Residents In Long-term Care Settings Research Articles

Efficacy of the residential care transition module: A telehealth intervention for dementia family caregivers of relatives living in residential long-term care settings.

The purpose of this study was to evaluate the efficacy of the Residential Care Transition Module, a six-session, psychosocial, and psychoeducational telehealth intervention for family caregivers of cognitively impaired relatives living in a residential long-term care setting. Eligible participants (including care recipients, regardless of time since admission) were randomized to treatment or usual care control conditions. Survey data were collected at baseline, 4 months, 8 months, and 12 months (N = 240). Primary analytic outcomes included caregiver subjective stress (a stress process mechanism) and depressive symptoms (a measure of global well-being). Secondary analytic outcomes included secondary role strains, residential care stress, caregiver sense of competence, and self-efficacy (additional mechanisms of action). General linear models tested for the main effects of the intervention at 4 months, and longitudinal mixed models examined the 12-month effects of the intervention. Post hoc analyses also examined the influence of moderators. No significant differences between the treatment and control groups for any primary analytic outcome were apparent. Caregivers in the treatment group whose relatives were admitted to residential long-term care in the prior 3 months were more likely to indicate reductions in depressive symptoms over the first 4 months of participation. Over the 12-month study period, caregivers in the treatment group who were employed reported increased self-efficacy over time. The heterogeneity of dementia care requires a broader consideration of key contextual factors that may influence the efficacy of nonpharmacological interventions. Aligning measures with the preferences, goals, and values of dementia caregivers may further demonstrate the direct benefits of interventions such as the Residential Care Transition Module. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Meditation Moderates the Relationship between Insecure Attachment and Loneliness: A Study of Long-Term Care Residents in Thailand.

Background and Objectives: Loneliness is prevalent among residents of long-term care settings, posing significant challenges to their mental wellbeing. Insecure attachment has been identified as a contributing factor to loneliness in this population. Previous research has suggested that meditation may have beneficial effects on mental health outcomes. This study aimed to examine the relationship between meditation, insecure attachment, and loneliness among residents of long-term care facilities in Thailand. Specifically, the study sought to investigate the moderating effect of meditation on the association between insecure attachment (both avoidance and anxiety) and loneliness. Materials and Methods: A cross-sectional study was conducted involving 236 residents living in long-term care homes in Thailand. Participants completed self-report measures including the 18-item Revised Experience of Close Relationship questionnaire (to assess attachment anxiety and avoidance), the Inner Strength-Based Inventory (to measure meditation practice), and the 6-item Revised Version of the University of California Los Angeles Loneliness Scale. Moderation analyses were performed to explore the role of meditation in the relationship between insecure attachment and loneliness. Results: The mean age of participants was 73.52 years, with females accounting for 57.6% of the sample. Among the participants, 58.4% reported engaging in meditation, with practice frequency ranging from often to daily. The mean meditation score was 2.92 out of 5, indicating regular but not daily practice. Meditation was found to moderate the relationship between insecure attachment (both avoidance and anxiety) and loneliness. Specifically, the moderation effect between attachment anxiety and loneliness was significant (B = 0.44, SE = 0.21, 95% CI [0.30, 0.86]), as was the interaction effect between attachment anxiety and loneliness (B = -0.34, SE = 0.17, 95% CI [-0.67, -0.02]). Conclusions: The findings suggest that the impact of meditation practice on loneliness is influenced by an individual's attachment dimension. Meditation demonstrates a moderating effect on attachment avoidance, anxiety, and loneliness, with variations observed in the direction of these effects. The clinical implications of these findings and recommendations for further research are discussed.

Supplemental Material for Efficacy of the Residential Care Transition Module: A Telehealth Intervention for Dementia Family Caregivers of Relatives Living in Residential Long-Term Care Settings

Supplemental Material for Efficacy of the Residential Care Transition Module: A Telehealth Intervention for Dementia Family Caregivers of Relatives Living in Residential Long-Term Care Settings

DEVELOPMENT AND VALIDATION OF THE MINNESOTA AL REPORT CARD FOR RESIDENT QUALITY OF LIFE DOMAINS

Abstract Assisted living (AL) describes long-term residential care settings that emphasize person-centered services and choice in a “home-like” environment. There is considerable variability in how AL is defined, what services are provided, and how quality is measured. Minnesota serves as a unique policy environment in which to study AL. In May 2019, Minnesota funded the development of an AL Report Card to measure and report on the quality of AL from resident and family perspectives, created in partnership with the University of Minnesota. Literature review, stakeholder feedback, and pilot testing were completed in 2020-21 and the survey was implemented statewide in 2021-22. Using 2021 AL resident quality of life (QoL) survey pilot data (N=1,392), the goal of this work was to assess the reliability and psychometric properties of the survey in measuring 7 QoL domains: food, staffing, environment, engagement, autonomy, culture, and security. The 7 domains were measured using 6, 10, 3, 6, 5, 3, and 6 items, respectively. We found acceptable internal consistency for four QoL domains: food, staff, security, and engagement (McDonald’s omega and Cronbach’s alpha ≥0.6). Confirmatory factor analysis was performed for each individual factor using diagonally weighted least squares for ordinal data. We found high interfactor correlations between the three domains with poor internal consistency (environment, culture, and autonomy). We collapsed these three domains into one overarching domain – climate – and found satisfactory data-model fit. Findings of stability and validity of QoL report card domains have important implications for adoption outside of Minnesota.

Perceived Work Environment, Educational Status, Staffing Levels, and Work Outcomes in Long-Term Care Settings During COVID-19.

Coronavirus disease (COVID-19) has severely affected older residents in long-term care (LTC) settings. However, care workers' perceptions of their work environment and potential impact on their work outcomes during the pandemic is not well known. This study examined associations between care staff's perceived work environment, educational status, and facility staffing levels and work outcomes of care staff in LTC settings during the COVID-19 pandemic. This study employed a cross-sectional, observational, correlational design. A total of 207 care staff were conveniently recruited from 30 LTC settings in South Korea. The perceived work environment, educational status of care staff, and facility staffing levels (ie, beds-to-registered nurse [RN] and beds-to-nursing assistant [NA] or care worker ratios), as well as their work outcomes (ie, general and COVID-19 specific outcomes) were collected using questionnaires. Multivariable binary logistic regressions were conducted, controlling for the characteristics of care staff (ie, age, sex, occupation, and career length) and facilities (ie, location, bed size, ownership, and residents' disease and care profiles). Approximately 45% of the participants were either NAs or care workers, and 38% were RNs. More than half (53.14%) perceived their work environment to be good. LTC staff who perceived their work environment to be poor were more likely to be dissatisfied with their work [odds ratio (OR) 20.88), experience high burnout (OR 8.63), intend to leave the facility within a year (OR 5.00), and experience increased overtime work (OR 3.58) and work-life imbalance (OR 1.93) due to COVID-19. LTC work environments should be improved and government-led initiatives for ensuring such improvements should be implemented to enable a better response to future public health crises and maintain the quality of care for and safety of residents in LTC settings.

55 Dysphagia identification practices in residential long-term care settings in the Republic of Ireland: a cross-sectional electronic survey

Abstract Background Dysphagia is common in older adults with neurological and/or neurodegenerative conditions requiring early identification to avoid serious complications, including malnutrition, dehydration and aspiration pneumonia. The aim of this study was to describe dysphagia identification practices in Residential Long-Term Care Settings (RLTCS) in the Republic of Ireland. Methods A cross sectional electronic survey was designed using Qualtrics XM Platform that included 40 questions divided in 5 sections. The survey was circulated via email to RLTCS to be completed by either a clinical nurse or nurse manager in each facility. Descriptive data analysis was conducted on survey responses using RStudio. Results There were 45 surveys completed out of N = 429 electronically circulated (10% response rate). All RLTCS that completed the survey reported to routinely implement dysphagia identification practices. Observation of signs and symptoms of dysphagia at mealtimes (100%), review of clinical records to identify dysphagia risk factors and comorbidities (93%) and resident self-report of swallowing difficulties (91%) were the most common dysphagia identification practices. Poor oral motor function (89%) and history of aspiration pneumonia (87%) were reported as the main dysphagia risk factors. A swallow screening test was less commonly used to identify dysphagia (42%). Coughing or choking on food or fluids, inability to swallow medication, oral or pharyngeal residue, delayed or absent initiation of swallow, leaking of food or fluids and difficulty with coordination of breathing and swallowing were identified by all respondents as key criteria for risk of dysphagia. Almost all participants reported that residents at risk of dysphagia were routinely referred to speech and language therapy services for further assessment. Conclusion A range of practices were identified in RLTCS that participated in the survey. Further research approaches are required to provide a more in-depth perspective of dysphagia identification practices and protocols used in RLTCS for timely and accurate identification of dysphagia to avoid associated complications.

Supporting resident engagement via web-based assessment system: experience of activity professionals from long-term care settings

ABSTRACT Loneliness, depression, and social isolation are observed among residents in long-term care settings. Activity professionals can help prevent this by encouraging residents and providing them with opportunities to be more active during daily life. Questionnaires measuring the extent to which activity professionals design and implement activities among residents are lacking. In addition, there are no measurement instruments to gain insight into activity professionals work performance. A web-based assessment system, ‘Elder Engagement Performance Improvement (EEPI),’ has the potential to help activity professionals support resident engagement. This study explored long-term care activity professionals’ experiences in using the EEPI assessment.Semi-structured interviews with 23 long-term care activity professionals (e.g. certified activities directors, therapeutic recreation specialists, life enrichment directors, and life engagement directors) were conducted and analyzed using qualitative content analysis.Activity professionals` experiences showed the EEPI was a means of improving the performance of activity professionals by increasing residents’ engagement both in quality and quantity. Four main themes emerged from this explorative investigation: (a) Lack of assessment tools, (b) Acceptance of the web-based assessment system, (c) Barriers to using the EEPI (time, staffing issues, and lack of management support), and (d) Areas for job improvement (person-centered activities and engagement).The EEPI may serve as a valuable tool in long-term care settings for activity professionals. The web-based assessment system, EEPI, facilitated activity professionals’ daily work and involved the residents’ interests in their activities, which may enhance resident engagement and reduce the risk of social isolation in long-term care facilities.

USING HYBRID EFFECTIVENESS DESIGNS TO FACILITATE IMPLEMENTATION: THREE CASE STUDIES IN DEMENTIA CARE RESEARCH

Abstract This individual symposium presentation will provide case examples of three “hybrid effectiveness” trials in dementia care in different care settings including community-based and residential long-term care settings, each of which incorporate implementation methods alongside traditional evaluations of effectiveness. We offer considerations related to conceptualization, study design, sampling, data collection, and analysis that may guide gerontologists who aspire to adopt hybrid effectiveness designs in their own work. We conclude with methodological recommendations to incorporate an implementation science lens throughout the lifecycle of gerontological (and/or dementia care) intervention development. By applying key principles from implementation science throughout the intervention development process, a truncated and more efficient implementation pipeline may be achievable in gerontological research. Moreover, incorporation of implementation science methods into standard intervention development and testing methodologies will result in older persons, their families, healthcare providers, and communities having the best evidence available at their disposal.

IMPLEMENTATION SCIENCE IN DEMENTIA CARE: METHODOLOGICAL, CULTURAL, AND SOCIODEMOGRAPHIC CONSIDERATIONS

Abstract The gap between aging science and practice persists. Getting the best possible evidence into the real world is a particular challenge in gerontology because of the complex needs of older persons, the family caregiving experience, the workforce shortage, and underlying structural concerns with how services for older people are regulated, paid for, and valued. The purpose of this symposium is to consider contextual dimensions to facilitate implementation, methodological considerations, strategies to inform cultural adaptation of evidence-based innovations, and how creativity and innovation in low- and middle-income countries can better inform implementation practices in resource rich countries and vice-versa. Specifically, Dr. Marie Boltz and colleagues will examine the conceptual and theoretical underpinnings of organizational readiness for implementation and the operationalization of the construct. Dr. Joseph Gaugler and co-authors will provide case examples of three “hybrid effectiveness” trials in dementia care in different care settings including community-based and residential long-term care settings, each of which incorporate implementation methods alongside traditional evaluations of effectiveness. Dr. Lauren Parker and her team will demonstrate how cultural adaptation strategies were applied to facilitate the implementation of a community-based, evidence-based dementia care intervention. Dr. Baker and colleagues consider implementation issues and innovations in low- and middle-income countries. Dr. Beth Prusaczyk, an implementation expert, will serve as Discussant and highlight future implementation issues to advance best practices that facilitate and expedite the translation of aging science.

Validation of the Spanish Version of the Fear of COVID-19 Scale (FCV-19S) in Long-Term Care Settings.

Fear of coronavirus disease 2019 (COVID-19) is one of the main psychological impacts of the actual pandemic, especially among the population groups with higher mortality rates. The Fear of COVID-19 Scale (FCV-19S) has been used in different scenarios to assess fear associated with COVID-19, but this has not been done frequently in people living in long-term care (LTC) settings. The present study is aimed at measuring the psychometric properties of the Spanish version of the FCV-19S in residents in LTC settings, following both the classical test theory (CTT) and Rasch model frameworks. The participants (n = 447), aged 60 years or older, were asked to complete the FCV-19S and to report, among other issues, their levels of depression, resilience, emotional wellbeing and health-related quality of life with validated scales. The mean FCV-19S score was 18.36 (SD 8.28, range 7−35), with higher scores for women, participants with lower education (primary or less) and higher adherence to preventive measures (all, p < 0.05). The Cronbach’s alpha for the FCV-19S was 0.94. After eliminating two items due to a lack of fit, the FCV-19S showed a good fit to the Rasch model (χ2 (20) = 30.24, p = 0.019, PSI = 0.87), with unidimensionality (binomial 95% CI 0.001 to 0.045) and item local independency. Question 5 showed differential item functioning by sex. The present study shows that the FCV-19S has satisfactory reliability and validity, which supports its use to effectively measure fear in older people living in LTC settings. This tool could help identify risk groups that may need specific health education and effective communication strategies to lower fear levels. This might have a beneficial impact on adherence to preventive measures.

44 CONTENT VALIDITY OF THE DYSPHAGIA PREVALENCE AND PRACTICES IN RESIDENTIAL LONG-TERM CARE SETTINGS SURVEY

Abstract Background Dysphagia is common in older adults living in Residential Long-Term Care (RLTC) settings, requiring timely diagnosis and appropriate management to avoid potential complications and improve quality of life. Current dysphagia prevalence rates, screening and management practices in RLTC settings in the Republic of Ireland are not known. Methods An online survey was developed, consisting of 40 questions to determine dysphagia prevalence rates and associated nursing practices in screening and managing dysphagia in RLTC settings. An expert panel was formed with individuals having clinical experience in swallow screening and dysphagia management in older adults. We calculated Item-level Content Validity Index (I-CVI) and modified Kappa statistic (k), to adjust for chance agreement, for all 40 items in terms of representativeness and clarity. A survey item is considered relevant where I-CVI≥0.78, between 0.70 and 0.77 requires revision, and below 0.70, is eliminated. For k values, agreement levels are considered as low (k=&amp;lt; 0.40), fair (k=0.40–0.59), good (k=0.60–0.74) and high (k=≥ 0.75). Results The expert panel consisted of three nurse managers, two nurse specialists and three senior speech and language therapists with postgraduate qualifications, up to three years of experience in dysphagia related research and three to thirty-six years of clinical practice. For clarity, all items scored I-CVI≥0.78 and k=≥0.75 except four items, for which I-CVI=0.75 and k=0.72. For representativeness, only one item had an I-CVI=0.75 and k=0.72, with all other scoring I-CVI≥0.78 and k=≥ 0.75. Conclusion Findings suggest that the DPP-RLTCS has high content validity in terms of clarity and representativeness even after adjusting for chance agreement.

Providing culturally appropriate residential dementia care for older adults with an Indian heritage: Perspectives from Sydney-based stakeholders.

Global migration and an increased life expectancy led to a growing number of people with dementia from Culturally and Linguistically Diverse (CaLD) backgrounds living in long-term residential care settings. These minority groups' wellbeing may be negatively impacted due to poor culturally appropriate care that fails to honour valued cultural traditions. This study considered culturally appropriate dementia care for older adults with an Indian heritage living in Sydney-based residential aged care facilities. The Nominal Group Technique was employed to collect data from three groups of stakeholders of Indian heritage over a period of 6 months: care staff (n = 8), family of residential care recipients (n = 8), and community-dwelling older adults (n = 7). Perspectives highlighted six concepts for consideration: (1) embracing a person-centred approach to promote culturally appropriate dementia care; (2) training staff in culturally appropriate forms of respect; (3) the impact of staff ratios on care; (4) the importance of familiarity to meaningful engagement; (5) the importance of food; and (6) the necessity of engaging family and the wider Indian community in residential care activities. Culturally appropriate dementia care for older adults with an Indian heritage is an area in need of further development. To ensure that residents with an Indian heritage are respected as an ethnic minority, it remains crucial that research is generated to inform policy development on each CaLD group as a separate entity.

The Ideal and the Real: Epistemic and Practice Tensions in Renovating Long-Term Residential Care Settings for Persons with Advanced Dementia

The Ideal and the Real: Epistemic and Practice Tensions in Renovating Long-Term Residential Care Settings for Persons with Advanced Dementia

Implications of the COVID-19 Pandemic on Adult Day Services

Adult day service (ADS) centers serve an important role in care provision for people living with dementia (PLWD). These programs provide socialization, activities, and access to many therapies for PLWD. Additionally, they offer respite to family caregivers so they can work, run errands, and recharge. In March 2020, like much of the nation, ADS sites across the nation were shut down. This left many PLWD and their caregivers without access to the services they depended on to manage day to day care. It also left many sites without a revenue source to pay employees and maintain buildings. Almost a year later, many states have still not reopened ADS and sites that have reopened have done so with a lower census, increased costs, and the lingering fear of a second closure. Much focus has been on the care of older adults in nursing homes or other residential long-term care settings but the challenges of ADS and the people they serve has been mostly ignored. The purpose of this symposium is to highlight the implications of the COVID-19 pandemic on ADS centers. Holly Dabelko-Schoeny will present data gathered from ADS Centers across Ohio. Lauren Parker, will then present data from ADS sites across the United States that examines the effect of COVID-19 on closures and programming during the closures. Katherine Marx will present the effect of ADS closures on family caregivers of persons living with dementia. Finally, Joseph Gaugler will explore this from a policy perspective and provide recommendations moving forward.

Measuring What Matters Across International Long-Term Care Settings

Measuring what matters most to residents, relatives and staff in residential long-term care settings is critical, yet underdeveloped in our predominantly frailty and deficits-focused measurement frameworks. The Worldwide Elements to Harmonize Research in Long-Term Care Living Environments (WE-THRIVE) consortium has previously prioritized measurement concepts in the areas of care outcomes, workforce and staffing, person-centered care, and care context. These concepts include knowing the resident and what matters most to the resident, and outcomes such as quality of life, and personhood. We present findings of our currently recommended measures, including both general population and dementia-specific measures, such as the Person-Centered Care Assessment Tool (PCAT), the Personhood in Dementia Questionnaire (PDQ), and the ICEpop CAPability Measure for Older People (ICECAP-O). We also describe remaining gaps in existing measures that will need to be addressed to fully specify common data elements focused on measuring what matters most to residents, relatives and staff.

Measuring What Matters in Long-Term Care: Common Data Elements in Brazil, China, and the United States

Internationally sharable common data elements on residential long-term care (LTC) settings, such as nursing homes and assisted living facilities, can facilitate comparisons across diverse LTC settings for valuable insights on LTC regulation and oversight, practice and operations, infrastructure development, human resources issues, and quality and safety. However, such insights are predicated on the premise that data elements capture information that matters to the full LTC community, including residents, relatives and staff, and are able to be collected across diverse care settings, including low-resource contexts. A critique of much current LTC measurement is its focus on deficits and loss, rather than thriving, person-centered care, and healthy aging, which have been established as important to LTC communities internationally. Further, measurement burden, cultural differences in perceptions of data sharing, and data infrastructure differences are key issues for international data. An international collaborative of LTC researchers—Worldwide Elements to Harmonize Research in Long-Term Care Living Environments (WE-THRIVE)—has developed a set of common data elements that are recommended for parsimoniously assessing key outcomes, workforce and staffing, person-centered care, and the contexts within which LTC settings operate. The studies in this symposium provide insights into the validation and implementation of WE-THRIVE recommended measures in diverse, low-resource LTC contexts, including LTC settings in Brazil, China, and rural Midwest US. Study findings validate WE-THRIVE measures, and provide new knowledge to inform capacity-building for the measurement of person-centered care and healthy aging outcomes in diverse, low-resource, LTC settings.

Transitions to Long-Term Residential Care Settings

During their life course, many older adults encounter a transition between care settings, for example, a permanent move into long-term residential care. This care transition is a complex and often fragmented process, which is associated with an increased risk of negative health outcomes, rehospitalisation, and even mortality. Therefore, care transitions should be avoided where possible and the process for necessary transitions should be optimised to ensure continuity of care. Transitional care is therefore a key research topic. The TRANS-SENIOR European Joint Doctorate (EJD) network builds capacity for tackling a major challenge facing European long-term care systems: the need to improve care for an increasing number of care-dependent older adults by avoiding unnecessary transitions and optimising necessary care transitions. During this symposium, four presenters from the Netherlands and Switzerland will present different aspects of transitions into long-term residential care. The first speaker presents the results of a co-creation approach in developing an intervention aimed at preventing unnecessary care transitions. The second speaker presents an overview of interventions aiming to improve a transition from home to a nursing home, highlighting the clear mismatch between theory and practice. The third speaker presents the impact of the COVID-19 pandemic on transitions into long-term residential care using an ethnographic study in a long-term residential care facility in Switzerland. The final speaker discusses the results of a recent Delphi study on key factors influencing implementing innovations in transitional care. The discussant will relate previous findings on transitional care with a U.S. perspective.

'I wouldn't choose this work again': Perspectives and experiences of care aides in long-term residential care.

To provide insight into the everyday realities facing care aides working in long-term residential care (LTRC), and how they perceive their role in society. A qualitative ethnographic case study. Data were collected over. 10months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi-structured interviews (70h) with 31 care aides; and naturalistic observation (170h). Data were analysed using reflexive thematic analysis. The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections - which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC. Care aides remain an unsupported workforce that is essential to the provision of high-quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role. What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings. What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care. Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings.

Infection prevention and control practices in long-term residential care settings: a multiple methods approach

Infection prevention and control practices in long-term residential care settings: a multiple methods approach

A mixed methods study on the manifestations of behavioural symptoms of dementia among veterans with and without posttraumatic stress disorder.

To explore how behavioural symptoms of dementia are manifested among veterans in residential long-term care settings, in the context of personal, interpersonal/social and environmental triggers and how the manifestations differ between veterans with and without posttraumatic stress disorder. Secondary analysis using a mixed methods approach. We analysed text data from a stratified random sample of 66 cases derived from the programme evaluation dataset of the Staff Training in Assisted Living Residences-Veterans Health Administration (STAR-VA) intervention from 2013 to 2016, using framework analysis. The detailed behavioural assessment descriptions in this dataset are consistent with contemporary non-pharmacologic symptom management. Qualitative categories were converted to quantitative variables for two group comparisons. Four patterns emerged linking specific types of triggers and behavioural symptoms: (1) unmet physical needs or emotional distress triggers non-aggressive behaviours; (2) unsolicited direct care approach triggers care refusal, resistance or combativeness; (3) interpersonal interactions interfering with self-direction trigger aggressive behaviours; and (4) uncontrolled stimulation from environments trigger non-aggressive behaviours. The organisational culture of care influenced how staff conceptualised behavioural symptoms. Veterans with co-existing posttraumatic stress disorder and dementia tended to exhibit rejection of care with aggression compared to those with dementia alone. Contextualised accounts of behavioural symptoms of dementia revealed symptom heterogeneity, with different clusters of multi-level triggers arising from specific personal, interpersonal and environmental circumstances. Distinct patterns of symptom manifestations between veterans with and without posttraumatic stress disorder suggest a tailored approach is required to meet each veteran's unique biopsychosocial needs. Classifying behavioural symptoms with their triggers rather than solely by behaviours provides important new information for developing person-centred, non-pharmacological interventions to improve outcomes for veterans with dementia. Multi-level interventions should be considered to meet veteran's needs that account for their earlier life history and current life circumstances.