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Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879. [ABSTRACT FROM AUTHOR]

Forecasts about the aging trend of the world population agree on identifying increased life expectancy as a serious risk factor for the financial sustainability of social healthcare systems if not properly supported by innovative care management policies. Such policies should include the integration within traditional healthcare services of assistive technologies as tools for prolonging healthy and independent living at home, but also for introducing innovations in clinical practice such as long-term and remote health monitoring. For their part, solutions for active and assisted living have now reached a high degree of technological maturity, thanks to the considerable amount of research work carried out in recent years to develop highly reliable and energy-efficient wearable sensors capable of enabling the development of systems to monitor activity and physiological parameters over time, and in a minimally invasive manner. This work reviews the role of wearable sensors in the design and development of assisted living solutions, focusing on human activity recognition by joint use of onboard electromyography sensors and inertial measurement units and on the acquisition of parameters related to overall physical and psychological conditions, such as heart activity and skin conductance. [ABSTRACT FROM AUTHOR]

Human posture recognition has a wide range of applicability in the detective and preventive healthcare industry. Recognizing posture through frequency-modulated continuous wave (FMCW) radar poses a significant challenge as the human subject is static. Unlike existing radar-based studies, this study proposes a novel framework to extract the postures of two humans in close proximity using FMCW radar point cloud. With radar extracted range, velocity, and angle information, point clouds in the Cartesian domain are retrieved. Afterwards, unsupervised clustering is implemented to segregate the two humans, and finally a deep learning model named DenseNet is applied to classify the postures of both human subjects. Using four base postures (namely, standing, sitting on chair, sitting on floor, and lying down), ten posture combinations for two human scenarios are classified with an average accuracy of 96%. Additionally, using the centroid information of human clusters, an approach to detect and classify overlapping human participants is also introduced. Experiments with five posture combinations of two overlapping humans yielded an accuracy of above 96%. The proposed framework has the potential to offer a privacy-preserving preventive healthcare sensing platform for an elderly couple living alone. [ABSTRACT FROM AUTHOR]

Background: Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time‐varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS). Methods: NHATS participants were included in this study if they: (1) resided in ALF from Round 1 (2011) through Round 8 (2018); (2) completed the sample person (SP) interview at baseline; (3) were admitted to ALF at age 65 years or older. We conducted Cox proportional hazards regression to examine candidate predictors (difficulty with basic activities of daily living (ADL), chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, self‐reported health, participation in social and physical activity, and sociodemographic) associated with transfer to a nursing home. Employing backward elimination, we built parsimonious final models for analysis. Results: The analytic sample included 970 participants of whom 143 transferred to nursing homes over 8 years. Those who had a better physical performance at baseline (HR = 0.83, 95% CI = 0.79–0.88) and were college educated (HR = 0.58, 95% CI = 0.36–0.92) demonstrated a significantly lower risk for transfer to a nursing home over 8 years. Residents who maintained physical activity (HR = 0.56, 95% CI = 0.37–0.86), better physical performance (HR = 0.87, 95% CI = 0.80–0.94), and difficulty with fewer basic ADLs (HR = 1.13, 95% CI = 1.02–1.26) were at lower risk for transfer to a nursing home over 8 years. Conclusions: Our findings can be used to identify older adults in ALFs at risk of transfer to a nursing home. Strategies to promote physical function and physical activity could avoid/delay the need to transfer. Helping older residents to age in place will have important health and economic benefits. [ABSTRACT FROM AUTHOR]

• Behavioral and psychological symptoms of dementia are common among assisted living residents. • Engagement in meaningful activities was significantly associated with decreased odds of having agitation but not with apathy, depression, or irritability. • Engagement in meaningful activities may help reduce agitation among AL residents. The purpose of this study is to assess the relationship between engagement in meaningful activities and behavioral and psychological symptoms of dementia (BPSD), including agitation, apathy, irritability, and depression among 71 assisted living (AL) residents with moderate to severe dementia. This secondary analysis used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD) in five AL communities. The Engagement in Meaningful Activities Scale and the Neuropsychiatric Inventory Questionnaire were completed. Logistic regression was used to compare those with and without each BPSD symptom of interest on engagement in meaningful activities while controlling for age, sex, and cognitive impairment. On average, participants were 85 years old, white, females. Perceived engagement in meaningful activities was significantly associated with decreased odds of having agitation (OR=0.94, 95 % CI [.88–0.99]) but not with apathy, depression, or irritability. Engagement in meaningful activities may help reduce agitation among AL residents. [ABSTRACT FROM AUTHOR]

Background and Objectives When older adults face increasing care needs or limited support, remaining safely and comfortably at home becomes challenging. Extant research has primarily concentrated on characteristics of the older adult or their primary caregiver on nursing home admission. This study examines the risk of older adults transitioning to residential care (e.g. assisted living, nursing home), focusing on the influence of their care network or involvement of multiple helpers. Research Design and Methods Using the National Health and Aging Trends Study, we conducted competing risk regression models that account for mortality, following 7,085 initially community-dwelling older adults across Rounds 1–9 (2011–2019). We assessed network composition, size, shared tasks, and the number of in-network specialists or generalists while controlling for individual sociodemographic and health factors. Results Individuals with care networks that shared medical tasks had the highest risk of moving to a residential care setting, followed by those sharing household tasks. Conversely, shared mobility or self-care and transportation responsibilities were associated with lower risks. Having more generalists, but not specialists, increased the risk. Larger networks were associated with heightened risk, although having close family members like a spouse was protective. Discussion and Implications The findings underscore that care network characteristics are critical to older adults' ability to age in place. Specifically, older adults with larger networks, lacking a spouse or child, and providing complex care are at greater risk for relocating. Understanding care networks can guide interventions related to care network coordination and resource allocation to help avoid or postpone a residential care move. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents' age, gender, comorbidities, and cognition. Understanding factors associated with engagement in meaningful activity can help to inform strategies for optimizing engagement among residents with dementia in assisted living. Method: This descriptive study used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). Linear regression was used to examine factors associated with engagement in meaningful activity. Results: A total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b= −2.09, p < 0.05). There were no associations found between function and behavioral symptoms with engagement in meaningful activity. Conclusion: Findings from this study show that pain is a significant factor that is negatively associated with residents' engagement in meaningful activity. Ongoing research is needed to help improve pain management for residents with dementia in assisted living and support their engagement in meaningful activity. [ABSTRACT FROM AUTHOR]

This pilot study examines Ohio's licensed nursing home administrators and state tested nursing assistant's perspectives about job satisfaction, future career and employment plans, potential beneficial changes to their organizations, and their thoughts on reducing turnover rates in their field. Ohio Board of Executives of Long-Term Services and Supports provided their contact list of all 1,969 licensed nursing home administrators in Ohio in the fall of 2023. Two surveys were created for licensed nursing home administrators and state tested nursing assistants. Results were analyzed for themes within the open-ended responses; 28 surveys were received from licensed nursing home administrators and 17 surveys were received from state tested nursing assistants. Residents and their families are among the top reasons for job satisfaction, many employees face symptoms of burnout, and wages are a concern among both state tested nursing assistants and licensed nursing home administrators. Future career plans differed between the two professions and had distinct driving factors. A discussion of licensed nursing home administrators' opinions on improving retention and turnover rates should include more accountability, personal responsibility, and adding opportunities for professional growth and development. [ABSTRACT FROM AUTHOR]

Older adults in assisted living facilities (ALF) are at risk for low physical activity (PA) and high sedentary behavior (SB), both of which place them at risk for negative health outcomes. The purpose of this scoping review was to synthesize evidence describing the volume of device-measured PA/SB, factors associated with PA/SB, and interventions designed to change PA/SB in older adults living in ALF. Twenty articles representing 15 unique studies were identified from eight electronic databases and grey literature. Residents in ALF spent 96–201 min/day in light PA (n = 2 studies), 1–9.74 min/day in moderate to vigorous PA (n = 2 studies), and 8.5–11.01 hr/day of SB during waking hours (n = 3 studies). Factors associated with PA included 16 personal factors (n = 6 articles), one social factor (n = 2 articles), and two environmental factors (n = 2 articles). Factors associated with SB included 14 personal factors (n = 4 articles) and one social factor (n = 1 article). No intervention successfully changed PA/SB. [ABSTRACT FROM AUTHOR]

Abstract Background Ageing populations and care workforce shortages across Europe are causing challenges for care services for older people. Therefore, it is paramount that limited care resources are allocated optimally, based on the clients’ care needs. Multiple functioning-related factors have been identified that determine the amount of care time clients receive, while organizational and other factors remain largely unexplored. The aim was to examine how various individual and organizational factors are associated with clients’ received care time in different care settings. Methods Cross-sectional observational study design with data from time and motion study, registers, and surveys was used. In total, 1477 home care clients and 1538 residents from assisted living facilities with 24/7 service participated, from 61 Finnish care units. Linear mixed-effect modeling was used to examine the association between individual and organizational-level variables and received care time. Results Physical functioning was the strongest predictor of received care time in both care settings. In home care, greater pain, more unstable health, and higher team autonomy were associated with increased care time. In assisted living, depressive mood and higher staffing level of the organization were associated with care time. Clients who received informal care also received significantly more care time from nurses in both care settings. Conclusions Physical functioning was the main driver of received care time. Interventions that maintain or improve physical functioning can help restrain the growing need of care resources, although it is important to ensure that each client receives care according to their holistic care needs.

Abstract Background Assisted living (AL) is an increasingly common residential setting for persons with dementia; yet concerns exist about sub-optimal care of this population in AL given its lower levels of staffing and services. Our objectives were to (i) examine associations between AL setting (dementia care vs. other), COVID-19 pandemic waves, and prevalent antipsychotic, antidepressant, anti-dementia, benzodiazepine, and anticonvulsant drug use among residents with dementia/cognitive impairment, and (ii) explore associations between resident and home characteristics and prevalent medication use. Methods We conducted a population-based, repeated cross-sectional study using linked clinical and health administrative databases for all publicly funded AL homes in Alberta, Canada, examined between January 2018 - December 2021. The quarterly proportion of residents dispensed a study medication was examined for each setting and period (pandemic vs. comparable historical [2018/2019 combined]) focusing on four pandemic waves (March-May 2020, September 2020-February 2021, March-May 2021, September-December 2021). Log-binomial GEE models estimated prevalence ratios (PR) for period (pandemic vs. historical periods), setting (dementia care vs. other) and period-setting interactions, adjusting for resident (age, sex) and home (COVID-19 cases, health region, ownership) characteristics. Results On March 1, 2020, there were 2,779 dementia care and 3,013 other AL residents (mean age 83, 69% female) with dementia/cognitive impairment. Antipsychotic use increased during waves 2–4 in both settings, but this was more pronounced in dementia care than other AL during waves 3 and 4 (e.g., adjusted [adj]PR 1.20, 95% CI 1.14–1.27 vs. adjPR 1.09, 95% CI 1.02–1.17, interaction p = 0.023, wave 3). Both settings showed a statistically significant but modest increase in antidepressant use and decrease in benzodiazepine use. For dementia care AL residents only, there was a statistically significant increase in gabapentinoid use during several waves (e.g., adjPR 1.32, 95% CI 1.10–1.59, wave 3). Other than a modest decrease in prevalent anti-dementia drug use for both settings in wave 2, no other significant pandemic effects were observed. Conclusions The persistence of the pandemic-associated increase in antipsychotic and antidepressant use in AL residents coupled with a greater increase in antipsychotic and gabapentinoid use for dementia care settings raises concerns about the attendant risks for residents with cognitive impairment.

Background: Ageing populations and care workforce shortages across Europe are causing challenges for care services for older people. Therefore, it is paramount that limited care resources are allocated optimally, based on the clients' care needs. Multiple functioning-related factors have been identified that determine the amount of care time clients receive, while organizational and other factors remain largely unexplored. The aim was to examine how various individual and organizational factors are associated with clients' received care time in different care settings. Methods: Cross-sectional observational study design with data from time and motion study, registers, and surveys was used. In total, 1477 home care clients and 1538 residents from assisted living facilities with 24/7 service participated, from 61 Finnish care units. Linear mixed-effect modeling was used to examine the association between individual and organizational-level variables and received care time. Results: Physical functioning was the strongest predictor of received care time in both care settings. In home care, greater pain, more unstable health, and higher team autonomy were associated with increased care time. In assisted living, depressive mood and higher staffing level of the organization were associated with care time. Clients who received informal care also received significantly more care time from nurses in both care settings. Conclusions: Physical functioning was the main driver of received care time. Interventions that maintain or improve physical functioning can help restrain the growing need of care resources, although it is important to ensure that each client receives care according to their holistic care needs. [ABSTRACT FROM AUTHOR]

Background: In the U.S., assisted living (AL) is increasingly a site of death, and anxiety about dying has been identified in long-term care residents and their caregivers. Communication about death and dying is associated with better quality of life and care at end of life (EOL). Objective: To understand communication behaviors used by AL residents and their informal caregivers (i.e., family members or friends) related to death and dying, and address communication needs or opportunities applicable to EOL care in AL. Design: A thematic analysis of in-depth interviews and fieldnotes from a subsample of data from a 5-year NIA-funded study. Setting/Subjects: Participants included 15 resident-caregiver dyads from three diverse AL communities in Atlanta, Georgia in the U.S. Measurements: Interview transcripts were coded for communication behavior. Concordances and discordances within dyads were examined. Results: We identified a typology of four dyadic communication behaviors: Talking (i.e., both partners were talking with each other about death), Blocking (i.e., one partner wanted to talk about death but the other did not), Avoiding (i.e., each partner perceived that the other did not want to communicate about death), and Unable (i.e., dyads could not communicate about death because of interpersonal barriers). Conclusions: Older residents in AL often want to talk about death but are blocked from doing so by an informal caregiver. Caregivers and AL residents may benefit from training in death communication. Recommendations for improving advance care planning and promoting better EOL communication includes timing these conversations before the opportunity is lost. [ABSTRACT FROM AUTHOR]

In this study, we present a novel framework for detecting anomalies in everyday activities within a smart-home environment. Our method utilizes the growing neural gas (GNG) concept to dynamically adapt to the changing behaviors of monitored individuals, eliminating the need for supervised input. To develop and evaluate our framework, we collected real-life data from environmental sensors that tracked the daily activities of 17 elderly subjects over a continuous two-year period. The proposed approach is highly versatile, capable of detecting a wide range of anomalies associated with daily living activities. We focus on activities that exhibit abnormal duration, frequency, or entirely new behaviors that deviate from established routines. The performance evaluation of our framework revolves around two key aspects: reliability and adaptability. Reliability measures the accuracy of detecting unusual events, while adaptability assesses the system's ability to accommodate changes in user behavior. This involves recognizing recurrent anomalous behaviors as new norms over time and transitioning from persistent anomalies during an initial phase. Our proposed anomaly detection system demonstrates promising results in real-life scenarios. It achieves good reliability, with true negative rate and true positive rate exceeding 90% and 80% respectively, across all activities and users. Additionally, the system swiftly adapts to new individuals or their evolving behaviors, adjusting within a span of 3 to 7 days for new behaviors. [ABSTRACT FROM AUTHOR]

Group activities and connection with nature are associated with improved well-being for older adults. This quasi-experiment tests the effectiveness of RASCALs, an innovative program of group activities using nature-focused livestream broadcasts. Assisted living residents in the experimental group (n = 16) lived in buildings that received RASCALs programming twice a week for 3 months. Compared to residents in the comparison group (n = 17) who received regular group activity programming, they experienced significant positive change in the Positive Relations with Others domain of well-being (β =.873, p =.008). Combining nature-focused livestream broadcasts with groups activities for older adults in assisted living communities may be an innovative and effective way to overcome barriers to accessing nature and improve residents' well-being. [ABSTRACT FROM AUTHOR]

Background: Assisted living (AL) is an increasingly common residential setting for persons with dementia; yet concerns exist about sub-optimal care of this population in AL given its lower levels of staffing and services. Our objectives were to (i) examine associations between AL setting (dementia care vs. other), COVID-19 pandemic waves, and prevalent antipsychotic, antidepressant, anti-dementia, benzodiazepine, and anticonvulsant drug use among residents with dementia/cognitive impairment, and (ii) explore associations between resident and home characteristics and prevalent medication use. Methods: We conducted a population-based, repeated cross-sectional study using linked clinical and health administrative databases for all publicly funded AL homes in Alberta, Canada, examined between January 2018 - December 2021. The quarterly proportion of residents dispensed a study medication was examined for each setting and period (pandemic vs. comparable historical [2018/2019 combined]) focusing on four pandemic waves (March-May 2020, September 2020-February 2021, March-May 2021, September-December 2021). Log-binomial GEE models estimated prevalence ratios (PR) for period (pandemic vs. historical periods), setting (dementia care vs. other) and period-setting interactions, adjusting for resident (age, sex) and home (COVID-19 cases, health region, ownership) characteristics. Results: On March 1, 2020, there were 2,779 dementia care and 3,013 other AL residents (mean age 83, 69% female) with dementia/cognitive impairment. Antipsychotic use increased during waves 2–4 in both settings, but this was more pronounced in dementia care than other AL during waves 3 and 4 (e.g., adjusted [adj]PR 1.20, 95% CI 1.14–1.27 vs. adjPR 1.09, 95% CI 1.02–1.17, interaction p = 0.023, wave 3). Both settings showed a statistically significant but modest increase in antidepressant use and decrease in benzodiazepine use. For dementia care AL residents only, there was a statistically significant increase in gabapentinoid use during several waves (e.g., adjPR 1.32, 95% CI 1.10–1.59, wave 3). Other than a modest decrease in prevalent anti-dementia drug use for both settings in wave 2, no other significant pandemic effects were observed. Conclusions: The persistence of the pandemic-associated increase in antipsychotic and antidepressant use in AL residents coupled with a greater increase in antipsychotic and gabapentinoid use for dementia care settings raises concerns about the attendant risks for residents with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Assisted living (AL) community caregivers are known to report lower quality of hospice care. However, little is known about hospice providers serving AL residents and factors that may contribute to, and explain, differences in quality. We examined the association between hospice providers' AL patient‐day volume and their quality ratings based on Hospice Item Set (HIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Surveys. Methods: This cross‐sectional study employed information from the Medicare Compare website and Medicare claims data. Medicare‐eligible AL residents were identified using previously validated methods and merged with hospice claims. Linear probability models adjusting for county fixed effects were used to examine the association between hospice provider AL volume, measured as the share of annual hospice patient days from AL residents, and quality measures obtained from HIS and CAHPS. Models controlled for hospice providers' profit status and daily patient census. Results: Higher AL‐volume hospice providers were 7 percentage points more likely to have caregivers reporting lower median scores on domains of pain assessment, dyspnea treatment, and emotional support. Their caregivers also reported lower scores in team communications and training family to provide care. Higher AL‐volume hospice providers also were 5 percentage points less likely to get higher aggregated scores from all CAHPS domains and 7 percentage points less likely to have higher HIS composite scores. Conclusions: Hospice providers serving higher volumes of AL patient days had lower quality scores. In order to identify targeted opportunities for quality improvement, research is needed to understand why lower quality providers are concentrated in the AL market. [ABSTRACT FROM AUTHOR]

Background and Objectives A better understanding of factors associated with assisted living admission and discharge practices can help identify communities that are more likely to allow residents to age in place. This study examined how state regulations and assisted living organizational characteristics related to community admission and discharge practices for bathing, getting out of bed, and feeding. Research Design and Methods Using data from a representative sample of 250 assisted living communities in seven states and a database of assisted living state regulations, we employed multilevel logistic regression models to examine regulatory and organizational correlates of assisted living community admission and discharge practices for 3 activities of daily living (bathing, getting out of bed, and feeding). Results States' regulations were not associated with assisted living community admission and discharge practices. However, assisted living communities above the median in the number of personal care staff members per resident were 17% (95% confidence interval [CI]: 6.5%, 27.1%) more likely to admit residents who needed assistance with feeding and 25.4% (95% CI: −37.7, −13.2) less likely to discharge these residents. For-profit communities were more likely to admit residents with bathing and feeding limitations. Discussion and Implications Organizational characteristics (e.g. for-profit affiliation, staffing levels) may, in part, drive admission and discharge practices, especially related to different care needs. The ability to house residents with advanced care needs may be influenced more by the organizational resources available to care for these residents than by states' admission and discharge regulations. [ABSTRACT FROM AUTHOR]

We examine what facility characteristics are associated with nurse turnover in residential care communities (RCCs). This is a cross-sectional study using the 2018 National Study of Long-term Care Provider Public Use File. There were 3331 RCCs (unweighted n = 272) represented when examining registered nurse (RN) turnover and when examining aide turnover there was a weighted sample of 13,676 RCCs (unweighted n = 68). RN turnover was 72% (95% confidence interval (CI) 59%, 84%), 52% reported 100% turnover. Aide turnover was 48% (95% CI 43%, 53%); 11% reported 100% turnover. We examined ownership and facility type, job design, economic, and working environment factors related to turnover. Using multivariate linear regression, non-profit RCCs had 25 percentage points lower RN turnover (95% CI: −44.46, −4.31) and 9.7 percentage points lower aide turnover (95% CI: 18.8, −0.6) compared to for-profits. We find larger RCCs had lower aide turnover. [ABSTRACT FROM AUTHOR]

Poor quality of care and patient safety, adverse patient outcomes, high rates of burnout and turnover, and increased job dissatisfaction are all linked to uncontrolled stress among nurses. Unmanaged nurse stress can lead to disorganized thinking, decreased ability to focus and concentrate, and can put patients at risk. The purpose of the integrative review was to determine the effects of a mindfulness-based stress reduction (MBSR) program to reduce the perceived stress levels of nurses. Included was a search of databases using key search terms and inclusion and exclusion criteria. Relevant peer-reviewed articles within the last five years were appraised to identify similarities and differences. This paper discusses the implications of unresolved stress on nurses and patients they care for including quality and safety of patient care, cost of nurse turnover rates related to stress, and poor work efficiency. Literature results suggest that implementation of a mindfulness-based stress reduction (MBSR) program leads to a reduction in perceived stress levels among nurses resulting in improved patient outcomes, increased job satisfaction, and reduction of organizational costs associated with the hiring and onboarding process. It is the conclusion of this integrative review that implementation of a MBSR program leads to improvements in stress reduction and indirectly positively impacts patient outcomes. It is recommended that organizations implement a formal eight-week mindfulness-based stress reduction program. There are no conflicts of interest or financial gains for the recommendations for MBSR implementation resources. These resources are solely provided for additional learning and implementation purposes. There are both free resources and for purchase resources available that guides implementation and operationalization of the MBSR program. [ABSTRACT FROM AUTHOR]

This study examined the feasibility of implementing an adaptive biking program to concurrently address health and well-being in assisted living memory care residents and staff. Using an intervention protocol designed around the Flourishing Through Leisure Model, resident and staff participants were matched into biking pairs to engage in eight 20-to 30-minute bike rides over four consecutive weeks. The research team assessed (a)recruitment capability and sample characteristics, (b) data collection procedures and outcome measures, (c) acceptability and suitability of the intervention and study procedures (d) resources and ability to manage and implement the study and intervention, and (e) preliminary participant responses to the intervention. Results in each area support the feasibility of implementation on a larger scale and provide insights for program improvements and research opportunities. Given the lack of structured intervention protocols that emphasize multiple domains of health for two populations concurrently, the study also documented a replicable RT adaptive biking protocol designed to meet the needs of both staff and residents. Implications for RT practice include increased awareness of the value of RT services among other health care providers, and new opportunities for interprofessional collaboration. [ABSTRACT FROM AUTHOR]

Long-term care settings are at the center of strongly debated approaches to policies that shape the delivery of care and operational practices. There is advocacy for transformational change within these settings to support a person-centered approach to care delivery, but it is difficult and multifaceted involving everything from changing the level of staffing and care models to developing appropriate metrics to assess an individual's quality of life. The physical environment is a key component for accomplishing the organizational and operational goals related to person-centered care, but providers and their design teams need the appropriate tools to guide evidence-based decision-making. The Environmental Audit Scoring Evaluation (EASE) is a tool that helps lend structure to the process of developing the environment for our senior population—especially those living with dementia. This perspective article will discuss how EASE aims to align the design process to more fully support the myriad environmental elements that have a demonstrable impact on the individual, and the associated quality of life they experience. The article will also explore how EASE differs from previous planning strategies that did not prioritize residents' psychological wellbeing in conforming to current person-centered philosophies.

Introduction. Currently, there is a fairly high demand from society for changing approaches to the life of people with disabilities, improving the level and quality of their lives. There is an increase in the number of people with disabilities who need to be assisted when receiving services for assisted living, assisted work and social employment of disabled people in the Russian Federation. The article considers the main methodological approaches to assessing the quality and effectiveness of support measures in the provision of services for assisted living, assisted work and social employment of persons with disabilities.Aim. The study of indicators of the quality and effectiveness of support measures for the formation of unified approaches in various departments of the support system of the Russian Federation aimed at improving the level of assistance and support to the population.Materials and methods. Normative legal and methodological documentation, special literature, information systems of federal executive authorities of the subjects of the Russian Federation. Applied general scientific methods (content analysis, analytical, system-structured, comparative) and methodological methods of systematization, comparison, generalization, interpretation, as well as special methods — formal legal, comparative legal.Results. The main approaches to assessing the quality and effectiveness of support measures may include: availability of receiving support events; compliance with goals and objectives; the economic component (the necessary costs for conducting support activities); competence and professionalism of specialists; satisfaction of recipients (improving the quality of life of recipients). To assess the quality and effectiveness of support measures, the following criteria are highlighted: improving the quality of life of assisted persons, including their physical, psychological and social well-being, improving social adaptation and inclusion of escorted persons in society; the communicative effectiveness of the work of the specialists of the support system, both in a group and individually with each assisted one; сost-effectiveness of support activities, optimization of resource use and reduction of costs for the provision of the support process; аssessment of the satisfaction of the assisted ones and their families with the assistance and support provided; the effectiveness of interdepartmental interaction, co-operation and co-ordination of work between various services and organizations in the support system; assessment of the achievement of targets and tasks in the support system. The score is determined for each criterion separately based on the amount of points received. If the amount is below 55% of the maximum possible, the rating is "unsatisfactory", if from 56 to 85% – "good", above 85% – "excellent". Thus, the introduction of methods for evaluating the effectiveness and quality of support measures will make them more accessible and useful for all categories of the population in need of the Russian Federation.Discussion. One of the key indicators of the quality and effectiveness of the support system's activities is the availability of support activities for all those in need. It is necessary to ensure equal access to quality support in obtaining social services for all categories of people in need, regardless of their place of residence, family income and other factors. Another important indicator is the effectiveness of the work of the specialists providing support. Training and advanced training of specialists, as well as modern methods of working with assisted ones and their families, will help to increase the effectiveness of assisting activities when receiving social services and improve the results of assistance, in general. Effective implementation of methods and technologies for assessing the quality, accessibility and effectiveness of the support system requires a systematic approach and co-ordination of efforts at various levels, interdepartmental interaction, regulation of legal relations in the support system in the Russian Federation.Conclusion. The main indicators of the quality and effectiveness of support contribute to providing feedback from both the assisted ones and those in need of support activities, as well as from the specialists of the support system and management structures. This will allow considering the opinions and needs of all participants in the support process, which contributes to the development of a sustainable and adaptive system.

Background: Little is known about mental health among Medicare beneficiaries with Alzheimer's disease or related dementias (ADRD) who reside in assisted living (AL) communities. The COVID‐19 pandemic may have curtailed ambulatory care access for these residents, but telehealth may have expanded it. We examined in‐person and telehealth use of ambulatory mental health visits among AL residents with ADRD, pre and during the COVID pandemic, focusing on race/ethnicity and Medicare/Medicaid dual status. Methods: A CY2018 cohort of AL residents with ADRD was identified. Outcome was any quarterly in‐person or telemedicine mental health visit based on national CY2019‐2020 Medicare claims. Key independent variables were individual race/ethnicity and dual status and the AL‐level proportion of dual residents. We estimated a linear probability model with random effects and robust standard errors. Quarterly indicators captured service use before and after the onset of the pandemic. Results: The study included 102,758 fee‐for‐service Medicare beneficiaries with ADRD in 13,400 ALs. One in five residents had any mental health visits prior to the COVID‐19 pandemic. Black residents, and those with dual Medicare/Medicaid eligibility, were significantly less likely to use mental health services prior to and during the pandemic. There were no significant differences in visits via telemedicine by race/ethnicity or individual dual status. Residents in AL communities with a higher proportion of duals had a lower likelihood of visits before and during the pandemic. Conclusions/Implications: Mental health service use among AL residents with ADRD was low and declining prior to the pandemic. Telehealth allowed for mental health visits to continue during the pandemic, albeit at a lower level. Residents in ALs with a higher proportion of duals were less likely to have in‐person or telehealth visits. The results suggest that some ALs may find it difficult to assure mental health service provision to this vulnerable population. [ABSTRACT FROM AUTHOR]

Age-related changes shape social connectedness, isolation and loneliness among older adults. Ageing often accompanies decisions about ageing in place or moving (i.e. senior living facility). Scant research compares these two living arrangements and even sparser research focuses on older women. This study, thus, poses the following questions: How do older women (aged 75+ years) experience social connectedness and perceived isolation? How does this experience vary between older women living alone in private homes and those living in assisted living facilities? Data include semi-structured interviews with women aged 75+ years who live alone in a private home or in an assisted living facility (N = 16). Findings revealed differences in three aspects of social connectedness: interactions, relationships and belonging. Private home participants' interactions underscored intentionality, with minimal investment in forging new or deeper relationships and an emphasis on belonging to the world through awareness, contribution and cognitive ability. The experiences of participants living in assisted living were characterised by availability of interactions and casual relationships. They emphasised belonging to the facility community, while positioning themselves between the status of resident and staff. Surprisingly, most participants in both groups did not express feelings of perceived isolation. Both had adapted their social connectedness expectations to reflect their current situation. [ABSTRACT FROM AUTHOR]

Older adults' wellbeing during the transition into an assisted living facility (ALF) is not well understood and may influence their wellbeing. The Mueller Assessment of Transition (MAT) was created to measure the impact of transition on older adults' wellbeing. Early developmental testing of the MAT revealed a hypothesized model with two constructs (adjustment strategies and constraints to wellbeing). Therefore, the purpose of this study was to confirm the factor structure of the MAT with a representative sample of older adults transitioning into ALFs. In a nationwide sample, 108 older adult participants completed the MAT to measure wellbeing when relocating into ALFs. Confirmatory factor analysis (CFA) assessed the structural validity of the MAT. Internal consistency was evaluated, and chi-square tests of association for regional differences in MAT scores were also conducted. The CFA produced strong fit indices to confirm the hypothesized 2-factor (constraints to wellbeing and adjustment strategies) model of the MAT. Cronbach's alpha for the internal consistency was 0.784 and chi-square test indicated no significant regional differences. The MAT was established as a valid and reliable standardized assessment. Implications for using the MAT as a tool to measure older adults' wellbeing and future research are discussed. [ABSTRACT FROM AUTHOR]

Gait speed and timed-up-and-go (TUG) predict cognitive decline, falls, and mortality. Dual-tasks may be useful in cognitive screening among people living with dementia (PWD), but more evidence is needed. This cross-sectional study aimed to compare single- and dual-task performance and determine the influence of dementia severity on dual-task performance and interference. Thirty PWD in two residential care facilities (Age: 81.3 ± 7.1 years; Montreal Cognitive Assessment: 10.4 ± 6.0 points) completed two trials of single- (feet apart) and dual-task posture (feet apart while counting backward), single- (walk 4 m) and dual-task gait (walk 4m while naming words), and single- (timed-up-and-go (TUG)), and dual-task functional mobility (TUG while completing a category task) with APDM inertial sensors. Dual-tasks resulted in greater sway frequency, jerk, and sway area; slower gait speed; greater double limb support; shorter stride length; reduced mid-swing elevation; longer TUG duration; reduced turn angle; and slower turn velocity than single-tasks (ps < 0.05). Dual-task performance was impacted (reduced double limb support, greater mid-swing elevation), and dual-task interference (greater jerk, faster gait speed) was related to moderate-to-severe compared to mild PWD. Moderate-to-severe PWD had poorer dynamic stability and a reduced ability to appropriately select a cautious gait during dual-tasks than those with mild PWD, indicating the usefulness of dual-tasks for cognitive screening. [ABSTRACT FROM AUTHOR]

Assess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. 2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for up to 2 years to track their NH placement. We used data from the Medicare Enrollment Database, the Medicare Beneficiary Summary File, Minimum Data Set, and a national directory of state-licensed AL communities. AL residents were identified using a validated, previously reported 9-digit zip code methodology. A cross-sectional study sample included 289,350 Medicare beneficiaries in 17,265 AL communities across 50 states and in the District of Columbia. The outcome was permanent NH placement: a continuous stay for more than 90 days. Key independent variable was presence of SMI—schizophrenia, bipolar disorder, and major depression. Other covariates included sociodemographic factors and presence of other chronic conditions, including ADRD. A linear probability model with robust SEs, and AL-level random effects, was used to test the association between SMI diagnoses, ADRD, and their interactions on NH placement. More than half (55.65%) of AL residents had a diagnosis of SMI, among them 93.2% had major depression, 28.5% schizophrenia, and 22.2% bipolar disorder. Individuals with schizophrenia and bipolar disorder had a significantly lower probability of NH placement, a 32% and a 15% decrease relative to the cohort mean, respectively. Placement risk was significantly greater for residents with ADRD compared to those without, increasing for those who also had schizophrenia or bipolar disorder, 12.9% and 1.5% relative to the sample mean, respectively. Presence of schizophrenia and bipolar disorder, in conjunction with ADRD, significantly increases the risk of long-term NH placement, suggesting that ALs may not be well prepared to care for these residents. [ABSTRACT FROM AUTHOR]

Assisted living (AL) simultaneously is home to older adults who cannot live independently and a place where people work and visit and, therefore, where value conflicts are apt to arise. In this report we present the "Typology of Ethical Issues in Assisted Living" with emphasis on its development. The typology derives from a synthesis of frameworks used in acute care spaces adapted and applied to data collected as part of an ethnographic study involving AL residents with dementia. Our work advances knowledge and has implications for future research and practice. [ABSTRACT FROM AUTHOR]

\nKEY POINTSQuality of care in assisted living communities (ALCs) is important to consumers. The coronavirus disease of 2019 (COVID-19) pandemic and associated emergency policies have posed major challenges on staff recruitment and retention. This study aimed to examine the relationship between organizational characteristics of ALCs in Florida and challenges with staff absence during COVID-19 (N = 129 ALCs). Results indicated that structures (provision of memory care services), processes of care (challenges hiring new staff, staff sent home to comply with precautions, and staff anxiety), and local COVID-19 positivity rate were significantly associated with staff absence due to fear of infection, sickness, or family responsibilities. ALC providers and state regulatory agencies should develop policies and procedures that take these issues into consideration to prepare for future emergencies and disasters. Infection control policies should reflect whether an ALC provides memory care services and inform ways to overcome potential challenges with protocols. Efforts to reduce staff anxiety and disaster-related concerns should also be considered to ensure quality of care during emergencies. ALCs who provided memory care services had significantly greater challenges with staff absence due to fear of infection during the COVID-19 pandemic.The administrative action of sending staff home to comply with COVID-19 precautions, difficulty hiring new staff, and staff anxiety were process characteristics of ALCs associated with greater challenges with staff absence.Policymakers should consider whether an ALC provides memory care services, faces potential challenges with infection control protocols, and addresses the mental health of staff when creating and implementing infection control policies.ALCs who provided memory care services had significantly greater challenges with staff absence due to fear of infection during the COVID-19 pandemic.The administrative action of sending staff home to comply with COVID-19 precautions, difficulty hiring new staff, and staff anxiety were process characteristics of ALCs associated with greater challenges with staff absence.Policymakers should consider whether an ALC provides memory care services, faces potential challenges with infection control protocols, and addresses the mental health of staff when creating and implementing infection control policies. [ABSTRACT FROM AUTHOR]

Physical activity is an important health behavior for older adults in assisted living, however the COVID-19 pandemic may have disrupted this behavior. This study examined the effects of the pandemic on physical activity experiences in this population. Semi-structured interviews were conducted and analyzed using thematic analysis. Participants described barriers to physical activity, transitions in their physical activity habits, and health driven motivations for physical activity as three key themes, with seven additional subthemes. Each theme included experiences specific to pandemic measures in assisted living and everyday experiences. No participant reported increased physical activity during the pandemic, most participants reported decreases. [ABSTRACT FROM AUTHOR]

We present a systematic literature review of dialogue agents for Artificial Intelligence (AI) and agent-based conversational systems dealing with cognitive disability of aged and impaired people including dementia and Parkinson's disease. We analyze current applications, gaps, and challenges in the existing research body, and provide guidelines and recommendations for their future development and use. We perform this study by applying Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We performed a systematic search using relevant databases (ACM Digital Library, Google Scholar, IEEE Xplore, PubMed, and Scopus). This study identified 468 articles on the use of conversational agents in healthcare. We finally selected 124 articles based on their objectives and content as directly related to our main topic. We identified the main challenges in the field and analyzed the typical examples of the application of conversational agents in the healthcare domain, the desired characteristics of conversational agents, and chatbot support for aged people and people with cognitive disabilities. Our results contribute to a discussion on conversational health agents and emphasize current knowledge gaps and challenges for future research. A systematic literature review of dialogue agents for artificial intelligence and agent-based conversational systems dealing with cognitive disability of aged and impaired people. Main challenges and desired characteristics of the conversational agents, and chatbot support for aged people and people with cognitive disability. Current knowledge gaps and challenges for remote healthcare and rehabilitation. Guidelines and recommendations for future development and use of conversational systems. [ABSTRACT FROM AUTHOR]

More than 1 in 5 older Americans live in rural areas (10.6 million of the 46.2 million aged 65 and older). Long-term care for aging rural populations is a growing challenge in the United States. Research on long-term care services in nonmetro areas has focused almost exclusively on nursing home care, despite growth of residential care alternatives. This paper uses unique facility-level data from the 2020 National Post-acute and Long-term Care Study (NPALS) to examine the relationship of residential care community (RCC) features in metro and nonmetro settings with adverse outcomes (emergency department visits, overnight hospital stays, and falls). Nationally, in 2020, about 13.5% of RCC residents made visits to the emergency department, 8.6% had overnight hospital stays, and 21.3% had falls. Controlling for facility characteristics, RCCs in metro areas had higher risks of overnight hospital stays (p <.001) but lower risks of falls (p =.06). [ABSTRACT FROM AUTHOR]

The aim of this study is to understand older adult decision-making processes and feelings regarding moving into assisted living facilities. Residents of assisted living facilities in Southern California (n = 46) were interviewed about why they moved, who was involved in the process, what factors they considered, and how they feel about their decision. Participants reported that changes in health, desire for social support, and anticipation for future needs were factors for moving. Most participants were involved in the decision, and focused on factors such as affordability, proximity to family, familiarity, amenities, and access to activities when choosing a facility. Overall, most participants shared positive or ambivalent feelings and very few participants shared negative feelings about their decision. [ABSTRACT FROM AUTHOR]

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Continuous and unobtrusive monitoring of daily human activities in homes can potentially improve the quality of life and prolong independent living for the elderly and people with chronic diseases by recognizing normal daily activities and detecting gradual changes in their conditions. However, existing human activity recognition (HAR) solutions employ wearable and video-based sensors, which either require dedicated devices to be carried by the user or raise privacy concerns. Radar sensors enable non-intrusive long-term monitoring, while they can exploit existing communication systems, e.g., Wi-Fi, as illuminators of opportunity. This survey provides an overview of passive radar system architectures, signal processing techniques, feature extraction, and machine learning's role in HAR applications. Moreover, it points out challenges in wireless human activity sensing research like robustness, privacy, and multiple user activity sensing and suggests possible future directions, including the coexistence of sensing and communications and the construction of open datasets.

Forecasts about the aging trend of the world population agree on identifying increased life expectancy as a serious risk factor for the financial sustainability of social healthcare systems if not properly supported by innovative care management policies. Such policies should include the integration within traditional healthcare services of assistive technologies as tools for prolonging healthy and independent living at home, but also for introducing innovations in clinical practice such as long-term and remote health monitoring. For their part, solutions for active and assisted living have now reached a high degree of technological maturity, thanks to the considerable amount of research work carried out in recent years to develop highly reliable and energy-efficient wearable sensors capable of enabling the development of systems to monitor activity and physiological parameters over time, and in a minimally invasive manner. This work reviews the role of wearable sensors in the design and development of assisted living solutions, focusing on human activity recognition by joint use of onboard electromyography sensors and inertial measurement units and on the acquisition of parameters related to overall physical and psychological conditions, such as heart activity and skin conductance.

Human posture recognition has a wide range of applicability in the detective and preventive healthcare industry. Recognizing posture through frequency-modulated continuous wave (FMCW) radar poses a significant challenge as the human subject is static. Unlike existing radar-based studies, this study proposes a novel framework to extract the postures of two humans in close proximity using FMCW radar point cloud. With radar extracted range, velocity, and angle information, point clouds in the Cartesian domain are retrieved. Afterwards, unsupervised clustering is implemented to segregate the two humans, and finally a deep learning model named DenseNet is applied to classify the postures of both human subjects. Using four base postures (namely, standing, sitting on chair, sitting on floor, and lying down), ten posture combinations for two human scenarios are classified with an average accuracy of 96%. Additionally, using the centroid information of human clusters, an approach to detect and classify overlapping human participants is also introduced. Experiments with five posture combinations of two overlapping humans yielded an accuracy of above 96%. The proposed framework has the potential to offer a privacy-preserving preventive healthcare sensing platform for an elderly couple living alone.

Background: Assistive Robotic Arms are designed to assist physically disabled people with daily activities. Existing joysticks and head controls are not applicable for severely disabled people such as people with Locked-in Syndrome. Therefore, eye tracking control is part of ongoing research. The related literature spans many disciplines, creating a heterogeneous field that makes it difficult to gain an overview. Objectives: This work focuses on ARAs that are controlled by gaze and eye movements. By answering the research questions, this paper provides details on the design of the systems, a comparison of input modalities, methods for measuring the performance of these controls, and an outlook on research areas that gained interest in recent years. Methods: This review was conducted as outlined in the PRISMA2020 Statement. After identifying a wide range of approaches in use the authors decided to use the PRISMA-ScR extension for a scoping review to present the results. The identification process was carried out by screening three databases. After the screening process, a snowball search was conducted. Results: 39 articles and 6 reviews were included in this article. Characteristics related to the system and study design were extracted and presented divided into three groups based on the use of eye tracking. Conclusion: This paper aims to provide an overview for researchers new to the field by offering insight into eye tracking based robot controllers. We have identified open questions that need to be answered in order to provide people with severe motor function loss with systems that are highly useable and accessible. [ABSTRACT FROM AUTHOR]

Background: Home time is an important patient‐centric quality metric, which has been largely unexamined among assisted living (AL) residents. Our objectives were to assess variation in home time among AL residents in the year following admission and to examine the associations with state regulations for direct care workers (DCW) training and staffing and for licensed nurse staffing. Methods: Medicare beneficiaries who entered AL communities in 2018 were identified, and their home time in the year following admission was measured. Home time was calculated as the percentage of time spent at home per day being alive. Resident characteristics and state regulations in DCW staffing, DCW training, and licensed staffing were measured. We used a multivariate linear regression model with AL‐level fixed effects to estimate the relationship between person‐level characteristics and home time. Linear regression models adjusting for resident characteristics were used to estimate the association between state regulations and residents' home time. Results: The study sample included 59,831 new Medicare beneficiary residents in 12,143 ALs. In the year following AL admission, residents spent 94% (standard deviation = 14.6) of their time at home. Several resident characteristics were associated with lower home time: Medicare–Medicaid dual eligibility, having more chronic conditions, and specific chronic conditions, for example, dementia. In states with greater regulatory specificity for DCW training and staffing, and lower specificity for licensed staffing, residents had longer adjusted home time. Conclusion/Implications: Home time varied substantially among AL residents depending on resident characteristics and state‐level regulatory specificity. AL residents eligible for Medicare and Medicaid had substantially shorter home time than the Medicare‐only residents, largely due to longer time spent in nursing homes. State AL regulatory specificity for DCWs and licensed staff also impacted AL residents' home time. These findings may guide AL operators and state legislators in efforts to improve this important quality of life metric. [ABSTRACT FROM AUTHOR]

Introduction: Promoting individuals' health across different life spans has always been key to a holistic nursing practice. Seniors are a diverse population who go through many physical and mental changes as they age. During the last decade, assisted living facilities (ALFs) have dramatically increased in numbers to provide care and living services in a home‐like environment. Aim: The aim of this descriptive exploratory study was to explore the quality of life as perceived by seniors who reside in assisted living facilities (ALFs). Design: This study utilized a descriptive exploratory design to investigate the quality of life of seniors living in ALFs. Methods: Seventeen residents from two ALFs were interviewed to gather their perspectives on the quality of their lives while living in an ALF. The interviews were conducted by the researcher and were audio‐recorded and transcribed verbatim. The data were analysed using thematic analysis. Results: Three major themes surfaced from residents' descriptions: 'physical environment', 'social environment' and 'home‐like atmosphere'. The quality of life in ALFs was found to be predominantly an outcome of the exchange between the personal capability of residents to adapt to changes and the capacity of the facility to meet residents' diverse needs. Patient or Public Contribution: Participants who discussed their quality of life in ALFs provided profound insights into this aspect of their lives. The findings from this study can potentially enlighten ALF stakeholders and enhance the quality of life for seniors residing in these facilities. [ABSTRACT FROM AUTHOR]

Increasingly technology is used in everyday occupations and the value of technology in active ageing is a growing area of interest. People aged fifty-five years and older who reside in supported housing and support staff are key stakeholders to involve in further exploration of the use of technology. A scoping review mapped out key findings relating to how adults aged fifty-five years and older who reside in supported housing use technology in their everyday occupations. A data extraction tool and thematic analysis approach was applied to the data to identify challenges and opportunities to technology use for this population. Three themes related to occupation were identified in which technology use for this population predominantly occurred: Activities of Daily Living (ADL's), Health management and Social and/or entertainment activities. Eight further themes reported opportunities and challenges to technology use; social relationships and support from others, physical and cognitive effects of ageing, adverse experiences with the use of technology, technical language, economic factors, ethical considerations and safety, digital gaps, and thoughts, beliefs and values. Technology use can promote engagement in everyday occupations for adults aged 55 years or older living in supported housing. However, concerns around access to technology as well as complex ethical issues associated with technology use were identified. Further studies exploring the relationship between technology use and engagement in everyday occupations are required to enhance understanding of this population. [ABSTRACT FROM AUTHOR]

The purpose of this study was to deeply understand older adults' acceptance of socially assistive robots and their influencing factors and to compare the strength of the correlation between each influencing factor variable and the acceptance. The literature search was performed in five databases from their inception to January 17, 2023. The meta-analysis was performed using Review Manager 5.4 and Stata 16.0 software. Thirteen papers were included in this study. The mean value of acceptability after using the inverse variance method was 3.68. Education level is strongly related to technology acceptance; perceived ease of use, perceived usefulness, technology experience, technology attitude, perceived hedonism, and convenience are moderately related; anxiety is only weakly related. [ABSTRACT FROM AUTHOR]

Purpose: Assisted Living (AL) residents are embedded in "care convoys" comprised of a dynamic network of formal and informal care partners. Using the convoys of care model—a multi-level framework connecting care convoy properties to resident outcomes—we examined healthcare management and communication between convoy members. We recommend strategies to engage primary care in supporting collaboration, communication, and consensus-building for older adults and their convoys. Methods: Data were collected from the longitudinal study, Convoys of Care: Developing Collaborative Care Partnerships in AL. Fifty residents and their care convoy members (N = 169) were followed in eight AL homes in Georgia over 2 years. Original data were analyzed using Grounded Theory Methods of qualitative data, including formal and informal interviewing, participant observation, and record review. Results: The convoys of care model provide an innovative perspective that will assist providers in supporting AL residents and their care partners to achieve better care outcomes. Findings demonstrate the utility of understanding the structure and function of social resources and implications for improving healthcare outcomes. Conclusion: This research informs the work of physicians and mid-level providers with patients in AL by providing strategies to uncover specific social determinants of health. Recommendations for use in patient encounters are enumerated. [ABSTRACT FROM AUTHOR]

It is helpful to think about the needs of patients with moderate to severe brain injury through the lens of disability law. However, there are limitations to current disability law that contribute to ongoing segregation and marginalization of individuals with severe brain injury. Indeed, one of the paradoxes of American jurisprudence is that more clear constitutional protections accrue to those who have definitively immutable conditions. Thus, as neuroscience brings new therapies to those with brain injury, they may become less protected by the constitutional elements of disability law because their conditions have changed and become mutable. This is the clinical progress that brain injury professionals all seek to achieve, but ironically these advances could potentially degrade the legal protections of patients who benefit from emerging treatments. In this paper, we will critically examine this paradox at the interface of medicine and the law and suggest that the Americans with Disabilities Act (ADA) could be nicely complemented by legislation we have named the Americans with Abilities Act (AWAA). Instead of focusing on disabilities that need protection, the AWAA seeks to sustain and foster newfound abilities made possible by the fruits of medicine and neuroscience. [ABSTRACT FROM AUTHOR]

Resident acuity, Medicaid's increased role in funding assisted living, and the COVID-19 pandemic have brought increased attention to the regulatory environment of assisted living facilities (ALFs) and the responsibilities of ALF administrators (ALFAs) are growing increasingly complex. This study explores, describes, and compares the education (degree and assisted living-specific training), experience, exam (competency), and continuing education requirements for ALFAs across all states, and how states' requirements compare to national assisted living associations' suggested standards for entry-level and ongoing practice. Wide variation in ALFA qualifications are identified, with some states found to have extremely low qualification requirements. [ABSTRACT FROM AUTHOR]