Senior House Research Articles

Characteristics of health care interventions in affordable senior housing: A scoping review

AimsOlder adults in affordable senior housing often experience chronic illness and unmet health care needs. This review describes studies reporting the characteristics and primary outcomes of health care interventions for older adults living in affordable senior housing. DesignA scoping review MethodsAfter a systematic search in three databases, a team of investigators screened 1,284 titles and abstracts and selected 31 records with reports on 28 studies for review. Narrative synthesis was used to describe studies of interventions in senior housing and primary outcomes. ResultsStudies typically used observational designs and added clinical staff, such as nurses and social workers, to provide health care interventions in groups (n = 15) or with individuals (n = 13). Outcomes were classified in four groups: wellness, symptom management, health care use, and physical function. A subset of 23 studies (82.1%) reported effective interventions. ImpactFindings identify innovative interventions to promote health in affordable senior housing.

“Do Your Best to Avoid it”: Appraisals and Coping with Discrimination-Related Stress Among Older Chinese Immigrants in Affordable Senior Housings During the COVID-19 Pandemic

ABSTRACT This study investigated how older Chinese immigrants in affordable senior housing facilities (ASHs) appraise and cope with anti-Asian discrimination and related stress during the COVID-19 pandemic. Qualitative interviews were conducted with 26 participants aged over 65, analyzing verbatim transcripts and field notes using thematic analysis. Four major domains were identified: (1) discriminatory experience, (2) appraisals of discrimination stress, (3) coping strategies, and (4) rationales behind coping. Among the participants, 11 (42%) reported experiencing discrimination either personally or by someone they know. Participants’ appraisals of discrimination stress varied, and most of them opted for disengagement coping strategies (e.g., avoidance, rationalization) attributing them to health concerns, individual characteristics, environmental and societal factors, and low acculturation. The findings suggest the need for more social and community resources to enhance coping capacity and resilience in this vulnerable population.

A Pilot Study of a Game-Based Cognitive Training Intervention for Public Senior Housing Residents in South Korea

The current study investigated the effects of a game-based intervention on cognitive function and mood for older adults in South Korea. In a nonrandomized controlled, pretest-posttest study, sixteen older adults were allocated to an intervention or control group. The intervention group received the 10-week cognitive training using Happy Table. The game-based cognitive training intervention significantly improved cognitive function and memory loss, whereas the control group maintained a similar level of impairment. However, there were no significant changes in anxiety and depression for both groups. The implementation of game-based intervention may be promising for improving cognitive abilities for older adults.

Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults.

Describe use of home-based clinical care and home-based long-term services and supports (LTSS) using a nationally representative sample of homebound older Medicare beneficiaries. Cross-sectional study. Homebound, community-dwelling fee-for-service Medicare beneficiaries participating in the 2015 National Health and Aging Trends Study (n= 974). Use of home-based clinical care [ie, home-based medical care, skilled home health services, other home-based care (eg, podiatry)] was identified using Medicare claims. Use of home-based LTSS (ie, assistive devices, home modification, paid care, ≥40hours/wk of family caregiving, transportation assistance, senior housing, home-delivered meals) was identified via self or proxy report. Latent class analysis was used to characterize patterns of use of home-based clinical care and LTSS. Approximately 30% of homebound participants received any home-based clinical care and about 80% received any home-based LTSS. Latent class analysis identified 3 distinct patterns of service use: class 1, High Clinical with LTSS (8.9%); class 2, Home Health Only with LTSS (44.5%); and class 3, Low Care and Services (46.6% homebound). Class 1 received extensive home-based clinical care, but their use of LTSS did not meaningfully differ from class 2. Class 3 received little home-based care of any kind. Although home-based clinical care and LTSS utilization was common among the homebound, no single group received high levels of all care types. Many who likely need and could benefit from such services do not receive home-based support. Additional work focused on better understanding potential barriers to accessing these services and integrating home-based clinical care services with LTSS is needed.

Active Aging in Senior Housing Residents and Community-Dwelling Older Adults: A Comparative Study in Finland.

Leading an active life in old age underpins positive life experience. This study aimed to compare the levels of active aging in senior housing residents and community-dwelling older people. We combined data from the BoAktiv senior house survey (N = 336, 69% women, mean age 83 years) and AGNES cohort study among community-dwelling older adults (N = 1021, 57% women, mean age 79 years). Active aging was assessed with the University of Jyvaskyla Active Aging scale. Data were analyzed with general linear models, and the analyses were stratified by sex. Men in senior houses demonstrated lower active aging scores in general than community-dwelling men. Women in senior houses showed greater will to be active, but poorer ability and possibilities for activity than community-dwelling women. Despite the social and supporting environment, senior housing residents' possibilities for leading an active life seem to be compromised, potentially leading to an unmet activity need.

The role of Grey Scale Inversion Imaging (GSII) as a diagnostic tool of neck of femur fractures: is it more effective?

Grey Scale Inversion Imaging (GSII), a radiology reading software, has been utilized to improve anatomical and pathological delineation and consequently increase the diagnostic accuracy in a variety of trauma and Orthopaedic conditions. The objective of this study was to assess whether Grey Scale Inversion Imaging (GSII) has any impact on the diagnostic accuracy and inter-observer reliability in diagnosing neck of femur fractures. We performed a retrospective, single-centre study, to identify 50 consecutive anteroposterior (AP) pelvis radiographs of patients who presented to our unit with suspected neck of femur fractures between 2020 and 2021. The images included a combination of normal pelvic radiographs and others with features suggestive either intracapsular or extracapsular neck of femur fractures, which had been confirmed on computed tomography (CT), magnetic resonance imaging (MRI) and/or subsequent surgery. Four independent observers (two Trauma and Orthopaedics (T&O) consultants, one T&O Trainee Registrar (ST3 level) and one Trainee Senior House Officer (SHO in T&O) reviewed the images and graded each radiograph image using the Likert scale in response to the statement "there is a fracture". Following this, the same radiographs were inverted to Grey Scale Inversion Imaging (GSII) grey scale images and reassessed. RAND correlation was used for statistical analysis. Overall, observers appeared to have similar accuracy with normal radiographic imaging and with GSI sequences. Grey Scale Inversion Imaging (GSII) of digital radiographs did not affect the diagnostic accuracy of detecting neck of femur fractures in our study.

Attitudes and knowledge of emergency doctors towards the end-of-life care in the emergency department: a national survey.

Emergency departments (EDs) are seeing an increase in patients requiring end-of-life (EOL) care. There is paucity of data of attitudes and knowledge of physicians providing EOL care in the ED both internationally and in Ireland. The aim of this project was to assess the attitudes and knowledge of ED physicians towards EOL care. This was a cross-sectional electronic survey of ED physicians working in Irish EDs and was facilitated through the Irish Trainee Emergency Research Network over a 6-week period. The questionnaire covered the following domains: demographic data, awareness of EOL Care, views and attitudes towards EOL care. In total, 441 responses were received, of which 311 had completed the survey across 23 participant sites. This represented a response rate of 44.8%. Majority of the respondents were under the age of 35 (62%), were male (58%) and at Senior House Officer level (36%). In terms of awareness, 32% (98) of respondents were not aware of palliative care services in their hospitals while only 29% (91) were aware of national EOL guidance. Fifty-five percent (172) reported commencing EOL care in the ED, however 75.5% (234) respondents reported their knowledge of EOL care to be limited or non-existent. Only 30.2% respondents felt comfortable commencing EOL care in the ED without speciality team input. There appears to be a lack of clarity on the roles and responsibilities of emergency medicine nurses and doctors in the care of the dying patient in ED with only 31.2% (95) being clear on this role. Significant differences were observed associated with clinical experience and physician grade. This study has highlighted a lack of awareness and knowledge of EOL care particularly amongst less experienced emergency medicine doctors. Formalized training and education programs in the provision of EOL care in the ED will improve comfort levels and knowledge amongst the emergency medicine doctors and improve the quality of care provided.

Loneliness Among Low-Income Older Immigrants Living in Subsidized Senior Housing: Does Perceived Social Cohesion Matter?

ABSTRACT This study compared the level of loneliness among older immigrants residing in subsidized senior housing with that of non-immigrant residents. The study also sought to examine the differential influence of perceived social cohesion on loneliness among these groups. 231 study participants were recruited from subsidized senior housing in St. Louis and the Chicago area. Multiple regression analyses showed that there was a significant difference in loneliness between immigrants and non-immigrants (b = .3, SE = 0.150, p < .05). Also, perceived social cohesion was negatively associated with loneliness (b=−.102, SE = .022, p < .001). Furthermore, immigration status moderated the relationship (b=−.147, SE = .043, p < .01), showing immigrants may benefit more from higher perceived social cohesion in terms of loneliness. The results suggest that perceived social cohesion may act as an important community-level protective factor against loneliness, particularly for older immigrants residing in subsidized senior housing. Creating socially cohesive environments, particularly for this subgroup, could be a crucial strategy for mitigating loneliness.

A Conceptual Framework for Quality Improvement of Senior Housing Programs

A Conceptual Framework for Quality Improvement of Senior Housing Programs

Self-Reported Wellbeing among the Elderly in the First Year after Relocation to Senior Housing

Growing numbers of older adults relocate to senior housing facilities when their physical or mental performance declines. The relocation is known to affect their well-being and provide both challenges and opportunities in new environment. The aim of this study was to explore self-reported well-being among older adults during the first year in senior housing facility. It was a longitudinal study, with repeated, structured interviews of 71 older adults, living in northern Finland. They were interviewed between June 2014 and December 2015. The interviews were conducted three and 12 months after relocation to senior housing facility. The participants used a five-point Likert scale to evaluate their subjective well-being. A nonparametric homogeneity test was performed to assess the statistical significance of change in well-being across the two measurement points. The participants reported statistically significant increases in security and decreases in independence, i.e., ability to cope with everyday activities, during the study period. There was a slight decrease in loneliness, but otherwise participants’ well-being decreased during the first year at a senior housing facility. The potential of subjective well-being in the relocation process is neither fully understood nor taken into account by senior housing organizations. There may be significant social and economic benefits for both carefully planning relocation and supporting the well-being of elderly people at senior housing facilities.

Safety Concerns for Persons with Dementia in Senior Housing: A Qualitative Study with Korean American Caregivers in Los Angeles

ABSTRACT Subsidized senior housing helps many socioeconomically disadvantaged older adults pursue independent living and aging in place. However, cognitive impairment or dementia poses a critical challenge to many residents’ ability to live independently and safely. Focusing on Korean American dementia caregivers, a group known to be vulnerable to caregiving burden but understudied, we explored the safety of persons with dementia in senior housing from the perspectives of caregivers. Qualitative data from nine caregivers whose care recipients were current or former residents of subsidized senior housing in Los Angeles were analyzed by the constant comparative method. Major concerns emerged were: (1) fire risks, (2) wandering, (3) physical injury (e.g., self-harm, falls), and (4) potential neglect. Caregivers also mentioned errors in the self-administration of medications, potential financial exploitation, and interpersonal conflicts. These concerns provide implications for services and programs for the safety of persons with dementia who live in senior housing.

Social network and mental health of Chinese immigrants in affordable senior housing during the COVID-19 pandemic: a mixed-methods study

Objective Chinese immigrant older adults who live in affordable housing are at high risk of experiencing social isolation during the COVID-19 pandemic, which can affect their mental health. Using a triangulation mixed-methods approach, this study describes Chinese immigrant older adults’ social network, mental health status, and their associations during the pandemic. Methods Semi-structured in-depth interviews were conducted with 26 Chinese immigrant older adults from June to August 2021. The structure and characteristics of participants’ social networks were assessed with a name-generating approach. Mental health status was self-reported with Geriatric Depression Scale and UCLA loneliness scale. Results This sample (mean age = 78.12, 69.23% female), on average, had 5.08 social ties in their network, and 58% were family ties. Participants reported decreased social contact, family and friends interaction patterns specific to immigrants, and constantly being in a low mood and bored. Having closer relationships with others and maintaining the same or higher contact frequency after COVID-19 onset was associated with fewer depressive symptoms. Resilience from religious beliefs, neighbors as role models, and wisdom learned from past experiences were reported. Conclusion Knowledge built in this study can inform respondence to future crises like the COVID-19 pandemic in affordable housing settings serving older immigrant populations.

Enhancing social connections through an acting and improvisation course for older Americans in low-income housing

ABSTRACT Background Older adults living in subsidized housing may be at increased risk of social isolation. Applied theater, a participatory art program, can facilitate social connections among older adults. Methods A professionally-facilitated 12-week acting and improvisation course was held in two federally subsidized buildings in an urban setting. The mixed-method design included thematic analysis of interviews, participant observation, field notes, and statistical analysis of change over time in social isolation, community belonging, and social exclusion. Results Participants were motivated to meet other building residents, and the course included aspects that encouraged social bonding. Conclusions Although recruitment of socially-isolated older adults presented challenges, this study presents lessons on what motivates residents of low-income senior housing to enroll in an acting program and how to design a theater course in this setting that promotes group bonding.

P02 Surgeon's narcissism, hostility, stress and meaning in life

Abstract Introduction Disruptive physician behaviour can affect patients’ safety. If surgical trainees throughout higher education experience disruptive behaviour, impaired work-life may follow. Therefore, we studied if surgeons were prone to disruptive behaviour in form of narcissism (N), hostility, perceived stress and the presence of meaning in life. Methods General surgeons in UK National Health Service from 2 hospitals participated with 3 level of training: senior house officer (SHO), specialist registrars (SPR) and consultants (CONS). Participants completed 52 VAS-formed questions plus demographics. Modified questionnaires were used for assessments of ‘Hostility’, ‘Narcissism’, Meaning in life, Quality of work-life and bullying. Results Altogether 33% of surgeons displayed narcissism and 22% could exhibit disruptive behaviour. By MANOVA significant differences between low, medium and high N groups was revealed in hostility (p&amp;lt;.01), perceived stress (p=.001), presence of meaning in life (p&amp;lt;.05). Regression analyses explained hostility both by N-scale (p=.000) and ‘being bullied during training’(p=.009) but negatively by ‘presence of meaning in life’(p=.004). Surgeons’ perceived stress was explained both by N-scale (p=.000) followed by ‘seeing others bullied during training (p=.000) and negatively by ‘working extra days beyond schedule’ (p=.007). Presence of meaning in life was explained mostly by ‘(eu)stress’ (p= .000) but negatively both by ‘doing extra work beyond schedule’ (p= .016) and hostility (p= .003). Conclusion Surgeons may exhibit disruptive behaviour in a challenging situation. Being bullied during surgical training predicted hostility. Seeing others being bullied during surgical training predicted stress. Eustress explained best surgeons’ experience of presence of meaning in life.

Immunizations in a Senior Housing Setting

Immunizations in a Senior Housing Setting

Cost awareness amongst irish ophthalmologists

BackgroundHealthcare systems have increasingly limited and stretched budgets. Clinicians have a key role in budget allocation. Awareness of the costs of high-use clinical items is important.AimsAssess awareness of the cost of commonly utilised clinical items amongst Irish OphthalmologistsMethodsIrish ophthalmologists were contacted and asked to fill out an anonymous survey. We assessed knowledge of hospital costs of surgical materials, medications and anti VEGF drugs as well as retail pharmacy costs of commonly prescribed medications. The cost of items to the hospital was recorded from pharmacy and ward order receipts from a single university hospital. The costs of items to the patient were calculated by taking an average of 3 prices charged by local retail pharmacies. For each estimate we calculated the absolute error from the true price. We calculated the mean absolute errors (MAE) and percentage errors (MAPE) across the different groups.ResultsWe received responses from 47 participants (15 Senior House Officers, 11 Registrars, 21 Consultant/Community Ophthalmologists). Despite 70% of respondents agreeing that the cost of an item should have a major role in its use, the average estimate was 124% inaccurate. Less than 50% of responses were within 50% of the true cost of the item. Self-perceived knowledge was acknowledged to be limited or very limited in 73% of responses.ConclusionsWe demonstrate variable and limited levels of cost awareness. Seniority and better self-perceived knowledge were not found to be associated with better estimate accuracy.

“Aging in Displacement: Urban Revitalization and Puerto Rican Elderhood in Chicago”

Displacement has marked the individual and collective lives of Puerto Ricans in Chicago, especially those who migrated in the 1950s and 1960s. For these older persons, the arrival of the gentry and the yuppies of yesterday, the hipsters of today, and the disappearance of familiar faces in their current neighborhoods are not new phenomena, but rather parts of a profoundly familiar process. They came of age in displacement. Today some Puerto Rican older adults have achieved housing security and are able to age in place because they live in low-income senior housing. Yet a sense of displacement still looms large in their daily lives with the upscaling of and new-build gentrification in their current neighborhood. This work sheds light on the meaning of place for older adult Puerto Ricans who have experienced what psychiatrist and urban studies scholar Mindy T. Fullilove calls a history of “serial displacement.” Through life history narratives and ethnographic snapshots, this paper highlights the neglected reality of “aging in displacement,” or the experience of growing up and growing older in a context of repeated socio-spatial dislocation and how individual and collective life histories of community upheaval texture the spatial and social meanings of place.

Health trajectories of elderly living in French senior housing: a longitudinal perspective

Senior housing for older adults could be an alternative or a transitional care model between home care and nursing home care. Using two longitudinal cohorts of community dwellers aged 65 years or older, we compared risks of mortality and of nursing homes admission between older adults who did or did not move to senior housing over time. In the 3C study (n = 2104, 17 years of follow-up), 143 (6.8%) participants moved into a senior housing during the follow-up. This move was associated with a lower risk of mortality (hazard ratio (HR): 0.64; 95% confidence interval (CI) 0.46–0.77) and a higher risk of nursing home admissions (HR: 1.54 (1.10–2.15)). The risks of hospitalizations (HR: 0.54 (0.40–0.73)) and falls (HR: 0.63 (0.50–0.79)) were lower. In the PAQUID study (n = 3777, 27 years of follow-up), 161 (4.3%) participants moved into a senior housing. This move was also associated with a lower mortality risk (HR: 0.72 (0.58–0.88)) and a higher risk of nursing home admissions (HR: 1.39 (1.05–1.86)). Our results showing lower risks of mortality suggest that senior housing may be a relevant model for vulnerable older adults.

高齢期の地域居住継続における生活支援ハウスの役割

In order to establish “community-based integrated care systems”, housing for those who find it difficult to remain in their homes should be provided. This study focused on Life Support House (LSH). Based on results, the role of LSH for residents to live continuously in their communities can be properly assessed. Questionnaire surveys of LSH and municipalities and interview survey on 12 LHS were conducted. Responses were analyzed by population scale. In smaller population areas, LHS cover shortage of welfare facilities and senior housing. In larger population areas, LHS provide residences to people in low-income.

Trends in Supply of Nursing Home Beds, 2011-2019

Nursing homes play a vital role in providing postacute and long-term care for individuals whose needs cannot be met in the home or community. Whether the supply of nursing home beds and, specifically, the supply of high-quality beds has kept pace with the growth of the older adult population is unknown. To describe changes in the supply of population-adjusted nursing home beds from 2011 to 2019. This cross-sectional study examines changes in the population-adjusted supply of nursing home beds across all US counties from 2011 to 2019 and describes county and nursing home characteristics where the supply of nursing home beds has increased vs decreased. Number of nursing home beds adjusted per 10 000 adults aged 65 years and older. The population-adjusted supply of nursing home beds declined from 2011 to 2019 for 86.4% of US counties, by a mean (SD) of 129.9 (123.8) beds per 10 000 adults aged 65 years or older per county from a baseline mean (SD) of 552.5 (274.4) beds per 10 000 adults aged 65 years or older per county in 2011. The share of beds that were high quality (4- or 5-star ratings) also declined, which was driven by a small number of counties where nursing home bed supply increased due to a proliferation of lower-quality beds. Simultaneously, metropolitan counties with declining numbers of nursing home beds also experienced declining number of senior housing residential beds (-11.3 [54.6] beds per 10 000 adults aged 65 years or older per county from a baseline mean [SD] of 354.8 [222.3]). The findings of this cross-sectional study suggest that the supply of nursing home beds, specifically high-quality nursing home beds, and senior residential housing beds have not kept pace with the demographics of an aging population. Understanding the supply of high-quality nursing home beds and associated geographic variation can inform targeted policies to best support older adults requiring nursing home care.