Term Care Settings Research Articles

Professional Caregivers’ Mental Health Problems and Burnout in Small-Scale and Traditional Long Term Care Settings for Elderly People With Dementia in The Netherlands and Belgium

The aim of this study was to provide an insight into burnout and mental health problems of professional caregivers working in traditional and small-scale long term care settings for elderly residents with dementia in the Netherlands and Belgium. This study was part of a larger study investigating similarities and differences between traditional and small-scale long term care settings for elderly residents with dementia. In this article, the perspective of the professional caregiver is of central importance. A survey was conducted among professional caregivers of residents with dementia, older than 65 years, at 2 measurement moments (at baseline and after 12 months). The questionnaire was administered to professionals working in traditional and small-scale long term care settings in the Netherlands and Belgium. Professional caregivers (n = 80) working in 5 different care settings completed a questionnaire. The questionnaire included items on personal data, mental health problems (GHQ-12), and burnout (UBOS-C, divided into emotional exhaustion, depersonalization, and personal accomplishment). Analyses were conducted using Mixed Models analysis. Although mental health problems and emotional strain increased significantly over time in both types of settings and countries, overall levels of health problems and burnout were low. As regards emotional strain, professional caregivers in small-scale living facilities showed significantly increased levels in comparison with traditional units. Two significant differences between the countries were also found, with less "depersonalization" and more "personal accomplishment" in Dutch settings compared with Belgian settings. No differences emerged for type of setting or over time on "depersonalization" and "personal accomplishment." The analyses were controlled for age, sex, educational level, and work experience in dementia care, but did not yield significant effects. Owing to cutbacks in expenditure, the growing number of people with dementia, and the heavier workload, the working environment will become increasingly challenging. Future research should focus on training professional caregivers working in long term care settings how to maximize the quality of client interaction while keeping burnout and mental health problems to a minimum.

Estimated energy expenditure of nursing assistants in long term care

Ergonomic research on nursing work has focused primarily on the biomechanical analysis of patient handling tasks. Few studies have addressed the intensity of a full day of nursing work as measured by changes in heart rate and energy expenditure. A pilot study was conducted between August 2009 and May 2010 to examine the intensity of performing nursing assistant work in long term care settings and to assess the usefulness of heart rate monitoring as a measure of work intensity. The residents of the facilities were physically dependent adults. The settings had floor-based mechanical lifting devices available and no-lift policies that restricted workers from lifting. Eight women between the ages of 19 and 54 from two facilities participated in this study. A wearable recorder allowed unobtrusive heart rate monitoring while nursing assistants worked their usual shift. Continuous heart rate monitoring for a full shift provided an estimation of energy expenditure. The data suggest that the nursing assistants worked at a moderate level yet were within the safe work intensity level recommended by NIOSH [32]. The information provides preliminary baseline data for nursing assistants who work with physically dependent adults using floor-based lifts in a no-lift environment.

Creating a Quality of Life Assessment Measure for Residents in Long Term Care

The objectives of this study were to (1) gain an empirical understanding of how stakeholder (residents, family members, staff) groups view quality of life (QoL) for residents in long term care; (2) create a visual map of the domain of QoL and describe differences in importance of key elements; and (3) identify key elements of QoL that could be used to develop a standardized assessment instrument for use in person-centered care planning. This is a descriptive study, using a mixed-method, qualitative/quantitative approach called "concept mapping." The study was conducted at a 240-bed skilled nursing facility located in a major metropolitan area. It is part of a not-for-profit religiously affiliated social service organization. A convenience sample included 3 groups of participants: staff members, family members of residents, and residents. Fifty-three people participated in the brain-storming sessions, and 45 people completed sorting and rating tasks. Sample sizes varied by group and by task. Statements about the elements of QoL for residents in long term care were elicited during 14 brain-storming sessions. Sorting and rating activities were completed using a final list of 88 items. A visual map was generated, with 5 clusters of elements representing 5 conceptual areas within QoL. Importance ratings of elements were similar for family members and staff members, and a set of elements rated as high in importance but requiring attention to implementation was produced. Family members and staff produced similar conceptual models of QoL, and their views on the importance of the various elements were consistent. There was a high degree of consensus regarding elements considered least important and those considered most important. Elements considered most important addressed quality of care, autonomy and respect, and aspects of daily life, including food and sleep. There was less concern with the physical appearance of the facility, the amenities offered, and issues related to independence; however, all items scored above the mean of 2.5 on the 5-point rating scale. This project has shown that it is possible to use concept mapping methodology to obtain facility-specific information about stakeholders' QoL perceptions in the long term care setting, and that residents' views can be assessed and incorporated.

Living with Ageing and Dying – Palliative and End of Life Care for Older People

Introduction SECTION 1 - WHAT IS DIFFERENT ABOUT DYING IN OLD AGE? 1. International trends in circumstances of death and dying amongst older people 2. The care of older people at the end of life: an historical perspective 3. Anti-ageing and scientific avoidance of death 4. The challenges of health technology for ageing and dying 5. The disadvantaged dying: ageing, ageism and palliative care provision for older people in the UK 6. What do we know about the congruence between what older people prioritise at the end of life and policy and practices? SECTION 2 - WHAT CAN A PUBLIC HEALTH PERSPECTIVE BRING TO IMPROVING THE END OF LIFE EXPERIENCE FOR OLDER PEOPLE? 7. Health promoting palliative care and dying in old age 8. User and community participation at the end of life 9. Advance care planning: international perspectives 10. New public health approaches to address diversity and end-of-life issues for older people? 11. Loss and bereavement in older age: developing community-based bereavement support SECTION 3 - INVOLVING CARERS AT THE END OF LIFE 12. The changing profile of the family caregivers of older people: a European perspective 13. Needs, access and support for older carers 14. Family carers, palliative care and the end-of-life 15. Costs of family caregiving 16. Workforce development: an international perspective on who will provide care SECTION 4 - THE SIGNIFICANCE OF PLACE AT THE END OF LIFE 17. Place matters: an exploration of the role of physical environment in end of life care 18. Improving care for older people living and dying in long term care settings: a whole system approach 19. The development and implementation of evidence based palliative care guidelines for residential care: lessons for other countries 20. Improving environments for care at the end of life in hospitals SECTION 5 - MOVING FORWARD: A DEBATE ABOUT PRIORITIES FOR RESEARCH AND SERVICE DEVELOPMENT 21. End of life care for older people with dementia: Priorities for research and service development 22. Evidence, evidence and evidence: future priorities for research and service development in improving palliative care for older people 23. Priorities for research and service development in primary care to improve end-of-life for older people 24. Priorities for specialist palliative care: an Australian perspective 25. Inter-disciplinary perspectives 26. Workforce capacity issues: a New Zealand perspective

Elders' Hypoglycemia Could Point to Cognitive Impairment

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of 497,900 veterans aged 65 years and older with diabetes, said Denise G. Feil, MD, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and her colleagues. “The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect,” said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry. Dietary changes that occur in dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added. Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk-benefit trade-off of intensive glycemic control in cognitively impaired patients had not been studied, the authors stated. They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age but would have similar rates of hypoglycemia. The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA1c values. They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition. They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA1c levels were nearly identical among all three cognitive groups, at about 7.0% CI. But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment had a nearly twofold risk of hypoglycemia (OR, 1.7). Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively). The study was funded by the VA's Health Services Research and Development Service. Dr. Feil received a VA Career Development Award. Neil Osterweil is a freelance writer based in Boston. We have long known that hypoglycemia is bad for the brain. These data support the notion that tight diabetic control may do more harm than good in some of our patients, and that following the recommendations of some professional organizations to aim for HbA1c levels of 7 may be ill-advised. The finding that patients with dementia seem to be more susceptible to hypoglycemia adds further motivation for us to avoid overly aggressive diabetic management in this population. AMDA's clinical practice guideline “Diabetes Management in the Long Term Care Setting” emphasizes the need to individualize the goals of diabetic management for each patient, and this new information supports that strategy. –Karl Steinberg, MD, CMD Editor in Chief

Exploring Variation in Rates of Polypharmacy Across Long Term Care Homes

Use of multiple, concurrent drug therapies, often referred to as polypharmacy, is a concern in the long term care (LTC) setting, where frail older adults are particularly at risk for adverse events. We quantified the scope of this practice by exploring variation in the use of nine or more drug therapies across LTC homes. Cross-sectional analysis of LTC home census data. All LTC homes in Ontario, Canada. A total of 64,394 LTC residents aged 66 years and older residing in 589 LTC homes in the fall of 2005. Facility-level rates of polypharmacy were compared with rates of use of Beers criteria and antipsychotic drug therapies. Multivariate logistic regression models were used to assess predictors of polypharmacy across residents and LTC homes. Nine or more drug therapies were dispensed concurrently to 10,007 (15.5%) of LTC home residents. Compared with those dispensed fewer drugs, residents receiving 9 or more drug therapies were more likely to have multiple comorbidities. There was threefold variation in polypharmacy rates across homes (26.2% versus 7.9%) and facility-level rates of polypharmacy were modestly correlated with rates of use of Beers criteria drugs (r= 0.27, P < .001) and antipsychotic drug therapies (r= 0.16, P < .001). Controlling for resident factors, those living in LTC homes with high polypharmacy rates were more likely to receive 9 or more drug therapies (odds ratio 1.9, 95% confidence interval 1.7-2.0). Residents in Ontario LTC homes commonly received nine or more concurrent drug therapies, particularly residents with multiple chronic conditions. The threefold variation in rate across homes suggests a role for this measure in guiding drug review at the facility level.

A study to explore the experience of advanced care planning among family caregivers and relatives of people with advanced dementia

BackgroundThe North West NHS End of Life Care Initiative aims to improve the quality of care received by older people with dementia in care settings at the end of their...

Investigation of a Cluster of Klebsiella Pneumoniae Carbapenemase-Producing Organisms on a Long-Term Care Ventilator Unit

The spread of isolates producing Klebsiella Pneumoniae Carpapenemase producing organsims has become a significant problem over the past 5 years. The incidence of such isolates has occurred with increasing frequency in the long term care setting. We report a cluster of Klebsiella Pneumoniae Carpapenemase producing organsims on our 10 bed long term care ventilator unit. Over a 3-week period, we isolated this organism from urine cultures on 3 separate patients. Analysis of pulse gel electrophesis (PFGE) indicated the same pattern on all 3 isolates. Subsequent surveillance cultures consisting of rectal swabs, sputum and urine cultures were obtained on all patients on that unit. 5 additional isolates from 3 of the other 7 patients were positive for the organism as well. (3 rectal swabs, 1 urine, 1 sputum).

A Family Booklet About Comfort Care in Advanced Dementia: Three-Country Evaluation

To evaluate a booklet on comfort care in dementia from the perspective of family with relevant experience, and assess nursing home resident and family factors associated with evaluations. Retrospective study. Long term care facilities in French-speaking Canada, and the Netherlands and Italy. Bereaved family (n = 138). An 8-item scale assessed the booklet's acceptability. Usefulness was rated on a 0 to 10 scale, and perceived usefulness referred to usefulness if family had had the booklet during the resident's stay. Families indicated preferred ways of obtaining, and the most appropriate time to get the booklet. Almost all families (94%) perceived the booklet as useful. Canadian and Dutch families evaluated the booklet's contents and format favorably, whereas Italian families' evaluations were less favorable. Almost all families endorsed roles for physicians or nurses and about half additionally accepted availability through own initiative, in print or through the Internet. Preference of timing was highly variable. Better acceptability, usefulness, and availability through own initiative were independently associated with non-Italian nationality, presence of more physical signs discussed in the booklet, feeling ill-prepared, and higher satisfaction with care. A preference of receiving the booklet early was more likely in Italian families, those without university education, and those involved with older residents. The booklet is suitable to inform Dutch and Canadian families on comfort care in dementia, but implementation in Italy requires further consideration. The booklet may be integrated in advance care planning in long term care, and made available outside long term care settings to serve families who wish to be informed early.

Over-reliance on Laboratory Diagnostics in the Long Term Care Setting: A Case for the Hands-on Provider

Introduction/Objective: Long term care relies heavily on telephone medicine for initial communication and management of clinical issues. Moreover, medicine has become reliant on laboratory tests. The following case illustrates the importance of the physical exam in the long term care setting.

Management of Phantom Limb Pain with Methadone in the Long Term Care Setting

Introduction/Objective: Phantom Limb Pain (PLP) in post-amputee patients is a common problem, with incidence of 50-85%, and has a profound impact on both physical and psychological well-being. Providing adequate pain control in these patients, many of whom reside in the long term care setting, can be very challenging.

Randomised active programs on healthcare workers' flu vaccination in geriatric health care settings in France: the VESTA study.

Because of a lack of efficacy of influenza vaccination in elderly population, there are still numerous outbreaks in geriatric health care settings. The health care workers (HCW) flu vaccination is known to get herd immunity and decrease the impact of influenza in elderly population living in geriatric health care settings. However, the rates of vaccinated HCWs are still low in France. The French Geriatric Infection Risk Institute (ORIG) performed the VESTA study, a three-phase multicentre to identify factors limiting vaccination in HCWs, and to develop and implement active programs promoting HCWs influenza vaccination. To implement multicenter programs to enhance HCW influenza vaccination. It was a cluster randomised interventional studies. 43 geriatric health care settings (GHCSs), long term care and rehabilitation care settings in France. 1814 Health care workers from 20 GHCSs in the interventional group and 2,435 health care workers in 23 GHCSs in the control group. After the failure of a first educational program giving scientific information and. tested during the 2005-06 flu season in 43 HCSs, a second program was designed with the help of marketing experts, one year after Program 1. The objectives were to involve HCWs in the creation of "safety zones", and to give personal satisfaction. Program 2 was tested during the 2006-07 season. 20 of the 24 HCSs from the Program 1 cluster were included in the Program 2 cluster (1,814 HCWs), and 16 of the 19 HCSs from the Control 1 cluster, plus 7 new HCSs with interest in participating, were included in the Control 2 cluster (23 HCSs; 2,435 HCWs). The efficacy of each program was assessed by calculating and comparing the percentage of vaccinated HCWs, from all HCSs taken together, in the program and control clusters. Program 1 failed to increase the HCW vaccination coverage rate (VCR) (Program 1: 34%; Control 1: 32%; p > 0.05),). Program 2 increased the VCR in HCWs (Program 2: 44%; Control 2: 27%; Chi2 test, p < 0.001) regardless their occupational group but only in the non previous vaccinated subgroup. In geriatric health care centres in France, an active multicenter program giving personal satisfaction and taking into account the profile of non-vaccinated HCWs was more effective in promoting flu vaccination than a scientifically factual information program. HCW involvement is required in program implementation in order to avoid rejection of top-down information.

Application of Long Term Care Principles in Acute Care: Comparison of Nosocomial Urinary Tract Infection Rates by Case Mix

Introduction/Objective: Nosocomial urinary tract infections are the most common type of nosocomial infections. Safe- guarding against them is an important strategic tool in trimming unnecessary costs, saving money, and increasing performance margins. Understanding the predictors for iatrogenic UTIs will help institutions focus on the specific problem areas. Case mix index is one such predictor in the long term care setting and may play a role in the determination of the quality of care in acute care.

The Use of Data for Process and Quality Improvement in Long Term Care and Home Care: A Systematic Review of the Literature

Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention. The most frequently cited issues contributing to unsuccessful quality improvement interventions were lack of staff, high staff turnover, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately quality of life, needs to be a priority.

The Appropriateness of Canine-Assisted Interventions (CAIs) on the Health and Social Care of Older People Residing in Long Term Care: A Systematic Review

Executive Summary Background: Canine-assisted interventions are used frequently in long term care settings, even though their effectiveness has not been definitively proven. One concern commonly described in the literature is the risk of zoonotic infection or animal-related injury/allergy associated with this type of interaction. To date, no systematic review has been undertaken to determine the appropriateness of canine-assisted interventions in relation to these issues. Objective: The aim of the review was to synthesise the best available evidence on the appropriateness of canine-assisted interventions on the health and social care of the older population residing in long term care with regards to zoonotic infection or animal-related injury/allergy. Data Sources: A comprehensive search was undertaken on 32 electronic databases and two reputable websites from their inception to 2009. The search was restricted to English language and both published and unpublished studies and papers were considered. Review Methods: The review took an inclusive approach and considered quantitative and qualitative studies that focussed on zoonotic risk/exposure/infection or animal-related injury/allergy from canine-assisted interventions used in long term care settings. In the absence of research studies, text and opinion were also considered. Critical appraisal of papers was to be undertaken using the appropriate Joanna Briggs Institute critical appraisal instrument and data extraction was to be via the Joanna Briggs Institute data extraction forms, dependant on design. Results: There were no studies located the met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to long term care, older people and canines. Conclusion: There is currently no evidence available to determine the appropriateness of canine-assisted interventions used for older people in long term care in regards to zoonotic risk/exposure/infection or animal-related injuries/allergies. There is a small body of literature available that focuses on health care but it is generalised and does not delineate between different age groups, settings or the animals used. Implications for Practice: No conclusive recommendations can be made regarding the use of canine-assisted interventions in long term care in the context of zoonotic infection and animal-related injuries/allergies. Text and opinion suggests that if a health care facility of any kind is planning to implement or is currently running this type of intervention (using any animal for people of any age group) the following should be considered: It should always be assumed that there is a risk of developing a zoonotic infection or an animal-related injury/allergy when involved in canine-assisted interventions Facilities undertaking canine-assisted interventions should develop their own infection control policy that includes a risk management strategy. They should also be aware of national and state health laws Prevention strategies should focus on hand washing, education and training, risk management and animal health/hygiene Any people who are involved in canine-assisted interventions (e.g. residents, family, staff, handlers) should be aware of these risks and educated on ways to minimise hazards Consent should always be obtained from people involved in canine-assisted interventions and the decision not to participate (regardless of reason) should be respected There are some people who should not participate in canine-assisted interventions due to their increased susceptibility of being injured or acquiring a zoonotic infection Implications for Research: Quantitative and qualitative research studies are urgently required to determine whether there is an increased risk of zoonotic infections or animalrelated injuries/allergies for those people involved in canine-assisted interventions undertaken in long term care. Those at risk need to be identified in a systematic way.

The Economic Feasibility of Canine-Assisted Interventions (CAIs) on the Health and Social Care of Older People Residing in Long Term Care: A Systematic Review.

Obtaining economic data on health care interventions and practices is extremely important, with the bulk of systematic reviews continuing to concentrate on the effectiveness of an intervention. Although popular, there is a scarcity of information available on the cost considerations associated with canine-assisted intervention programs for older population residing in long term care facilities. The aim of the review was to synthesise the best available evidence on the economic feasibility of canine-assisted interventions on the health and social care of the older population residing in long term care. A comprehensive search was undertaken on 32 electronic databases from their inception to 2009. The search was restricted to English language and both published and unpublished studies were considered. An expert in the field, and various contacts from a reputable organisation involved in delivering programs, were also contacted to determine if any other papers or reports were available. This review considered quantitative/economic research papers that addressed the feasibility of canine-assisted intervention programs used for older people residing in long term care. In the absence of research papers, text and opinion were considered. Critical appraisal and data extraction of papers was to be undertaken using the appropriate Joanna Briggs Institute instruments dependant on design. There were no studies located that met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to canine-assisted interventions, long term care settings and older people. The economic feasibility of a canine-assisted intervention program in a long term care facility remains largely unknown. The evidence is additionally hampered by a lack of scientific data to support whether canine-assisted interventions provide physical, emotional and social benefits to older people, particularly in the longer term. Preliminary evidence from textual papers suggest long term care facilities that are contemplating introducing a program should consider the following aspects: the available resources the facility can offer (staff, time, resources, training), setup/changes to infrastructure, the mode of program delivery (independent, resident animal), insurance and liability and program evaluation. Regardless of cost, the preferences and safety of staff, residents' and their family should always be considered. Economic studies are urgently required to determine the feasibility of providing canine-assisted interventions in long term care settings.

The Appropriateness of Canine-Assisted Interventions (CAIs) on the Health and Social Care of Older People Residing in Long Term Care: A Systematic Review.

Background: Canine-assisted interventions are used frequently in long term care settings, even though their effectiveness has not been definitively proven. One concern commonly described in the literature is the risk of zoonotic infection or animal-related injury/allergy associated with this type of interaction. To date, no systematic review has been undertaken to determine the appropriateness of canine-assisted interventions in relation to these issues. The aim of the review was to synthesise the best available evidence on the appropriateness of canine-assisted interventions on the health and social care of the older population residing in long term care with regards to zoonotic infection or animal-related injury/allergy. A comprehensive search was undertaken on 32 electronic databases and two reputable websites from their inception to 2009. The search was restricted to English language and both published and unpublished studies and papers were considered. The review took an inclusive approach and considered quantitative and qualitative studies that focussed on zoonotic risk/exposure/infection or animal-related injury/allergy from canine-assisted interventions used in long term care settings. In the absence of research studies, text and opinion were also considered. Critical appraisal of papers was to be undertaken using the appropriate Joanna Briggs Institute critical appraisal instrument and data extraction was to be via the Joanna Briggs Institute data extraction forms, dependant on design. There were no studies located the met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to long term care, older people and canines. There is currently no evidence available to determine the appropriateness of canine-assisted interventions used for older people in long term care in regards to zoonotic risk/exposure/infection or animal-related injuries/allergies. There is a small body of literature available that focuses on health care but it is generalised and does not delineate between different age groups, settings or the animals used. No conclusive recommendations can be made regarding the use of canine-assisted interventions in long term care in the context of zoonotic infection and animal-related injuries/allergies. Text and opinion suggests that if a health care facility of any kind is planning to implement or is currently running this type of intervention (using any animal for people of any age group) the following should be considered:Implications for Research: Quantitative and qualitative research studies are urgently required to determine whether there is an increased risk of zoonotic infections or animalrelated injuries/allergies for those people involved in canine-assisted interventions undertaken in long term care. Those at risk need to be identified in a systematic way.

The Economic Feasibility of Canine-Assisted Interventions (CAIs) on the Health and Social Care of Older People Residing in Long Term Care: A Systematic Review

Background Obtaining economic data on health care interventions and practices is extremely important, with the bulk of systematic reviews continuing to concentrate on the effectiveness of an intervention. Although popular, there is a scarcity of information available on the cost considerations associated with canine-assisted intervention programs for older population residing in long term care facilities. Objective The aim of the review was to synthesise the best available evidence on the economic feasibility of canine-assisted interventions on the health and social care of the older population residing in long term care. Data Sources A comprehensive search was undertaken on 32 electronic databases from their inception to 2009. The search was restricted to English language and both published and unpublished studies were considered. An expert in the field, and various contacts from a reputable organisation involved in delivering programs, were also contacted to determine if any other papers or reports were available. Review Methods This review considered quantitative/economic research papers that addressed the feasibility of canine-assisted intervention programs used for older people residing in long term care. In the absence of research papers, text and opinion were considered. Critical appraisal and data extraction of papers was to be undertaken using the appropriate Joanna Briggs Institute instruments dependant on design. Results There were no studies located that met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to canine-assisted interventions, long term care settings and older people. Conclusion The economic feasibility of a canine-assisted intervention program in a long term care facility remains largely unknown. The evidence is additionally hampered by a lack of scientific data to support whether canine-assisted interventions provide physical, emotional and social benefits to older people, particularly in the longer term. Implications for Practice Preliminary evidence from textual papers suggest long term care facilities that are contemplating introducing a program should consider the following aspects: the available resources the facility can offer (staff, time, resources, training), setup/changes to infrastructure, the mode of program delivery (independent, resident animal), insurance and liability and program evaluation. Regardless of cost, the preferences and safety of staff, residents' and their family should always be considered. Implications for Research Economic studies are urgently required to determine the feasibility of providing canine-assisted interventions in long term care settings.

Long-term complication: Florida's death certification process and long-term care

This article discusses the medical-legal aspects of death certification in Florida long-term care settings based on an examination of relevant Florida laws and federal guidelines and a comparison of those laws and guidelines to actual medical practice. A review of the health care literature and Florida law, supplemented by interviews with key informants, supports the conclusion that Florida statutes provide a clear protocol for efficient death certification, but do not ensure the accuracy of death certificates. The death certification process in Florida long term care settings could be improved through increased physician training, the development of quality controls, and the expanded use of electronic patient medical records.

高齢者の整容・美容ケアに関する職員教育用ツール

高齢者の整容・美容ケアに関する職員教育用ツール