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Background: Patients with inflammatory bowel disease (IBD) are at increased risk of thrombosis. They often need parenteral nutrition (PN) requiring intravenous access for prolonged periods. We assessed the risk of deep vein thrombosis (DVT) associated with peripherally inserted central catheters (PICCs) and tunneled catheters for patients with IBD receiving home PN (HPN). Methods: Using the Cleveland Clinic HPN Registry, we retrospectively studied a cohort of adults with IBD who received HPN between June 30, 2019 and January 1, 2023. We collected demographics, catheter type, and catheter‐associated DVT (CADVT) data. We performed descriptive statistics and Poisson tests to compare CADVT rates among parameters of interest. We generated Kaplan‐Meier graphs to illustrate longevity of CADVT‐free survival and a Cox proportional hazard model to calculate the hazard ratio associated with CADVT. Results: We collected data on 407 patients, of which, 276 (68%) received tunneled catheters and 131 (32%) received PICCs as their initial catheter. There were 17 CADVTs with an overall rate of 0.08 per 1000 catheter days, whereas individual rates of DVT for PICCs and tunneled catheters were 0.16 and 0.05 per 1000 catheter days, respectively (P = 0.03). After adjusting for age, sex, and comorbidity, CADVT risk was significantly higher for PICCs compared with tunneled catheters, with an adjusted hazard ratio of 2.962 (95% CI=1.140–7.698; P = 0.025) and adjusted incidence rate ratio of 3.66 (95% CI=2.637–4.696; P = 0.013). Conclusion: Our study shows that CADVT risk is nearly three times higher with PICCs compared with tunneled catheters. We recommend tunneled catheter placement for patients with IBD who require HPN infusion greater than 30 days. [ABSTRACT FROM AUTHOR]

Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia. [ABSTRACT FROM AUTHOR]

Background: As the number of nursing home residents with multiple healthcare needs grows, the demand for nursing expertise increases. The implementation of new care models involving nurses with expanded roles is crucial for ensuring quality care in nursing homes. Objectives: To investigate the characteristics and activities of nurses employed in nursing homes in expanded roles and the factors associated with variation in the activities performed. Methods: This multicentre cross‐sectional survey in Switzerland collected data from a convenience sample of 118 nursing homes between September 2018 and October 2019. From a subsample of 62 nursing homes, we analysed the characteristics and activities of 104 nurses in expanded roles. Associations between the activities performed and the educational background of the nurses in expanded roles, their direct supervisors' positions and the presence of physicians in the nursing homes were examined. Results: Most Registered Nurses in expanded roles were diploma educated (48%), with fewer having a bachelor's (35%) or master's degree (17%). Overall, direct clinical practice and guidance and coaching activities were conducted monthly to weekly; consultation, evidence‐based practice, collaboration and ethical decision‐making activities were conducted monthly. We saw variations where a higher educational background was associated with more frequent evidence‐based practice activities (z = 3.47, p < 0.001), and if direct supervisors were ward managers, nurses in expanded roles worked more frequently below their scope of practice (z = 4.10, p < 0.001). Conclusion: This is the first study to use Hamric's integrative Advanced Practice Nursing model to examine the activities of nurses in expanded roles in nursing homes. We found considerable variation in their activities, where nursing homes seem to adapt their roles to their educational background and the local context. Implications for Practice: Our findings show the importance of clarifying role expectations for Registered Nurses in expanded roles, allowing them to practice at the top of the licence to meet residents' complex healthcare needs. [ABSTRACT FROM AUTHOR]

AbstractIntroductionAimMethodsResultsConclusionsPatients with chronic obstructive pulmonary disease (COPD) often require treatment from different healthcare professionals at different levels of care. Previous research indicates shortcomings in interprofessional collaboration and rocky transitions between primary care, specialised care and long-term care.The aim was to explore how nurses and physical therapists experience their role in interprofessional collaboration and the care delivery pathway for patients with COPD.Semi-structured interviews were conducted with nurses (n = 4) and physical therapists (n = 7) from different levels of care between October 2020 and January 2021 and analysed using qualitative content analysis.Insufficient time and continuity along with unclear routines were perceived as inhibiting interprofessional collaboration and transitions within the care delivery pathway. Dialogue between healthcare professionals was considered important to increase familiarisation with other professional roles and to enhance mutual support. Insufficient competence and low priority in healthcare was perceived as placing responsibility on the silent patient group to contact healthcare for follow-ups.This study provides insights into the experiences of nurses and physical therapists regarding several insufficiencies in interprofessional collaboration and the care delivery pathway. It is necessary to increase COPD-related competence among healthcare professionals, develop and clarify routines and provide conditions for dialogue between healthcare professionals. [ABSTRACT FROM AUTHOR]

Summary: This population-based study analyzes hip fracture and osteoporosis treatment rates among older adults, stratified by place of residence prior to fracture. Hip fracture rates were higher among older adults living in the community and discharged to long-term care (LTC) after fracture, compared to LTC residents and older adults living in the community. Only 23% of LTC residents at high fracture risk received osteoporosis treatment. Purpose: This population-based study examines hip fracture rate and osteoporosis management among long-term care (LTC) residents > 65 years of age compared to community-dwelling older adults at the time of fracture and admitted to LTC after fracture, in Ontario, Canada. Methods: Healthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures (identified using the Public Health Agency of Canada algorithm and International Classification of Diseases (ICD)-10 codes) and osteoporosis management (pharmacotherapy) among adults > 66 years from April 1, 2014 to March 31, 2018. Sex-specific and age-standardized rates were compared by pre-fracture residency and discharge location (i.e., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS). Results: At baseline (2014/15), the overall age-standardized hip fracture rate among LTC residents was 223 per 10,000 person-years (173 per 10,000 females and 157 per 10,000 males), 509 per 10,000 person-years (468 per 10,000 females and 320 per 10,000 males) among the community to LTC cohort, and 31.5 per 10,000 person-years (43.1 per 10,000 females and 25.6 per 10,000 males). During the 5-year observation period, the overall annual average percent change (APC) for hip fracture increased significantly in LTC (AAPC = + 8.6 (95% CI 5.0 to 12.3; p = 0.004) compared to the community to LTC group (AAPC = + 2.5 (95% CI − 3.0 to 8.2; p = 0.248)) and the community-to-community cohort (AAPC − 3.8 (95% CI − 6.7 to − 0.7; p = 030)). However, hip fracture rate remained higher in the community to LTC group over the study period. There were 33,594 LTC residents identified as high risk of fracture (FRS score 4 +), of which 7777 were on treatment (23.3%). Conclusion: Overall, hip fracture rates have increased in LTC and among community-dwelling adults admitted to LTC after fracture. However, hip fracture rates among community-dwelling adults have decreased over time. A non-significant increase in osteoporosis treatment rates was observed among LTC residents at high risk of fracture (FRS4 +). Residents in LTC are at very high risk for fracture and require individualized based on goals of care and life expectancy. [ABSTRACT FROM AUTHOR]

Background: Quantifying the informal caregiver burden is important for understanding the risk factors associated with caregiver overload and for evaluating the effectiveness of services provided in Long-term Care (LTC). Objective: This study aimed to develop and validate a Caregiver Strain Index (CSI)-based score for quantifying the informal caregiver burden, while the original dataset did not fully cover evaluation items commonly included in international assessments. Subsequently, we utilized the CSI-based score to pinpoint key caregiver burden risk factors, examine the initial timing of LTC services adoption, and assess the impact of LTC services on reducing caregiver burden. Methods: The study analyzed over 28,000 LTC cases in Southern Taiwan from August 2019 to December 2022. Through multiple regression analysis, we identified significant risk factors associated with caregiver burden and examined changes in this burden after utilizing various services. Survival analysis was employed to explore the relationship between adopting the first LTC services and varying levels of caregiver burden. Results: We identified 126 significant risk factors for caregiver burden. The most critical factors included caregiving for other disabled family members or children under the age of three (β = 0.74, p < 0.001), the employment status of the caregiver (β = 0.30–0.53, p < 0.001), the frailty of the care recipient (β = 0.28–0.31, p < 0.001), and the behavioral symptoms of dementia in care recipients (β = 0.28–2.60, p < 0.05). Generally, caregivers facing higher burdens sought LTC services earlier, and providing home care services alleviated the caregiver's burden. Conclusion: This comprehensive study suggests policy refinements to recognize high-risk caregivers better early and provide timely support to improve the overall well-being of both informal caregivers and care recipients. Highlights: This study introduced an effective approach for quantifying the burden on informal caregivers, despite the limitations posed by the original dataset's incomplete coverage of evaluation items typically found in international assessments. Through analysis of over 28,000 cases, critical risk factors were pinpointed, such as caring for other disabled family members or young children, caregivers' employment status, care recipients' frailty, and behavioral symptoms of dementia, emphasizing the need for targeted caregiver support. Survival analysis revealed that caregivers experiencing higher burdens tend to seek Long-term Care (LTC) services—such as accompaniment on outings, companion services, and home respite services—earlier, which underscores the critical role of these services in supporting caregivers. Providing home care services alleviates caregiver burden, suggesting policy refinements to enhance the well-being of informal caregivers and care recipients through timely and practical support. [ABSTRACT FROM AUTHOR]

Background: Assistive technology carries the promise of alleviating public expenditure on long-term care, while at the same time enabling older adults to live more safely at home for as long as possible. Home-dwelling older people receiving reablement and dementia care at their homes are two important target groups for assistive technology. However, the need for help, the type of help and the progression of their needs differ. These two groups are seldom compared even though they are two large groups of service users in Norway and their care needs constitute considerable costs to Norwegian municipalities. The study explores how assistive technology impacts the feeling of safety among these two groups and their family caregivers. Methods: Face-to-face, semi-structured interviews lasting between 17 and 61 min were conducted between November 2018 and August 2019 with home-dwelling older adults receiving reablement (N = 15) and dementia care (N = 10) and the family caregivers (N = 9) of these users in seven municipalities in Norway. All interviews were audio-recorded, fully transcribed, thematically coded and inductively analyzed following Clarke and Braun's principles for thematic analysis. Results: Service users in both groups felt safe when knowing how to use assistive technology. However, the knowledge of how to use assistive technology was not enough to create a feeling of safety. In fact, for some users, this knowledge was a source of anxiety or frustration, especially when the user had experienced the limitations of the technology. For the service users with dementia, assistive technology was experienced as disturbing when they were unable to understand how to handle it, but at the same time, it also enabled some of them to continue living at home. For reablement users, overreliance on technology could undermine the progress of their functional improvement and thus their independence. Conclusion: For users in both service groups, assistive technology may promote a sense of safety but has also disadvantages. However, technology alone does not seem to create a sense of safety. Rather, it is the appropriate use of assistive technology within the context of interactions between service users, their family caregivers and the healthcare staff that contributes to the feeling of safety. [ABSTRACT FROM AUTHOR]

Aims Design Methods Data Sources Results Conclusions Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To identify the safety incident reporting systems and processes used within care homes to capture staff reports of safety incidents, and the types and characteristics of safety incidents captured by safety incident reporting systems.Systematic review following PRISMA reporting guidelines.Databases were searched January 2023 for studies published after year 2000, written in English, focus on care homes and incident reporting systems. Data were extracted using a bespoke data extraction tool, and quality was assessed. Data were analysed descriptively and using narrative synthesis, with types and characteristics of incidents analysed using the International Classification for Patient Safety.Databases were CINAHL, MEDLINE, PsycINFO, EMBASE, HMIC, ASSISA, Nursing and Allied Health Database, MedNar and OpenGrey.We identified 8150 papers with 106 studies eligible for inclusion, all conducted in high‐income countries. Numerous incident reporting processes and systems were identified. Using modalities, typical incident reporting systems captured all types of incidents via electronic computerized reporting, with reports made by nursing staff and captured information about patient demographics, the incident and post‐incident actions, whilst some reporting systems included medication‐ and falls‐specific information. Reports were most often used to summarize data and identify trends. Incidents categories most often were patient behaviour, clinical process/procedure, documentation, medication/intravenous fluids and falls. Various contributing and mitigating factors and actions to reduce risk were identified. The most reported action to reduce risk was to improve safety culture. Individual outcomes were often reported, but social/economic impact of incidents and organizational outcomes were rarely reported.This review has demonstrated a complex picture of incident reporting in care homes with evidence limited to high‐income countries, highlighting a significant knowledge gap. The findings emphasize the central role of nursing staff in reporting safety incidents and the lack of standardized reporting systems and processes.The findings from this study can inform the development or adaptation of safety incident reporting systems in care home settings, which is of relevance for nurses, care home managers, commissioners and regulators. This can help to improve patient care by identifying common safety issues across various types of care home and inform learning responses, which require further research.This study addresses a gap in the literature on the systems and processes used to report safety incidents in care homes across many countries, and provides a comprehensive overview of safety issues identified via incident reporting.PRISMA.A member of the research team is a patient and public representative, involved from study conception. [ABSTRACT FROM AUTHOR]

Purpose: Some diseases require that patients receive parenteral nutrition (PN) over a prolonged time period. Long-term administration of PN can further complicate an already complex therapy, posing additional risk of potential complications. This article is based on presentations and discussions held at the International Safety and Quality of PN Summit, providing insights into aspects of home PN (HPN) and examples of good HPN practice. Summary: One critical step in the HPN process is when patients transition from a hospital to a home setting, and vice versa. Generally, electronic PN ordering is not feasible in an HPN setting, leading to potential difficulties in communication and coordination. HPN requires that patients (or their home caregivers) administer PN, and thus their education and competency are crucial. Likewise, the choice of PN formulation is of great importance. For example, using more modern intravenous lipid emulsions containing medium-chain triglycerides, olive oil, and/or fish oil can provide benefits in terms of liver function during long-term HPN. Internationally, there are wide variations in delivery of HPN, with compounded PN dominating in some countries while others make greater use of marketauthorized multichamber bags (MCBs). Patient-related factors, institutional considerations, and the availability of different MCB formulations, are also contributing factors guiding formulation and delivery system preferences. Conclusion: Education and communication remain key components of a successful HPN process. The information shared here may help to motivate efforts to improve HPN processes and to consider the often-differing perspectives of patients and their healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Increase in functional disability in aging societies is an international medical and public health issue. Masticatory function may be a potential risk factor for functional disability, but the role of frailty in the association has not been clarified. Methods: Forty thousand five hundred sixty-two community-dwelling older adults aged 65 years and over who were insured by public health insurance as of April 2018 were followed up for a median of 3.0 years. Masticatory function was categorized as good, moderate, or poor based on a self-reported questionnaire. The development of functional disability was defined as a new certification of the need for long-term care. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs). Results: During the follow-up period, 1,397 individuals experienced functional disability. After adjusting for age, sex, comorbidities, medical history, and lifestyle behaviors, the HR for incident functional disability was significantly higher in the moderate and poor groups compared to the good group (moderate, HR 1.21 [95% CI, 1.07–1.37]; poor, HR 1.64 [95% CI, 1.03–2.62]). However, after additional adjustment for frailty-related factors—namely, underweight, regular exercise, and gait speed—the association was attenuated in both the moderate group (HR 1.06 [95% CI, 0.94–1.21]) and the poor group (HR 1.51 [95% CI, 0.94–2.41]). Conclusions: Masticatory dysfunction was significantly associated with incident functional disability in a community-dwelling older Japanese population. Our findings suggest that masticatory dysfunction may be a surrogate of frailty rather than a direct cause of functional disability. [ABSTRACT FROM AUTHOR]

AbstractWhile the number of older people living with dementia grows, savings in public resources leads to situations where services and supports for older people are cut, even in the traditionally generous Nordic welfare states, such as Finland. This development is expected to lead to care poverty, meaning older people are not receiving the services they need. Our aim was to uncover whether care poverty already exists within institutional care for older adults in Finland. Thematic analysis was utilized to study 19 interviews with family members of people with dementia living in a nursing home. Signs of care poverty were found in relation to timeliness and safety of access to long-term care and quality of professional care. In addition, the threshold of questioning the care system was high, and managing disagreements about care with professionals was challenging for the family members. The results raise concerns that reducing long-term care risks the whole concept of welfare states. Family members should be more systematically involved in needs assessment and decision-making concerning the care of older people with dementia. [ABSTRACT FROM AUTHOR]

AbstractOwing to the complex links between housing and care, placing housing policy in the context of long-term care (LTC) policies is difficult; this leads to a limited number of studies on this topic. However, the practical relevance of links between these two policy fields is self-evident. To partially challenge a separation between housing and LTC policies in research, we apply the concept of ‘housing as an infrastructure of care’, as defined by Power and Mee (Housing Studies, 35(3), 2020). The article conceptualises and contextualises how housing policies interplay with LTC policy instruments by contributing to a similar outcome. After discussing the theoretical implications, the article provides an empirical illustration of this argument through a comparative housing analysis of two carefully selected cases: Austria and the Czech Republic. LTC policies in these two countries are based on remarkably similar cash instruments, notably implemented in contrasting housing policy contexts. As these cash benefits lead to similar outcomes in encouraging informal care provided chiefly by families, the analysis seeks to understand how different housing policies matter for these outcomes. The analysis discusses how particular housing policy instruments may create uneven care capacities. [ABSTRACT FROM AUTHOR]

Background: Reviews of depression interventions in nursing home residents resulted in positive findings. However, because of the heterogeneity of the studies, it remains unclear what works for whom. Considering moderator effects may contribute to a comprehensive understanding of depression treatment in residents. Therefore, this study aims to review depression interventions, examining moderator effects of (1) residents' factors, and (2) components specific of interventions. Methods: A Bayesian network meta-analysis of randomized controlled trials primarily aimed at reducing depressive symptoms among residents was conducted. First, intervention types, e.g., exercise interventions, were compared to care as usual. Second, meta-regression analyses were conducted for moderator effects of residents' factors (i.e., severity of depressive symptoms, physical dependency, and cognitive impairment) and components identified as specific to an intervention (e.g., music, creativity, positivity). Results: Our search across six databases resulted in 118 eligible studies: 16 on neurobiological interventions, 102 on non-pharmacological interventions. Compared to care as usual, cognitive interventions, such as cognitive behavioral therapy and goal-oriented therapy, showed the strongest effects (MD = -1.00, 95% CrI [-1.40 to -0.66]). Furthermore, the severity of depressive symptoms moderated the effect of interventions (ƅ = -0.63, CrI 95% [-1.04 to -0.22]), while none of fifteen identified intervention-specific components did. In residents with a depression diagnosis, there were larger effect sizes for interventions including daily structure, psychoeducation, healthy food, creativity, positivity, and an activating/encouraging environment, whereas interventions focusing on distraction and relaxation had larger effect sizes in those residents without. Conclusions: By examining the moderator effects, we provided an integrative perspective on the observed variations in effects across different target groups, and components of depression interventions. This approach underscores the complex nature of interventions, emphasizing the need for continued transdisciplinary research, and the exploration of potential moderators. Future investigations should carefully assess residents' factors and choose interventions and their components accordingly. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) has become one of the major public health threats worldwide, emphasizing the necessity of preventing the development and transmission of drug resistant microorganisms. This is particularly important for people with vulnerable health conditions, such as people with intellectual disabilities (ID) and long-term care residents. This study aimed to assess the current status of AMR, antimicrobial stewardship (AMS) and infection prevention and control (IPC) in Dutch long-term care facilities for people with intellectual disabilities (ID-LTCFs). Methods: A web-based cross-sectional survey distributed between July and November 2023, targeting (both nonmedically and medically trained) healthcare professionals working in ID-LTCFs in The Netherlands, to study knowledge, attitudes and perceptions regarding AMR, AMS and IPC. Results: In total, 109 participants working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. The knowledge levels of AMR and IPC among nonmedically trained professionals (e.g., social care professionals) were lower than those among medically trained professionals (p = 0.026). In particular regarding the perceived protective value of glove use, insufficient knowledge levels were found. Furthermore, there was a lack of easy-read resources and useful information regarding IPC and AMR, for both healthcare professionals as well as people with disabilities. The majority of the participants (> 90%) reported that AMR and IPC need more attention within the disability care sector, but paradoxically, only 38.5% mentioned that they would like to receive additional information and training about IPC, and 72.5% would like to receive additional information and training about AMR. Conclusion: Although the importance of AMR and IPC is acknowledged by professionals working in ID-LTCFs, there is room for improvement in regards to appropriate glove use and setting-specific IPC and hygiene policies. As nonmedically trained professionals comprise most of the workforce within ID-LTCFs, it is also important to evaluate their needs. This can have a substantial impact on developing and implementing AMR, AMS and/or IPC guidelines and policies in ID-LTCFs. [ABSTRACT FROM AUTHOR]

Background: Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides. Methods: In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations. Results: Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints. Conclusions: Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes. [ABSTRACT FROM AUTHOR]

Care aides in long-term care (LTC) institutions care for older disabled residents at high risk for COVID-19. However, they experienced many stressors during the COVID-19 pandemic. This study aims to explore the working experiences of care aides in LTC institutions following the relaxation of COVID-19 regulations in Taiwan. This qualitative descriptive study included 20 care aides who had cared for residents with COVID-19. Data were obtained via semi-structured interviews. Caring for residents with COVID-19 and the difficulties, resources and teamwork, and impact of care aides' work on their lives were discussed. Consequently, four themes were identified. First, difficulties in care, which included physical limitations by protection, workload, and impact of work schedule on the lives of the care aides. Second, psychological impact, such as worry, social isolation, and burnout. Third, interpersonal relationships with supervisors, colleagues, residents, and their families. Fourth, infection control policy from the institution and government. When infection control policies were relaxed, care aides had difficulties in caring for residents; furthermore, their family and social lives were also affected. They were required to learn knowledge of and skills for COVID-19 management. Institutions were required to provide support in materials, care processes, environment, and management. [ABSTRACT FROM AUTHOR]

Caregivers of chronically ill, disabled, or elderly family members encounter substantial physical, social, emotional, and financial difficulties. This study aims to identify how the stresses and strains associated with caregiving for family members impact caregivers’ perceptions of health, well-being, and quality of life. Method: A systematic scoping review was done using PubMed, MEDLINE, CINAHL, JSTOR, EBSCO and Google Scholar, to search for primary research on caregiver burden, published between 2019 and 2023, and in English. Fifteen quantitative research studies were selected for the study. Results: Thematic analysis on characteristics that impact the health, well-being and quality of life of caregivers, most of whom are women, showed that women self-perceived the negative impact of care burden more than men did while increasing the range of type of care provided increase women’s self-perceptions of their abilities. In developing country contexts, caregiving for elderly family members can begin earlier in the lifespan, thus increasing the care burden. Perception of lack of competence to provide care, doing more than 20 hours of unpaid caregiving per week, and caring for prolonged periods of time over years impacted the mental health of caregivers. Physical and mental health burden also depended on the level of physical, behavioural, and intellectual impairment of the care recipients. Providing low intensity unpaid care of less than ten hours per week appeared to boost carers’ self-perception of physical well-being. The perceived quality of available social support and work supervisor support was significant in reducing depressive symptoms and improved perceptions of wellbeing. Conclusion: To improve the well-being of caregivers, it is essential to provide respite care, palliative care, and end of life care facilities to reduce the number of care work hours per week the family carers provide, to reduce the duration of care, and to alleviate significant care burden. Social insurance based paid leave, means-based financial support for caregivers, with capacity development, and social support networks, can be implemented to reduce the disproportionate health and wealth penalties on those caring for ill, disabled, and elderly family members. [ABSTRACT FROM AUTHOR]

Home healthcare contributes to improving patients’ quality of life and alleviating pressure on the healthcare system. As such, long-term care policies have been vigorously promoted in Taiwan. To provide and promote the continuous use of efficient home healthcare services, it is essential to understand the intentions or service expectations of patients and their families regarding home healthcare visits. Methods: Employing purposive sampling, interviews were conducted with patients and their family members or caregivers. A qualitative research method was adopted using in-depth interviews to understand the intentions of and attitudes toward the continuous use of home healthcare visits and their related factors. Results: According to the Andersen Healthcare Utilization Model, enabling factors are the most frequently mentioned influences, followed by predisposing factors and need factors. Among these, the most critical aspects include having the choice of healthcare brand, maintaining constant communication, and having access to diversified services, and service providers with positive attitudes. Therefore, in order to enhance the intentions to continue using home healthcare utilization, enabling and predisposing factors should be prioritized. Conclusions: This study explores the importance and effectiveness of enabling, predisposing, and need factors, and how they impact home healthcare. Being able to choose a healthcare brand is an enabling factor that is crucial for patients when deciding to use home healthcare. Given consistent conditions, the availability of home healthcare services that address physical, mental, and spiritual well-being encourage patients to receive medical care continually. [ABSTRACT FROM AUTHOR]

Objectives: In India, globalisation is purported to have contributed to shifting family structures and changing attitudes to long‐term care (LTC) facility use. We investigated the attitudes to and usage frequency of LTC in India. Methods: We conducted secondary analyses of: (a) The Moving Pictures India Project qualitative interviews with 19 carers for people with dementia and 25 professionals, collected in 2022, exploring attitudes to LTC; and (b) The Longitudinal Ageing Study in India (LASI) 2017–2018, cross‐sectional survey of a randomised probability sample of Indian adults aged 45+ living in private households. Results: We identified three themes from qualitative data: (1) LTC as a last resort, describes how LTC could be acceptable if care at home was "impossible" due to the person's medical condition or unavailability of the family carer, for example, if family members lived overseas or interstate. (2) Social expectations of care at home from family members and paid carers and; (3) Limited availability of LTC facilities in India, especially in rural localities, and the financial barriers to their use. Of 73,396 LASI participants, 40 were considering moving to LTC; 18,281 had a parent alive, of whom 9 reported that their father, and 16 that their mother, lived in LTC. LTC use was rare. While a third of participants with a living parent lived in urban areas, 14/24 of those with a parent in LTC lived in an urban area, supporting our qualitative findings that LTC is mainly accessed in urban areas. Conclusions: Preference for intergenerational community care combined with limited availability and societal stigma contribute to low rates of LTC use among Indian families. Future social policies should consider how to plan for greater equity in strengthening care at home and in the community, and bolstering respite and LTC services as a last resort. Key points: In India, the demand for long‐term care (LTC) facilities is low, with only a small number of people residing or considering residing in one. Most people prefer intergenerational community care at home.Contrary to the population as a while, more people who had a parent living in LTC were residing in urban versus rural areas; in qualitative interviews, family carers and healthcare professionals of people with dementia reported having less access to LTC in rural areas, which may be linked to increased financial challenges and limited resources for more specialised care.Given the strong preference for care at home over LTC, initiatives are needed to increase community resources for family carers of older adults with unrecognised and undiagnosed conditions such as dementia. Additionally, there should be improved access to LTC for those with fewer financial resources. [ABSTRACT FROM AUTHOR]

Student carers are students who provide unpaid support to an individual who could not manage without their care. A scoping review was undertaken to determine the themes and concepts which underpin student carers' experiences within higher education, examine student carers' experiences of support and identify any gaps in the literature. A comprehensive literature search was conducted between February and May 2020. The search yielded 2,484 items, of which 14 articles were included in the review. Data from each article were extracted, charted and analysed using thematic analysis. The articles revealed that caring responsibilities could have a negative impact on student carers' physical and mental health, university performance and financial status. Both formal and informal sources of support were referenced. Further, it was noted that universities had rigid rules and policies which did not suit the flexible needs of student carers. A paucity of research examined the impact studying had on student's ability to provide care. Finally, issues relating to research design were observed, and a lack of demographic information or detail on the caring duties performed was found. A more robust evidence base is required to facilitate the development of interventions to support student carers in education. [ABSTRACT FROM AUTHOR]

Purpose: Caregiver burden (CB) is typically self-assessed by caregivers. However, an emerging concept is assessment of CB by the recipients of care, i.e., the patient. The specific objectives are (1) to assess the level of agreement between care recipients' and caregivers' view on CB, across financial, physical, emotional, and social domains; (2) to explore two care recipient perspectives: their self-perceived burden (CR-SPB), and their interpretation of the caregiver's view (Proxy-CB). Methods: Data were collected from 504 caregiver-care recipient dyads in the U.S. using an online Qualtrics panel. The survey assessed caregiver burden using CarerQol and newly developed items. The level of agreement between responses was quantified using weighted kappa (κ) coefficients for individual items and intraclass correlation coefficients (ICC) for index/summary scores. Results: The average age of caregivers was 49.2 years, and 62.7 years for care recipients. Dyads most commonly consisted of spouses/partners (34.5%); 68.3% lived together. Proxy-CB aligned more closely with caregiver's view, with moderate to substantial agreement across CB domains (from κ = 0.48 for emotional to κ = 0.66 for financial). In the same perspective, the CarerQol-7D Index showed moderate agreement (ICC = 0.58) and the summary score of CB items substantial agreement (ICC = 0.76). Care recipients generally overestimated CB in the Proxy-CB perspective, while they underestimated it in the CR-SPB perspective. Conclusion: Results demonstrate there is a difference between perspectives. Strong agreement in Proxy-CB perspective suggests that care recipients can potentially substitute for caregivers depending on the domain. CR-SPB agrees less with caregivers and may provide complementary information. [ABSTRACT FROM AUTHOR]

Background: Dietitians are central members of the multidisciplinary long‐term care (LTC) healthcare team. The overall aim of this current investigation is to gain a better understanding of dietitian involvement in LTC resident's end‐of‐life care via referrals. Methods: Retrospective chart reviews for 164 deceased residents (mean age = 88.3 ± 7.3; 61% female) in 18 LTC homes in Ontario, Canada, identified dietitian referrals and documented eating challenges recorded over 2‐week periods at four time points (i.e., 6 months, 3 months, 1 month and 2 weeks) prior to death. Nutrition care plans at the beginning of these time points were also noted. Logistic mixed effects regression models identified time‐varying predictors of dietitian referrals. Bivariate tests identified associations between nutrition orders and dietitian referrals that occurred in the last month of life. Results: Nearly three‐quarters (73%) of participants had at least one dietitian referral across the four observations. Referrals increased significantly with proximity to death; 45% of residents had a referral documented in the last 2 weeks of life. Dietitian referrals were associated with the number of eating challenges (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.27, 1.58). Comfort‐focused nutrition care orders were significantly more common when a dietitian was referred (25%) compared with when a dietitian was not referred (12%) in the final month of life (p = 0.04). Conclusions: Our findings suggest that dietitians are involved in end‐of‐life and comfort‐focused nutrition care initiatives, yet they are not engaged consistently for this purpose. This presents a significant opportunity for dietitians to upskill and champion palliative approaches to nutrition care within the multidisciplinary LTC team. Key points: Dietitian referrals increased in prevalence in the last 2 weeks of life for residents living in Ontario long‐term care homes.Residents experienced a variety of complex eating challenges that required additional support from a dietitian.Dietitian referrals were associated with the initiation of comfort‐focused nutrition care orders.With earlier engagement, dietitians would be well positioned to champion and manage a palliative approach to care among multidisciplinary long‐term care teams. [ABSTRACT FROM AUTHOR]

Understanding the preferences of old-age adults for their long-term caregivers can improve person-centred health care and the quality of long-term care (LTC). This study examines Chinese older adults' preferences for long-term caregivers. This is a cross-sectional study. A national representative discrete choice experiment (DCE) surveyed 2031 adults aged 50–70 across 12 provinces in China. Each DCE scenario described five attributes: type of caregivers, place of LTC, contents of LTC, out-of-pocket payments, and quality of life (QoL). Preferences and the marginal willingness to pay (WTP) were derived using mixed-logit and latent class models. Older adults displayed higher preferences for long-term caregivers who improve their QoL, incur lower out-of-pocket payments, and provide medical LTC services at home, with the maximum WTP of $22.832 per month. QoL was rated as the most important LTC factor, followed by the place of LTC and the type of caregivers. When the level of QoL improved from poor to good, respondents would be willing to pay $18.375 per month more (95% confidence interval: 16.858 to 20.137), and the uptake rate increased by 76.47%. There was preference heterogeneity among older people with different sex, education, family size, and knowledge of LTC insurance. QoL was the most important factor in older Chinese adults' preference for caregivers. Home care and medical care from formal caregivers was preferred by older adults. We recommend training family caregivers, raising older people's awareness of LTC insurance, and guiding policymakers in developing people-oriented LTC and a multi-level LTC system. [ABSTRACT FROM AUTHOR]

This paper develops an overlapping generations model that links a public health system to a pay-as-you-go (PAYG) pension system. It relies on two assumptions. First, the health system directly finances curative health spending on the elderly. Second, public pensions partially depend on health status by introducing a component indexed to society’s average level of old-age disability. Reducing the average disability rate in the economy then lowers pension benefits as the need to finance long-term care services also drops. We study the effects of introducing such a ‘comprehensive’ Social Security system on individual decisions, capital accumulation, and welfare. We first show that health investments can boost savings and capital accumulation under certain conditions. Second, if individuals are sufficiently concerned with their health when old, it is optimal to introduce a health-dependent pension system, as this will raise social welfare compared to a system where pensions are not tied to the society’s average level of old-age disability. Our analysis thus highlights an important policy recommendation: making PAYG pension schemes partially health-dependent can be beneficial to society. [ABSTRACT FROM AUTHOR]

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014–2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work–life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides. [ABSTRACT FROM AUTHOR]

Background: Based on previous evidence person‐centred care (PCC) as a quality indicator is important in long‐term care (LTC) settings for older people. Effective ways to increase nurses' person‐centred care competence are missing. Aim: To evaluate the effectiveness of a continuing education (CE) intervention named 'Person First—Please' (PFP) for improving nurses' PPC competence and its connection to PPC climate. Methods: Quasi‐experimental cluster design with intervention and control groups was carried out in LTC settings for older people. The intervention group (n = 77) received a 10‐week CE intervention, with control group (n = 123) working as usual. The primary outcome was professional nurses' PCC competence. Secondary outcome was the PCC climate as perceived by nurses and, residents with their next of kin. Measurements were conducted pre−/post‐intervention and after 6 weeks using the validated, Person‐centred Care Competence scale and the Person‐centred Care Climate questionnaire, staff and patient versions. Data was analysed with descriptive and inferential statistics. Results: PCC competence was significantly increased in the intervention group and remained after 6 weeks of follow‐up. PCC climate increased in the intervention group in total score and also in all sub‐scales, across residents with their next of kin. The control group did not show any significant change. Comparisons of PCC competence and PCC climate in time between intervention and control groups confirmed that changes seen between groups were statistically significant in intervention group. Limitations: Measurements were self‐assessments, which may have been affected by bias, especially in context of competence assessment. Conclusion: The intervention was effective in increasing professional nurses' PCC competence and on person‐centred care climate in long‐term care settings for older people. [ABSTRACT FROM AUTHOR]

Background and Objectives Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes' unit organizational context with care aides' psychological empowerment. Research Design and Methods This cross-sectional study analyzed survey data from 3765 care aides in 91 Western Canadian nursing homes. Random-intercept mixed-effects regressions were used to examine the associations between nursing home unit organizational context and care aides' psychological empowerment, controlling for care aide, care unit, and nursing home covariates. Results Organizational (IVs) culture, social capital, and care aides' perceptions of sufficient time to do their work were positively associated with all four components of psychological empowerment (DVs): competence (0.17 [0.13, 0.21] for culture, 0.18 [0.14, 0.21] for social capital, 0.03 [0.01, 0.05] for time), meaning (0.21 [0.18, 0.25] for culture, 0.19 [0.16, 0.23] for social capital, 0.03 [0.01, 0.05 for time), self-determination (0.38 [0.33, 0.44] for culture, 0.17 [0.12, 0.21] for social capital, 0.08 [0.05, 0.11] for time), and impact (0.26 [0.21, 0.31] for culture, 0.23 [0.19, 0.28] for social capital, 0.04 [0.01, 0.07] for time). Discussion and Implications In this study, modifiable elements of organizational context (i.e. culture, social capital, and time) were positively associated with care aides' psychological empowerment. Future interventions might usefully target these modifiable elements of unit level context in the interest of assessing their effects on staff work attitudes and outcomes, including the quality of resident care. [ABSTRACT FROM AUTHOR]

Background and Objectives Personal care interactions can provide vital opportunities for caregivers to engage with a person living with advanced dementia. However, interactions may also be a contentious experience, what makes this so is not fully understood. We aimed to examine features of personal care interactions between caregivers and people with advanced dementia to understand how care may be improved. Research Design and Methods This was a naturalistic observation study using one-off video-recorded observations of personal care interactions between 14 people with advanced dementia and 12 caregivers (n = 7 care-home staff, n = 5 family carers) in the United Kingdom (total observation time 03:01:52). Observations were analyzed with observational video coding to determine the frequency of actions of people with dementia and qualitative content analysis for in-depth examination. Results Refusals of care were present in 32% of video sections. Active engagement of people with dementia was observed in 66% of sections. Rare contentious interactional components were characterized by the person with dementia appearing to show uneasiness and caregivers being flustered and uncertain. However, caregivers typically emanated a nurturing attentiveness, were attuned to the person, and skilled in seamlessly supporting them through care activities. Discussion and Implications Findings draw on real-world empirical evidence to reinvigorate the notion of person-centeredness in dementia care. The findings provide much needed insight into practical ways to improve care interactions for people with advanced dementia and enhance their personhood. Appropriate training/guidance for caregivers could support positive personal care experiences for both the person with dementia and caregiver. [ABSTRACT FROM AUTHOR]

Airway anomalies, symptoms and interventions are commonly reported in children with oesophageal atresia with tracheoesophageal fistula (OA/TOF). The purpose of this study was to assess the incidence of these airway pathologies and those requiring interventions in the long-term. A retrospective case note review of all patients admitted to the Neonatal Unit at the Royal Hospital for Children, Glasgow between January 2000 and December 2015 diagnosed with OA/TOF. Included patients had a minimum of 5 years follow-up. 121 patients were identified. 118 proceeded to OA/TOF repair. 115 patients had long-term follow-up data. Ninety-five (83%) children had one or more airway symptom recorded. Thirty-six (31%) neonates underwent airway endoscopy at the time of their initial OA/TOF repair. Forty-six (40%) children underwent airway endoscopy at a later date due to airway symptoms. Airway pathologies identified included airway malacia, thirty-two (28%), subglottic stenosis, eleven (10%), tracheal pouch, twenty-five (22%), laryngeal cleft, seven (6%) and recurrent fistula, five (4%). Airway interventions included endoscopic division of tracheal pouch, ten (9%), tracheostomy, seven (6%), aortopexy, six (5%), repair of recurrent fistula, five (4%), endoscopic repair of laryngeal cleft, three (3%) and four (3%) required open airway reconstruction for subglottic stenosis. One child (1%) remains tracheostomy dependent. Long-term airway pathologies are common in children with OA/TOF. Many of these are remediable with surgical intervention. Clinicians should be cognisant of this and refer to Airway Services appropriately. • What is currently known about this topic? Short-term airway outcomes from large series and long-term outcomes for patients referred for treatment at otolaryngology/aerodigestive centres • What new information is contained in this article? This study describes long-term airway outcomes for all patients seen in our centre with TOF/OA not just those who have required specialist airway intervention. [ABSTRACT FROM AUTHOR]

Background: As the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons. Methods: A scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE. Results: Thirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality. Conclusion: The findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care. [ABSTRACT FROM AUTHOR]

Background: In Japan, the number of older adults requiring long-term care insurance (LTCI) is increasing and the cost is becoming a social problem. In these fields, the role of geriatric rehabilitation includes maintaining the physical function and LTCI certification levels. The prevalence of sarcopenia is high among older adults requiring LTCI certification, and there are many opportunities to assess the handgrip strength, walking speed, and muscle mass. This study aimed to identify sarcopenia-related assessments sensitive to transitions in LTCI certification levels and determine cut-off values to predict them. Methods: This prospective cohort study analyzed 98 daycare users (mean age ± standard error: 78.5 ± 0.8 years) between March 2019 and 2023. The participants received LTCI certification before the study, and their levels were renewed between baseline and follow-up (six months later). The measurements included handgrip strength, usual walking speed, body composition, and SARC-F score. Participants were classified into maintenance, deterioration, and improvement groups according to the changes in their LTCI certification levels. We identified factors contributing to the deterioration of LTCI certification levels using baseline and before and after comparisons, multivariate analyses, and receiver operating characteristic analyses. Results: No significant differences were observed in the baseline data among the groups. Only the deterioration group showed significant changes in the usual walking speed (baseline: 0.64 ± 0.25 m/s, follow-up: 0.53 ± 0.21 m/s, P = 0.008) and body fat percentage (baseline: 29.2 ± 9.9%, follow-up: 27.7 ± 10.3%, P = 0.047). Binomial logistic regression showed that changes in usual walking speed (P = 0.042) and body fat percentage (P = 0.011) were significantly associated with the deterioration of LTCI certification levels, even after adjustment. The cutoff values of change to discriminate the deterioration of LTCI certification levels were −0.14 m/s at the usual walking speed (P = 0.047) and −1.0% for body fat percentage (P = 0.029). Conclusions: Decreases in usual walking speed and body fat percentage may predict worse certification levels in older adults requiring LTCI. [ABSTRACT FROM AUTHOR]

Purpose: Nursing home closures have raised concerns about access to post‐acute care (PAC) and long‐term care (LTC) services. We estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures. Methods: We identify nursing home closures and the availability of PAC and LTC services in nursing homes, home health agencies, and hospitals with swing beds using the Medicare Provider of Services file (2008–2018). Using distances between ZIP codes, we summarize distances to the closest provider of PAC and LTC services for rural and urban ZIP codes with nursing home closures from 2008 to 2018 and no nursing homes in 2018. Findings: Compared to urban ZIP codes, rural ZIP codes experiencing nursing home closure had higher distances to the closest nursing home providing PAC (6.4 vs. 0.94 miles; p < 0.05) and LTC services (7.2 vs. 1.1 miles; p < 0.05), and these differences remain even after accounting for the availability of home health agencies and hospitals with swing beds. Distances to the closest providers with PAC and LTC services were even higher for rural ZIP codes with no nursing homes in 2018. About 6.1%–15.7% of rural ZIP codes with a nursing home closure or with no nursing homes had no PAC or LTC providers within 25 miles. Conclusions: Nursing home closures increased distances to nursing homes, home health agencies, and hospitals with swing beds for rural residents. Access to PAC and LTC services is a concern, especially for rural areas with no nursing homes. [ABSTRACT FROM AUTHOR]

This paper studies optimal linear policy directed at private long‐term care insurance in the context where individuals are myopic, that is, underestimate their dependency risk. Without government intervention, myopic individuals underinsure, while the first‐best optimum requires full insurance. To decentralize the first‐best, one needs personalized linear subsidies on private insurance premiums combined with personalized lump‐sum taxes to finance these subsidies and redistribute resources among individuals. In the second‐best setting where only uniform instruments can be used, the determination of the optimal insurance subsidy rate includes three main considerations: standard efficiency concern, correction for myopia, and redistributive concerns. While the correction for myopia pushes for a higher subsidy rate, the analysis of the redistributive concerns is far less straightforward. Overall, the redistributive concerns depend on three main factors: whether wealthier individuals are less myopic, how the probability of dependency varies with wealth and what is the type of absolute risk aversion exhibited by individual preferences. [ABSTRACT FROM AUTHOR]

Family caregivers are a key part of states' long-term care systems, and longitudinal data and evaluations on family caregivers can help states more effectively develop and implement policy to support these populations. Several states have developed data-collection initiatives and evaluations to better understand how their programs can be modified to best support caregivers and care recipients. This article highlights examples of approaches to family caregiver data collection and research at the state level. [ABSTRACT FROM AUTHOR]

During the COVID-19 outbreak, the care services interruption/delay resulted in increased amount of care for informal caregivers of older people with long-term care needs. This study aimed at understanding how the Pandemic affected physical health, mental well-being and quality of life of older people' informal caregivers of different ages and to what extent starting caregiving affected such life realms among new caregivers. An online survey was carried out in Winter 2020–2021 targeted to informal caregivers living in 16 European countries. A sub-sample of 848 adult (aged 18–64) was compared to another of 542 older (over 65) informal caregivers. People who started caring during the Pandemic were also identified and the impact of the Pandemic on the three life realms of this group were analysed separately by gender and age. The differences between the two groups of adult and older caregivers were estimated using logistic regression, adjusted for potential confounders. Analyses were repeated after propensity score matching. During the second Pandemic wave hitting Europe in Winter 2020-21, regardless of age, being female entailed a worsening in physical health, mental well-being and quality of life, in line with previous research Also new caregivers were mostly females and their physical health and quality of life were worsened by caregiving. Gender-specific work-life balance policies and measures are needed to support female working caregivers. More attention should be paid to older female caregivers through scheduled physical and mental health screenings and home visits. Future studies on the topic in a gender and intergenerational perspective are encouraged. [ABSTRACT FROM AUTHOR]

Social participation (SP) is often argued to have a favorable impact on health outcomes. This study examines whether and to what extent social participation can reduce and postpone the need for long-term care (LTC) among middle-aged and older adults in Japan. We used longitudinal data of 17,454 individuals born from 1946 to 1955, obtained from a 17-wave nationwide panel survey conducted from 2005 to 2021 in Japan. We examined (1) whether SP at baseline (2005) was associated with a lower risk of having LTC needs in the last wave (2021) using logistic regression models and (2) whether SP at baseline postponed the onset of these needs using Cox proportional hazards models, both controlling for baseline covariates. The results of different SP activities were compared. Participating in one or more SP activities in 2005 was associated with lower needs for LTC in 2021, with an odds ratio of 0.69 (95% confidence interval [CI], 0.49–0.96), and postponed their onset, with a hazard ratio of 0.71 (95% CI, 0.65–0.78). However, these favorable features of SP were observed only for leisure activities, and no satisfaction with SP activities had a limited association with LTC needs. The results suggest that SP can be associated with a lower risk of LTC needs and postpone their onset; however, these favorable features are limited to leisure activities, and satisfaction with SP activities is needed to enhance them. [ABSTRACT FROM AUTHOR]

We examine the causal effects of PM2.5 exposure on the burden of long-term care (LTC) by matching a satellite-based PM2.5 (particulate matter smaller than 2.5 micrometers (µm) in diameter) dataset with a nationally representative longitudinal study in China from 2011 to 2018. We find significant adverse effects of PM2.5 exposure--instrumented by thermal inversions--on the LTC burden. A 10 µg/m³ increase in annual PM2.5 exposure increases average monthly hours of LTC and the associated financial costs by 28 h and CNY 452, respectively. The effects are greater for those who had never smoked nor experienced severe PM2.5 pollution (annual average PM2.5 > 35 µg/m³) in the previous 5 years. We also find that as PM2.5 increases, chronic diseases, particularly cardiovascular diseases, could lead to a higher likelihood of LTC dependency but reduce the total hours and costs of LTC provision. Finally, we find that PM2.5 reduces the total years of LTC need, suggesting that PM2.5 increases LTC costs by increasing the severity of LTC dependency, rather than the duration of LTC need. Our findings can assist policymakers in planning for LTC provisions and clean air policies. [ABSTRACT FROM AUTHOR]

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Older adults residing in long-term care often experience declines in physical and cognitive functions despite the access to in-house physical activity (PA) programs. This study aimed to evaluate the associations of PA with physical function and global cognitive function in older adults living in long-term care, while examining potential sex differences. A cross-sectional analysis of baseline data from a two-arm cluster randomized controlled trial was conducted, involving 67 participants (34 men, 33 women). PA levels were assessed using tri-axial accelerometers. Physical function, including muscular strength, postural sway, and Short Physical Performance Battery (SPPB) and cognitive function were measured. Spearman correlation analysis revealed no significant associations between PA metrics and muscular strength, postural sway, or global cognitive function across the entire samples (p ≥ 0.091). Multiple linear regression models were developed for the entire sample, males, and females to examine the associations between PA and physical function measures and global cognitive function. After adjustments for confounders, light PA was significantly associated with higher SPPB sub-scores (gait: β = 0.600, p

IntroductionCurrent demographic trends predict continuously growing numbers of individuals reliant on care, which has to be accounted for in future planning of long-term care-resources. The projection of developments becomes especially necessary in order to enable healthcare systems to cope with this future burden and to implement suitable strategies to deal with the demand of long-term care. This study aimed to project the prevalence of long-term care and the number of care-dependent people in Germany until 2050.MethodsWe used the illness-death model to project the future prevalence of long-term care in Germany until 2050 considering eight different scenarios. Therefore, transition rates (incidence rate and mortality rates) describing the illness-death model are needed, which have been studied recently. Absolute numbers of people in need for long-term care were calculated based to the 15th population projection of the Federal Statistical Office.ResultsNumbers of people in need for long-term care will increase by at least 12%, namely 5.6 million people, in the period of 2021 until 2050. Assuming an annual incidence-increase of 2% from 2021 to 2050 the number of care-dependent individuals could potentially rise up to 14 million (+180%).ConclusionOur projections indicated a substantial rise in the number of care-dependent individuals. This is expected to lead to raising economic challenges as well as a stronger demand for healthcare and nursing personnel.

ABSTRACT Introduction Restrictive practice use in residential aged care homes internationally is unacceptably high. Although policies and legislation mandate the reduction or elimination of restrictive practices, there remains a gap in knowledge regarding strategies that have been effective in achieving a sustained reduction in restraint use. There is an urgent need to identify effective and feasible interventions that aged care staff can implement in everyday practice to reduce restraint use. Safewards is an evidence‐based programme that has demonstrated effectiveness in reducing conflict and restrictive practice use in inpatient psychiatric settings and has the potential to address the issue of restraint use in aged care homes. This study aims to evaluate the feasibility of Safewards in reducing restrictive practices in residential aged care homes. Methods This pilot and feasibility study will adopt a mixed methods process and outcomes evaluation. Safewards will be implemented in two Australian residential aged care homes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation outcomes. Additionally, the Consolidated Framework for Implementation Research will be used to guide qualitative data collection (including semi‐structured interviews with residents/family members, aged care leaders and staff) and explain the facilitators and barriers to effective implementation. Conclusion This study will provide pilot evidence on the feasibility of the Safewards programme in residential aged care homes. Understanding the processes and adaptations for implementing and evaluating Safewards in residential aged care will inform a future trial in aged care to assess its effectiveness. More broadly, the findings will support the implementation of an international aged care policy of reducing restrictive practices in residential aged care. Patient or Public Contribution A person with lived experience of caring for someone with dementia is employed as a Safewards facilitator and is a member of the steering committee. Residents and family members will be invited to participate in the project steering committee and provide feedback on their experience of Safewards. Trial Registration ACTRN12624000044527.

Context: Defining long-term care (LTC) is relevant to determining the access, coverage, and types of services. European Union (EU) countries are guided by the same principles for providing long-term care. However, there is variation in how individual countries define long-term care. Objective: To review available policy documents from European Union countries that provide a definition of LTC and create a framework that captures these definitions. Methods: We conducted a qualitative document review analysis. The sources of evidence included policy documents, such as reports by or for the European Commission, official EU websites, and national websites providing information about the LTC system or services. Long-term care definitions were extracted verbatim from the sources or adapted based on the described eligibility for accessing LTC services. We conducted a thematic analysis through a focused reading and re-reading, identifying and refining codes, and categorizing these codes into themes. Findings: Official definitions of long-term care were found for 22 European Union countries. We identified eight codes that were categorized into three themes: physical disability, person-centered care, and mental capacity. Most of the countries mentioned physical disability, while only a limited few were explicit about providing person-centered care services and evaluating mental capacity. Limitations: We only explored reports written in English and did not conduct interviews with local experts. Implications: Our review suggests that most European Union countries define long-term care mainly based on physical disabilities. Broadening this definition to include mental capacity and person-centered care could promote more comprehensive care. Future research should explore documents in national languages and interviews with experts.

Background Urinary tract infection is the most diagnosed infection in older people. It accounts for more than 50% of antibiotic prescriptions in care homes and is a frequent reason for care home residents being hospitalised. Objective This realist review developed and refined programme theories for preventing and recognising urinary tract infection, exploring what works, for whom and in what circumstances. Design The review used realist synthesis to explore existing literature on the detection and prevention of urinary tract infection, complemented by stakeholder consultation. It applies to the UK context, although other healthcare systems may identify synergies in our findings. Data sources Bibliographic databases searched included MEDLINE, CINAHL, EMBASE, Cochrane Library, Web of Science Core Collection (including the Social Sciences Citation Index), Sociological Abstracts, Bibliomap and National Institute for Health and Care Research Journals Library. Data selection and extraction Title and abstract screening were undertaken by two researchers independently of each other. Selection and assessment were based on relevance and rigour and cross-checked by a second researcher. Data extracted from the included studies were explored for explanations about how the interventions were considered to work (or not). Evidence tables were constructed to enable identification of patterns across studies that offered insight about the features of successful interventions. Data analysis and synthesis Programme theories were constructed through a four-stage process involving scoping workshops, examination of relevant extant theory, analysis and synthesis of primary research, teacher–learner interviews and a cross-system stakeholder event. A process of abductive and retroductive reasoning was used to construct context–mechanism–outcome configurations to inform programme theory. Results The scoping review and stakeholder engagement identified three theory areas that address the prevention and recognition of urinary tract infection and show what is needed to implement best practice. Nine context–mechanism–outcome configurations provided an explanation of how interventions to prevent and recognise urinary tract infection might work in care homes. These were (1) recognition of urinary tract infection is informed by skills in clinical reasoning, (2) decision-support tools enable a whole care team approach to communication, (3) active monitoring is recognised as a legitimate care routine, (4) hydration is recognised as a care priority for all residents, (5) systems are in place to drive action that helps residents to drink more, (6) good infection prevention practice is applied to indwelling urinary catheters, (7) proactive strategies are in place to prevent recurrent urinary tract infection, (8) care home leadership and culture fosters safe fundamental care and (9) developing knowledgeable care teams. Limitations We adapted our approach and work to online interactions with stakeholders and as a research team because of COVID-19. This also had an impact on bringing stakeholders together at a face-to-face event at the end of the project. Studies focusing on the prevention of urinary tract infection in care home settings were predominantly from the USA and Europe where the regulatory and funding systems for the long-term care of the elderly have some differences, particularly in the USA where national reporting plays a significant role in driving improvements in care. Conclusions Care home staff have a vital role in the prevention and recognition of urinary tract infection, which can be enabled through integration and prioritisation within the systems and routines of care homes and delivery of person-centred care. Promoting fundamental care as a means of facilitating a holistic approach to prevention and recognition of urinary tract infection helps staff to recognise how they can contribute to antimicrobial stewardship and recognition of sepsis. Challenging assumptions made by staff about the presentation of urinary tract infection is complex and requires education that facilitates ‘unlearning’ and questioning of low-value practices. Programmes to prevent urinary tract infection need to be co-designed and supported through active and visible leadership by care home managers with support from specialist practitioners. Future work We will focus on co-designing tools that facilitate implementation of our findings to ensure they fit with the care home context and address some of the challenges faced by care home leaders. This will underpin action at care home and system levels. Further research is needed to better understand the perspectives of residents and family carers, the effectiveness of non-pharmacological, pharmacological and specialist practitioner interventions and non-traditional approaches to training and educating the workforce in care home settings. Study registration This study is registered as PROSPERO CRD42020201782. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130396) and is published in full in Health Technology Assessment; Vol. 28, No. 68. See the NIHR Funding and Awards website for further award information. Plain language summary This study was about how interventions to prevent and recognise urinary tract infections might work in care homes to reduce urinary tract infection in older people. We used an approach called realist synthesis. This aims to understand everything that influences how care is delivered to find out what works in particular situations and settings. We did this by talking to care home staff, residents, family carers and other experts about how to reduce urinary tract infection in older people living in care homes. We combined their experiences and ideas with the evidence from the research literature. From this, we developed three areas of focus: care approaches to support accurate recognition of urinary tract infection care approaches to prevent urinary tract infection/catheter-associated urinary tract infection making best practice happen. Our research shows that care staff are best placed to recognise subtle changes in a resident’s behaviour or well-being which might indicate an infection. There are several things care staff can do to proactively help residents from developing a urinary tract infection such as prioritising residents’ hydration needs and addressing poor fluid intake. Putting in place infection prevention measures such as caring for, or where possible, removing a urinary catheter can also help. Actively monitoring residents to determine reasons for changes in behaviour can increase the focus on preventative activities and help avoid inappropriate treatment. The detection and prevention of urinary tract infection in older people could be improved in several ways, including: education tailored to the roles and work of care home staff leaders of care homes providing a culture of safety and improvement where urinary tract infection is recognised as something preventable rather than unavoidable having a safe and supportive environment where staff are confident to communicate their concerns all care team members, residents and their families and other professionals linked with the home having a common language and shared goals in the recognition, prevention and diagnosis of urinary tract infection. The COVID-19 pandemic required us to adapt our approach and work mainly online both in our interactions with stakeholders and as a research team. While this provided opportunities to extend our reach to a wider group of stakeholders, it also limited some of our engagement work. Scientific summary Background Urinary tract infection (UTI) is the most diagnosed infection in older people, accounting for more than 50% of antibiotic prescriptions in long-term care settings. It is a frequent reason for hospitalisation from care homes. Guidance about strategies for UTI prevention and recognition in care homes is limited and focuses on indwelling urinary catheters and catheter-associated urinary tract infections (CAUTIs). It does not account for the varying contexts in which care is delivered, the challenges presented by residents with complex health needs or the demands of care delivery by unqualified care staff with limited supervision from registered nurses. As little is known about the practicality of implementing interventions to prevent UTI in care homes in the UK, this review aimed to create an evidence-informed theoretical explanation of which strategies are effective (or not) in the prevention and recognition of UTI and CAUTI in older people in care homes. Objectives To identify which interventions could be effective, the mechanisms by which these strategies work (or why they fail), for whom and under what circumstances. To understand what needs to be in place for the implementation of programmes to support the prevention of UTI and its recurrence in older people with and without a urinary catheter living in care homes in the UK. Through identifying the active components of complex interventions designed to prevent UTI in older people living in care homes, we sought to help guide the development and successful delivery of future programmes. More specifically, we planned to produce actionable recommendations to underpin the prevention and recognition of UTI in older people of relevance to UK care homes. Review methods We used realist synthesis as its explanatory focus and emphasis on understanding how complex interventions work in context fitted with our aim and objectives. Multiple types of evidence were sought to construct programme theory through a four-stage process that involved a high degree of stakeholder engagement throughout, including scoping workshops with care home staff, residents and carers, teacher–learner interviews and a cross-system stakeholder event. Context–mechanism–outcome configurations (CMOcs) were developed to test initial programme theory propositions and explain how they might or might not work and in which contexts and circumstances. This provided a clear account of the mechanisms of action that were considered essential to understanding how interventions to prevent UTI can and should be delivered in UK care homes. Evidence sources The review drew on evidence from health and social care, including primary research relating to UTI prevention and recognition in older people in care homes and improvement project reports. In September 2020, during stage 1 of the research, a generic topic-based multipurpose search was undertaken and focused on evidence that directly addressed the prevention and recognition of UTI in older people in long-term care facilities. Bibliographic databases searched were MEDLINE, CINAHL, EMBASE, Cochrane Library, Web of Science Core Collection (including the Social Sciences Citation Index), Sociological Abstracts, Bibliomap and National Institute for Health and Care Research (NIHR) Journals Library. Further searches were undertaken in October 2020 using key index studies (highly cited) to find ‘sibling’ studies/papers, for example, contemporaneous papers or studies that share a context by means of Google Scholar and ‘Publish or Perish’ software. Additional supplementary searches were undertaken in stage 2 (July–December 2021) to address gaps in evidence and inform the realist synthesis. These were informed by the tentative programme theories with the aim of refining them. A targeted approach with purposive searches of academic and grey literature focused specifically on continence and UTI, hydration and UTI, non-antimicrobial strategies for recurrent UTI, recognition of soft signs and family involvement in older people’s care in care homes. Data extraction Full-text papers were screened and reviewed to determine their relevance and rigour. Relevance was defined as the extent to which evidence contributed to theory building, testing and refinement and rigour as the extent to which methods used were credible and trustworthy. Data were extracted from included studies using a bespoke data extraction form to record explanations about how the interventions were considered to work (or not). The data were organised into evidence tables to enable comparison of findings and identification of patterns across studies that offered insight about the components of successful interventions. In stage 3, we tested and refined the programme theory through nine ‘teacher–learner’ interviews with a range of participants. A mixture of purposive and convenience sampling was used to gain perspectives from individuals reflective of the different audiences likely to be interested in acting on the findings from this review. Semistructured interview schedules, guided by the content of the CMOc, were used to ensure the interviews focused on participants’ perspectives of the theories as relevant to their role and expertise. In stage 4, further input was gained from an online stakeholder event that included participants from across the care system, commissioners and regulators of care. Results Fifty-six papers were included in the review. The scoping review and stakeholder engagement identified three theory areas that address the prevention and recognition of UTI and show what is needed to implement best practice. Nine CMOcs provided an explanation of how interventions to prevent and recognise UTI might work in care homes to reduce UTI: (1) recognition of UTI is informed by skills in clinical reasoning, (2) decision-support tools enable a whole care team approach to communication, (3) active monitoring is recognised as a legitimate care routine, (4) hydration is recognised as a care priority for all residents, (5) systems are in place to drive action that helps residents to drink, (6) good infection prevention practice is applied to indwelling urinary catheters, (7) proactive strategies are in place to prevent recurrent UTI, (8) care home leadership and culture foster safe fundamental care and (9) developing knowledgeable care teams. The prevention of UTI in older people living in care homes requires attention to fundamental aspects of their physical and psychosocial needs with clear communication across the whole care team that is trusted and valued by residents and families. This necessitates a context of care with a culture of safety and person-centredness, promoted by commissioners, regulators and providers, where leadership and resources are committed to support preventative action by knowledgeable care staff. For the prevention of UTI to be fully realised in care homes, it is crucial to attend to the hydration needs of all residents, adhere to infection prevention measures in the care of indwelling urinary catheters and increase access to specialists to identify appropriate treatment options for residents with recurrent UTI. Care staff need knowledge and skills to differentiate between UTI and other diagnoses using their knowledge of the resident and what is normal for them. Assumptions by staff about the inevitability of infection and tendencies to consider non-evidence-based signs and symptoms as being a UTI by default need to be challenged. Use of decision-support tools that enable staff to gather and convey accurate and relevant information about a resident’s condition using a shared language helps them to feel that their knowledge of the resident is valued by healthcare professionals (HCPs) and that their concerns will be listened to. Protocols for active monitoring provide the opportunity to focus on preventative measures and permit a more reflective approach to the recognition and diagnosis of UTI, reducing the potential for inappropriate treatment. Conclusion At the outset of this review, we identified that the coherence and detail of what works for providers to prevent UTI in older people living in UK care homes was lacking. What we now know is that care home staff have a vital role in the prevention and recognition of UTI, which can be enabled through improved integration and prioritisation within the systems and routines of care homes and delivery of person-centred care. Promoting fundamental care as a means of facilitating a more holistic approach to prevention and recognition of UTI helps staff to recognise how they can contribute to antimicrobial stewardship and the recognition of sepsis. Challenging assumptions about UTI presentation is complex and requires education that facilitates ‘unlearning’ and questioning of low-value practices. Programmes to prevent UTI need to be co-designed and supported through active and visible leadership by care home managers. The involvement of specialist practitioners such as community matrons, specialist pharmacists, continence advisors and infection prevention specialists may help to create a network of practitioners that provides peer support for change. Limitations The COVID-19 pandemic required us to adapt our approach and work mainly online both in our interactions with stakeholders and as a research team. While this provided opportunities to extend our reach to a wider group of stakeholders, it also limited some of our engagement work. We wanted to have greater input from residents and their families, but this was not possible in the circumstances. The move to virtual meetings also had an impact on our intention to bring a wide range of stakeholders together, including representatives of care home residents, at a face-to-face event towards the end of the project with many preferring to meet virtually. We acknowledge that these adaptations may have limited the generation of insights and discussion to inform both the review and our strategies for development and dissemination of outputs. For this reason, we recognise the importance of continuing to engage with stakeholders as part of our ongoing work, reporting this process and any outcomes. Studies focusing on the prevention of UTI and CAUTI in care home settings were predominantly from the United States of America (USA) and Europe where the regulatory and funding systems for the long-term care of older people has some differences, particularly in the USA where national reporting plays a significant role in driving improvements in care. Furthermore, care homes (also known as nursing homes) in the USA provide a range of medical services including post-acute care, rehabilitation, palliative and hospice care, as well as long-term care. The studies undertaken in the UK and Europe were primarily focused on interventions to reduce antimicrobial resistance through stewardship but had significant learning that was transferable to the prevention and recognition of UTI. Our synthesis tried to take account of these differences, but we are aware that we will not have reflected all realities. Through the review, we identified several tools and resources that were being used by staff in care homes in addition to those reflected in the literature. It became clear from our teacher–learner interviews and stakeholder event that adding another set of tools would be unhelpful and that any resource we developed would need to follow the principles of co-design to address some of the challenges faced by care home leaders. The difficulty in bringing stakeholders to achieve this was insurmountable within the period for this review. Implications for practice The review findings point towards actionable recommendations for UTI prevention and recognition in the care of older people living in care homes, which we describe in relation to organisational- and system-level actions. These centre on the need to align UTI prevention and recognition to the goals of person-centred, fundamental care and prioritise this in routine daily care to improve quality and safety. For example, understanding and targeting personal barriers to drinking more fluids, such as fears about incontinence and getting to the toilet, may assist in addressing poor fluid intake. This in turn can help to reduce falls, confusion and drowsiness, as well as UTI. Care home providers Best practice to prevent and recognise UTI in care home residents requires focusing on a set of evidence-informed actions as part of routine daily care with the involvement of the whole care team, including individual residents, their family carers and care home staff. Preventative actions include: supporting each resident’s hydration preferences and needs use of fluid intake monitoring systems that enable realistic targets and actions to be agreed for residents with poor fluid consumption accessing specialists who can support the care of residents with recurrent UTI applying infection prevention practice to the care and management of indwelling urinary catheters. Accurate recognition of UTI requires: knowledge of the individual resident and what is normal for them understanding of evidence-based signs and symptoms of UTI use of structured tools that align with existing care processes and a shared language to convey accurate and relevant information to healthcare professionals. Care home staff need opportunities to: develop knowledge and skills so they can interpret a resident’s signs and symptoms and consider possible explanations for generalised changes in their condition reflect on practice and learn from each other about how to recognise a UTI and support preventative actions. System level A system-wide approach with regulatory and inspection frameworks aligned to evidence on prevention and recognition of UTI is vital to ensure that resources and infrastructure are available to enable care home managers and their staff to prioritise this as part of person-centred care. There is a need to: integrate prevention of UTI with diagnostic and antimicrobial stewardship in the care of older people living in care homes harmonise the prevention and recognition of UTI decision and communication tools with those focused on recognising deterioration to facilitate adoption and integration in care homes use cocreative approaches to develop and implement resources and improvement initiatives that involve the whole care team, residents and family carers build a knowledgeable workforce of care home support workers and registered nurses who can deliver evidence-informed care and communicate their observations in a way that enables care to be reviewed before escalation improve access to expert practitioners and services to support the provision of personalised, multidisciplinary assessment and treatment plans for residents with recurrent UTI who have the greatest potential to benefit from effective treatment. Research recommendations Well-designed research to improve the prevention and recognition of UTI in older people living in care homes should address the following: perspectives and beliefs of residents and family carers relating to the prevention and recognition of UTI and the concept of active monitoring to avoid unnecessary treatment the effectiveness of specialist practitioners in supporting initiatives to recognise and prevent UTI, including expertise in facilitating improvement the effectiveness of preventative pharmacological and non-pharmacological interventions to manage recurrent UTI in care homes the effectiveness of non-traditional education interventions such as huddles or structured reflection to facilitate decision-making in care homes in cocreating interventions research should be explicit about the elements of an intervention that can be tailored to individual care homes and those which are important to deliver as intended. Study registration This study is registered as PROSPERO 2020 CRD42020201782. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130396) and is published in full in Health Technology Assessment; Vol. 28, No. 68. See the NIHR Funding and Awards website for further award information.

This paper investigates whether a shift towards formal long-term care (LTC), typically associated with increased public spending in LTC, correlates with a lower likelihood of dying in hospitals compared to homes or care homes. Additionally, the study aims to assess how demographic, socioeconomic, and health-related variables are associated with the place of death across European countries. For this purpose, the study employs multinomial logistic regression on the data concerning 16,633 individuals aged 50 and over, who died between 2004 and 2021 in 24 European countries. The countries are grouped in two country groups to control for variations in their LTC systems. The first group consists of countries with more generous public funding for LTC, while the second group includes those where LTC is less funded and structured. Results indicate that the place of death is associated with the country’s healthcare system, demographic characteristics, socioeconomic status, and medical conditions. While hospitals remain the most common setting for death, this trend is shifting as recent years have seen a rise in deaths at home or in care homes across both country groups.

Loneliness and social isolation affect more than 1 in 4 community-dwelling older adults in the United States, who may also require long-term care support. Despite being seen as a solution to the long-term care crisis, most older adults prefer to age in place rather than using skilled nursing facilities. However, in-home care is unsustainable due to a shortage of direct care workers and may exacerbate social isolation by confining older adults to their homes. Adult Day Services (ADS) addresses both issues. ADS provides care to adults with physical, functional, and or cognitive limitations in non-residential, congregate, community-based settings. ADS also provides daily cognitive and physical stimulation, often with medical support, in a social and supported environment, centered around the needs and preferences of participants. Before the COVID-19 pandemic, nearly 5,000 ADS centers were widely available. However, with limited public support, the ADS industry has struggled as demand by the growing number of older adults and families need health and social support. The ADS industry must be recognized for its unique ability to buffer social isolation and loneliness in chronically ill older adults while serving as an effective platform for chronic disease management. This perspective piece highlights the critical role of ADS centers in reducing loneliness and social isolation and promoting healthy equity. We also explore the benefits of ADS, the financial, policy, and societal barriers to utilizing ADS, and the potential solutions to ensure its sustainability and growth.

Background: Adults with cognitive impairment are prone to living alone in large numbers but receive relatively little attention. This study aimed to evaluate whether living alone with cognitive impairment was associated with a higher burden of functional disability but lack of informal care. Methods: 982 observations of adults living alone with cognitive impairment and 50,695 observations of adults living with others and with normal cognition were identified from 4 waves (2011/2012, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). A matched comparator was selected using propensity score matching (1:2). Functional disability included disability in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and mobility. The time of receiving informal care was measured in monthly hours. Results: Adults living alone with cognitive impairment demonstrated significantly higher odds ratio of ADL disability (OR = 1.59, 95 % CI: 1.30, 1.95), IADL disability (OR = 1.19, 95 % CI: 1.00, 1.44), mobility disability (OR = 1.38, 95 % CI: 1.12, 1.70), but received fewer hours of informal care (β = −127.7 h per month, standard error = 25.83, P

Nursing homes struggle with safety issues, despite decades of intervention. This may, in part, stem from a reliance on a historical perspective that views safety as an intrinsic part of well-designed systems, with errors resulting from knowable, fixable causes. A new perspective (Resilient Health Care) assumes, instead, that in complex systems such as nursing homes, uncertainties and trade-offs occur in the course of everyday work. In this view, Resilient Health Care performance requires adapting to changes at different system levels to maintain high-quality care. An evidence-based program known as LOCK offers nursing homes a practical method for operationalizing a Resilient Health Care perspective. The LOCK program provides structures and processes that support frontline staff to successfully and safely navigate the complex interactions and factors that affect their daily provision of care. Published by Elsevier Inc. on behalf of AMDA — The Society for Post-Acute and Long-Term Care Medicine. [ABSTRACT FROM AUTHOR]