide). The complexities of EDs are further compounded by treatment dropout, poor treatment outcomes, and relapse. One way to better understand these complexities is to investigate broad, transdiagnostic risk factors that contribute to the etiology and maintenance of EDs, such as emotion regulation (ER) difficulties. We longitudinally tested the relationship between ER difficulties and ED outcomes in a sample of 101 female ED patients in a southeastern U.S. residential ED treatment facility. Consistent with hypothesis, there were significant improvements in both ER difficulties and eating pathology from admission to discharge. Further, improvement in ER difficulties was associated with improvements in eating pathology. These findings further substantiate the role of ER difficulties in eating disorders and provide further evidence for the relationship between ER difficulties and eating pathology among residential eating disorder patients.

Risk Factors Associated with Unplanned Hospitalization Among Long-Term Care Facility Residents: A Retrospective Study in Central Taiwan.

Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21-1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02-1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03-1.33) and renal failure (OR = 1.63, 95% CI = 1.42-1.86), high fall risk (OR = 2.67, 95% CI = 2.30-3.10), and being bedridden (OR = 6.55, 95% CI = 5.48-7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15-2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally.

Managers of Aged Care Residential Services in Australia 2006-2021: Transformation reform

Objectives: This article provides analyses of the number and characteristics of managers of aged care residential services in relation to number of aged people, residents of aged care facilities and people employed in them. Design: The research design follows specifications provided by the authors for tabulations prepared by the Australian Bureau of Statistics (ABS) from the censuses of population conducted by ABS in 2006 and 2021. Analyses undertaken by the authors show changes that have taken place in the number of managers of aged care residential facilities in relation to the number of aged people, residents of aged care facilities, and people employed in them. Further, the analyses examine changes in the demographic characteristics of managers, their working hours and income, over time. Findings: There was a substantial decline in the proportion of the growing number of people aged 70 years and over who lived in aged care residential services during the 15-year period. While there was a large increase in the number of employees and managers per resident, and a slight increase in the number of managers per employee. The proportion of female managers fell, and the average age of managers increased slightly. The proportion of managers at graduate level rose substantially. Although the average income of aged care residential services managers was similar to that in all industries in 2021, their increase was larger than in all industries during the 15-year period. Average hours worked remained similar over time. The proportion of Australia-born managers declined while that of managers born in Asia rose substantially, and the proportion of indigenous managers about doubled during the 15-year period. Implications: Relevance to those concerned with the evolving transformation of aged care in Australia and those interested with management training of the growing number of managers of aged care residential services.

Comparison of Intelligent Community Design from the Perspective of Modernization--Shenzhen and Singapore as examples

With the continuous advancement of modernization, globalization, and urbanization, smart communities have received widespread attention as an important part of modern urban development. Taking two typical cases, Shenzhen and Singapore, as objects, this study compares and analyzes the design and practice experiences of the two smart communities from the modernization perspective. By comparing the design and practice of the two smart communities in Shenzhen and Singapore, it explores the common features and differences of smart community construction in different modernization contexts and provides reference and inspiration for smart community construction in future cities. Through literature research and case studies, a comparative analysis is conducted to study the design concepts, practice methods, and effects of two smart communities in Shenzhen and Singapore. The results of the study show that Shenzhen focuses on innovation and cutting-edge technology, which improves the efficiency of community governance and the quality of life of residents;Singapore focuses on community autonomy, and through intelligent management and residents' cooperation, it has improved the level of community facility management and residents' participation.This study provides useful experience and enlightenment for the construction of other urban smart communities, and provides a reference for promoting the smooth progress of urban modernization.

Stress and Coping Behavior Exhibited by Family Members Toward Long-Term Care Facility Residents While Hospitalized.

With the increase in the elderly population, institution-based care has become another option for elderly people. In Changhua, Taiwan, the number of long-term institutions has doubled in the past decade, and more families are choosing to send their elders to institutions for care. However, there is stress induced by having to care for these elders when they come back to their family members when hospitalized. Therefore, this study aimed to understand the stress and coping behaviors of family members in regard to hospitalized long-term care facility residents and identify relevant factors that affect and predict the stress and coping behaviors exhibited by these family members. In this study, a quantitative and cross-sectional survey was conducted using the convenience-sampling method; family members of long-term care facility residents hospitalized in a regional hospital in central Taiwan were selected as the research participants and a total of 162 family members were admitted. The data were collected in the form of questionnaires including basic information and data on the stress and coping behaviors of the family members. The data were collected and coded by using SPSS 22.0 to perform descriptive and inferential statistical analysis. The standard average score of total stress for family members was 57.03 points, which corresponds to a moderate level. The four perceptions of stress by family members were, in order, physiological, life, psychological, and economic. Furthermore, family income, work status, and the relationship between residents of the family members and physiological, psychological, and economic factors had predictive power for their problem-oriented coping behaviors, with an explanatory power of 59.6%. Life aspects, gender, marital status, and the number of hospitalizations in half a year had significant predictive power for the family members' emotion-oriented coping behaviors, with an explanatory power of 19.0%. The family members had high levels of stress, especially physical stress, and the total scores of stress perception were higher for those who were younger than 39 years old and had no rotating family members. Additionally, the coping behavior of the main caregiver was mainly problem-oriented. The results of this study may serve as a reference that can help nursing staff in clinical or long-term care facilities to provide or develop effective and individualized services for family members of facility residents.

Effect of Cognitive Decline on Mandibular Movement during Mastication in Nursing Home Residents.

Background: Many studies have reported on the relationship between cognitive and masticatory functions. However, it remains unclear how the mandibular movements change during chewing in facility residents as dementia progresses. This study aimed to investigate the relationship between a kinematic analysis of mandibular movement during mastication and cognitive function in facility residents. Methods: Sixty-three participants were included from two long-term care facilities. The primary outcome variable was the kinematic data of mandibular movement during mastication. The participants chewed rice crackers, and their faces were recorded during this motion. The partial correlation coefficient between kinematic data and cognitive function was calculated. Furthermore, group comparisons were performed after dividing the participants into three groups based on their cognitive function. Results: Circular motion frequency was significantly correlated with the ABC dementia scale, even after adjusting for the appendicular skeletal muscle index, Eichner index, and short-form mini-nutritional assessment. The cycle and circular motion frequencies were markedly lower in the severe dementia group than in the mild dementia group. Conclusions: With declining cognitive function, mandibular movements during mastication decrease in circular motion and increase in linear motion. Additionally, our results suggested that residents with severe cognitive impairment had more linear mandibular motions during mastication than those with mild cognitive impairment. This may make it more difficult for residents with cognitive decline to ingest normal solid foods.

Burnout, working alliance, and ward atmosphere: A multisite study of mental health professionals and patients with schizophrenia.

This study examined the association between burnout, psychological distress, ward atmosphere, and working alliance (WA) among mental health workers treating patients with schizophrenia spectrum disorder (SSD). Data were collected from 345 patients with SSD and 151 mental health workers across 98 residential facilities (RFs) as part of the DiAPAson project from October 2020 to October 2021. Participants were excluded from the study if they exhibited patient-operator matching errors, dropped out, or had many missing Maslach Burnout Inventory (MBI) scores. The final sample included 282 patients and 155 healthcare workers. Burnout was assessed using theMBI. Psychological distress was evaluated with the 12-item version of the General Health Questionnaire. WA and ward atmosphere were evaluated with the WA Inventory and the Ward Atmosphere Scale, respectively, in both staff and patients. Sociodemographic and clinical data was also collected and analysed. Burnout was associated with a less supportive ward atmosphere, a weaker WA, and higher staff distress. Severe psychiatric symptoms evaluated with Brief Psychiatric Rating Scale in patients were also linked to staff burnout levels. Discrepancies in the perceptions of the ward atmosphere and the WA were observed between staff and patients, with patients reporting better perceptions in both domains. Our findings highlight the complex dynamics of well-being within psychiatric care settings, emphasizing the importance of role clarity, professional autonomy, and a positive ward atmosphere in mitigating burnout. Interventions focused on such factors may help support mental health professionals involved in SSD patient care. ISRCTN registry ID ISRCTN21141466.