Residential Care Facilities Research Articles

COVID-19 and Its Influence on Prevalence of Dementia and Agitation in Australian Residential Aged Care: A Comparative Study

Agitation is one of the most common and persistent behavioral and psychological symptoms among persons with dementia (PWD) in residential aged care facilities (RACFs). While most studies have explored the general impact of COVID-19 on the mental health and well-being of aged care residents, there has been limited research on the pandemic’s impact on agitation in dementia within RACFs. This knowledge is crucial to ensuring that RACFs are better equipped to handle future public health emergencies. Therefore, this retrospective cohort study investigates the impact of the pandemic on agitation incidents within 40 Australian RACFs. Using Python, we extracted agitation symptoms from nursing notes and compared the frequency and percentage of symptom occurrence pre-pandemic versus during-pandemic. Chi-square tests examined any significant change in the prevalence of dementia and agitation in dementia between the comparative groups and periods. Dementia prevalence dropped significantly during the second year of the pandemic, with a concurrent increase in early-onset dementia cases. Overall, agitation symptoms decreased by 20.1%, but six symptoms significantly increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%). Conversely, pacing decreased by 15.88% and speaking loudly decreased by 10.9%. Over half of the care recipients with dementia experienced agitation symptoms 2–5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021. Despite the co-occurrence of symptoms such as falls, confusion, and weakness, there was no evidence to suggest that these comorbidities were specific to COVID-19; rather, they appeared to be prevalent even before the pandemic. Persons with agitation in dementia had a significantly higher death rate during the COVID-19 pandemic than otherwise.

Medicine communication from hospital to residential aged care facilities: a cross-sectional survey of aged care facility staff.

Continuity of medicines management can be compromised when older people are transferred between hospital and residential aged care facilities. This study explored medicines management practices at facilities during patients' transfer of care from hospital, and staff experiences with medicines information handover from hospitals. An electronic cross-sectional questionnaire sent to all residential aged care facilities within a metropolitan region in Australia, in February 2022. The questionnaire comprised 23 questions covering facilities' profiles, medicines management practices, and medicines management at transfer of care from 2 public hospitals. Of 53 listed facilities, 31 [58.5%] responded. Facilities varied in size ranging between < 50 and up to 200 beds. Twenty-seven [87.1%] facilities offered more than one level of care. Of those 27 facilities, 26 [96.3%] offered dementia care, and 23 [85.2%] offered palliative care. Six (19.4%) solely used hardcopy medication charts. Handover from hospitals to manage patients' medicines at transfer was inconsistent with only 15 [48.4%] reporting consistently receiving appropriate documentation. Residential aged care facilities varied in size and level of care. Diverse processes exist for medicines management. There is inconsistency in information received when residents transfer from hospital to facilities, potentially compromising patient safety.

Efficacy of pain treatment therapies for chronic pain among clients in assisted living facilities: A systematic review

Background: More than 60% of residents in assisted living homes experience pain, a complex and subjective emotion. Here, we examine the effectiveness of pain management treatments for residents in assisted living facilities who suffer from chronic pain. Method: In this review, the PRISMA Statement was adhered to. Included were intervention studies, whether or not they were randomized. Retrospective studies, studies without a control group, and studies without an intervention were among the studies that were excluded. Subjects having chronic pain who were 60 years of age or older, of any gender, and permanently residing in an institutional environment, such as a assisted living facilities or residential care facility, were included in studies that matched the qualifying requirements. Result: Eight papers total—three non-randomized and five randomized controlled trials—were included in our systematic review. Acupuncture, massage, music therapy, and analgesics are among the interventions employed. Analgesics was the most effective intervention. Exercise had similar effects to social interventions on neuropsychiatric symptoms, pain, and medication intake in older adults with chronic pain; Epsom salt hot fermentation is more effective than regular salt; and acupressure is anticipated to be a beneficial and effective nursing intervention for the elderly with chronic pain. Conclusion: The most beneficial treatment outcome was obtained from the analgesic medication therapy. Alternative therapies without the use of drugs provide modest to significant therapeutic results.

Improving Advanced Care Planning: Documentation of DNA CPR Orders and TEPs in Residential Care Admissions

Abstract Background Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders and Treatment Escalation Plans (TEPs) are key components of advanced care planning for managing patients with progressive life-limiting illnesses and significant frailty. Our study aimed to determine the proportion of such patients being transferred from residential care facilities with documented TEPs upon medical admission, examine whether these TEPs were revised during the hospital stay, and assess patient outcomes at 14 days post-presentation. Methods We reviewed the lists of patients who had been referred for medical admission via the emergency department over a one-month period and identified those presenting from residential care facilities. We excluded those under the age of 65. We reviewed relevant medical notes and collected anonymised data into an Excel spreadsheet on a password protected computer. Results We identified 34 patient’s relevant patients. Notes were available for review in 31 cases (17 male; age range 66 to 96 years old, mean age 82.3). Of the 31 cases reviewed, the mean Clinical Frailty Score was 7.4. Residential care facilities sent documentation outlining TEPs in 19/31 cases. In those cases, 4/19 specified full resuscitation. In 3/4 of these cases, the TEP was revised during their admission. In one case, documentation specified that the patient did not want to be transferred to hospital under any circumstances. A total of 14 patients had no documentation regarding TEP. Of those, 7/14 went on to have DNA CPR orders filled out during their admission. At 14 days post presentation, 7 had died in hospital, 16 were discharged back to their residential care facility, and the remainder remained inpatient. Conclusion These findings underscore the need for better advance care planning, potentially improving patient management and reducing the emotional burden on patients, healthcare providers and families during critical moments.

Day Centre Functional Physiotherapy Classes for Older People; Client Survey

Abstract Background Our Long-Term Residential Care facility provides physiotherapy services for approximately 117 Day Care clients. As part of our local Quality Improvement Programme, we wished to assess client perception of Day Centre Functional physiotherapy classes to help ascertain their perception regarding exercise intensity of classes, ability to follow guidance in class and ask questions. Emphasis of the class is to promote a learning environment, improve health literacy and functional independence of clients. As Falls Prevention is key re National Programme for older people (NCOP) and National Frailty Education, questions related to falls frequency and fear of falls prevalence. Methods This was a survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (&amp;gt; 65 years), This was a qualitative survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (&amp;gt; 65 years) Results 70% response rate. 100% reported feeling comfortable asking Physio instructor questions &amp; that exercise guidance was clear and understandable. 96% reported being physically able to keep up with class intensity. 80% reported class intensity as moderate, 20% as high, 0% reported class intensity as easy. 84% reported a fear of falling. 17% reported no fall in the previous year. 68% reported 1-3 falls, 15% reported &amp;gt; 3 falls in last year. Class attendances reported: 4% 0-5 classes, 18% 5-10 classes, 78% more than 10 classes. Conclusion Results obtained from the survey have provided worthwhile feedback and supports that Falls prevention measures should address fear of falls. Significant findings on client satisfaction/perception of exercise intensity noted. Next steps will include tailoring physiotherapy classes for this demographic to include fear of falling, optimising exercise intensity, promoting health literacy and best practice for exercise prescription. Also, consideration of further objective testing of balance post physio class programme period to ascertain success of exercise classes.

Skip The Dip For Urinary Tract Infection in over 65s. A National Initiative To Reduce Antibiotic Prescribing In Older Persons

Abstract Background Urinary tract infection (UTI) is the most common reason for antibiotic use in older persons in residential care. Dipstick urinalysis for UTI is an ingrained practice. Inappropriate use of dipstick urinalysis can lead to inappropriate antibiotic prescribing, contributing to adverse effects and antimicrobial resistance. The ‘Skip the Dip for UTI in over 65s’ quality improvement initiative (QI) aims to raise awareness of best practice for diagnosis and management of suspected UTI to reduce unnecessary antibiotic use. It supports implementation of national guidance stating dipstick urinalysis is not recommended for assessment of evidence of UTI in people 65 years and over. Methods Focus groups with nursing staff in older persons residential care facilities (OPRCFs) identified barriers and facilitators for implementing national guidance on dipstick urinalysis for UTI. Supporting resources developed included a resident leaflet on UTI, staff handbook and webinar recording, hosted on www.antibioticprescribing.ie. Antimicrobial pharmacists delivered workshops on improving assessment of suspected UTI in the HSE OPRCFs from September 2023 to March 2024. Monthly monitoring of antibiotic use for UTI was established in all 119 HSE OPRCFs. Surveys to establish dipstick urinalysis practice in the OPRCFs were administered in March 2023 and March 2024. Results A baseline survey in 2020/21 indicated 98% HSE OPRCFs (133/135) performed dipstick urinalysis for residents with symptoms of UTI, reducing to 53% (57/107) in March 2023, and 24% (25/103) in March 2024 following this QI. Prevalence of antibiotics for treatment of UTI in the HSE OPRCFs decreased by 38%, from a baseline of 2.6% (114/4,446 residents) in 2020/21, to 1.6% (66/4,222 residents) in March 2024. Conclusion The ‘Skip the Dip for UTI in over 65s’ QI has resulted in a change in practice, with the majority of HSE OPRCFs now reporting dipstick urinalysis is not performed for UTI assessment, with a considerable reduction in antibiotics prescribed for UTIs.

Appropriate Prescribing of Antipsychotic Medication Amongst Long-Term Care Facility Residents Admitted to Hospital

Abstract Background In Ireland, it is estimated that up to 45% of long-term care facility residents (LTCR) living with dementia are prescribed antipsychotic medication1. Although antipsychotics have moderate benefit in treating neuropsychiatric symptoms, their use must be carefully weighed against an adverse side effect profile. This study aims to describe the prevalence of antipsychotic usage in LTCR admitted to hospital, and to determine the appropriateness of the prescription as outlined by the National Clinical Guideline 21. This study describes the efficacy of a new Nursing Home Liaison (NHL) service (consisting of two advanced practice nurses) in reducing inappropriate prescribing. Methods Hospital admissions were screened daily to identify LTCR. Medical chart and drug kardex review was performed to collect demographic data, dementia diagnosis, and antipsychotic prescription. Anticholinergic burden was calculated using the ACB score. If the indication for antipsychotic was not clear post review, the NHL service obtained collateral history to determine reason for prescription, making recommendations to wean and stop the medication where appropriate. Results Data was prospectively collected on 50 consecutive LTCR, 28 (57%) were male and the average age was 81years. 26 (51%) of patients had a diagnosis of dementia. A total of 11 (22%) patients were prescribed antipsychotics; of these, seven (64%) had dementia and the rest had psychiatric diagnoses. The mean anticholinergic burden was 2.4 (range 0-7). Five (45%) of the antipsychotic prescriptions were not justified as per Guideline 21 or were no longer needed. These were amended as per the advice of the NHL service. Conclusion This study highlights rates of inappropriate prescribing of antipsychotics among LTCR, resulting in high anticholinergic burden and the associated risks. Medication review and advice from a specialist NHL service, was effective in reducing inappropriate prescriptions. Further education and dissemination of Guideline 21 is prudent to ensure proper prescribing and de-prescribing practices.

Efficacy of a Nursing Home Liaison Service In Supporting Early Hospital Discharge For Long-Term Care Facility Residents

Abstract Background Long-term care facility residents (LTCR) are prone to acute illness and hospital admission due to underlying factors including advanced age, chronic comorbidity and increased frailty. A new Nursing Home Liaison (NHL) service (consisting of two advanced practice nurses) commenced recently with the aim of providing early supported discharge for LTCR admitted to hospital. This study aims to describe the efficacy of the NHL service in reducing length of stay (LOS) and readmission rates for LTCR in comparison to data from the year prior to NHL commencement. Methods Hospital In-Patient Enquiry (HIPE) data was retrospectively obtained for the pre-service group (PSG), consisting of all medically admitted LTCR in 2022. This included demographic data, International Classification of Diseases diagnosis, LOS, and discharge outcome. The same prospective data was obtained by chart review for the service group (SG), for LTCR following the initialization of NHL between September 2023 and March 2024. Unpaired t-test and Chi-squared test was used to determine significant difference between the two groups. Results There were 249 LTCR in the PSG and 171 in the SG. The average age (84 vs 81) and dementia diagnosis rate (60% vs 55%) were similar amongst the two groups. The most common reason for admission in both groups was infection (60% vs 40%). The median LOS was significantly lower for the SG as compared to the PSG (8 vs 6 days, p=0.02). The PSG also had higher seven-day (6.4% vs 4.1% p=0.3) and 30-day (14.5% vs 7.6% p=0.03) readmission rates. Conclusion The introduction of a dedicated NHL service for LTCR has resulted in a significant reduction in hospital LOS and readmission rates. By providing enhanced communication through telehealth review and assistance with advanced care planning, the NHL service effectively bridges the gap between acute and community care, resulting in improved patient flow and delivery of person-centred outcomes.

Antibiogram development for Australian residential aged care facilities.

Knowledge of local antibiotic resistance data, provided by antibiograms (a cumulative summary of in vitro-antimicrobial-susceptibility-test results), can aid prescribing of appropriate empirical antibiotics. This study aimed to explore the feasibility of antibiogram development for residential aged care facilities (RACFs). Retrospective observational study of culture and sensitivity data. Nine RACFs in Queensland, Australia. Available antimicrobial susceptibility results were collected retrospectively for all residents of recruited RACFs from January 1, 2020, to December 31, 2022. Data were managed and analyzed with WHONET software®, and antibiograms were developed in accordance with the CLSI-M39 guidelines. Antibiogram data beyond the standard 12-months and pooling of data from geographically similar RACFs were explored as options to improve feasibility and validity of the antibiograms. The most prevalent bacteria in the RACFs were Escherichia coli and Staphylococcus aureus. Due to the low number of positive cultures (less than 30) for individual RACFs, an annual antibiogram was not feasible. Extending the time-period to three years improved feasibility of antibiograms for E.coli in seven RACFs and S.aureus in five RACFs. Combining the data from closely located RACFs allowed for sufficient urinary and skin swab isolates to produce annual pooled antibiograms for all three years. Use of extended time period antibiograms can provide RACF specific urinary and skin/soft tissue resistance data without the necessity of private pathology provider input. However, pooled syndromic antibiograms can be made available on an annual basis, which may be the preferred option.

Wastewater-Based Surveillance Reveals the Effectiveness of the First COVID-19 Vaccination Campaigns in Assisted Living Facilities.

The COVID-19 pandemic has disproportionately affected vulnerable populations, including residents of assisted living facilities (ALFs). This study investigates the impact of non-pharmaceutical interventions (NPIs) and mass vaccination campaigns on SARS-CoV-2 transmission dynamics within four ALFs in Maricopa County, Arizona, United States from January to April 2021. Initial observations reveal a significant SARS-CoV-2 prevalence in Maricopa County, with 7452 new COVID-19 cases reported on 4 January 2021. Wastewater surveillance indicates elevated viral loads within ALFs with peak concentrations reaching 1.35 × 107 genome copies/L at Facility 1 and 4.68 × 105 copies/L at Facility 2. The implementation of NPIs, including isolation protocols, resulted in a rapid decline in viral loads in wastewater. Following mass vaccination campaigns, viral loads reduced across all facilities, except Facility 4. Facility 1 demonstrated a mean viral load decrease from 1.65 × 106 copies/L to 1.04 × 103 copies/L post-vaccination, with a statistically significant U-statistic of 28.0 (p-value = 0.0027). Similar trends are observed in Facilities 2 and 3, albeit with varying degrees of statistical significance. In conclusion, this study provides evidence supporting the role of NPIs and vaccination campaigns in controlling SARS-CoV-2 transmission within ALFs.

Physical Function Trajectory among High-Functioning Long-Term Care Facility Residents: Utilizing Japanese National Data.

Physical function trajectory (PFT) is associated with mortality and hospitalization risks. We aimed to identify and compare the PFTs of newly admitted high-functioning older adults during their first six months at long-term care (LTC) facilities. In this multicenter retrospective cohort study, we included newly admitted high-functioning older adults (Barthel index > 60) from 47 Japanese LTC facilities. The primary outcome was physical function changes after admission. Data were collected from the Long-Term Care Information System for Evidence (LIFE), which monitored LTC facility residents' function between 1 January 2021 and 31 January 2022. A group-based trajectory model and binomial logistic regression analyses were applied to identify and compare residents' PFTs. Among the 718 residents included, the average age was 85.69 years and 64.5% were female. PFTs were classified as maintenance (66.0%), improvement (9.5%), slight decline (16.6%), and large decline (7.9%). The improvement group had significantly fewer residents who expressed a lack of interest in daily activities (odds ratio (OR) 0.45; 95% confidence interval (CI) 0.21-0.97) compared to the maintenance group. The large decline group had significantly more residents with a low BMI at admission (OR 2.42; 95% CI 1.29-4.55) and residents who did not use dentures (OR 0.49; 95% CI 0.26-0.95), compared to the maintenance group. Considering future PFTs may aid the development of care plans and the provision of appropriate interventions. Moreover, utilizing existing data has the potential to maintain residents' physical independence and enhance the quality of care without burdening residents themselves or staff.

Sarcopenia interventions in long-term care facilities targeting sedentary behaviour and physical inactivity: A systematic review.

Sedentary behaviour and physical inactivity are independent risk factors for sarcopenia for long-term care facility residents. Understanding the components, mechanisms and context of interventions that target change in these risk factors can help optimize sarcopenia management approaches. This study aimed to identify, appraise and synthesize the interventions targeting sedentary behaviour and physical inactivity, construct a Theory of Change logic model, inform complex sarcopenia intervention development and identify areas for improvement. Eight electronic databases, including Embase and Web of Science, were searched for eligible interventional studies from inception until February 2024. Narrative synthesis was used. The Theory of Change was applied to develop a logic model presenting the synthesized results. A Cochrane risk of bias assessment tool was used for quality appraisal. The study included 21 articles involving 1014 participants, with mean ages ranging from 72.5 to 90.4years. The proportion of female participants ranged from 8.0% to 100.0%. The applied sarcopenia diagnosis criteria varied, including those of the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People. The overall risk of bias in the included studies was moderate. Interventions primarily targeted physical inactivity, with resistance training being the most common intervention type. The reporting of intervention adherence was insufficient (only 11 out of 21 included studies provided adherence reports), and adherence overall and by intervention type was not possible to discern due to inconsistent criteria for high adherence across these studies. Four categories of intervention input were identified: educational resources; exercise equipment and accessories; monitoring and tailoring tools; and motivational strategies. Intervention activities fell into five categories: determining the intervention plan; educating; tailoring; organizing, supervising, assisting and motivating; and monitoring. While sarcopenia-related indicators were commonly used as desired outcomes, intermediate outcomes (i.e., sedentary time and physical activity level) and other long-term outcomes (i.e., economic outcomes) were less considered. Contextual factors affecting intervention use included participant characteristics (i.e., medical condition and education level) and intervention provider characteristics (i.e., trustworthiness). The findings led to the development of a novel logic model detailing essential components for interventions aimed at managing sarcopenia in long-term care facilities, with a focus on addressing sedentary behaviour and physical inactivity. Future sarcopenia interventions in long-term care facilities should fully attend to sedentary behaviour, enhance adherence to interventions through improved education, monitoring, tailoring and motivation and establish an agreed standard set of outcome measures.

Nursing Staff's Perspectives of Care Robots for Assisted Living Facilities: Systematic Literature Review.

Care robots have been proposed in response to nursing shortages in assisted living facilities (ALFs) and the growing population of older adults. While the use of care robots may improve the general health and well-being of older adults, their introduction changes the work of nursing staff fundamentally, and it has implications for the entire health care system. In developing such technology, it is important to include end users, but so far, the nursing staff's perspectives have largely been ignored. This study aims to examine the literature on nursing staff's attitudes, needs, and preferences related to the use of care robots in ALFs, in order to discover gaps in the literature and guide future research. This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 protocol. On May 12, 2023, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, the IEEE Xplore Digital Library, and the ACM Digital Library using predetermined search terms. Included publications, written in English, focused on the predevelopment phase, in which information was gathered on nursing staff's attitudes, needs, and preferences regarding care robots for ALFs. Publications were excluded if they did not provide peer-reviewed empirical data. The studies' findings were summarized, coded, and analyzed into major themes using thematic analysis and narrative synthesis. Their quality was assessed using McGill University's Mixed Methods Appraisal Tool and the Joanna Briggs Institute's critical appraisal tools. The final sample included 15 studies. Most of the studies (n=11, 73%) were rated as good quality; however, there was a general lack of reporting on important methodological decisions and sample characteristics. Nursing staff desired care robots that could assist with physically demanding tasks and reduce their workload but had mixed feelings on whether robots could or should assist with social tasks. In addition, nursing staff are concerned about the ethics of care robots, as well as about their safety, accessibility, and operability. The nursing staff's culture, qualification, and role in the facility may influence their perspectives of care robots. The studies lacked theory-driven designs and large sample sizes. Eight (53%) studies mentioned using a participatory design approach, but a lack of established criteria for what constitutes participatory design leads to varying degrees of methodological quality. There was consensus among nursing staff that care robots should serve as nursing assistants to reduce workload. Whether robots could or should assist with social tasks remains a question. Further research is needed to mitigate nursing staff's concerns and understand the socioecological factors that influence their perspectives of care robots and their adoption in ALFs. In addition, theory-driven and large sample size study designs are necessary, as well as work to develop clear criteria for related participatory design research.

Dementia mindset of caregivers providing residential care for older persons: study protocol for a replication study on the validation of the Dementia Mindset Scale

IntroductionProfessional caregivers’ perspectives on dementia and on people living with dementia (PlwD) can influence their feelings, judgements and behaviours in work situations, for example, how they think about symptoms, disease...

The Impact of Trauma-Informed Training for a Youth Residential Center on Staff Attitudes and Behavior

ABSTRACT Purpose Children with behavioral issues in residential care settings have high rates of trauma, with a range of trauma experiences such as abuse and neglect, issues with attachment, and multiple disruptions in placements. Staff in these settings should have an understanding of trauma, its impact, and how to engage in trauma-informed practice. The purpose of this study was to examine whether a trauma-informed training, developed specifically based on the identified needs of a residential group care facility, had an impact on future staff attitudes and behaviors. Materials and methods A 3-h training was delivered by the researchers. Three identical sessions were provided to all 48 staff, regardless of education and role, across a 3-day period. Prior to the training, staff were given a pretest survey measuring components of trauma-informed (TI) practice that indicated how often the staff members engaged in TI practice. Thirty days later, the same participants completed a posttest survey to gauge if the training had an impact on their subsequent attitudes and behavior. Results There were improvements in many of the trauma-informed practice areas on the posttest survey. T-test analysis revealed five trauma-informed practice areas had improvements that were statistically significant from the pretest survey. Discussion The findings present the opportunity for recommendations for trauma-informed training development and delivery, as well as providing implications for the field of social work. Conclusion This study demonstrates the feasibility of administering a trauma-informed training program and observing relatively rapid improvements in future attitudes and behavior among staff.

Examining the Mechanisms of Virtual Reality Tourism's Impact on the Mental Well-Being of Long-Term Care Facility Residents: Perspectives on Presence and Flow.

This study investigates the mechanisms of virtual reality (VR) tourism's impact on the well-being of residents in long-term care facilities (LTCFs). It aims to understand how presence and flow during VR experiences can enhance well-being. This experimental study used a quantitative approach with structured questionnaires to investigate VR experiences among LTCF residents in Taiwan. After obtaining ethical approval, 145 eligible participants from four LTCFs completed a full five-week VR tourism experience. Data collection took place from June to November 2022. This study employed Partial Least Squares Structural Equation Modeling (PLS-SEM) with Smart PLS software to analyze the causal relationships between latent variables. The results confirm that the more vivid the virtual reality image (β = 0.240, p < 0.05), the more immersive the experience (β = 0.267, p < 0.05), the greater the ability to control the experience (β = 0.465, p < 0.001), and the greater the ability to stimulate curiosity during the experience (β = 0.290, p < 0.05), the greater the sense of presence. Increased presence leads to user engagement and a state of flow (β = 0.556, p < 0.001), which is essential for personal hedonia (β = 0.453, p < 0.001) and eudaimonia (β = 0.220, p < 0.001). This study elucidates the mechanisms through which VR tourism experiences enhance well-being among LTCF residents, emphasizing the critical roles of presence and flow in promoting both hedonic and eudaimonic dimensions of well-being.

Delirium Incidence and Predictors in SARS-CoV-2 Vaccinated Residents in Long-Term Care Facilities (LTCF): Insights from the GeroCovid Vax Study

ObjectiveSARS-CoV-2 vaccination can bring an important benefit for older people in terms of reduction of mortality and hospitalization; however, reports of rare adverse effects like altered consciousness and delirium among this demographic have raised concerns. This study aimed to assess delirium incidence post-SARS-CoV-2 vaccination and its predictors in older residents across 60 Italian long-term care facilities (LTCFs). DesignThis is a prospective cohort study considering data from GeroCovid Vax, a multicenter cohort study jointly performed by the Italian Society of Gerontology and Geriatrics (SIGG) (Florence, Italy) and the Italian National Institute of Health (Istituto Superiore di Sanità—ISS, Rome, Italy), and sponsored by the Italian Medicines Agency (Agenzia Italiana del Farmaco—AIFA). Setting and ParticipantsGeroCovid Vax enrolled LTCFs residents aged ≥60 who received at least 1 anti–SARS-CoV-2 vaccine dose. MethodsBaseline data covered sociodemographic details, chronic diseases, medications, nutritional status, cognitive and functional assessments, mobility, and frailty. Delirium was assessed post-first, second, and booster vaccine doses using DSM-5 criteria. Data analysis involved descriptive statistics, multivariate logistic regression, and network analysis. ResultsA total of 2521 participants (mean age 83.10 ± 9.21 years, 70.7% female) were analyzed. Delirium incidence post-first, second, and booster doses was 3.5%, 1.6%, and 1.5%, respectively. Age, preexisting cognitive disorders, and frailty were significant predictors of delirium, with odds ratios (ORs) of 1.70 (95% CI, 1.08–2.77), 2.05 (95% CI, 1.40–2.97), and 1.77 (95% CI, 1.25–2.52), respectively. Prior use of antipsychotics (OR, 1.75; 95% CI, 1.22–2.51) and antidepressants (OR, 1.77; 95% CI, 1.25–2.52) correlated significantly with delirium. Network analysis indicated a strong association between anorexia and delirium. Conclusion and ImplicationsPost-vaccination delirium is infrequent and decreases with subsequent doses. Timely assessments for frailty and cognitive impairment could aid in stratifying delirium risk among LTCF residents, facilitating enhanced prevention measures and close monitoring for delirium indicators.

The nutritional and feeding status of children living in selected residential child care facilities in Zambia: implications for programs and policies.

This study aimed to estimate the prevalence of undernutrition and risk of feeding difficulties and describe common feeding practices for children from birth to 10 years of age living in residential care in Zambia. This was a secondary analysis of de-identified cross-sectional data on 397 children living in 22 residential care facilities in four provinces. Child demographics, anthropometrics, hemoglobin levels, risk for feeding difficulties, and facility-level feeding practices were collected by a trained study team using Count Me In, a digital health app. Interviews with staff were conducted at 15 residential care facilities. Around half of the study sample were boys (53.4%) and <5 years old (55.4%). Special healthcare needs were reported in 10.3% of the children, with cerebral palsy being the most common (3.5%). Underweight, stunting, wasting (using weight-for-length/height), and anemia were found in 22.4, 28.0, 7.1 and 54.7% of children, respectively, with higher rates in children with special healthcare needs and children <24 months old. Duration of residential care was positively associated with length/height-for-age but not weight-for-age or weight-for-length/height z-scores. A risk for feeding difficulties was found in 41.4 and 26.0% of children with and without special healthcare needs, respectively. Suboptimal bottle-feeding practices, including the use of altered nipples and poor caregiver-infant interactions, were observed for infants <12 months old. Residential care staff reported suboptimal diets in their facilities and gaps in knowledge and resources to meet children's nutritional needs. These results demonstrate that a large proportion of children living in residential care in Zambia are at high risk for undernutrition and feeding difficulties and contribute to the small body of literature on children living in residential care, both in Zambia and globally. In the context of Zambia's efforts to improve child nutrition and reform its alternative care, these findings can inform programming and policies for children living in residential care to fulfill their rights to health and family care.

Qualitative Comparative Analysis of exercise interventions for fall prevention in residential aged care facilities

BackgroundExercise interventions are highly effective at preventing falls in older people living in the community. In residential aged care facilities (RACFs), however, the evidence for effectiveness is highly variable, warranting exploration of drivers of successful trials. This study aims to identify the conditions of randomised controlled trials (RCTs) that are associated with reducing falls in RACFs and test whether it can explain the variability.MethodsRCTs testing exercise interventions in RACFs compared to usual care, reporting rate or risk of falls from the 2018 Cochrane Collaboration review and a search update to December 2022 were included. Two authors independently extracted and coded trial conditions and outcomes according to a theory developed from prior Intervention Component Analysis. Trial outcomes were coded as successful or unsuccessful based on point estimates for the rate or risk ratio for falls, or p value. Qualitative Comparative Analysis (QCA), utilising Boolean minimisation theory, was conducted to determine the key conditions driving trial success. A subgroup meta-analysis and the GRADE approach was applied to the final theory.ResultsEighteen trials undertaken in 11 countries with 2,287 residents were included. Participants were predominately ambulant females aged 70 to 80 with cognitive impairment. Most interventions were fully supervised or supervised at the start of the intervention. QCA identified two configurations as drivers of successful exercise falls prevention programs: (i) group exercise that is moderate or low intensity, or (ii) for independent ambulatory residents, exercise for more than 1 h per week. The combination of configuration (i) and (ii) had consistency and total coverage scores of 1, indicating all trials were explained. This combination was associated with a reduction in falls (rate ratio 0.45, 95%CI 0.34 to 0.59; risk ratio 0.66, 95%CI 0.53 to 0.82; low certainty evidence).ConclusionTo successfully reduce falls in RACFs, exercise programs should provide continuous supervised moderate-intensity group exercise. For programs that mostly include independent ambulatory residents, exercise for at least 80 min per week should be provided. As many current residents are frail, tailored exercise is likely necessary and an individualised dose may be required. Future trials should test exercise interventions for less mobile residents.

Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns

IntroductionDuring 2020–2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings.MethodsA longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality.ResultsDuring the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0–4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19–1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12–1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86–1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates.ConclusionThese findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents’ care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.