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Background: Many studies have reported on the relationship between cognitive and masticatory functions. However, it remains unclear how the mandibular movements change during chewing in facility residents as dementia progresses. This study aimed to investigate the relationship between a kinematic analysis of mandibular movement during mastication and cognitive function in facility residents. Methods: Sixty-three participants were included from two long-term care facilities. The primary outcome variable was the kinematic data of mandibular movement during mastication. The participants chewed rice crackers, and their faces were recorded during this motion. The partial correlation coefficient between kinematic data and cognitive function was calculated. Furthermore, group comparisons were performed after dividing the participants into three groups based on their cognitive function. Results: Circular motion frequency was significantly correlated with the ABC dementia scale, even after adjusting for the appendicular skeletal muscle index, Eichner index, and short-form mini-nutritional assessment. The cycle and circular motion frequencies were markedly lower in the severe dementia group than in the mild dementia group. Conclusions: With declining cognitive function, mandibular movements during mastication decrease in circular motion and increase in linear motion. Additionally, our results suggested that residents with severe cognitive impairment had more linear mandibular motions during mastication than those with mild cognitive impairment. This may make it more difficult for residents with cognitive decline to ingest normal solid foods. [ABSTRACT FROM AUTHOR]

Background: With the increase in the elderly population, institution-based care has become another option for elderly people. In Changhua, Taiwan, the number of long-term institutions has doubled in the past decade, and more families are choosing to send their elders to institutions for care. However, there is stress induced by having to care for these elders when they come back to their family members when hospitalized. Therefore, this study aimed to understand the stress and coping behaviors of family members in regard to hospitalized long-term care facility residents and identify relevant factors that affect and predict the stress and coping behaviors exhibited by these family members. Method: In this study, a quantitative and cross-sectional survey was conducted using the convenience-sampling method; family members of long-term care facility residents hospitalized in a regional hospital in central Taiwan were selected as the research participants and a total of 162 family members were admitted. The data were collected in the form of questionnaires including basic information and data on the stress and coping behaviors of the family members. The data were collected and coded by using SPSS 22.0 to perform descriptive and inferential statistical analysis. Results: The standard average score of total stress for family members was 57.03 points, which corresponds to a moderate level. The four perceptions of stress by family members were, in order, physiological, life, psychological, and economic. Furthermore, family income, work status, and the relationship between residents of the family members and physiological, psychological, and economic factors had predictive power for their problem-oriented coping behaviors, with an explanatory power of 59.6%. Life aspects, gender, marital status, and the number of hospitalizations in half a year had significant predictive power for the family members' emotion-oriented coping behaviors, with an explanatory power of 19.0%. Conclusions: The family members had high levels of stress, especially physical stress, and the total scores of stress perception were higher for those who were younger than 39 years old and had no rotating family members. Additionally, the coping behavior of the main caregiver was mainly problem-oriented. The results of this study may serve as a reference that can help nursing staff in clinical or long-term care facilities to provide or develop effective and individualized services for family members of facility residents. [ABSTRACT FROM AUTHOR]

Background: This study explores COVID-19 emergency admission and length of hospital stay hospitalization outcomes for Long-Term Care Facility (LTCF) residents with dementia. Methods: Utilizing a cross-sectional case control design, we employed logistic regression to analyze Texas Inpatient Public Use Data File (PUDF) for 1,413 dementia patients and 1,674 non-dementia patients (>60 years) to predict emergency admission and length of hospital stay with mediation by pre-existing conditions. Results: LTCF residents with dementia have a higher likelihood of COVID-19 emergency admission and shorter hospital stays. Adjusting for confounders of demographics, health insurance, and lifestyle, dementia diagnosis remained significantly associated with emergency admission and shorter hospital stays with preexisting conditions. Conclusion: Findings underscore the heightened risk for adverse COVID-19 hospitalization care disparities with dementia. Targeted health support programs for LTCF residents with dementia should aim to improve their COVID19 hospitalization outcomes, treating pre-existing health conditions and reducing their risk for excess mortality. [ABSTRACT FROM AUTHOR]

Providing a safe and secure living environment for residents that is supported by a dedicated healthcare team is one of the core values of nursing homes. Nursing homes must protect residents from the risk of going missing, track quarantined residents and visitors to control the spread of infection, and maintain proactive nursing rounds. However, recruiting and retaining qualified caregivers and medical staff has long been a challenge. Therefore, using advanced technology to ensure the safety and security of residents is highly desirable. In this work, we first demonstrate the applicability of indoor tracking applications in a nursing home, such as resident and asset tracking, nursing assistant management, visitor tracking, infection control, and vital-sign monitoring. To monitor the locations of residents and staff, Bluetooth tags were used, providing real-time data for location tracking. We then conduct a series of quantitative analyses to illustrate how indoor tracking data can support the management of nursing homes, including characterizing residents' activities in daily living and assessing the performance and workload of nursing assistants. Finally, we use qualitative research to evaluate the acceptability of an indoor positioning system in the nursing home. The results show that the implemented indoor positioning applications can improve the quality of healthcare and working efficiency, thereby providing a safer and more secure living environment for residents. [ABSTRACT FROM AUTHOR]

This study investigates the mechanisms of virtual reality (VR) tourism's impact on the well-being of residents in long-term care facilities (LTCFs). It aims to understand how presence and flow during VR experiences can enhance well-being. This experimental study used a quantitative approach with structured questionnaires to investigate VR experiences among LTCF residents in Taiwan. After obtaining ethical approval, 145 eligible participants from four LTCFs completed a full five-week VR tourism experience. Data collection took place from June to November 2022. This study employed Partial Least Squares Structural Equation Modeling (PLS-SEM) with Smart PLS software to analyze the causal relationships between latent variables. The results confirm that the more vivid the virtual reality image (β = 0.240, p < 0.05), the more immersive the experience (β = 0.267, p < 0.05), the greater the ability to control the experience (β = 0.465, p < 0.001), and the greater the ability to stimulate curiosity during the experience (β = 0.290, p < 0.05), the greater the sense of presence. Increased presence leads to user engagement and a state of flow (β = 0.556, p < 0.001), which is essential for personal hedonia (β = 0.453, p < 0.001) and eudaimonia (β = 0.220, p < 0.001). This study elucidates the mechanisms through which VR tourism experiences enhance well-being among LTCF residents, emphasizing the critical roles of presence and flow in promoting both hedonic and eudaimonic dimensions of well-being. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) is an integral part of good quality end-of-life care. This study aimed to explore the role and practice of ACP among health and social care professionals (HSCPs) in a community long-term care facility. Methods: This was a mixed-methods study. The study purposefully sampled 12 HSCPs from one community long-term care facility in Macao, China. All data were collected in November 2022. Results: Some participants had discussed with terminally ill residents or with families in terms of end-of-life care preferences, the average correct rate of ACP knowledge was 67.4%. Interview data showed that HSCPs were primarily concerned with information-giving. The responsibility of decision-making was found to have been placed predominantly on family members of the residents. Conclusion: Study findings raised awareness in that the execution of ACP has remained in discord with the expectations in practicing ACP. The study illuminated that the perceived sense of responsibility among HSCPs was influenced by the potential legal risks involved and consequentially impacted on the adherence to individual's decisions. [ABSTRACT FROM AUTHOR]

Hand hygiene (HH) among health care workers (HCWs) is crucial in preventing infections in nursing homes. However, HH compliance (HHC) among HCWs remains low. This study aimed to investigate the effect of feedback lights on HCWs' HHC. A 5-month interventional study was conducted in 3 wards in a nursing home in Denmark. During the intervention period, a green light with a smiley appeared on the alcohol-based hand rub (ABHR) dispensers when HCWs used the ABHR, acknowledging HCWs for using the ABHR. HHC was monitored using an automatic HH monitoring system (AHHMS). A total of 64 HCWs were enrolled. The AHHMS collected 23,696 HH opportunities in apartments and dirty utility rooms. Overall, HHC in the apartments increased from 50% at baseline (95% CI: 48, 53) to 56% (95% CI: 54, 58) during the intervention. However, the increased HHC level was not sustained during follow-up. The AHHMS enabled the assessment of the intervention. We found a significant effect of light-guided feedback in the apartments. However, the increased HHC was not sustained after the light was switched off. • Feedback with light on alcohol-based hand rub was investigated in nursing home wards. • Hand hygiene compliance (HHC) was measured using an automatic hand hygiene system. • The light had an immediate, significant effect on health care workers' (HCWs') HHC. • The increased HHC level was not sustained over time. • The light did not change HCWs' HHC in dirty utility rooms. [ABSTRACT FROM AUTHOR]

Background: Loneliness, anxiety and depressive symptoms are common among older residents in long‐term care facilities (LTCFs), which can negatively impact their quality of life and increase mortality rates. Addressing these psychological health issues is an important task for nursing staff. There is a need for easy and accessible interventions to improve older residents' negative emotions. Tactile massage (TM) is a form of touch therapy that induces oxytocin, which can help individuals feel relaxed, experience pleasure and reduce anxiety. TM can also provide a sense of security and care for individuals. Objective: This study aimed to evaluate the effects of TM in improving older residents' psychological health in LTCFs. Design: In this study, we applied a two‐arm randomised controlled trial research design. Methods: We used convenience sampling to enrol 55 older residents in three long‐term care facilities who were randomly assigned to an intervention group and a comparison group. The intervention group received TM by research assistants on both hands for 15 min per time, twice a week for 4 weeks and the comparison group received regular care. Data were collected before and after the intervention. Generalised estimating equations (GEEs) were used to evaluate the effectiveness of the intervention. Results: There were no significant differences in loneliness, anxiety, depressive symptoms, happiness, ear temperature, heart rate or diastolic blood pressure between the two groups after the intervention. However, the intervention group had significant improvements in comfort (B = 0.86, p < 0.001), relaxation (B = 1.00, p < 0.001), respiratory rate (B = −0.16, p = 0.021) and systolic blood pressure (B = − 4.17, p = 0.002) compared to the control group. Conclusions: TM can help older residents who live in LTCFs feel relaxed and comfortable. Implications for Practice: TM can be easily implemented as it requires no tools. We recommend that nursing staff and healthcare professionals incorporate TM as part of their care routines. They also can encourage family members to perform TM on residents during their visits to enhance residents' comfort and relaxation. Reporting Method: The Consolidated Standards of Reporting Trials (CONSORT) checklist was used for this paper. Trial Registration: ClinicalTrials.gov (NCT05052138) [ABSTRACT FROM AUTHOR]

Abstract Background In Taiwan, residents with and without dementia mostly co-live in long-term care facilities. The behavioral and psychiatric symptoms of dementia residents often pose challenges for others living together. This study explored the symbiotic experiences of residents without dementia co-living with those with dementia in long-term care facilities in Taiwan to present their experiences of living together. Methods This was a cross-sectional descriptive study with a phenomenological design. Semi-structured face-to-face interviews were conducted with 30 residents without dementia from three long-term care institutions in Taiwan. Colaizzi’s data processing steps were used for analysis. Results The analysis of interview transcripts revealed that the experiences of residents who lived with those with dementia were that of a “symbiosis.” Three core themes were found: “the impact of co-living,” “facing difficulties and coping,” and “companionship and reciprocity.” This study showed that residents without dementia may be affected by the behavioral and psychiatric symptoms of residents with dementia when co-living in long-term care facilities. However, there are also positive and mutually beneficial interactions between them. By helping people with dementia in their daily lives, residents without dementia feel happy and accomplished and their self-worth is enhanced. Furthermore, residents with dementia have more opportunities for social engagement and co-living interactions. Conclusion These results can guide long-term care facilities without special care dementia units to support residents without dementia, reduce the interference of the behavioral and psychiatric symptoms of residents with dementia, and promote mutual benefits. However, these findings warrant further investigation.

Background: In Taiwan, residents with and without dementia mostly co-live in long-term care facilities. The behavioral and psychiatric symptoms of dementia residents often pose challenges for others living together. This study explored the symbiotic experiences of residents without dementia co-living with those with dementia in long-term care facilities in Taiwan to present their experiences of living together. Methods: This was a cross-sectional descriptive study with a phenomenological design. Semi-structured face-to-face interviews were conducted with 30 residents without dementia from three long-term care institutions in Taiwan. Colaizzi's data processing steps were used for analysis. Results: The analysis of interview transcripts revealed that the experiences of residents who lived with those with dementia were that of a "symbiosis." Three core themes were found: "the impact of co-living," "facing difficulties and coping," and "companionship and reciprocity." This study showed that residents without dementia may be affected by the behavioral and psychiatric symptoms of residents with dementia when co-living in long-term care facilities. However, there are also positive and mutually beneficial interactions between them. By helping people with dementia in their daily lives, residents without dementia feel happy and accomplished and their self-worth is enhanced. Furthermore, residents with dementia have more opportunities for social engagement and co-living interactions. Conclusion: These results can guide long-term care facilities without special care dementia units to support residents without dementia, reduce the interference of the behavioral and psychiatric symptoms of residents with dementia, and promote mutual benefits. However, these findings warrant further investigation. [ABSTRACT FROM AUTHOR]

The increasing elderly population is driving higher utilization rates of long-term care facilities, where residents often have multiple chronic diseases, making them potential candidates for palliative care. Timely palliative care interventions can improve their quality of life and medical autonomy. This study systematically reviews the effectiveness of palliative care programs in long-term care facilities. Databases such as PubMed, EMBASE, Cochrane Library, and Airiti Library were searched up to 31 December 2023, using PICO criteria and the following keywords: 'care home', 'nursing home', 'residential aged care facility', and 'long-term care facility' for patients; and 'Gold Standard Framework in Care Homes', 'integrated care pathway', 'care home project', and 'palliative care program' for interventions. Seven articles were included. The results indicate that the Program of All-Inclusive Care for the Elderly (PACE) intervention did not significantly influence overall quality of life but did improve the quality of death. There were no statistical differences in comfort or quality of death between the dementia and non-dementia groups. However, PACE significantly reduced healthcare costs. The implementation of the Liverpool Care Pathway (LCP) notably enhanced the control of terminal symptoms, while the Gold Standard Framework in Care Homes (GSFCH) effectively improved end-of-life care rates, do-not-resuscitate (DNR) signing rates, advance care planning (ACP) completion rates, and reduced inappropriate readmission rates. While palliative care interventions are shown to improve the quality of end-of-life care, their practical application should be adapted to fit the implementation conditions and capabilities of domestic long-term care facilities. [ABSTRACT FROM AUTHOR]

This qualitative narrative study presents three stories told by older community-dwelling partners to spouses moving into long-term care facilities because of cognitive decline. Applying Alvesson and Kärreman's mystery method to these stories reveals that when spouses' caring needs increase, care partners must take on increasing loads of practical work and responsibilities. These partners become lost in the transitions between care work, extended family, and attending to their couplehood. When their spouses move into long-term care, living apart presents new challenges of care and couplehood, each day presenting new and unforeseen tasks to manage. Our findings suggest that if couplehood is to be maintained, well-established habits and work division between the spousal partners are both drivers and barriers. It necessitates agency, creativity from the community-dwelling partner, as well as a supportive extended family and sufficient economic resources. More knowledge is required regarding the interdependent expectations between the next-of-kin, long-term care residents, and caregiving staff members. [ABSTRACT FROM AUTHOR]

Background This quality assurance study was conducted during the COVID-19 pandemic to describe the profile of patients aged 65 years and older admitted to a transition unit in a long-term care (LTC) facility and to evaluate the impact of admission modalities, compliance with screening and hand hygiene practices, risk of COVID-19, and time to access a geriatric rehabilitation unit (GRU). Methods A prospective study was conducted using administrative and medical records from three Montreal public LTC facilities offering a rehabilitation program for 312 patients admitted between May 2020 and February 2021. The results are reported for the entire sample and compared according to the mode of admission. Results The incidence of COVID-19 during the transition unit stay was estimated to be 11 cases or 3.5% in 14 days. Assessment of screening compliance showed deficiencies for 41.3% of patients, and the frequency of hand hygiene audits was not strictly adhered to. More COVID-19 cases were recorded in patients admitted to the transition unit by bed availability than in the cohort mode. The time to access a rehabilitation unit was 7.2 days or 23.5% shorter for patients admitted by bed availability. Conclusions The study, conducted from a continuous practice improvement perspective, showed that the implementation of a transition unit in the LTC facilities helped control the transmission of COVID-19, but also revealed flaws in screening and hand hygiene practices. [ABSTRACT FROM AUTHOR]

Xiaoyu Zhou,1– 3 Fei Du,1– 3 Wei Peng,4 Li Bai,5 Leyi Peng,1– 3 Xiaorong Hou1– 3 1College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 2Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 3Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China; 4The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, People’s Republic of China; 5Hospital of Zigong Mental Health Central, Sichuan, 643021, People’s Republic of ChinaCorrespondence: Xiaorong Hou, Chongqing Medical University, No. 1, Medical College Road, Yuzhong District, Chongqing, 400016, People’s Republic of China, Email xiaoronghou@cqmu.edu.cnPurpose: Long-term care facilities are increasingly challenged with meeting the diverse healthcare needs of the elderly population, particularly concerning medication management. Understanding medication information literacy and behavior among this demographic is imperative. Therefore, this qualitative study aims to explore medication information literacy and develop distinct medication profiles among elderly long-term care residents.Material and Methods: In this study, we conducted in-depth semi-structured interviews with 32 participants aged 65 or older residing in a long-term care facility. The interviews were designed to explore participants’ understanding of medication information, medication management practices, and experiences with healthcare providers. Thematic analysis was employed to analyze the interview data, allowing for the identification of common patterns and themes related to medication-taking behavior among the elderly residents.Results: The thematic analysis revealed four distinct medication behavior profiles among the elderly long-term care residents: (1) Proactive Health Self-Managers, (2) Medication Information Adherents, (3) Experience-Based Medication Users, and (4) Nonadherent Medication Users. These findings provide valuable insights into the diverse approaches to medication management within long-term care facilities and underscore the importance of tailored interventions to support the specific needs of each profile.Conclusion: This study highlights the necessity for tailored medication education and support to optimize medication management for the elderly. With the aging population expansion, addressing the unique medication challenges within long-term care facilities becomes increasingly critical. This research contributes to ongoing endeavors to enhance healthcare services for the elderly, striving for safer and more effective medication-taking behavior.Keywords: medication information literacy, medication profile, long-term care facility, qualitative study, elderly

Aim: To examine the mental health conditions of family caregivers residing away from their loved ones who experienced visitation restrictions during the coronavirus disease 2019 pandemic. Design: A mixed-methods design applying the Kessler Scale-10 for the quantitative measurement of psychological distress and an open-ended question for qualitative analysis. Methods: The participants were recruited from care facilities between February and September 2021. This cross-sectional study included 197 family caregivers who were utilizing formal residential care services for their loved ones. Using thematic analyses, open-ended responses regarding the impact of visitation restrictions were coded. These themes were then examined to determine thematic patterns across caregiver characteristics. Results: Thirteen themes were identified regarding the impact of visitation restrictions. Many participants reported primary harmful effects as follows: ‘inability to confirm the type of care and lifestyle assistance provided to an older relative’ and ‘difficulty communicating with an older relative because of the inability to converse face-to-face’. Younger age, being employed, poor sleep, poor relationship quality with the care recipient and experiencing harmful effects from the visitation restrictions were associated with psychological distress. Conclusion: Our findings suggest that to maintain positive mental health after a care transition, it is important for family caregivers to take part in the care of their loved ones and ensure information sharing between the care recipient's family and institution. Impact: These findings suggest that both residents and family caregivers living outside facilities may feel distressed due to separation. Therefore, institutional care staff needs to consider how to adjust facility procedures or communication with family caregivers. [ABSTRACT FROM AUTHOR]

Aim: To determine how the nighttime sleep patterns of older adults in a long‐term care facility vary according to cognitive function and participation in daytime activities. Methods: This observational study was conducted with older adults aged ≥65 years who are residents of a long‐term care facility. Nighttime sleep was monitored using a non‐wearable sleep monitor for 8 weeks. Based on the Mini‐Mental State Examination scores for assessment of cognitive function, participants were classified into non‐dementia, mild‐to‐moderate dementia, and severe dementia groups. The Mann–Whitney U test and Kruskal–Wallis test were used to analyze the data. Results: Twenty three older adults were included in this study. Sleep onset latency was significantly longer in the severe dementia group than in the non‐dementia (p =.027) and mild‐to‐moderate dementia (p =.041) groups. Sleep efficiency was significantly lower in the severe dementia group than in the mild‐to‐moderate dementia group (p =.003), whereas wakefulness after sleep onset was significantly longer in the severe dementia group than in the mild‐to‐moderate dementia group (p =.011). The number of days spent engaging in recreational activities was <50%, whereas those spent taking a nap was >60% in all older adults. Older adults with mild‐to‐moderate dementia had better sleep and participated in more daytime activities than those with severe or no dementia. Moreover, bathing in a bathtub improved sleep onset latency. Conclusions: This study demonstrates that participation in daytime activities and bathing in a bathtub affect nighttime sleep in older adults. [ABSTRACT FROM AUTHOR]

Background: Older nursing home residents are at a greater risk of falling due to frailty. Exercise is effective at hampering frailty and related adverse events, including falls. Objectives: Our purpose was to evaluate the effect of a 12-week moderate-intensity multicomponent exercise programme on the number of falls and physical functioning among older nursing home residents. Also, we examined the association between the number of falls and demographics as well as physical and cognitive baseline data. Methods: The study protocol was registered on clinicaltrials.gov with the following identifier: NCT05835297. Older adults aged 65 years and over were recruited from a nursing home, and eligible and consenting residents were randomly allocated to two parallel groups: the intervention group, which performed a multicomponent exercise programme composed of strength, balance, and aerobic training (n = 12), and the control group, which received usual care (n = 12). Outcomes included falls, and measures of strength, balance, and mobility. Results: We had high adherence to exercise sessions, and no adverse events were recorded. We observed a non-significant reduction in falls (p = 0.34) and a significant improvement in Short Physical Performance Battery (p = 0.003) after the exercise programme. Falls were associated with being female and having diminished physical or cognitive function. Conclusions: Multicomponent exercise programmes should be implemented regularly in nursing homes for their effectiveness. Future studies with bigger samples, including participants with worse physical and cognitive impairments, as well as follow-up periods are required. [ABSTRACT FROM AUTHOR]

Keeping abreast of the antimicrobial stewardship–related articles published each year is challenging. The Southeastern Research Group Endeavor identified antimicrobial stewardship–related, peer-reviewed literature that detailed an actionable intervention during 2022. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight actionable interventions used by antimicrobial stewardship programs to capture potentially effective strategies for local implementation. [ABSTRACT FROM AUTHOR]

• We developed a tool to assess how staff ensure resident safety in care facilities. • Our questionnaire tool comprises 28 items and six factors. • The resident safety activity questionnaire proved to be valid and reliable. This study developed and tested a questionnaire to evaluate the safety activities supporting older adult residents' quality of care among long-term care facility staff. The process included item construction, expert review and pilot testing, testing of reliability and validation with 268 staff from 12 targeted facilities in South Korea. The final questionnaire yielded 28 items across six domains: proactive activities for emergency situations, comfort management, prevention of infections, staff training and communication, sufficient goods and equipment, and adequate personnel. These factors explained 73.48 % of the total variance. The fit indices in the confirmatory factor analysis were acceptable, and the total Cronbach's ⍺ was 0.952 (sub-domains: 0.823 –.895), indicating high reliability. The findings suggest the reliability and validity of the newly-developed Resident Safety Activity Questionnaire, enabling an accurate evaluation of the safety of long-term care facility residents and serving as an indicator for improving care quality in such establishments. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a commensal bacterium in humans, but it sometimes causes opportunistic infectious diseases such as suppurative skin disease, pneumonia, and enteritis. Therefore, it is important to determine the prevalence of S. aureus and methicillin‐resistant S. aureus (MRSA) in individuals, especially older adults. In this study, we investigated the prevalence of S. aureus and MRSA in the oral cavity and feces of residents in long‐term care facilities (LTCFs). S. aureus was isolated from the oral cavity of 61/178 (34.3%) participants, including 28 MRSA‐positive participants (15.7%), and from the feces of 35/127 (27.6%) participants, including 16 MRSA‐positive participants (12.6%). S. aureus and MRSA were isolated from both sites in 19/127 individuals (15.0%) and 10/127 individuals (7.9%), respectively. Among 19 participants with S. aureus isolation from both sites, 17 participants showed the same sequence type (ST) type. Then, we analyzed the correlation of S. aureus and MRSA in the oral cavity and rectum with the participant's condition. S. aureus and MRSA positivity in the oral cavity was significantly related to tube feeding, while there was no correlation of rectal S. aureus/MRSA with any factors. Our findings regarding the oral inhabitation of MRSA and its risk factors indicate the importance of considering countermeasures against MRSA infection in LTCFs. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the frequency of hypovitaminosis D among older adults and its association with the level of functionality. Methods: This cross-sectionalobservational study of older adults residing in a non-profit long-term care facility assessed functionality with the Katz Index of Independence in Activities of Daily Living. Vitamin D levels were classified as: deficient (< 20 ng/mL), insufficient (21–29 ng/mL), or normal (≥ 30 ng/mL). We used the chi-square test and Student'ds t-test to compare dchotomous and continuous variables, respectively. Analysis of variance with Tukey's post hoc test was used to assess differences between groups. Results: The sample consisted of 63individuals whose mean age was 81 (61–113) years: 36(55.4%) women and 27 (44.6%) men. The mean vitamin D level was 18.6 ng/mL, being < 30 ng/mL in 84.1%. The level was normal in 10 (15.9%), insufficient in 17 (27%), and deficient in 36 (57.1%). Vitamin D deficiency was present in 76.5% of those with total functional dependence (Katz = 5–6). Conclusions: We observed a high frequency of hypovitaminosis D, especially vitamin D deficiency, which was very common among those with significant functional dependence.

Objectives: The COVID-19 pandemic has challenged society, especially residents of long-term care facilities (LTCF). This study investigated rates of infection, hospitalization, and death due to COVID-19 among LTCF residents and staff in Minas Gerais, Brazil and identified strategies to control the spread of the disease. Methods: This cross-sectional study collected data from 164 LTCF (6017 older adults). The owners or managers were invited to answer an electronic questionnaire. The questionnaire included 55 items, divided into 3 sections. Results: Of the participating LTCF, 48.7%, 39.6%, and 32.3% reported COVID-19 infections, hospitalizations, and deaths, respectively, among residents, while 68.9%, 7.3%, and 1.2% reported COVID-19 infections, hospitalizations, and deaths, respectively, among staff. Preventive measures were identified and classified as organizational, infrastructural, hygiene items/personal protective equipment, and staff training. Conclusion: The strategies used in the daily routines of LTCF during the pandemic were classified. The challenges experienced in Brazilian facilities were similar to those observed worldwide. The results highlight the importance of continuity and the need to improve protective measures for LTCF residents, especially in low- and middle-income countries.

Abstract Background Elderly residents with physical and cognitive impairments in long-term care facilities are vulnerable to safety risks. Purpose This study investigated factors that influence patient safety cultures in delirium nursing care in long-term care facilities. Methods A cross-sectional survey was conducted among 214 nurses working in 12 long-term care facilities using a structured questionnaire from February 15, 2022, to March 14, 2022. Data analysis was performed using Pearson’s correlation coefficients and hierarchical analysis with SPSS/WIN 25.0 software. Results Significant factors associated with patient safety culture were identified. Organizational factors included the availability of delirium care manuals, nursing education and experience in delirium care, and the perceived necessity of delirium education. Individual factors included nurse-to-patient ratios, and nurses marital status. Conclusion To foster a strong patient safety culture, attention should be given to the availability of delirium care resources, the promotion of specialized and ongoing education and experience, and adequate staffing levels.

Abstract Background The increasing prevalence of multimorbidity has created a serious global public health problem in aging populations. Certain multimorbidity patterns across different age ranges and their association with health status remain unclear. The main aim of this study is to identify multimorbidity patterns discrepancies and associated health status between younger-old and oldest-old. Methods The Ethics Committee of Nanjing Medical University approved the study protocol (No.2019–473). Convenience sampling method was used to recruit older adults aged ≥ 60 years with multimorbidity from July to December 2021 from 38 Landsea long-term care facilities in China. The multimorbidity patterns were analyzed using network analysis and two-step cluster analysis. One-Way ANOVA was utilized to explore their association with health status including body function, activity of daily living, and social participation. A Sankey diagram visualized the flow of health status within different multimorbidity patterns. This study is reported following the STROBE guidelines. Results A total of 214 younger-old (60–84 years) and 173 oldest-old (≥ 85 years) were included. Leading coexisting diseases were cardiovascular disease (CD), metabolic and endocrine disease (MED), neurological disease (ND), and orthopedic disease (OD). Cluster 1 (53, 24.8%) of CD-ND (50, 94.3%; 31, 58.8%), cluster 2 (39, 18.2%) of MED-ND-CD (39, 100%; 39, 100%; 37, 94.9%), cluster 3 (37, 17.3%) of OD-CD-MED-ND (37, 100%; 33, 89.2%; 27, 73.0%; 16, 43.2%), and cluster 4 (34, 15.9%) of CD-MED (34, 100%; 34, 100%) were identified in the younger-old. In the oldest-old, the primary multimorbidity patterns were: cluster 1 (33, 19.1%) of CD-respiratory disease-digestive disease-urogenital disease (CD-RD-DSD-UD) (32, 97.0%; 9, 27.3%; 8, 24.2%; 7, 21.2%), cluster 2 (42, 24.3%) of ND-CD-MED (42, 100%; 35, 83.3%; 14, 33.3%), cluster 3 (28, 16.2%) of OD-CD-MED (28, 100%; 25, 89.3%; 18, 64.3%), and cluster 4 (35, 20.2%) of CD-MED (35, 100%; 35, 100%). Younger-old with CD-ND or MED-ND-CD, and oldest-old with ND-CD-MED have worse health status compared with other multimorbidity patterns (e.g., CD-MED and OD-CD-MED). Conclusion Discrepancies in common patterns of multimorbidity across age groups suggest that caregivers in long-term care facilities should consider changes in multimorbidity patterns with ageing when developing prevention plans for individualized management. Neurological disease concurrent with other diseases was the major determinant of health status, especially for the oldest-old. Interventions targeting multimorbidity need to be focused, yet generic. It is essential to assess complex needs and health outcomes that arise from different multimorbidity patterns and manage them through an interdisciplinary approach and consider their priorities to gain high-quality primary care for older adults living in long-term care facilities.

Background/Purpose: Long-term care facilities (LTCFs) are high-risk settings for the novel coronavirus disease (COVID-19). The aim of the study was to describe the extent and the impacts of 2021 COVID-19 outbreaks on LTCFs in Taiwan. Methods: We retrospectively analyzed the data of each COVID-19 outbreak in LTCFs from May 15 to July 31, 2021 in Taiwan. We characterized the features of LTCFs with outbreaks and compared the characteristics of infected staff members and residents of the affected LTCFs. Results: COVID-19 outbreaks were reported in 16 LTCFs (0.9%). The outbreak was significantly associated with LTCFs with ≥50 beds [adjusted odds ratio (aOR), 6.3; 95%confidence interval [CI], 1.9–21.1] and location of Taipei metropolitan area (aOR, 4.6; 95%CI, 1.7–12.8). Resident cases accounted for 75.4% (203/269) of confirmed cases affected by outbreaks. The 30-day all-cause mortality was 24.2% for residents only and was significantly associated with age ≥65 years [adjusted hazard ratio (aHR, 4.3; 95%CI, 1.7–10.5)], presence of symptoms on diagnosis (aHR, 2.2; 95%CI, 1.3–3.7), and LTCF occupancy rate ≥80% (aHR, 3.0, 95%CI, 1.3–7.4). Conclusion: COVID-19 outbreaks have a critical impact on residents in LTCFs owing to the advanced age and high prevalence of chronic comorbidities in this population. Multi-pronged infection control measures and mass testing are vital for mitigating COVID-19 transmission in LTCFs.

Providing a safe and secure living environment for residents that is supported by a dedicated healthcare team is one of the core values of nursing homes. Nursing homes must protect residents from the risk of going missing, track quarantined residents and visitors to control the spread of infection, and maintain proactive nursing rounds. However, recruiting and retaining qualified caregivers and medical staff has long been a challenge. Therefore, using advanced technology to ensure the safety and security of residents is highly desirable. In this work, we first demonstrate the applicability of indoor tracking applications in a nursing home, such as resident and asset tracking, nursing assistant management, visitor tracking, infection control, and vital-sign monitoring. To monitor the locations of residents and staff, Bluetooth tags were used, providing real-time data for location tracking. We then conduct a series of quantitative analyses to illustrate how indoor tracking data can support the management of nursing homes, including characterizing residents’ activities in daily living and assessing the performance and workload of nursing assistants. Finally, we use qualitative research to evaluate the acceptability of an indoor positioning system in the nursing home. The results show that the implemented indoor positioning applications can improve the quality of healthcare and working efficiency, thereby providing a safer and more secure living environment for residents.

This study investigates the mechanisms of virtual reality (VR) tourism’s impact on the well-being of residents in long-term care facilities (LTCFs). It aims to understand how presence and flow during VR experiences can enhance well-being. This experimental study used a quantitative approach with structured questionnaires to investigate VR experiences among LTCF residents in Taiwan. After obtaining ethical approval, 145 eligible participants from four LTCFs completed a full five-week VR tourism experience. Data collection took place from June to November 2022. This study employed Partial Least Squares Structural Equation Modeling (PLS-SEM) with Smart PLS software to analyze the causal relationships between latent variables. The results confirm that the more vivid the virtual reality image (β = 0.240, p < 0.05), the more immersive the experience (β = 0.267, p < 0.05), the greater the ability to control the experience (β = 0.465, p < 0.001), and the greater the ability to stimulate curiosity during the experience (β = 0.290, p < 0.05), the greater the sense of presence. Increased presence leads to user engagement and a state of flow (β = 0.556, p < 0.001), which is essential for personal hedonia (β = 0.453, p < 0.001) and eudaimonia (β = 0.220, p < 0.001). This study elucidates the mechanisms through which VR tourism experiences enhance well-being among LTCF residents, emphasizing the critical roles of presence and flow in promoting both hedonic and eudaimonic dimensions of well-being.

Background: Light influences the secretion of melatonin in the body and regulates circadian rhythms, which play an important role in sleep and mood. The light level of rooms in long-term care facilities is usually far below the threshold required to regulate the body's circadian rhythm, and insufficient light can easily lead to sleep and mood disturbances among older residents in nursing homes. Therefore, the objective of this study was to investigate the effects of light therapy on sleep and circadian rhythm in older adults with type 2 diabetes residing in long-term care facilities. Methods: This study was a prospective, single-blind, randomized controlled trial. Participants were randomly assigned to either the light therapy (LT) group or the control group and received the intervention for four weeks. Primary outcomes included the Pittsburgh Sleep Quality Index (PSQI) and objective sleep parameters recorded by a sleep monitoring bracelet, Morningness-Eveningness Questionnaire (MEQ). The secondary outcome included glycated serum protein (GSP). Data was collected at three time points: at baseline (T0), immediate post-treatment (T1), and 4-week follow-up (T2). A linear mixed model analysis was used to analyzed the data. Results: We enrolled 45 long-term care residents. Compared with the control group, significant reductions in PSQI scores were observed at T1 and T2. At T2, the sleep score of objective sleep parameters was significantly higher in the LT group compared to the control group. Additionally, compared to the baseline T0, MEQ scores were significantly lower in the LT group at T1 and T2, with no significant difference in the control group. There was no significant difference between groups in glycated serum protein values at T1 and T2. However, compared to T0, glycated serum protein values decreased in the LT group while increased in the control group at T2. Conclusion: Light therapy had a positive effect on subjective sleep quality and circadian rhythm time type in long-term care residents with type 2 diabetes, and had a possible delayed effect on objective sleep. However, no discernible alterations in blood glucose levels were detected in this study. [ABSTRACT FROM AUTHOR]

Background: Understanding the relationship among changes in Clinical Dementia Rating (CDR), patient outcomes, and probability of progression is crucial for evaluating the long-term benefits of disease-modifying treatments. We examined associations among changes in Alzheimer's disease (AD) stages and outcomes that are important to patients and their care partners including activities of daily living (ADLs), geriatric depression, neuropsychiatric features, cognitive impairment, and the probabilities of being transitioned to a long-term care facility (i.e., institutionalization). We also estimated the total time spent at each stage and annual transition probabilities in AD. Methods: The study included participants with unimpaired cognition, mild cognitive impairment (MCI) due to AD, and mild, moderate, and severe AD dementia in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) database. The associations among change in AD stages and change in relevant outcomes were estimated using linear mixed models with random intercepts. The probability of transitioning to long-term care facilities was modeled using generalized estimating equations. The total length of time spent at AD stages and annual transition probabilities were estimated with multistate Markov models. Results: The estimated average time spent in each stage was 3.2 years in MCI due to AD and 2.2, 2.0, and 2.8 years for mild, moderate, and severe AD dementia, respectively. The annual probabilities of progressing from MCI to mild, moderate, and severe AD dementia were 20, 4, and 0.7%, respectively. The incremental change to the next stage of participants with unimpaired cognition, MCI, and mild, moderate, and severe AD dementia (to death) was 3.2, 20, 26.6, 31, and 25.3%, respectively. Changes in ADLs, neuropsychiatric features, and cognitive measures were greatest among participants who transitioned from MCI and mild AD dementia to more advanced stages. Participants with MCI and mild and moderate AD dementia had increasing odds of being transitioned to long-term care facilities over time during the follow-up period. Conclusions: The findings demonstrated that participants with early stages AD (MCI or mild dementia) were associated with the largest changes in clinical scale scores. Early detection, diagnosis, and intervention by disease-modifying therapies are required for delaying AD progression. Additionally, estimates of transition probabilities can inform future studies and health economic modeling. [ABSTRACT FROM AUTHOR]

Background: Elderly residents with physical and cognitive impairments in long-term care facilities are vulnerable to safety risks. Purpose: This study investigated factors that influence patient safety cultures in delirium nursing care in long-term care facilities. Methods: A cross-sectional survey was conducted among 214 nurses working in 12 long-term care facilities using a structured questionnaire from February 15, 2022, to March 14, 2022. Data analysis was performed using Pearson's correlation coefficients and hierarchical analysis with SPSS/WIN 25.0 software. Results: Significant factors associated with patient safety culture were identified. Organizational factors included the availability of delirium care manuals, nursing education and experience in delirium care, and the perceived necessity of delirium education. Individual factors included nurse-to-patient ratios, and nurses marital status. Conclusion: To foster a strong patient safety culture, attention should be given to the availability of delirium care resources, the promotion of specialized and ongoing education and experience, and adequate staffing levels. [ABSTRACT FROM AUTHOR]

Background: The increasing prevalence of multimorbidity has created a serious global public health problem in aging populations. Certain multimorbidity patterns across different age ranges and their association with health status remain unclear. The main aim of this study is to identify multimorbidity patterns discrepancies and associated health status between younger-old and oldest-old. Methods: The Ethics Committee of Nanjing Medical University approved the study protocol (No.2019–473). Convenience sampling method was used to recruit older adults aged ≥ 60 years with multimorbidity from July to December 2021 from 38 Landsea long-term care facilities in China. The multimorbidity patterns were analyzed using network analysis and two-step cluster analysis. One-Way ANOVA was utilized to explore their association with health status including body function, activity of daily living, and social participation. A Sankey diagram visualized the flow of health status within different multimorbidity patterns. This study is reported following the STROBE guidelines. Results: A total of 214 younger-old (60–84 years) and 173 oldest-old (≥ 85 years) were included. Leading coexisting diseases were cardiovascular disease (CD), metabolic and endocrine disease (MED), neurological disease (ND), and orthopedic disease (OD). Cluster 1 (53, 24.8%) of CD-ND (50, 94.3%; 31, 58.8%), cluster 2 (39, 18.2%) of MED-ND-CD (39, 100%; 39, 100%; 37, 94.9%), cluster 3 (37, 17.3%) of OD-CD-MED-ND (37, 100%; 33, 89.2%; 27, 73.0%; 16, 43.2%), and cluster 4 (34, 15.9%) of CD-MED (34, 100%; 34, 100%) were identified in the younger-old. In the oldest-old, the primary multimorbidity patterns were: cluster 1 (33, 19.1%) of CD-respiratory disease-digestive disease-urogenital disease (CD-RD-DSD-UD) (32, 97.0%; 9, 27.3%; 8, 24.2%; 7, 21.2%), cluster 2 (42, 24.3%) of ND-CD-MED (42, 100%; 35, 83.3%; 14, 33.3%), cluster 3 (28, 16.2%) of OD-CD-MED (28, 100%; 25, 89.3%; 18, 64.3%), and cluster 4 (35, 20.2%) of CD-MED (35, 100%; 35, 100%). Younger-old with CD-ND or MED-ND-CD, and oldest-old with ND-CD-MED have worse health status compared with other multimorbidity patterns (e.g., CD-MED and OD-CD-MED). Conclusion: Discrepancies in common patterns of multimorbidity across age groups suggest that caregivers in long-term care facilities should consider changes in multimorbidity patterns with ageing when developing prevention plans for individualized management. Neurological disease concurrent with other diseases was the major determinant of health status, especially for the oldest-old. Interventions targeting multimorbidity need to be focused, yet generic. It is essential to assess complex needs and health outcomes that arise from different multimorbidity patterns and manage them through an interdisciplinary approach and consider their priorities to gain high-quality primary care for older adults living in long-term care facilities. [ABSTRACT FROM AUTHOR]

Low intake of micronutrients is associated with health-related problems in nursing home residents. As their food intake is generally low, it is expected that their micronutrient intake will be low as well. The nutrient intake of 189 residents (mean age 85.0 years (SD: 7.4)) in five different Dutch nursing homes was measured based on 3-day direct observations of intake. Micronutrient intake, without supplementation, was calculated using the Dutch food composition table, and SPADE software was used to model habitual intake. Intake was compared to the estimated average requirement (EAR) or adequate intake (AI) as described in the Dutch dietary reference values. A low intake was defined as >10% not meeting the EAR or when the P50 (median) intake was below the AI. Vitamin A, thiamin, riboflavin, niacin, B6, folate, B12, C, D, E, copper, iron, zinc, calcium, iodine, magnesium, phosphorus, potassium, and selenium were investigated. Our data showed that vitamin and mineral intake was low for most assessed nutrients. An AI was only seen for vitamin B12 (men only), iodine (men only), and phosphorus. A total of 50% of the population had an intake below the EAR for riboflavin, vit B6, folate, and vitamin D. For reference values expressed in AI, P50 intake of vitamin E, calcium, iodine, magnesium, potassium, and selenium was below the AI. To conclude: micronutrient intake in nursing home residents is far too low in most of the nursing home population. A "food-first" approach could increase dietary intake, but supplements could be considered if the "food-first" approach is not successful. [ABSTRACT FROM AUTHOR]

Long-term care facilities (LTCFs) are high-risk settings for the novel coronavirus disease (COVID-19). The aim of the study was to describe the extent and the impacts of 2021 COVID-19 outbreaks on LTCFs in Taiwan. We retrospectively analyzed the data of each COVID-19 outbreak in LTCFs from May 15 to July 31, 2021 in Taiwan. We characterized the features of LTCFs with outbreaks and compared the characteristics of infected staff members and residents of the affected LTCFs. COVID-19 outbreaks were reported in 16 LTCFs (0.9%). The outbreak was significantly associated with LTCFs with ≥50 beds [adjusted odds ratio (aOR), 6.3; 95%confidence interval [CI], 1.9–21.1] and location of Taipei metropolitan area (aOR, 4.6; 95%CI, 1.7–12.8). Resident cases accounted for 75.4% (203/269) of confirmed cases affected by outbreaks. The 30-day all-cause mortality was 24.2% for residents only and was significantly associated with age ≥65 years [adjusted hazard ratio (aHR, 4.3; 95%CI, 1.7–10.5)], presence of symptoms on diagnosis (aHR, 2.2; 95%CI, 1.3–3.7), and LTCF occupancy rate ≥80% (aHR, 3.0, 95%CI, 1.3–7.4). COVID-19 outbreaks have a critical impact on residents in LTCFs owing to the advanced age and high prevalence of chronic comorbidities in this population. Multi-pronged infection control measures and mass testing are vital for mitigating COVID-19 transmission in LTCFs. [ABSTRACT FROM AUTHOR]

IntroductionResidents of long-term care facilities (LTCFs) are at high risk of morbidity and mortality due to COVID-19, especially when new variants of concern (VOC) emerge. To provide intradisciplinary data in order to tailor public health interventions during future epidemics, available epidemiologic and genomic data from Slovenian LTCFs during the initial phases of the COVID-19 pandemic was analyzed.MethodsThe first part of the study included SARS-CoV-2 reverse-transcription Real-Time PCR (rtRT-PCR) positive LTCF residents, from 21 facilities with COVID-19 outbreaks occurring in October 2020. The second part of the study included SARS-CoV-2 rtRT-PCR positive LTCF residents and staff between January and April 2021, when VOC Alpha emerged in Slovenia. Next-generation sequencing (NGS) was used to acquire SARS-CoV-2 genomes, and lineage determination. In-depth phylogenetic and mutational profile analysis were performed and coupled with available field epidemiological data to assess the dynamics of SARS-CoV-2 introduction and transmission.Results370/498 SARS-CoV-2 positive residents as well as 558/699 SARS-CoV-2 positive residents and 301/358 staff were successfully sequenced in the first and second part of the study, respectively. In October 2020, COVID-19 outbreaks in the 21 LTCFs were caused by intra-facility transmission as well as multiple independent SARS-CoV-2 introductions. The Alpha variant was confirmed in the first LTCF resident approximately 1.5 months after the first Alpha case was identified in Slovenia. The data also showed a slower replacement of existing variants by Alpha in residents compared to staff and the general population.DiscussionMultiple SARS CoV-2 introductions as well as intra-facility spreading impacted disease transmission in Slovenian LTCFs. Timely implementation of control measures aimed at limiting new introductions while controlling in-facility transmission are of paramount importance, especially as new VOCs emerge. Sequencing, in conjunction with epidemiological data, can facilitate the determination of the need for future improvements in control measures to protect LTCF residents from COVID-19 or other respiratory infections.

Abstract Background Swallowing/feeding difficulty is a serious hidden health problem in the older population. Although oral intake services based on the degree of this difficulty have been provided and revised in Japanese public long-term care (LTC) insurance since 2006, their implementation has not been examined. We evaluated the impact of policy changes on these services. Methods The nationwide database of LTC service uses in Japan was analysed for three oral intake services: Enhanced Oral Function in daycare facilities whose users were slightly disabled, Maintenance of Oral Ingestion and Transition to Oral Ingestion from tube feeding in residential facilities. Data were extracted for each June from 2015 to 2020 when monthly usage of these services was aligned and each June from 2009 to 2020 for the proportion of users according to LTC insurance certification. The major policy changes were the addition of municipal provision in Enhanced Oral Function and a requirement for multidisciplinary collaboration in Maintenance of Oral Ingestion in 2015. The impact of the medical fee reduction for developing percutaneous gastro-tubing to Transition to Oral Ingestion was also examined. Results Between 2015 and 2020, the use of Enhanced Oral Function and Maintenance of Oral Ingestion increased and Transition to Oral Ingestion decreased, resulting in a total increase in use of 275,000 times or approximately 5,000 times per 100,000 among all older adults with LTC insurance certification. Concerning the proportion of users’ disability status, the major users of Enhanced Oral Function in 2020 were slightly disabled and independent older adults (70%, up from 55% to 2009). Regarding the major users of Maintenance of Oral Ingestion between 2013 and 2020, care-need level 5 (most severe) decreased by 11%, whereas the total of care-need levels 4 and 3 increased by 9%. The use of Transition to Oral Ingestion, which had been declining, showed a further decline after reduction of the medical fee for percutaneous gastro-tubing in 2014. Conclusions Due to policy changes, Enhanced Oral Function and Maintenance of Oral Ingestion have increased in the number of use among slightly disabled persons. However, this increase may be insufficient given the hidden swallowing/feeding difficulty.

Abstract Aim To explore the acquisition behaviours for nutrition‐related information of older adults in a long‐term care facility. Design A qualitative descriptive design was used in this study. Methods Sixteen older adults in a long‐term care facility were recruited using purposive sampling between March and May 2021. Data were collected via face‐to‐face semi‐structured interviews, based on open questions regarding acquisition behaviours for nutrition‐related information and flexible question formulation, and the data were analysed using an inductive–deductive method. A health promotion model was used as a conceptual framework to regulate the refinement of themes. Results Three themes were identified in this study. The first theme discussed the individual characteristics and experiences of older adults that contributed to their acquisition behaviours for nutrition‐related information. The second theme described behaviour‐specific cognitions of and the effects on the participants regarding the influencing factors involving various internal individual elements and external physical environment. The third theme explored the positive behavioural outcomes of the participants resulting from these acquisition behaviours. Conclusion Acquisition behaviours for nutrition‐related information of older adults in long‐term care facilities were affected by both individual characteristics and external physical environment factors. Access to nutritional information can help older adults cultivate a healthy diet. Although they exhibited a significant interest in nutrition, the participants still encountered several difficulties. Based on the actual care needs of the older people, appropriate nutritional information interventions should be provided by healthcare providers working in long‐term care facilities so as to improve the ability of the older people to acquire information independently. Patient or public contribution All 16 participants actively participated in the interview process and the preliminary preparation of the article.

Background: To evaluate antibody responses against the primary series of vaccination of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2] vaccines in the staff and residents of Japanese geriatric intermediate care facilities. Methods: All subjects (159 staff and 96 residents) received two doses of the BNT162b2 mRNA vaccine 3 weeks apart. Baseline data of subject were collected using a structured form. Serum samples were collected three times: before vaccination, 3 weeks after the first dose, and 4 weeks after the second dose, and anti-receptor binding domain of the spike protein of SARS-CoV-2 [anti-RBD] IgG was measured using two immunoassays. Results: After the second dose, geometric mean titers [GMT] of anti-RBD with both the Abbott and Roche assay were significantly lower in residents than staff (2282 AU/mL vs. 8505 AU/mL, and 258 U/mL vs. 948 U/mL, respectively). Multivariate analysis of characteristics affecting antibody responses (≥1280 AU/mL for Abbott and > 210 U/mL for Roche) showed lower odds ratios [ORs] for older age (adjusted OR per 10 year increase [aOR] = 0.62, 95 % confidence interval [95 %CI]; 0.38–1.02), steroid usage (aOR = 0.09, 95 %CI; 0.01–0.60) and regular nonsteroidal anti-inflammatory drugs [NSAIDs] usage (aOR = 0.16, 95 %CI; 0.03–0.88). Conclusions: Elderly people and steroid and NSAID users had lower antibody responses following the second vaccine dose.

Aim: The main purpose of this research is to understand the wayfinding experience of older adults with dementia in long-term care facilities and identifying environmental design elements that support older adults' spatial abilities. Background: Wayfinding problems are the earliest symptoms of dementia, and older adults with cognitive impairment are more likely to get lost in the community and consequences cause psychological responses such as insecurity, agitation, and falling in their environment. Method: The research used data collected from 30 caregivers of two long-term care facilities in the Midwest through a survey and interview on their perceptions of wayfinding design elements. Results: The research findings highlighted on caregivers' perception on wayfinding experience of older adults with dementia. The findings show a significant difference between importance and satisfaction on floor pattern and visibility in the facilities. Study indicated that glass partitions in the middle of the hall and corridor can create visual obstruction for older adults and barrier for staff as well to keep visual track on them. The qualitative study revealed that different colored doors for individual patient room in a memory care enhance older adults' wayfinding abilities. In addition, in case of multisensory stimuli, noise and smell can improve their wayfinding abilities as well. Conclusion: The conclusion of the study highlights the importance of understanding the design elements that can be effective in creating a safer environment for older adults with dementia. [ABSTRACT FROM AUTHOR]

Background: Swallowing/feeding difficulty is a serious hidden health problem in the older population. Although oral intake services based on the degree of this difficulty have been provided and revised in Japanese public long-term care (LTC) insurance since 2006, their implementation has not been examined. We evaluated the impact of policy changes on these services. Methods: The nationwide database of LTC service uses in Japan was analysed for three oral intake services: Enhanced Oral Function in daycare facilities whose users were slightly disabled, Maintenance of Oral Ingestion and Transition to Oral Ingestion from tube feeding in residential facilities. Data were extracted for each June from 2015 to 2020 when monthly usage of these services was aligned and each June from 2009 to 2020 for the proportion of users according to LTC insurance certification. The major policy changes were the addition of municipal provision in Enhanced Oral Function and a requirement for multidisciplinary collaboration in Maintenance of Oral Ingestion in 2015. The impact of the medical fee reduction for developing percutaneous gastro-tubing to Transition to Oral Ingestion was also examined. Results: Between 2015 and 2020, the use of Enhanced Oral Function and Maintenance of Oral Ingestion increased and Transition to Oral Ingestion decreased, resulting in a total increase in use of 275,000 times or approximately 5,000 times per 100,000 among all older adults with LTC insurance certification. Concerning the proportion of users' disability status, the major users of Enhanced Oral Function in 2020 were slightly disabled and independent older adults (70%, up from 55% to 2009). Regarding the major users of Maintenance of Oral Ingestion between 2013 and 2020, care-need level 5 (most severe) decreased by 11%, whereas the total of care-need levels 4 and 3 increased by 9%. The use of Transition to Oral Ingestion, which had been declining, showed a further decline after reduction of the medical fee for percutaneous gastro-tubing in 2014. Conclusions: Due to policy changes, Enhanced Oral Function and Maintenance of Oral Ingestion have increased in the number of use among slightly disabled persons. However, this increase may be insufficient given the hidden swallowing/feeding difficulty. [ABSTRACT FROM AUTHOR]

In 2022, we undertook a point prevalence screening study for Enterobacterales with extended-spectrum β-lactamases (ESBLs), high-level AmpC cephalosporinases and carbapenemases, and also methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in a long-term care facility (LTCF) and the associated acute-care hospital Geriatrics unit in Bolzano, Northern Italy. Urine samples and rectal, inguinal, oropharyngeal, and nasal swabs were plated on selective agar plates. Metadata of the patients, including demographic data, were collected, and risk factors for colonization were determined. ESBL, AmpC, carbapenemase, and quinolone resistance genes were investigated by the HybriSpot 12 PCR AUTO System. The following colonization percentages by multidrug-resistant (MDR) bacteria have been found in LTCF residents: all MDR organisms, 59.5%; ESBL producers, 46.0% (mainly CTX-M-type enzymes); carbapenemase producers, 1.1% (one Klebsiella pneumoniae with KPC-type); MRSA, 4.5%; VRE, 6.7%. Colonization by MDR bacteria was 18.9% for LTCF staff and 45.0% for Geriatrics unit patients. Peripheral vascular disease, the presence of any medical device, cancer, and a Katz Index of 0 were significant risk factors for colonization of LTCF residents by MDR bacteria in univariate and/or multivariate regression analysis. To conclude, the ongoing widespread diffusion of MDR bacteria in the LTCF suggests that efforts should be strengthened on MDR screening, implementation of infection control strategies, and antibiotic stewardship programs targeting the unique aspects of LTCFs. ClinicalTrials.gov ID: 0530250-BZ Reg01 30/08/2022. [ABSTRACT FROM AUTHOR]

Background and Objectives Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living. Research Design and Methods Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC. Only English articles were reviewed. Based on the Meleis' Health Transition (MHT) model, we categorized findings into: (a) transition conditions ; (b) patterns of response ; and (c) health services and interventions. Results We included 204 unique studies. Age, cognitive/functional impairments, and caregiver burden were the most consistent risk factors for older persons' transitions to FBC. Caregiver burden was the only consistent risk factor in both quantitative and qualitative literature. Other factors around health service use or nonmedical factors were examined in a small number of studies, or demonstrated mixed or nonsignificant results. Key research gaps relate to transitions to intermediate levels of FBC, research in public health systems, and research employing qualitative and interventional methods. Discussion and Implications We expanded the MHT model to capture informal caregivers and their critical role in transitions from home to FBC settings. More research is needed to address practical needs of clients and caregivers while at home, and self-directed care funding models could be expanded. Theory-driven interventional research focusing on caregivers and successful hospital discharge is critically needed. [ABSTRACT FROM AUTHOR]

• Empirical antibiotic prescribing for UTI in older adults in LTCF remains prevalent due to limitations for adequate urinalysis and culture in this setting. • LTCF residents have higher incidence of antibiotic resistance. • Definitive antibiotic prescribing for UTI and appropriate antibiotic stewardship should be considered in the LTCF population. In this study, we compared the proportion of antibiotic resistance between patients who visited the emergency department (ED) with urinary tract infection (UTI) from long-term care hospitals (LTCH), which is a type of long-term care facilities (LTCF) and the community. We assessed the resulting difference in prognosis. Older adults who visited the ED between January and December 2019 and were diagnosed with UTI were divided into community residents and LTCH residents. We investigated the antibiotics sensitivity rates, end of therapy (EOT), and the patient's outcomes were evaluated. The antibiotic resistance rate was higher in LTCH residents. LTCH residents had a higher in hospital mortality rate compared to community residents. EOT was found to be longer, and admission rate and in-hospital mortality rate were also higher in LTCH residents. LTCF residents had a higher rate of antibiotic resistance and a poor prognosis. [ABSTRACT FROM AUTHOR]

Aim: To explore the acquisition behaviours for nutrition‐related information of older adults in a long‐term care facility. Design: A qualitative descriptive design was used in this study. Methods: Sixteen older adults in a long‐term care facility were recruited using purposive sampling between March and May 2021. Data were collected via face‐to‐face semi‐structured interviews, based on open questions regarding acquisition behaviours for nutrition‐related information and flexible question formulation, and the data were analysed using an inductive–deductive method. A health promotion model was used as a conceptual framework to regulate the refinement of themes. Results: Three themes were identified in this study. The first theme discussed the individual characteristics and experiences of older adults that contributed to their acquisition behaviours for nutrition‐related information. The second theme described behaviour‐specific cognitions of and the effects on the participants regarding the influencing factors involving various internal individual elements and external physical environment. The third theme explored the positive behavioural outcomes of the participants resulting from these acquisition behaviours. Conclusion: Acquisition behaviours for nutrition‐related information of older adults in long‐term care facilities were affected by both individual characteristics and external physical environment factors. Access to nutritional information can help older adults cultivate a healthy diet. Although they exhibited a significant interest in nutrition, the participants still encountered several difficulties. Based on the actual care needs of the older people, appropriate nutritional information interventions should be provided by healthcare providers working in long‐term care facilities so as to improve the ability of the older people to acquire information independently. Patient or public contribution: All 16 participants actively participated in the interview process and the preliminary preparation of the article. [ABSTRACT FROM AUTHOR]

We characterized serology following a nursing home outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) where residents were serially tested by reverse-transcription polymerase chain reaction (RT-PCR) and positive residents were cohorted. When tested 46-76 days later, 24 of 26 RT-PCR-positive residents were seropositive; none of the 124 RT-PCR-negative residents had confirmed seropositivity, supporting serial SARS-CoV-2 RT-PCR testing and cohorting in nursing homes.

This paper interprets the content and recommendations of the guidelines on infection prevention and control in long-term care facilities put forward by the World Health Organization （WHO） during the 2019 coronavirus disease （COVID-19） pandemic， and actively explores the key points of nursing and infection prevention and control measures for the long-term care facilities under the background of repeated outbreaks， with the aim of providing care measures and infection prevention and control measures that suit our national conditions to improve the living standards of the elderly and protect them from viral infection amid the recurring pandemic.

Background: Coronavirus disease 2019 (COVID-19) remains a threat to vulnerable populations such as long-term care facility (LTCF) residents, who are often older, severely frail, and have multiple comorbidities. Although associations have been investigated between COVID-19 mRNA vaccine immunogenicity, durability, and response to booster vaccination and chronological age, data on the association of clinical factors such as performance status, nutritional status, and underlying comorbidities other than chronological age are limited. Here, we evaluated the anti-spike IgG level and neutralizing activity against the wild-type virus and Delta and Omicron variants in the sera of LTCF residents, outpatients, and healthcare workers before the primary vaccination; at 8, 12, and 24 weeks after the primary vaccination; and approximately 3 months after the booster vaccination. This 48-week prospective longitudinal study was registered in the UMIN Clinical Trials Registry (Trial ID: UMIN000043558). Results: Of 114 infection-naïve participants (64 LTCF residents, 29 outpatients, and 21 healthcare workers), LTCF residents had substantially lower anti-spike IgG levels and neutralizing activity against the wild-type virus and Delta variant than outpatients and healthcare workers over 24 weeks after the primary vaccination. In LTCF residents, booster vaccination elicited neutralizing activity against the wild-type virus and Delta variant comparable to that in outpatients, whereas neutralizing activity against the Omicron variant was comparable to that in outpatients and healthcare workers. Multiple regression analyses showed that age was negatively correlated with anti-spike IgG levels and neutralizing activity against the wild-type virus and Delta variant after the primary vaccination. However, multivariate regression analysis revealed that poor performance status and hypoalbuminemia were more strongly associated with a lower humoral immune response than age, number of comorbidities, or sex after primary vaccination. Booster vaccination counteracted the negative effects of poor performance status and hypoalbuminemia on the humoral immune response. Conclusions: LTCF residents exhibited suboptimal immune responses following primary vaccination. Although older age is significantly associated with a lower humoral immune response, poor performance status and hypoalbuminemia are more strongly associated with a lower humoral immune response after primary vaccination. Thus, booster vaccination is beneficial for older adults, especially those with a poor performance status and hypoalbuminemia. [ABSTRACT FROM AUTHOR]

Background: The population is aging globally. Older people living in long-term care facilities have many functional impairments, such as mobility problems and depression. Digital games and so-called exergames can offer a motivating and entertaining way to maintain older people's physical activity and thus their ability to function. However, previous studies have reported conflicting results about the effects of digital gaming and have focused on community-dwelling older people. Objective: To identify, critically appraise, and synthesize evidence about the effectiveness of digital games on older people's physical, psychological, and social functioning and physical and social activity in long-term care facilities. Methods: Five databases were systematically searched, and relevant studies were screened. Fifteen randomized-controlled trials and quasi-experimental studies (total N = 674) were included in meta-analysis. Results: All digital games used in interventions were exergames. Meta-analysis showed that exergame interventions have a statistically significant large effect on physical functioning [number of studies (N) = 6, standardized mean difference (SMD) = 0.97, p = 0.001] measured by Timed Up and Go or Short Physical Performance Battery and self-assessed physical activity (N = 3, SMD = 1.20, p < 0.001) and medium effect on social functioning (N = 5, SMD = 0.74, p = 0.016) compared to alternative intervention or no intervention. Social activity was not measured in any study. Conclusions: The results are encouraging that exergames effectively increase the functioning and activity of older adults living in long-term facilities. Successful implementation of such activities requires the competence of nursing staff and rehabilitation professionals in digitalization. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the impacts of the restrictions implemented in LTCF during the COVID-19 pandemic on the psychological and functional status of older adults. Design: A retrospective multicentre study is designed. We hypothesize that the negative effects of the restrictions will lead to a higher rate of decline between the measures taken immediately before and after the lockdown than between the two measures taken before the lockdown. Setting and participants: 365 participants recruited in four Spanish LTCFs in Galicia and Valencia. Methods: Impacts of restrictions on cognitive (MMSE), affective (GDS) and functional status (Barthel index, Tinetti) were analyzed by Linear Mixed Models with random intercepts, random slopes, and personal and contextual factors as covariates. Results: Social measures covaried significantly with the cognitive and functional status but did not predict longitudinal change. MMSE, Barthel index and Tinetti scores decreased significantly across pre- and post-lockdown measurement times, but only the Tinetti scores showed a specific impact of the restrictions. Conclusions: Only performance-based functional measures showed the real impact of restrictions. The findings highlight the importance of having data from several pre-lockdown measurements to enable identification of changes that can be causally attributed to the restrictions. The findings also support the resilience of older adults in mitigating the effect of the restrictions. [ABSTRACT FROM AUTHOR]

Background The aim of the current study was to develop and validate a Perceived Relocation Stress Scale. Methods A cross-sectional research design was used. A total of 175 older adults residing in long-term care facilities in Southern Taiwan for at least 1 y were recruited. An exploratory factor analysis was performed to examine item convergent and discriminant validity. Concurrent validity was checked using the Depression Anxiety and Stress scale. The reliability was analyzed using Cronbach's alpha and intraclass correlation coefficients. Results The face and content validity of the scale were verified by adequately measuring the scale items. Factor analysis consisted of four components (challenge/chance, positive appraisal, threat, loss), with a total variance of 67.35%. The content validity was determined by an expert panel to systematically examine the relevance of all items. The results of item convergent and discriminant validity supported the constructs of the scale. The alpha coefficient for the overall scale was.958, indicating good internal consistency reliability. Conclusions The Perceived Relocation Stress Scale is a reliable and valid measurement to assess the stress perceived by older individuals being transferred to a long-term care facility. [ABSTRACT FROM AUTHOR]

• Good morale and positive attitudes about work were reported by a majority at all time points. • Nonetheless, PPE use and other infection prevention measures were challenging and made the job harder. • Most staff felt well trained and competent to follow recommendations to prevent COVID-19 transmission. • A majority felt there was good support from their managers and colleagues to prevent COVID-19. Staff actions to prevent infection introduction and transmission in long-term care facilities (LTCFs) were key to reducing morbidity and mortality from COVID-19. Implementing infection control measures (ICMs) requires training, adherence and complex decision making while trying to deliver high quality care. We surveyed LTCF staff in England about their preparedness and morale at 3 timepoints during the COVID-19 epidemic. Online structured survey targeted at LTCF workers (any role) administered at 3 timepoints (November 2020-January 2021; August-November 2021; March-May 2022). Narrative summary of answers, narrative and statistical summary (proportionality with Pearson's chi-square or Fisher's Exact Test) of possible differences in answers between waves. Across all 3 survey waves, 387 responses were received. Morale, attitudes towards working environment and perception about colleague collaboration were mostly positive at all survey points. Infection control training was perceived as adequate. Staff felt mostly positive emotions at work. The working environment remained challenging. Masks were the single form of PPE most consistently used; eye protection the least used. Mask-wearing was linked to poorer communication and resident discomfort as well as mild negative health impacts on many staff, such as dehydration and adverse skin reactions. Hand sanitizer caused skin irritation. Staff morale and working practices were generally good even though the working environment provided many new challenges that did not exist pre-pandemic. [ABSTRACT FROM AUTHOR]