Term Care Research Articles

Promising Best Practices Implemented in Long- Term Care Facilities During the COVID-19 Pandemic to Address Social Isolation and Loneliness: A Scoping Review

<strong>Context:</strong> Throughout the current COVID-19 pandemic, tremendous effort has been made to implement innovative practices to address social isolation and loneliness (SIL) in long-term care facilities (LTCFs), disproportionally affected by COVID-19. These interventions have not yet been synthesized. This review intended to gather the current promising best practices (PBPs) implemented in LTCFs to alleviate SIL in older persons during the COVID-19 pandemic as well as during the SARS and H1N1 pandemics, using an intersectional lens. <strong>Methods:</strong> An extensive search was done in nine electronic databases. Arksey and O’Malley’s framework was used to format the scoping review. Two independent reviewers screened citations for inclusion, blindly. The selection of articles was conducted blindly by two coauthors. Finally, 16 studies were analyzed out of 9,077 records. <strong>Results:</strong> Two main themes of findings arose from this review. They comprised proximal PBPs directly addressing SIL in LTCF residents such as pseudo-contact interventions (e.g., chat from balcony or behind transparent barriers/glasses), remote communication tools (e.g., phone or video chat, voice mail/text messaging), and humanoid robots. Distal PBPs included measures implemented to prevent or mitigate the development of COVID-19, including COVID-19 screening approaches, outbreak preparedness, quarantining approaches for both residents and staff. <strong>Conclusion:</strong> This scoping review found varied PBP implemented during the multiple waves of the COVID-19 pandemic as well as evidence supporting their effectiveness. The contribution of this study is significant as most of the PBP investigated should be prioritized by public policymakers or institutions to provide more satisfactory services to the elderly and their families.

Vaccination Strategies against Seasonal Influenza in Long Term Care Setting: Lessons from a Mathematical Modelling Study

seasonal influenza in nursing homes is a major public health concern, since in EU 43,000 long term care (LTC) facilities host an estimated 2.9 million elderly residents. Despite specific vaccination campaigns, many outbreaks in such institutions are occasionally reported. We explored the dynamics of seasonal influenza starting from real data collected from a nursing home located in Italy and a mathematical model. Our aim was to identify the best vaccination strategy to minimize cases (and subsequent complications) among the guests. after producing the contact matrices with surveys of both the health care workers (HCW) and the guests, we developed a mathematical model of the disease. The model consists of a classical SEIR part describing the spreading of the influenza in the general population and a stochastic agent based model that formalizes the dynamics of the disease inside the institution. After a model fit of a baseline scenario, we explored the impact of varying the HCW and guests parameters (vaccine uptake and vaccine efficacy) on the guest attack rates (AR) of the nursing home. the aggregate AR of influenza like illness in the nursing home was 36.4% (ward1 = 56%, ward2 = 33.3%, ward3 = 31.7%, ward4 = 34.5%). The model fit to data returned a probability of infection of the causal contact of 0.3 and of the shift change contact of 0.2. We noticed no decreasing or increasing AR trend when varying the HCW vaccine uptake and efficacy parameters, whereas the increase in both guests vaccine efficacy and uptake parameter was accompanied by a slight decrease in AR of all the wards of the LTC facility. from our findings we can conclude that a nursing home is still an environment at high risk of influenza transmission but the shift change room and the handover situation carry no higher relative risk. Therefore, additional preventive measures in this circumstance may be unnecessary. In a closed environment such as a LTC facility, the vaccination of guests, rather than HCWs, may still represent the cornerstone of an effective preventive strategy. Finally, we think that the extensive inclusion of real life data into mathematical models is promising and may represent a starting point for further applications of this methodology.

Academic women departmental heads’ coping mechanisms during COVID-19: A capabilities approach perspective

This paper explored women departmental heads’ leadership experiences in higher education during the COVID-19 pandemic. This paper highlighted aspects of their care and coping mechanisms in terms of them working in virtual spaces. Most scholars have examined employees’ effects and challenges while working from home during a lockdown. However, most studies are silent on women in leadership, especially concerning the provision of resources to enhance effective leadership during this crisis. The paper draws on three concepts of Sen’s Capabilities approach: functionings, freedoms, and agency. This approach facilitates an incisive understanding of institutional and individual coping mechanisms that might be beneficial for women leaders to mitigate the challenges of the devastating COVID-19 lockdowns. The qualitative narrative approach, supported by a feminist lens, provides a critical, in-depth understanding of the real-life stories of women in leadership positions when making-sense of their challenges in working in a virtual environment. Data which was collected through semi-structured interviews with ten female heads of department, was analysed thematically by applying the Capabilities Approach as an analytical tool. The findings indicated that functionings and freedoms are inextricably intertwined to institutional ethnographies. These ethnographies might support or hamper the coping capabilities of women leaders in academic institutions, especially during the COVID-19 crisis.

Safety and efficacy of a cardiovascular polypill in people at high and very high risk without a previous cardiovascular event: the international VULCANO randomised clinical trial

BackgroundCardiovascular (CV) polypills are a useful baseline treatment to prevent CV diseases by combining different drug classes in a single pill to simultaneously target more than one risk factor. The aim of the present trial was to determine whether the treatment with the CNIC-polypill was at least non-inferior to usual care in terms of low-density lipoprotein cholesterol (LDL-c) and systolic BP (SBP) values in subjects at high or very high risk without a previous CV event.MethodsThe VULCANO was an international, multicentre open-label trial involving 492 participants recruited from hospital clinics or primary care centres. Patients were randomised to the CNIC-polypill -containing aspirin, atorvastatin, and ramipril- or usual care. The primary outcome was the comparison of the mean change in LDL-c and SBP values after 16 weeks of treatment between treatment groups.ResultsThe upper confidence limit of the mean change in LDL-c between treatments was below the prespecified margin (10 mg/dL) and above zero, and non-inferiority and superiority of the CNIC-polypill (p = 0.0001) was reached. There were no significant differences in SBP between groups. However, the upper confidence limit crossed the prespecified non-inferiority margin of 3 mm Hg. Significant differences favoured the CNIC-polypill in reducing total cholesterol (p = 0.0004) and non-high-density lipoprotein cholesterol levels (p = 0.0017). There were no reports of major bleeding episodes. The frequency of non-serious gastrointestinal disorders was more frequent in the CNIC-polypill arm.ConclusionThe switch from conventional treatment to the CNIC-polypill approach was safe and appears a reasonable strategy to control risk factors and prevent CVD.Trial registration This trial was registered in the EU Clinical Trials Register (EudraCT) the 20th February 2017 (register number 2016-004015-13; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2016-004015-13).

Risk Assessment and Prophylaxis of Venous Thromboembolism in Patients of Medical Ward of Northwest General Hospital and Research Center, Peshawar, Pakistan: A Quality Improvement Project.

Background Venous thromboembolism (VTE) is a condition that occurs when a blood clot forms in veins. Hospitalization increases the risk of VTE so timely risk assessment and adequate prophylaxis for VTE should be done to prevent this potentiallyfatal complication. Local problem Data from developing countries regarding VTE prophylaxis is scarce. VTE is a neglected area of research in Pakistan. So this closed-loop clinical audit was conducted to evaluate the VTE risk assessment and prophylaxis practices and to analyze the importance of educational intervention in improving the standard of care. Patients and methods We adopted the National Institute for Health and Care Excellence (NICE) guidelines for VTE prophylaxis as an audit standard.We collected dataon a specially designed proforma by prospectively reviewing the hospital notes of patients in the Medical Ward of Northwest General Hospital and Research Center, Peshawar, Pakistan. Phase A included 60 patients and after educational intervention, Phase B was conducted with 90 patients. Intervention The results of Phase A were presented in the Clinicopathological Conference (CPC) meetings of the hospital. Healthcare workers were educated regarding the risks of VTE and the importance of timely prophylaxis. Posters were also displayed in the ward for highlighting the importance of VTE prophylaxis. Results In Phase A, only 5% of patients were risk assessed for VTE and of those eligible for prophylaxisonly 22.2% received the prescription. Phase B showed a significant adherence to standard practices. In Phase B, 100% of patients were risk assessed for VTE and75% received the prophylaxis. Conclusion There was poor compliance with standard VTE risk assessment and prophylaxis prescribing practices. However, a simple and effective educational intervention markedly improved patient care in terms of VTE strengthening the impact of clinical audits in the improvement of care.

The unmet needs of older adults living in nursing homes in Mainland China: a nation-wide observational study

BackgroundThe unmet needs of older adults in nursing homes could result in their poor health status physically and psychologically. The aim of this study was to understand the characteristics of unmet needs of older adults residing in nursing homes in China, and to probe into the contributing factors.MethodsIn this cross-sectional design, the demographic and health status questionnaire, Modified Barthel Index, the Numerical Rating Scale for pain assessment, Geriatric Depression Scale, Camberwell Assessment of Need for the elderly were employed to survey older adults living in 38 nursing homes in 13 cities in China from July 2017 to June 2018 through a multi-stage, stratified sampling scheme. The Short Portable Mental Status Questionnaire was adopted to exclude participants with severe cognitive impairment. Aside from descriptive analysis, a raft of hierarchical logistic regression models were run by sequentially controlling for the independent variables at 5 levels (demographic characteristics, health status, pain, ADL, and depression), aiming to identify the influencing factors of the unmet needs of the residents.ResultsThe effective sample size involved 2063 older adults (63.4% female versus 36.6% male), with a response rate of 98.5%. The median and inter-quartile range of the total needs and unmet needs of the sample was 3(1, 4) and 0(0, 1) respectively, with 122 older participants having more than 3 unmet needs (high unmet need category) versus 1922 older ones having ≤ 3 unmet needs (low unmet need category). The unmet needs of older adults in nursing homes mainly fell into social domains. Gender, religion, educational background, marital status, living condition before admission, room type, incomes, staffing, number of diseases, pain, Barthel Index, and depression were contributive to unmet needs of older adults in long-term care facilities in the final model that was adjusted for all levels of variables (all p < 0.05).ConclusionUnderstanding the influencing factors of the unmet needs of older adults in long term care provides clues for healthcare professionals to offer better care for this population. System-level support to nursing homes and training of staff are highlighted. Plus, taking measures to beef up social connections for the older adults to meet their social needs was suggested.

CONTINUOUS WORK-BASED LEARNING IN THE NURSING HOME SETTING

Abstract Nursing homes face challenges caused by increasing numbers of older adults with frailty and multimorbidity, and complexity of care in combination with decades of under resourcing and severe workforce challenges. In most countries the vast majority of direct care in LTC homes is provided by a large unregulated workforce that is largely unregulated, female, racialized and poorly remunerated. The results are severe difficulties in recruiting and retaining staff at all levels and a tendency to substitute less qualified workers for more highly qualified and more highly remunerated. Less well reported are the significant pressures that critical LTC home managers face. However, they are equally under duress especially in the wake of a global pandemic. Developing a culture of continuous learning and integrating this into daily nursing practice is one promising way to attenuate these challenges, ensure a high quality of care and a better equipped nursing staff. However, insight into strategies and interventions that contribute to such a continuous work-based learning culture in nursing homes is still relatively limited. In this symposium we will focus on different approaches to increasing workplace learning in long term care.

PARTICIPATORY DESIGN: AN ESSENTIAL PROCESS FOR SOCIALLY ASSISTIVE ROBOTIC ACTIVITIES IN LONG-TERM CARE SETTINGS

Abstract We conducted participatory design research for long term care (LTC) socially assistive robotic activities comprised of social, cognitive and physical components and enhanced human-robot (HRI) and human-human interactions (HHI). Repeated sessions were conducted with 10 geriatric experts (physicians, activity directors, nurses, occupational therapist) and 12 LTC residents (ages 70–92). Two robots, animal and humanoid, were used in combination with virtual reality. Four collaborative activities for paired older adults were designed and evaluated: playing drums to music, completing paintings, a fishing game, and training a dog with simple commands. Within each activity, three levels of difficulty were designed. Stakeholder feedback was obtained through observations and interviews. Numerous modifications were made following each session that addressed hardware, software and activity issues. Modifications were necessary both for the HRI and HHI aspects of the activity. Our experience demonstrates the necessity for participatory design in the deployment of technology for LTC settings.

INTERVENTIONS TARGETING LONELINESS AND ISOLATION AMONG LONG-TERM CARE RESIDENTS: A SYSTEMATIC REVIEW

Abstract The impact of loneliness and social isolation on health is a significant concern among people residing in long term care. Researchers have begun to design and test interventions to lessen the burden of these impacts on the individual as well as our already strained healthcare system. The purpose of this review is to synthesize types and outcomes of interventions designed to reduce loneliness and isolation among long term care residents. Six databases: CINAHL, PUBMED, Cochrane, Web of Science, PsycInfo, and Embase were searched to identify studies leveraging the use of various interventions for alleviating feelings of loneliness and isolation within long term care residents. Multiple keywords were used including loneliness, social isolation, long-term care, nursing home, treatment, and strategies. Articles were screened if they were published between 2012 and present. Twenty studies were included in this systematic review. All studies have a small sample size. Only four studies were randomized controlled trials. Interventions included laughter therapy, adaptive sports, social robotics, horticultural therapy, spirituality, electronic cognitive behavioral therapy, music therapy, virtual reality, expressive arts, telephone discussions, video conferencing, peer mentoring, and animal assisted therapy. The majority of the interventions demonstrate a significant improvement in alleviating feelings of loneliness and social isolation, while some interventions also show improvement in quality of life and physical ability. However, some studies have a high attrition rate. Future research is needed to utilize a more rigorous design with a large sample size. Participant engagement should be considered as part of the intervention activities.

EXPLORING HOUSING AND HOUSING DISCRIMINATION FOR LGBT OLDER ADULTS IN COASTAL NORTH CAROLINA

Abstract This study explored the beliefs, experiences, and needs related to housing and housing discrimination in LGBT older adults living in coastal North Carolina. Surveys were administered to staff (N = 138) of various types of older adult living communities (including long term care, public housing, and specific units of care including memory care and skilled nursing) to understand the status of discrimination, any integrative activities and human diversity/cultural sensitivity training offerings for staff. Findings indicate that nearly 80% of the participants received no training in the specific needs of LGBT communities and less than 10% provided inclusionary marketing/advertisement. No prior studies to date have been conducted on housing needs or discrimination of LGBT older adults within this coastal region. Implications include extensive need for cultural sensitivity education to plan for and improve housing experiences for LGBT older adults.

RESILIENCE AMONG RESIDENTS, THEIR FAMILY, AND STAFF OF A CONTINUING CARE RETIREMENT COMMUNITY

Abstract There is emerging literature about older adults’ experience of loneliness during the COVID-19 pandemic in long term care (LTC) facilities due to isolation protocols. Additionally, staff challenges while providing care for older adults in LTC has also been highlighted. While the literature emphasizes negative pandemic experiences, a gap exists with understanding resilience during the pandemic in LTC settings. The aim of this qualitative descriptive study was to explore the experience of resilience in a Continuing Care Retirement Community (CCRC) among residents, their family members, and staff. We conducted 19 in-person interviews and 1 via Zoom in fall 2021 with 5 residents (65 and older), 5 family members, and 10 staff (e.g., administrators, nurses, nursing assistants). A conventional content analysis was employed. While we did hear how the pandemic had a negative impact on everyone, the main themes of resilience identified were: 1) overcoming the pandemic together (sense of community); 2) experience and adaptation (over time being able to adapt to the disruption in their life); 3) staying safe (engaging in precautions and self-care strategies); and 4) positivity (mindset of getting through anything and relying on spirituality). Study findings can inform CCRC administrators on how to support residents, their family, and staff during future pandemics and other challenging times that may disrupt normal routines.

MIGRATION ACROSS THE LIFE COURSE AMONG OLDER ADULTS FROM PUERTO RICO

Abstract The prior literature regarding migration among Hispanics to US states has largely focused on younger migrants and often excluded people from Puerto Rico (e.g., Hispanic Paradox; Bostean, 2013). However, older Puerto Ricans appear to be moving to the US mainland (US Census Bureau, 2020, 2021). Therefore, the primary objective of this research was to examine migration among Medicare beneficiaries from Puerto Rico. Using data from Medicare, our results showed that migration trends among Medicare beneficiaries from Puerto Rico have increased over the past decade, including those with special needs. There were 5,593 (1%) Medicare beneficiaries who migrated in 2009 compared to 12,382 (~2%) beneficiaries who migrated in 2018. Among those who migrated, 3,679 were 65 and older in 2009 compared to 8,805 in 2018. The majority of older adults who moved to US states were female (59%), about 75 years old and were enrolled in Medicare Advantage. Destination states among Medicare beneficiaries from Puerto Rico included Florida, New York and New Jersey (comparable to those reported for the general population of Puerto Rico in the US Census). This research has policy implications. Although people from Puerto Rico have different reasons for migrating, those with long term care needs may have multiple varying reasons to move to the mainland. However, migration to the US may have additional challenges for people with high needs (Mellgard et al., 2019). For instance, Medicare coverage/network may not transfer to the US and plan switching/disenrolling may not be a straightforward process for people leaving Puerto Rico.

A DEDICATED APPROACH TO PALLIATIVE DEMENTIA CARE

Abstract Nursing staff play a central role in the palliative care for people with dementia. Development of their palliative care competences may support timely recognition and addressing of individual needs of persons with dementia and their family caregivers in long term care. In the DEDICATED (Desired Dementia Care Towards End of Life) project, we aim to develop materials to support nursing staff in providing palliative dementia care. The first step of the project concerned a needs assessment, mapping the perspectives of nursing staff, family caregivers and people with dementia (scoping review, surveys and semi-structured interviews). Using these studies’ results as a starting point, an intervention (the DEDICATED approach) was built, using an iterative co-creation approach involving nursing staff and educators (N=12). These ‘ambassadors’ were also trained to disseminate the approach within their care teams and nursing curricula. First reactions from the pilot study regarding the DEDICATED-materials are positive and nurses and nurse educators are eager to use the materials (www.dedicatedwerkwijze.nl). Currently the DEDICATED-approach is being evaluated using a mixed methods pretest-posttest controlled design comparing three groups: a design group (12 wards), a test group (28 wards, 28 new-trained ambassadors) and a control group (12 wards). The main outcomes of study are e.g. self-efficacy, empowerment and engagement in providing palliative care for people with dementia. A secondary outcome involves longitudinal trends of the quality of dying of persons with dementia within the group.

RESIDENT-TO-RESIDENT AGGRESSION: PREVALENCE AND RISK FACTORS

Abstract This study examines the rates and risk factors of resident-to-resident aggression in long term care facilities in Hong Kong. A total of 800 personal care worker participated. Participants averaged 42.03 years of age (SD=7.63), were mostly female (92.7%), married (79.1%) and reported an average of 6.28 years of experience in long term care. 96.9 percent of the participants provided care to residents with dementia but 58.9% considered the training they received insufficient. Resident-to-resident aggression was common: All participants reported having witnessed verbal aggression (100%), 18% disruptive behaviors, 11.8% physical violence, and 3.1% sexual aggression.Resident-to-staff aggression was commonly reported with verbal aggression being the most common (97.6%) following by other disruptive behaviors (13.7%), physical violence (10.7%), and sexual aggression (8.5%). Logistic regression analysis indicated that disruptive behaviors and physical violence were associated with perpetrator male gender, dementia, and neuropsychiatry symptoms, as well as staff prior and current experience of taking care of persons with dementia, not having received training in dementia care, and perceived insufficiency of training. Sexual aggression was associated with perpetrator male gender and staff female gender. There is an urgent need to provide supportive services to prevent and intervene resident-to-resident aggression in long term care facilities. Improving management of behavioral and psychological symptoms of dementia through sufficient staff training and adequate staffing ration may be helpful in this aspect.

LONG-TERM CARE STAFF DECISION-MAKING PROCESSES IN DETERMINING DAILY WELL-BEING OF RESIDENTS

Abstract Much of the care provided to residents in long term care (LTC) comes from staff with minimal training, particularly in the area of the assessment of complex clinical presentations. This study utilized semi-structured focus group techniques with 25 clinical staff to understand how they determine whether a resident is functioning within or outside their daily “norm” and how they follow-up on these determinations. The overall finding was that each staff member develops an internally stored phenotype of each resident’s norm. Three primary themes emerged: 1) the staff’s phenotype becomes the ‘gold standard’ to determine whether there is a change and/or a cause for concern; 2) staff include sleep routines, fatigue, participation in usual activities, physical and mental status, and social interactions with others in their phenotypes. Staff reflect in what seems like a random manner through these comparisons, and, from this process, 3) a judgement emerges that helps inform clinical decision-making and potential action of the staff member. In most scenarios, staff decided there was no cause for concern. The identified weakness in this strategy was that staff rarely mentioned or used complementary and confirmatory formal assessment or referral mechanisms to ensure their judgment was correct. Thus, staff utilize complex multidimensional thinking and memory in decision-making but lack the skills or institutional structure to augment this with more formal and reliable techniques. This represents an interesting opportunity to build on existing assessment skills with additional types of assessment, technology-based information and formal referral mechanisms.

OPTIMIZING MEDICATION RECONCILIATION AMONG OLDER ADULTS DURING COVID-19 INFECTION TREATMENT WITH PAXLOVID

Abstract COVID-19 infection treatment (CIT) has reframed optimizing medication reconciliation in older adults. In December 2021, FDA authorized Emergency Use Authorization of Paxlovid (Nirmatrelvir/Ritonavir), protease inhibitor blocking SARS-CoV-2 replication, to reduce severe COVID-19 and mortality in high-risk patients1. Pharmacodynamic and pharmacokinetic changes in geriatric population warrant a stepwise, patient-centered approach for prescribing Paxlovid by reviewing - 1) drug-drug interactions with current medications2, 2) renal dosing, 3) risks-benefits-alternatives, 4) adverse drug events (ADE), i.e. polypharmacy and prescribing cascade. Case A – Community-dwelling 65-year-old Hispanic male history of paroxysmal ventricular tachycardia and end-stage renal disease (ESRD) requiring CIT- 1) Paxlovid contraindication with Amiodarone2 2) ESRD – not candidate 3) risks outweigh benefits, 4) safer alternatives with less ADE. Case B – Long term care 80-year-old Hispanic female history of stroke, type 2 diabetes mellitus and dementia requiring CIT -1) Paxlovid contraindication with Atorvastatin2 (Atorvastatin held during Paxlovid treatment then restarted at lower dose “deprescribing”), 2) estimated glomerular filtration rate 46 with renal dosing – Paxlovid 150mg/100mg, 3) benefits outweigh risks, 4) monitored ADE in controlled setting. Optimizing medication reconciliation during CIT in older patients can decrease preventable ADE. Further research is essential to align CIT efficacy with the fundamental geriatric principles, including shared decision-making, long-term prognosis, and life care planning. 1Najjar-Debbiny R, Gronich N, Weber G, Khoury J, Amar M, Stein N, Goldstein LH, Saliba W. Effectiveness of Paxlovid in Reducing Severe COVID-19 and Mortality in High Risk Patients. Clin Infect Dis. 2022 Jun 2:ciac443. 2Lexicomp Drug Interaction Checker. Accessed August 6, 2022.

Development of a Novel Rollator Equipped with a Motor-Driven Chest Support Pad and Investigation of its Effectiveness

In recent years, a rapid increase in bedridden elderly, due to cerebral strokes and other diseases, has become a social problem due to soaring medical costs and heavy burden of long term care support. Therefore, development of walk rehabilitation devices for the elderly, suffered from cerebral strokes, is strongly expected. In the research so far, the authors have developed a rollator with a chest support pad that can rotate freely with one degree of freedom, and the effectiveness of its walk assistance was evaluated. In this study, a novel rollator using a motor-driven chest support pad was developed. A compact system to combine data collect system and motor control was configured. Walk measurements for six subjects were conducted using the developed rollator. The relationship between the movements of the lower limbs and rotation of the motor driven chest support pad was investigated. Time series and power spectrum results were analyzed, and the effectiveness of the motor-driven chest support pad on movement of the lower limb during walking was discussed.

WAYFINDING DESIGN IN LONG-TERM-CARE COMMUNITIES: EVALUATION OF COMPLEXITY

Abstract Wayfinding, the ability to find one’s way, is a significant problem for many older adults; especially those with cognitive impairment. Long term care communities (LTCC) are often fraught with challenges for wayfinding. Those who cannot find their way are at risk for decreased engagement and loss of independence. A critical need is to assess architectural and design features that promote effective wayfinding in an objective way. This study describes the results of a wayfinding design evaluation of 12 LTCC (4 Assisted living; 2 Independent Living; and 6 mixed residency). We measured space syntax axial integration (SSAI; a measure of the visual connectedness) and a Revised Wayfinding Checklist. The results showed low integration values in all communities, ranging from an R3 of 1.43-2.03, indicating low connectedness (and increased wayfinding complexity). The Checklist score totals ranged from 23 – 34 (M = 27.45) out of a possible total of 17 – 51. Results showed that the buildings were overall complex, all had long corridors (&amp;gt;100 feet), over half used multiple elevators to get to common areas; and over 60% had complex, multi-building layouts. Design wise, visibly accessible restrooms were not present; over half of the LTCC had insufficient lighting; and signage color/contrast and letter size was less than recommended. All sites had few directional signs at decision points. Thus, the review of these LTCC showed that most buildings were very complex, with low connectedness, and had room to improve design features like signage and lighting to support wayfinding ability for the residents.

ADDRESSING SOCIAL ISOLATION IN NURSING HOMES DURING COVID-19: A NATIONAL SURVEY

Abstract COVID-19 related policies introduced extraordinary social disruption in nursing homes. In response to the unprecedented COVID-19 pandemic, congregated long term care living facilities attempted and/or implemented innovative intervention strategies to alleviate loneliness in residents. We surveyed Directors of Nursing/Administrators of 1,669 homes sampled in strata defined by size (number of beds 30–99, 100+) and quality ratings (1, 2–4, 5) between February-May 2022. The response rate was 30%. Almost 2/3rds of respondents completed it online and the rest via paper. Analyses included nonresponse survey weights to provide nationally representative results. Among a list of 17 situations that occurred, staff shortages was identified as extremely stressful by the majority. Staff were extremely stressed about doing more to meet resident needs and keeping up with rapidly changing regulations which often lacked clinical sense. One third of respondents were extremely concerned about their home’s ability to meet residents’ social needs before vaccines, dropping to 13% after vaccines. Nursing homes tried and perceived as most useful using technology (tablets, phones, emails), assigning staff as a family contact, and staff spending more time with residents. Nearly 60% were extremely concerned about staff burnout/mental health before vaccines and 40% remained extremely concerned after vaccines. Many nursing homes attempted to mitigate the harmful effects of social isolation during the pandemic, despite the stressful circumstances in which staff worked. The extent to which various approaches were implemented varied. While concerns about social isolation reduced after vaccines were available, administrators remain extremely concerned about staff burnout and mental health.

ASSOCIATION BETWEEN INCREASED CAREGIVER BURDEN AND MENTAL HEALTH DURING THE COVID-19 PANDEMIC IN JAPAN

Abstract During the COVID-19 pandemic, informal caregivers’ mental health was more deteriorated than non-caregivers. The objective of this study was to examine the association between increased caregiver burden and severe psychological distress (SPD) during the pandemic. We used cross-sectional data from a nationwide internet survey conducted between August and September 2020 in Japan. Of 25,482 participants aged 15–79 years, 1,920 informal caregivers were analyzed (mean age, 52.3 ± 15.9 years; men, 48.8%). SPD was defined as the Kessler 6 Scale (K6) ≥ 13. The self-rated change in caregiver burden was measured with the single question item. A binary logistic regression analysis was used to examine the association between SPD and increased caregiver burden, adjusted for demographic, socioeconomic, health, and caregiving variables. To examine the differential association between increased caregiver burden and SPD, interaction terms were added and binary logistic regression was separately conducted in all variables. Of total caregivers, 56.7% reported the increased caregiver burden and 19.3% were SPD. Increased caregiver burden was significantly associated with SPD, with an adjusted odds ratio 1.90 (95% confidence interval 1.37–2.66). The association between increased caregiver burden and SPD was stronger among married caregivers, with disease treatment, and with their care-receiver’s care need level 1–2 (Japanese long term care service levels). This study demonstrated that increased caregiver burden was associated with SPD during the pandemic. Therefore, measures against mental health for the caregivers with increased caregiver burden need to be implemented immediately.