Term Care Institutions Research Articles

Disability Human Rights and Reparations for People with Dementia in Long Term Care Institutions: An Empirical Study

Disability Human Rights and Reparations for People with Dementia in Long Term Care Institutions: An Empirical Study

Disability Human Rights and Reparations for People with Dementia in Long Term Care Institutions: An Empirical Study

Disability Human Rights and Reparations for People with Dementia in Long Term Care Institutions: An Empirical Study

Implementation of Preventive Care in the setting of primary care: opportunities, hurdles and policy needs for integration of Preventive Care in the daily practice of primary care practitioners.

In Flanders, as in the entire industrialized world, the population is eldering and chronic conditions and comorbidities are increasing importantly. Today, non-communicable diseases (NCD’s) have an important negative impact on the quality of life and represent the most important cause of premature and/ or preventable death. Moreover, they also put an enormous burden on the health care system, in terms of need for health professionals, procedures and medicines, short and long term care institutions as well as on the affordability of the health care system. The knowledge that the majority of these NCD’s can be avoided by prevention, through a healthy lifestyle and early detection, calls for more emphasis on and means for preventive health care.
 Traditionally and still today, the primary and secondary care practice in Flanders is focused on curation and preventive health care is mainly practiced by others, such as school health services and Maternal and child health services. The fundamental principles of curative and preventive care are very different. Curative care is based on an individual approach and is driven by individual demands. However preventive health care is mainly based on population health management and driven by, often not expressed, population needs.
 When it comes to implementation of preventive care, the WHO advocates a Health in all Policies approach, in which preventive care is implemented in all life settings surrounding the citizen, in order to achieve an integrated preventive care policy that is supported by all policy domains and is part of daily life. One of these settings is health care.
 In this workshop we want to exchange experiences on implementation of preventive health care into primary healthcare and to explore the opportunities, hurdles and policy needs to come to a successful adoption of preventive health care in the setting of primary healthcare. To introduce the debate, the session will start with two short presentations of 10-15 minutes in which experiences in two different health care systems, i.e. a national health care system and a predominant private health care system, are shared with the participants.

Reparations for people living with dementia: Recognition, accountability, change, now!

There is a significant and longstanding problem of harm to people living with dementia in long term care institutions ('LTC institutions', referred to by others as 'care homes', 'nursing homes', 'long term care', 'residential aged care facilities'), along with a failure to redress the harm or hold people accountable for this harm. This article reports on an Australian project that found reparations must be a response to harm to people living with dementia in residential aged care. Using a disability human rights methodology, focus groups were conducted with people living with dementia, care partners and family members, advocates and lawyers to explore perspectives on why and how to redress harm to people living with dementia in Australian LTC institutions. Researchers found four key themes provide the basis for the necessity and design of a reparative approach to redress - recognition, accountability, change, now. The article calls for further attention to reparations in dementia scholarship, with a particular focus on the role that can be played in the delivery of reparations by the LTC industry, dementia practitioners, and dementia scholars. Ultimately, this article provides a new understanding of responses to violence, abuse, neglect and other harms experienced by people living with dementia in LTC institutions, which centres justice, rights, and transformative change.

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain.

A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a "nosocomiun", i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

Is the Increase in Record of Skin Wounds in Hospitalized Patients in Internal Medicine Units a Side Effect of the COVID-19 Pandemic?

Wound care is an important public health challenge that is present in all areas of the healthcare system, whether in hospitals, long term care institutions or in the community. We aimed to quantify the number of skin wounds reported after and during the COVID-19 pandemic. This descriptive longitudinal retrospective study compared of wound records in patients hospitalized in the internal medicine service during the first year of the COVID-19 pandemic (from 1 March 2020, to 28 February 2021) and previous-year to the outbreak (from 1 January 2019, to 31 December 2019). A sample of 1979 episodes was collected corresponding to 932 inpatients, 434 from the pre-pandemic year and 498 from the first year of COVID-19 pandemic; 147 inpatients were diagnosed with SARS-CoV-2 infection (3.2%). The percentage of wound episodes in the first year of the COVID-19 pandemic was higher than the pre-pandemic year, 17.9% (1092/6090) versus 15% (887/5906), with a significant increase in the months with the highest incidence of COVID cases. This study shows an increase in the burden of wound care during the COVID-19 pandemic, and it could be attributable to the increase in the number of patients hospitalized for SARS-CoV-2 infection in internal medicine units.

Research utilisation in older people care: Translation, cross-cultural adaptation and validation of instruments into Brazilian Portuguese.

To translate and culturally validate the Estabrooks' Kinds of Research Utilization (RU) and the Conceptual Research Utilization Scale (CRU) into Brazilian Portuguese; and to describe the research use by health professionals working on Long Term Care Institutions (LTCI) for older people. Research utilisation ensures greater quality and effectiveness in the care provided by health professionals. However, there are no instruments to evaluate research utilisation in Latin America countries, like Brazil. A methodological cross-sectional questionnaire validity and descriptive study. The translation and adaptation of the instruments was performed in seven steps following psychometric guidelines. The instruments evaluate research utilisation by health professionals in clinical practice. The RU is composed of single-items of instrumental, persuasive, conceptual and overall forms; and the CRU the conceptual form through a 5-item scale. Professionals of technical level and graduated working in nine LTCI were evaluated from August to December 2018. Descriptive and inferential (reliability, correlation, internal consistency and structure of CRU) analyses were conducted. Sample composed of 117 professionals, 67.5% of healthcare aides and 32.5% of graduated health professionals. All forms of research utilisation showed high implementation in practice (about 75% of the time, or frequently). CRU internal consistency (α=0.885) and structure were adequate. There were significant correlations between RU and CRU (from very low r=0.187 to high r=0.712). Intra-rater, inter-rater and alternate forms reliability ranged from moderate to substantial. The Brazilian versions of the RU and the CRU are valid, reliable and acceptable for evaluating research utilisation by professionals working on LTCI. It is of great relevance to introduce these instruments in low- and middle-income countries to have future data on how much older people care is influenced by the best evidence available. These instruments can be adapted to different healthcare settings and populations.

Multidimensional analysis of frailty in older people of a Brazilian community: a cross-sectional study

In Brazil, the aging process takes place under unfavorable economic, social and health conditions. Therefore, a better understanding of the functionality patterns of different elderly populations becomes essential, especially in times of Covid-19. The objective of study is to assess the functionality of institutionalized and community older people. Cross-sectional study with 51 older people, divided into two groups: Institutionalized Older People Group (GII) and Community Older People Group (GIC), assessed by the Mini Mental State Examination, Clinical Functional Vulnerability Index-20 (IVCF-20), Barthel Scale, Lawton Scale and Tinneti Scale, descriptive analysis, multivariate multiple correspondence technique, multinomial and binomial logistic regression, with the R software were performed. The results showed: the quartiles: robust GIC (IVCF-20=6.75), independent (Lawton=21/Barthel=100). The fragile GII (IVCF-20=18), partially dependent (Lawton=13/Barthel=100). In GII association of frail older people and high risk of falls. In the GIC there is no association. The GIC showed more chances compared to the GII: 198.34 cognitively normal; 5.48 robust; more than 100,000 independents; and 14 low risk of falls. In this way, it is concluded that older people in the community have better functional performance than older people living in the two Long Term Care Institutions.

Cognitive training in institutionalized older adults using telecommunication technology during social isolation

AbstractBackgroundSince last year the world has faced a pandemic. In Brazil it caused one of the World´s highest rate of death and it is known that the older adults are in the risk group for having worse outcomes of the disease and therefore need to be in strict social isolation. Previous studies have indicated cognitive and mood performance improvement from cognitive training in older adults, but there isn´t enough scientific evidence on the effectiveness of these training performed remotely by telecommunication technology.MethodsThe study was developed with 12 older people from a public long term care institution who completed all the phases of this study. The individuals were included in a group according to cognitive performance: (1) cognitively preserved; (2) mild cognitive impairment; and (3) severe cognitive impairment. They were evaluated through a cognitive and depression assessment tools. The instruments were applied in two moments: before and five months after the cognitive training intervention.Results84% were female with a mean age of 78.0±9.3 years and 4.3±4.0 years of schooling (Table 1). There was no significant improvement in cognitive (20.6 ± 6.1 vs. 20.4 ± 7.6, p = 0.86) or mood performance (2.4 ± 1.7 vs. 2.5 ± 1.9, p = 0.80) (Table 2).ConclusionConsidering the need for social isolation the evaluated older persons were deprived for a long time of contact with family members and other activities at the institution, which could have caused a negative impact on their cognitive performance. The present results could be interpreted as if the remote cognitive training contributed to protect the cognitive performance from worsening. Also, it was only possible to carry out a few sessions of training and maybe, with more sessions, the effect could have shown significant results. The training effect could have been lost because of the time that passed between the end of the intervention and the second assessment in the groups. In addition, there is still no scientific evidence on the effectiveness of remote training as opposed to in person training. Thus, more studies are needed to validate remote cognitive training as an effective strategy.

Study of Caregivers, Job Stress and Burnout of Long Term Care Institution in Taichung City

The purpose of this study was to analyze the job stress and burnout of long-term caregiver (LTC), and the relationship between them. A total of 250 valid questionnaires were collected from caregivers of LTC in Taichung, Taiwan. After statistical analysis, the results show that: 1. LTC feel the highest job stress is “having to make a decision immediately in case of emergency.” 2. LTC feel highest job burnout is the “when they felt tired after work every day”. 3. The LTC with junior college education level felt more pressure on “work and family balance” than those with other education levels. 4. In terms of emotional exhaustion, unmarried caregivers are higher than others. 5. LTC feel highest job stress is related to burnout. Based on the above results, this study not only proposes management implications, and but also suggestions for future research.

Perfil socioambiental de idosos de uma região do Pantanal Matogrossense: Um estudo das endoparasitoses

Como o processo natural do envelhecimento, o idoso apresenta mudanças morfofisiológicas e imunológicas deixando o mais susceptível as infecções parasitárias. As endoparasitoses constituem um problema de saúde pública no Brasil, apresentando variações de acordo com as condições de saneamento básico, nível socioeconômico, grau de escolaridade, idade e hábitos de higiene, entre outras variáveis. O objetivo geral deste trabalho foi analisar a prevalência de endoparasitas em idosos frequentadores do Centro de Convivência e idosos e funcionários da Instituição de Longa Permanência no município de Cáceres-MT. As amostras foram analisadas empregando três técnicas laboratoriais, sendo elas: Hoffmann, Ritchie e técnica de coloração Safranina modificado, no laboratório de Biologia Parasitaria da Universidade do Estado do Mato Grosso (UNEMAT). A prevalências de parasitas intestinais entre os idosos do Centro de Convivência (46,98%), idosos da Instituição de Longa Permanência (83,33%) e funcionários (84,61%). Os endoparasitas Criptosporidium sp., Cyclospora sp. e Giardia lamblia foram os mais prevalentes, com 22%, 19% e 18%, respectivamente. Esse estudo avaliou ainda as características sociodemográficas e hábitos de higiene pessoal dos idosos do Centro de Convivência e dos funcionários da ILP. Os resultados sugeriram uma condição epidemiológica preocupante da população idosa da ILP pois os altos índices de prevalência tanto nos idosos quanto nos funcionários evidenciam o alto risco de infecção e reinfecção nesse ambiente e mostra a necessidade de programas educacionais de conscientização das práticas higiênicas e de atenção básica a saúde da população idosa nessas instituições.

MEANING OF CARE FOR RESIDENT OLDER ADULTS, FAMILY MEMBERS AND PROFESSIONALS WORKING IN LONG-TERM CARE INSTITUTIONS

ABSTRACT Objective to understand the meaning of care from the perspective of resident older adults, family members and professionals from Long-Term Care Institutions for Older Adults. Method a descriptive and exploratory study with a qualitative approach, developed with 14 resident older adults, 35 family members and 41 professionals from Long Term Care Institutions for Older Adults, located in the city of Florianópolis, Brazil. The data were collected between May 2017 and January 2018, being organized through the Atlas.ti software for the analysis of qualitative data and analyzed according to the content analysis method proposed by Bardin, in the light of the Theory of Social Representations. Results for the older adults, care was linked to three main dimensions: technical care related to the institution, family care, and self-care. The meaning of care from the perspective of family members was related to the moment experienced with the institutionalization of the aged family member, mainly characterized by the dimensions of affective care, when providing comfort and technical care. For the professionals, technical care was related to the affective character. Conclusion care could be understood in different ways, from different perspectives, but it also made it possible to identify points of synchrony among the participants.

Horta comunitária como atividade lúdica para idosos institucionalizados

Objetivo: relatar a experiência da implementação de uma horta comunitária, em uma Instituição de Longa Permanência para Idosos, no intuito de promover um ambiente ecossocial acolhedor e uma atividade lúdica para o bem-estar de idosos. Método: trata-se de relato de experiência sobre a implementação de uma horta comunitária em uma Instituição de Longa Permanência para Idosos, localizada na cidade de Fortaleza, Ceará, Brasil, realizada em 2018. A atividade foi desenvolvida por meio de integração interdisciplinar entre os Cursos de Graduação em Enfermagem e Agronomia de uma universidade pública. Resultados: a experiência vivenciada permitiu conhecer a personalidade dos moradores da instituição, histórias e aspirações destes. Conclusão: a implementação da horta comunitária na instituição contribuiu de forma significativa para o bem-estar dos idosos, rompeu a monotonia e o sentimento de abandono vivenciados no dia a dia dos idosos institucionalizados e viabilizou o aproveitamento de um espaço inutilizado.

INSTITUCIONALIZAÇÃO DE IDOSOS E CUIDADO FAMILIAR: PERSPECTIVAS DE PROFISSIONAIS DE INSTITUIÇÕES DE LONGA PERMANÊNCIA

Objetivo: identificar o cuidado familiar prestado a idosos institucionalizados, percebido por profissionais de Instituições de Longa Permanência para Idosos.Método: estudo do tipo descritivo e exploratório, com abordagem qualitativa, desenvolvido com 41 profissionais. Dados coletados de maio de 2017 a janeiro de 2018, com entrevistas individuais semiestruturadas. Para organização do processo de análise dos dados, utilizou-se o software Atlas.ti, cujo conteúdo foi submetido à análise de discurso de Bardin.Resultados: as percepções que emergiram das falas dos profissionais participantes sobre a institucionalização tiveram origem nas experiências atuais e vivenciadas. A presença ou ausência da família estava ligada às relações de cuidado, havendo distinção de percepções entre os profissionais das diferentes instituições.Conclusão: percebeu-se que o cuidado familiar, enquanto experiências pessoais para os profissionais, foi significativo para construir as percepções acerca da institucionalização de idosos e do familiar como cuidador.

Evaluation of the effects of a systematized music stimulation program on cognition and mood aspects of the elderly: The possibility of cognitive rehabilitation based on art in the Brazilian Amazon

AbstractBackgroundIn Brazil, the elderly population has the highest growth rate. The estimated number of aged is 32 million for the year 2020. The city of Maraba, in the state of Para, located in and Brazil's Amazon region presents a very low Urban Development Index for Longevity. Previous studies have shown that music can enhance the willingness of the elderly to participate in other social activities, contributing to social interaction and, consequently, to prevention of depression. In addition to an important resource to stimulate memory and attention.MethodThe study was developed with 13 elderly from two public long term care institutions who completed all the stages of this study. They were evaluated through a neuropsychological assessment tool. It was composed of 9 objective tests about memory, executive function, attention, praxis and information processing speed. The instruments was applied in two moments: before and after the musical stimulation intervention which consisted of 12 weekly sessions lasting one and a half hours.Result92.3% were man, 69.2% aged 60‐70 years and 73% with a low level of formal education (Table 1). All had the diagnosis of mild to moderate dementia. There was significant improvement in cognitive performance of sustained attention and immediate recall short‐term memory between the baseline application and the post‐intervention (‐3.8 ± 2.0 vs. ‐2.2 ± 1.8, p = 0.07 and 3.6 ± 1.1 vs. 4.8 ± 2.0, p = 0.02, Table 2 and Figures 1 and 2). Significant improvement in mood symptoms was also observed (5.5 ± 2.0 vs. 4.5 ± 1.8, p = 0.04, Table 2 and Figure 3).ConclusionThe results corroborate with other studies, demonstrating the effectiveness of musical stimulation as a way to slow the progression of cognitive impairment, also contributing to euthymic mood. Thus, this would be an accessible and low cost technique for performing cognitive stimulation/rehabilitation in elderly with dementia and possibly delaying the onset or progression of mood and/or cognitive symptoms. Even to elderly people living in long‐term care institutions who show a faster progression of cognitive decline compared to community‐dwelling elderly also benefit from this intervention strategy.

Impacts of social distancing triggered by COVID-19 in the elderly residents from Long-Term Care Institutions of Brazil

Introduction: The Coronavirus disease (COVID-19) has a high lethality rate among the elderly people, who are more vulnerable to novel diseases, especially those kept in Long Term Care Institutions for the Elderly (LTCIs). Objective: To describe and discuss how the current social isolation imposed by the pandemic has impacted the senior citizens residing in Brazilian LTCIs. Methodology: Primary research was carried out employing the PubMed and SciELO databases, using the keywords “Coronavirus infection” and “Institutionalized elderly health” and with the keywords “COVID-19" and “Institutionalized elderly” and their respective correlatives in English to search for articles published until September 2020. Results and Discussion: Five Scientific Articles, one Research Note, one Epidemiological Bulletin, and one Technical Note were organized in a table to display their findings. Additionally, other applicable data was collated directly from the hands-on experience of one of the authors, who undertook preceptorship for Physiotherapy interns at a Brazilian LTCI. These institutions can possibly potentiate the propagation and dissemination of this viral disease, therefore, the presently enforced prophylactic strategies, (e.g. social distancing), are essential to help maintain the well-being of the population, even if this may be a detriment to their quality of life. Conclusion: The limitations imposed on social interactions by the pandemic have a negative impact on the cognitive and physical aspects of the elderly people at the LTCIs, who already experience conditions of exclusion and isolation.

PERCEPTION OF INSTITUTIONALIZED ELDERLY ABOUT QUALITY OF LIFE: AN INTEGRATIVE REVIEW

Abstract: Aging is a physiological process that happens over time permeated by biological, psychosocial and cultural changes. Through the increase in life expectancy and, consequently, population aging worldwide, the Long Term Care Institutions for the Elderly (ILPI) stand out in caring for these elderly people, making it necessary to know what life is like for the elderly in this environment. Given the above, the study aimed to verify in the literature the perspective of institutionalized elderly about quality of life. Thus, the study is an integrative literature review with a qualitative approach, using Lilacs, Scielo and Medline databases as a means of research, taking advantage of the following Health Sciences Descriptors (DeCS): “Elderly”, “Quality of life” and “institutionalized”. The study sample consisted of 16 articles, which discussed the theme of the study, in which it was sought to verify the perception of institutionalized elderly about quality of life, it was decided to carry out two thematic categories: 01) Quality of Life for the Elderly Institutionalized, and 02) Perception of the Institutionalized Elderly. In view of the above, the study was able to show that the elderly who reside, live in a Long-Term Care Facility for the Elderly (ILPI), it is necessary to be active, dynamic, prepared to carry out their activities of daily living, in order to achieve their quality of life, harmonize health and promote healthy aging. Keywords: Elderly, Quality of Life, Institutionalized.

COVID-19 and Geriatric Dentistry: What will be the new-normal?

Older adults may face many barriers when accessing oral health care. The most vulnerable groups are people living in long term care institutions and the homebound. These barriers are related but not limited to socio-economic issues, medical and oral health problems. Some socio-economic problems are lack of finances, absence of dental insurance, lack of social support networks, and being institutionalized. Some general health problems are multiple co-morbidities, polypharmacy, dementia, and reduced autonomy. Some oral health problems are having heavily restored dentitions, dry mouth, root caries, and inability to maintain adequate oral hygiene independently. In addition to these existing barriers, many new barriers have arisen which are expected to further reduce access to oral health care for older adults due to the emergence of the COVID-19 pandemic. Older adults are at greater risk of fatal outcomes from COVID-19 infection and many dental procedures have an increased risk of creating aerosols, thereby spreading COVID-19 infection. Consequently, older adults due to fear are less likely to seek or receive oral health care until a treatment or vaccine is developed for COVID-19 infections. In this article, the authors discuss the implications of the COVID-19 pandemic to the practice of geriatric dentistry, and what is expected to be the “new normal” in this field of dentistry. KeywordsAged; COVID-19; Geriatric dentistry; Older adults,;Oral health; SARS-CoV-2.

Doctors and Nurses' Perceptions of Tele-consultation in Long Term Care Institutions in South Korea

Doctors and Nurses' Perceptions of Tele-consultation in Long Term Care Institutions in South Korea

Aspectos relevantes do silêncio para a construção do sentido em dados de uma idosa moradora de uma instituição de longa permanência

O objetivo deste artigo é apresentar um recorte da pesquisa desenvolvida com a linguagem de idosos moradores na Instituição de Longa Permanência para Idosos – ILPI, em Vitória da Conquista, Bahia, Brasil. Os dados foram coletados a partir de filmagem e gravação dos idosos em meio a situações enunciativo-discursivas, considerando a história dos sujeitos e seus atravessamentos, bem como a condição de produção desses discursos e o conceito de dado-achado (COUDRY, 1988). Neste artigo, apresentamos a análise de dados referentes ao silêncio que ocorre em sessões com uma das moradoras dessa ILPI. Para tanto, recorremos ao pensamento sobre o silêncio a partir de diferentes áreas, como: da Música, da Filosofia, da Psicanálise e da Análise do Discurso, enquanto disciplina de entremeio da Linguística, com conceitos relevantes para este trabalho. Apesar de serem áreas distintas, observamos que compartilham para o fato que o silêncio não é o zero, vazio, o que nos leva a interpretâ-lo como sentido. Assim, consideramos, por meio das análises, que o silêncio permeia cada signo e se infla de sentido, e que, quando está só, por si só, significa, possibilitando o sujeito institucionalizado rememorar momentos de dependência, (re)elaborar seus desejos, suas respostas.