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Little is known about physical activity (PA) and sedentary behavior (SB) among nursing home residents although PA is known as a health promoter. This study examined PA, SB, and their predictors among nursing home residents (n = 63). Dependent variables were accelerometry-based PA and SB. Predictor variables included in a path analysis were age, sex, body mass index, Barthel Index, cognitive status (Mini-Mental State Examination), physical performance (hand grip strength and habitual walking speed), and well-being (World Health Organization-5 well-being index). PA was very low (M steps per day = 2,433) and SB was high (M percentage of sedentary time = 89.4%). PA was significantly predicted by age (β = −0.27, p =.008), body mass index (β = −0.29, p =.002), Barthel Index (β = 0.24, p =.040), and hand grip strength (β = 0.30, p =.048). SB was significantly predicted by body mass index (β = 0.27, p =.008) and Barthel Index (β = −0.30, p =.012). Results might be helpful for everyday practice to identify individuals at high risk for low PA and high SB. [ABSTRACT FROM AUTHOR]

BackgroundMany long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment.ObjectiveThe purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress.DesignThis study was a descriptive, cross-sectional survey using targeted sampling.ParticipantsA total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting.MethodsThis study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses.ResultsThe mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001).ConclusionSince the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.Clinical relevanceOur study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Background: Non-life-threatening cases treated by emergency services have been increasing in recent years, especially in older people. In a region in Germany with approximately 600,000 inhabitants, the role of a specially trained community paramedic (Gemeindenotfallsanitäter, G-NFS) was introduced in 2019. The G-NFS is dispatched to low-acuity requests, attends the assignment alone and is allowed to treat patients at home. Aim: The aim of this study was to analyse the assignments attended by the G-NFS relating to the suspected diagnoses, with a focus on older people (≥ 65 years) according to their care setting. Methods: In this descriptive, retrospective study, we analysed the anonymous assignment report forms 07/2023–12/2023 of cases where patients were aged ≥ 65 years. The suspected diagnoses (free text field) were categorised according to the International Classification of Primary Care 2nd Edition (ICPC-2) scheme. Furthermore, baseline characteristics, urgency of the assignment, provided measures, transport and further treatment were analysed, stratified by care setting. Results: Of the 1,643 included anonymous assignment report forms, 52.9% (n = 869) related to patients aged ≥ 65 years. In this population, the mean age was 80.7 years (SD 8.2), 49.6% were female and most were in long-term care, whether as home care recipients (34.8%) or as nursing home residents (26.9%). The most frequent diagnoses were categorised as urological (24.9%), general and unspecified (13.7%), circulatory (13.6%), digestive (12.8%), musculoskeletal (11.5%) and respiratory (10.3%). In 52.7% of the cases no transport was necessary, while 73.7% of urological cases did not need to be transported. Conclusion: The G-NFS was dispatched mainly to older people. Most of them were in long-term care and were not transported. The most common suspected diagnoses were categorised as urological, followed by general and unspecified, and circulatory, and differed by care setting. There is a strong need to strengthen outpatient healthcare structures for low-acuity health issues in older and immobile patients. [ABSTRACT FROM AUTHOR]

Unpaid eldercare provided by family comes with costs to caregivers, including the limitations eldercare responsibilities may place on labor force participation and work hours. This study examines the relationship between the frequency of unpaid eldercare and work behavior for previously full-time workers using multivariate regression and 2011–2018 American Time Use Survey data. High-frequency eldercare provision is associated with a decreased probability of being in the labor force for both men and women, and 5.5 fewer weekly hours worked for men ages 25–49, conditional on working full time 2–5 months prior. Policymakers should consider the relationship between work and unpaid caregiving for high-frequency caregivers in addressing growing care demand. [ABSTRACT FROM AUTHOR]

Housing conditions and quality are well-established structural or social determinants of health. Poor quality housing also has the potential to affect care needs, but there is much less research on the topic, particularly on nonspecialist housing. Based on analysis of in-depth interviews with 44 people aged 65 and older living in England, their unpaid carers (N = 22), or as a carer-care recipient dyad (N = 6), (total N = 72), this study sought to explore the perceived relationship between people’s housing conditions and characteristics and their care needs. Findings indicate three key themes within this relationship: condition of home (cold and damp; state of repair; cleanliness and clutter); space and design (space, access); and legal relationship with the home (ability to carry out remedial work; precarity). There was variation in how and whether housing affected care needs by housing tenure, financial resources, and the type and level of care need. Care needs can increase requirement for warmer, less damp homes and be a barrier to improving homes. In turn, housing has a role to play in preventing the occurrence or worsening of care needs. Improving housing through policy and practice actions could reduce care needs and improve the lives of older people now and in the future. [ABSTRACT FROM AUTHOR]

Background: Regular dental l check-ups and good oral hygiene are challenging for nursing home residents, resulting in poor oral health. The interRAI instrument for Long-Term Care Facilities (LTCF) enables caregivers to evaluate residents' health, including oral health, and to integrate oral care into general care planning. Because the current oral heal1th section in the interRAI instruments does not accurately identify residents who need help with daily oral care or dental referral, the interRAI Oral Health Section (OHS-interRAI) was developed. The OHS-interRAI differs from the current section by including more items, response options and guidelines, photographs, instruction videos, and Collaborative Action Points to alert caregivers when oral care is needed. This study describes and compares residents' oral health status assessed by caregivers using the current section and the OHS-interRAI. Methods: This cross-sectional study includes baseline data of adults aged 65 years or older in Flemish and Dutch nursing homes, collected by professional caregivers (e.g., nurses, nurse aids, therapists). Assessments with the current section dated from October 2016 to January 2023, and with the OHS-interRAI from October 2020 to January 2023. Results: InterRAI assessments of 12,476 residents from 158 nursing homes with the current section were compared with those of 1212 residents from 37 nursing homes with the OHS-interRAI. The OHS-interRAI assessments showed more missing data. A higher proportion of oral health problems was detected with the OHS-interRAI compared to the current section for chewing function (13.7% vs. 6.8%), dry mouth (9.8% vs. 7.6%), teeth (22.1% vs. 16.6%),and gums (7.8% vs. 3.1%). There was no significant difference in the proportion of residents with discomfort or pain in the mouth. Conclusions: More missing OHS-interRAI data may be attributed to regulatory decisions on using the interRAI LTCF instrument. Caregivers identified more oral health problems with the OHS-interRAI, which may be due to its additional features, such as photographs and extensive instructions. The Collaborative Action Points included in the OHS-interRAI support continuity of care and enable integration of oral care into general care. Further research is needed to evaluate whether the OHS-interRAI accurately identifies residents who need help with daily oral hygiene or dental referral. [ABSTRACT FROM AUTHOR]

Although long-term care is a substantial financial risk for elderly Americans, only about 10% purchase insurance, with many of the remainder relying on Medicaid. Faced with rising Medicaid expenditure on long-term care, states introduced long-term care partnership programmes in the hope of reducing Medicaid spending by encouraging the purchase of private insurance. Using numerical optimization techniques, we show theoretically that partnership programmes will only modestly increase long-term care insurance coverage. Most of the benefits will go to those who would have purchased non-partnership policies. Thus, the potential costs to Medicaid will exceed the savings. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is fundamental to nursing home residents' health. Likewise, physical capacity (PC) is essential to carry out activities of daily living. Although PC and PA are associated, misalignment has been reported in specific subgroups. Increased PC is oftentimes not linked to high PA (i.e., Can do - don't do) and vice versa (i.e., Can't do - do do). Therefore, identifying other contextual factors influencing PA in misaligned groups is important. This study aimed to identify contextual factors in nursing home residents with aligned or misaligned PA and PC. Methods: In total, 180 nursing home residents (≥ 65 years, 79.4% females) were divided into four quadrants (Q1: Can do - do do; Q2: Can do - don't do; Q3: Can't do - do do; Q4: Can't do - don't do) based on thresholds for PA (≥ or < 2,500 steps/day) and PC (≤ or > 0.5 m/s gait speed). Kruskal-Wallis H test and effect sizes (ES) were applied to analyze quadrants' differences regarding PA (steps per day), objective motor capacity, life-space mobility, activities of daily living (ADL), psychosocial well-being, cognition, subjective mobility-related concerns, and spatial orientation. Results: Specific contextual factors differed significantly between the groups. Compared to Q1, Q2 presents a significantly lower life-space mobility (ES: 0.35) and objective motor capacity (ES: 0-36-0.49); Q3 has a lower objective motor capacity (ES: 0.55–1.10); Q4 shows lower independence in ADL (ES: 0.57), life-space mobility (ES: 0.48), subjective mobility-related concerns (ES: 0.38) and objective motor capacity (ES: 0.99–1.08). No significant group differences were found for psychosocial well-being, cognition, and spatial orientation. Conclusions: This study provides new insights into PA behavior of nursing home residents. Key variables linked to PA are objective motor capacity, life-space mobility, ADL, and subjective mobility-related concerns. Surprisingly, some potentially impactful variables such as cognition, orientation, and psychosocial well-being did not differ between the groups. This may suggest that these variables may not represent key targets for interventions aiming to improve PA. This study builds the foundation for further research into the underlying mechanisms behind PA behaviors and supports future efforts to plan specific, targeted interventions for nursing home residents. Trial registration: The trial was prospectively registered at DRKS.de with registration number DRKS00021423 on April 16, 2020. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions In long‐term care (LTC), the incidence of hip or vertebral fractures are eight times that in the community. Despite the wide availability of osteoporosis therapy, LTC residents are omitted from pivotal trials and not treated. Denosumab is a relatively new, monoclonal antibody therapy for osteoporosis treatment. Via a randomized trial, we sought to determine the safety and efficacy of denosumab in LTC residents.We conducted a 2‐year, double‐blind, placebo‐controlled, randomized clinical trial in 201 osteoporotic men and women aged ≥ 65 years, living in LTC communities. Participants with multimorbidity, dysmobility, and cognitive impairment were not excluded. The intervention was denosumab 60 mg subcutaneous every 6 months or placebo. Our primary outcome measures were hip and spine bone mineral density (BMD) improvement at 24 months. Secondary outcomes included BMD at other skeletal sites, function, and safety.We included 123 women and 78 men with a mean ± standard error age of 81.5 ± 0.6. Overall, 83% and 71% completed 12 and 24 months, respectively. Compared with placebo, the women receiving denosumab had a greater 24‐month percent increase in spine (7.41 ± 0.93 vs. 2.15 + 0.56; p = 0.014), and total hip BMD (4.62 ± 0.62 vs. −0.19 ± 0.79; p = 0.007); and men in spine (7.91 ± 0.96 vs. 1.12 ± 1.13; p = 0.002) and total hip (3.74 ± 0.55 vs. 0.48 ± 0.74; p = 0.018). There were no significant differences in safety metrics.Denosumab was a safe and effective therapy for improving BMD in osteoporotic older men and women with multiple comorbidities in LTC. [ABSTRACT FROM AUTHOR]

Currently, over 5.7 million adults 65+ are projected to have a SUD, and the number of fatal overdose deaths among older adults is rising in both community and facility settings. This exploratory study involved surveys of 37 nursing facilities (NF) in Kentucky in order to identify current admission practices to screen, prevent, and/or address resident substance use. Respondents indicated that they were ill-equipped to address such problems and fail to offer specialized programs for residents or training for staff. Training and best practices for residents, their families, and staff should be established to address residents with substance use and SUD. [ABSTRACT FROM AUTHOR]

Health information technologies (HIT) provide opportunities to support staff as well as residents and their families in long-term care (LTC) homes. Yet, LTC homes lag behind other healthcare organizations in HIT adoption, and little is known about the factors that inform and shape LTC home managers’ decisions. We conducted an exploratory Delphi study with a panel of 19 Canadian LTC managers who were surveyed through three iterative rounds (brainstorming, narrowing down, and ranking) to solicit their input on the key factors that influence HIT adoption decisions. An authoritative list of 25 factors, described and ranked in importance, was produced. The top five identified factors were (in order of importance): availability of funding, impact on workload and efficiency, value proposition, ease of use, and impact on residents’ outcomes. The findings of this research may inform policies and interventions that provide training and workshop opportunities for managers in LTC and increase the awareness of the advocacy and leadership role that managers can play in advancing technology adoption in support of older adults’ care. The results can also be used to support funding from LTC home governing bodies, which is tied to the technology adoption portfolio, to institutionalize the commitment to technological transformation in LTC. [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]

Background: Although many healthcare settings have since returned to pre‐pandemic levels of operation, long‐term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre‐pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid. Methods: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over‐dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non‐dually enrolled residents. Results: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre‐pandemic years for all examined subgroups. For example, compared with 2018–2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher. Conclusions: In 2022, emergency department and hospital utilization rates among long‐term residents were lower than pre‐pandemic levels and mortality rates were higher than pre‐pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents. [ABSTRACT FROM AUTHOR]

Aims: To analyse the concept of eating experiences in people living with dementia. Design: Rodgers' evolutionary method of concept analysis was used as a framework for the paper. Data Sources: The literature was searched using electronic databases PubMed, Google Scholar, CINHAL, PsycInfo, Web of Science, Embase and Elsevier databases. These databases cover a variety of disciplines, including but not limited to nursing, medicine and occupational therapy. The relevant literature published from 1989 to April 2023 was thoroughly examined. Any quantitative or qualitative studies published in English focused on eating or dining experiences in people with dementia were included. Review Methods: Rodgers' evolutionary method for concept analysis was used. The attributes, antecedents, consequences and case examples of the concept were identified. Results: Twenty‐two articles met the inclusion criteria, identifying key attributes of self‐connection, the special journey of life and self‐interpretation. Antecedents, as framed by the socio‐ecological model, were categorized to represent intrapersonal (personal preferences, individual culture, mealtime routines), interpersonal (social interaction) and environmental (dining room environment, policies) factors. Consequences were divided into external (nutritional health, physical health and quality of life) and internal (personhood, autonomy and independence, dignity and feeling valued and mental well‐being) domains. Conclusion: A theoretical definition and conceptual model of eating experiences in people living with dementia was developed. The identified attributes, antecedents and consequences can be utilized in nursing education, research and intervention approaches. Impact: This article allows nurses and other healthcare professionals to better understand people living with dementia through the relationship between eating and interpersonal, intrapersonal and environmental aspects to develop personalized interventions and care strategies to achieve an optimal quality of life. Patient or Public Contribution: Not applicable. [ABSTRACT FROM AUTHOR]

Aims: To assess visitors' perceptions of the benefits and challenges related to engaging in a remote visit intervention, which was designed to address the loneliness of people living with moderate to severe dementia in care homes. Design: A qualitative descriptive study. Methods: Twenty‐four people living with dementia in care homes in Canada and their family and friends (i.e., remote visitors) took part in facilitated remote visits in 2021. Each person living with dementia received scheduled visits for 30–60 min per week for 6 weeks. Participants chose to complete one longer visit, or multiple shorter visits, per week. Twenty remote visitors participated in semi‐structured interviews after six weeks to discuss their perspectives on the effectiveness, benefits and challenges of the program in relation to addressing experiences of loneliness of the person living with dementia. Conventional content analysis was used to analyze the data. Results: We describe three themes and several sub‐themes. Themes support the use of remote visits to enhance, rather than replace, in‐person visits; the benefits of remote visits for the person living with dementia and their remote visitors; and the conditions that lead to a successful remote visit. Conclusion: Remote visitors reported that facilitated visits had positive effects for both visitors and people living with dementia with respect to loneliness, communication, relationships, and social connection. Implications for Patient Care: Clinicians can consider the factors that contributed to positive experiences of remote visits. The factors include individualized, facilitated visits that were flexible, and the use of reliable technology in a supportive, distraction‐free environment. Impact: Loneliness and social isolation are growing health concerns. When experienced by people living with dementia residing in long‐term care homes, loneliness and social isolation can result in lower levels of quality of life and well‐being, and higher levels of anxiety and responsive behaviours.Remote visitors perceived that facilitated remote visits have the potential to address loneliness and improve quality of life for people living with dementia and also offer social support to remote visitors.The findings can impact clinician practice by guiding the use of remote visits in care homes, and inform future intervention research to evaluate the effectiveness of remote visits for people living with dementia and their remote visitors. Reporting Method: This manuscript adheres to the relevant EQUATOR guidelines (the Consolidated criteria for reporting qualitative research or COREQ). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Over the course of the last year and a half, the Coronavirus has swept across the world causing death and devastation to our geriatric population residing in long term care facilities, also known as nursing homes. This paper explores the complicated grief responses exhibited by individuals who were affected by nursing home resident COVID-19 deaths. Nursing home resident survivors, families of the deceased residents, and healthcare workers in this situation have experienced a wide variety of complicated grief responses that need to be addressed. To address this need, an application will follow regarding the usage of a garden memorial ritual and ceremony to help these grievers in their first steps of mourning. [ABSTRACT FROM AUTHOR]

To determine the frequency of physical therapy (PT) services and potential disparities in receiving PT among Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings. Secondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017-2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date. To identify potential disparities in access to PT services, we performed multivariable logistic regression to determine resident demographic, clinical, and community factors associated with receiving PT. Not applicable. Medicare fee-for-service LTC residents aged ≥65 years. Not applicable. Receiving PT services. Of the 999,495 LTC residents with a history of spine pain, 49.6% received PT. Only 12.1% of PT episodes specifically treated spine pain. The odds of receiving PT were higher for residents with pain in multiple spine regions or neuropathic pain (OR, 1.27; 95% confidence interval CI, 1.26-1.29) and for residents with inpatient admissions (OR, 1.76; 95% CI, 1.75-1.78). Odds of receiving PT were lower for residents from minoritized racial and ethnic groups, and for residents with dementia (OR, 0.89; 95% CI, 0.88-0.90), depression (OR, 0.95; 95% CI, 0.94-0.96), or who lived in urban or more socioeconomically deprived areas. Although nearly half of LTC residents with histories of spine pain received PT services, most PT was not for spine pain. There are potential disparities in access to PT for LTC residents from minoritized groups living in urban and more deprived areas. Further work should examine PT outcomes and remove barriers to PT for LTC residents with histories of spine pain. [ABSTRACT FROM AUTHOR]

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Who is responsible for health care? Neoliberal policies since the 1970s seem to place this responsibility increasingly on the individual, in a process that is called responsibilization. The recent literature on neoliberalism, however, has questioned the preference of free-market liberalism for individual responsibility and shows how neoliberals often made common cause with communitarian conservatives on social policies. Melinda Cooper, for instance, has argued in her book Family Values that free-market liberals and social conservatives in the US both identified the family as a 'wholesale alternative to the 20-century welfare state'. This article investigates whether this coalition of neoliberals and social conservatives, who agree on the importance of familial solidarity in addition to market freedom, has also played a role in the making of Dutch health care policies. By tracing how responsibility for long-term care has been allocated in the postwar Netherlands in the specific case of children with (cognitive) disabilities, the author will show how 'the family' has increasingly been embraced by policymakers as the main responsible party. This is remarkable because the Dutch postwar welfare state sought to loosen family ties in favour of individual arrangements. However, attempts by different stakeholders to deinstitutionalize Dutch health care during the 1990s unintentionally moved the state's responsibility for long-term care not so much onto individuals as onto families. [ABSTRACT FROM AUTHOR]

Background and Objectives Oral health of older adults in nursing homes is poor, which can negatively affect general health and well-being. Most oral health problems are preventable with good oral hygiene and regular dental check-ups. Caregivers can help improve residents' oral health through regular oral health assessments. The interRAI instrument used in Long-Term Care Facilities to evaluate older adults' health and well-being, has the potential to integrate oral care into general care planning. The recently optimized Oral Health Section for inclusion in the interRAI instruments (OHS-interRAI) enables nondental caregivers to identify residents requiring help with oral hygiene and/or a dental referral. This study reports the first data obtained using the OHS-interRAI, describing the oral health situation of older adults in Flemish and Dutch nursing homes. Research Design and Methods In this cross-sectional study, interRAI Long-Term Care Facilities data, including OHS-interRAI data, were collected from October 2020 to January 2023 and analyzed from 417 and 795 persons aged 65 years or older in Flemish and Dutch nursing homes, respectively. Results Most common oral health problems were poor oral hygiene and compromised teeth. Differences in oral health were found between Flemish and Dutch residents. Flemish residents had significantly more problems with chewing, dry mouth, oral and denture hygiene, and tongue condition than their Dutch counterparts. They also had a higher need for help with oral hygiene (19.4% vs 14.0%), and a dental referral (36.8% vs 20.9%). Older adults in Flemish nursing homes (20.3%) had significantly fewer dental check-ups than those in Dutch nursing homes (73.5%). Discussion and Implications The use of the OHS-interRAI by nondental caregivers identified at least one-third of the residents requiring help with oral hygiene and/or a dental referral. By means of trigger algorithms (Collaborative Action Points), the OHS-interRAI enables the integration of oral care into general care planning. [ABSTRACT FROM AUTHOR]

Background: Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention "Learning to feel better... and help better" has shown positive results regarding family caregivers' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention. Methods: A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups. Findings: A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes. Conclusion: Findings suggest that psychoeducation, with active skills training based on caregivers' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Preventing functional disability benefits the quality of life of older adults and mitigates the economic burden of an aging society. However, the most effective physical performance tests and optimal cut points for identifying older adults at risk of functional disability remain unclear, and Japan lacks physical function‐based assessment tools. We aimed to identify the physical performance tests related to functional disability and to develop a predictive test battery for it.We included 975 older adults (mean 72.8 ± 5.2 years, 55.4% women) in Kasama City, Japan. Functional disability was defined as certification of care level 2 or above based on the long‐term care insurance system. Cox proportional hazards analysis examined the association between physical performance tests and incident functional disability.During a mean follow‐up of 8.6 years (maximum 14 years), 236 participants (24.2%) developed functional disability. After adjusting for covariates, higher performances in grip strength, single‐leg balance with eyes open (SLB), timed up‐and‐go (TUG), five‐repetition sit‐to‐stand (5‐STS), and 5‐m habitual walk were significantly associated with a lower risk of functional disability. In a stepwise model, SLB, TUG, and 5‐STS were key predictors of functional disability. Receiver operating characteristic analysis determined optimal cut points of 32.6/32.7 s for SLB, 6.5/6.6 s for TUG, and 7.8/7.9 s for 5‐STS. We developed a predictive battery combining these cut points (area under the curve = 0.78).The developed battery of physical performance tests predicts future functional disability and is useful for screening older adults at high risk. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsClinical implicationThis study aimed to assess the knowledge, attitude, and practice of the healthcare professionals and paid caregivers toward non-pharmacological interventions (NPIs) for managing behavioural and psychological symptoms of dementia (BPSD) in Australian residential aged care homes (RACHs).A cross-sectional, online survey was completed by RACH staff and physicians over the period 6 March-31 August 2023. Descriptive statistics were used to present the results.Ninety-six respondents participated (41.7% aged 35–54 years, 80.2% female, 38.5% nurses). While 50–65% of the respondents were extremely familiar with 15 of NPIs, only 22% believed there was a sufficient funding for their implementation, and 6% felt there were sufficient human resources. Although 66% of the respondents viewed NPIs as more useful than medications, only 46% expected consistent positive outcomes from NPIs. The most used NPIs were redirection, behaviour management, and validation therapy.The study highlights that barrier such as inadequate funding, limited human resources, skepticism about NPIs’ effectiveness, unfamiliarity with certain NPIs, and unfavourable attitude toward NPIs are likely to slow NPI adoption for BPSD management.To improve practice, it is essential to address these barriers through targeted education, and training, increased funding, and enhancement of the workforce. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Discussion Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community‐based rehabilitation model for care homes, namely Interdisciplinary Care Home‐bAsed Reablement Program (I‐CHARP), by examining whether (and, if so, how) I‐CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia.I‐CHARP is a 4‐month bio‐behavioural‐environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8–12 full individual sessions and additional eight brief follow‐ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi‐experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I‐CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi‐structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I‐CHARP processes and implementation issues.In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes.Trial Registration: Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088.Protocol version: 1.0 dated 20 July 2023 [ABSTRACT FROM AUTHOR]

The demand for home-based eldercare, especially for those with dementia, has been growing as societies age; in this context, the acute shortage of local care labor has resulted in the use of migrant workers in many countries. Taiwan, Singapore, and Austria, all emphasizing the family’s responsibility for eldercare, have long histories of recruiting migrant workers for home-based eldercare. However, cases of mistreatment of migrant caregivers and care recipients have aroused public concern regarding migrant workers’ care capabilities and working conditions. Migrant caregivers have also reported that their lack of care skills and sufficient rest hamper their work with care recipients who have dementia. This commentary provides a critical review of the laws and policies pertaining to live-in migrant care workers’ care capabilities and working conditions; the effects of such legal frameworks; and recent changes in Taiwan, Singapore, and Austria. This article enhances our cross-country understanding of the advantages and disadvantages of using foreign labor for eldercare in private homes. Governments should enact legislation that supports live-in migrant care workers’ care capabilities and welfare, thereby also improving the well-being of care recipients and their families. [ABSTRACT FROM AUTHOR]

Background: Appropriate use of medication is a key indicator of the quality of care provided in long-term care (LTC). The objective of this study was to determine whether resident-facility language concordance/discordance is associated with the odds of potentially inappropriate prescribing of antipsychotics (PIP-AP) in LTC. Methods: We conducted a population-based, retrospective cohort study of LTC residents in Ontario, Canada from 2010 to 2019. We obtained resident language from standardized resident assessments, and derived facility language by determining the proportion of residents belonging to each linguistic group within individual LTC homes. Using linked administrative databases, we identified all instances of PIP-AP during a 1-year follow-up period. PIP-AP was defined using the STOPP-START criteria, which have previously been shown to predict adverse clinical events such as emergency department (ED) visits and hospitalizations. The association between linguistic factors and PIP-AP was assessed using adjusted multivariable logistic regression analysis. Results: We identified 198,729 LTC residents consisting of 162,814 Anglophones (81.9%), 6,230 Francophones (3.1%), and 29,685 Allophones (14.9%). The odds of PIP-AP of were higher for both Francophones (aOR 1.15, 95% CI 1.08–1.23) and Allophones (aOR 1.11, 95% CI 1.08–1.15) when compared to Anglophones. When compared to English LTC homes, French LTC homes had greater odds of PIP-AP (aOR 1.12, 95% CI 1.05–1.20), while Allophone homes had lower odds of PIP-AP (aOR 0.82, 95% CI 0.77–0.86). Residents living in language-discordant LTC homes had higher odds of PIP-AP when compared to LTC residents living in language-concordant LTC homes (aOR 1.07, 95% CI 1.04–1.10). Conclusion: This study identified linguistic factors related to the odds of PIP-AP in LTC, suggesting that the linguistic environment may have an impact on the quality of care provided to residents. [ABSTRACT FROM AUTHOR]

Generating and translating high‐quality evidence is integral to providing safe and effective medication management for residents of aged care homes. Residents are often under‐represented in trials of medication effectiveness and safety. This paper reviews opportunities and challenges for generating and translating evidence for safe and effective medication management in aged care homes. There are an increasing number of randomized controlled trials (RCTs) being conducted in aged care homes. Observational studies can also help address the evidence‐practice gap arising from underrepresentation of residents in RCTs. Stepped‐wedge and helix counterbalanced designs may help overcome limitations of traditional RCTs for evaluating medication management interventions in the aged care setting. Strategies for generating evidence include building effective partnerships with aged care homes and organizations, using novel trial designs, leveraging existing data and knowledge sharing through international platforms. Strategies for translating evidence include using quality indicators for audit and feedback, provision of education and training, engaging internal and external stakeholders, and development of local action plans and guideline implementation tools. There is an emerging interest in the role of knowledge brokers to facilitate knowledge translation. Future directions for generating and translating evidence include strengthening international research collaboration, industry partnerships, standardizing aged care home data to support national and international comparisons, and optimizing the use of technology. Initiatives may include improving access to routinely collected administrative health and medication data for conducting high‐quality observational studies. Future studies should assess outcomes prioritized by residents to ensure that medication management strategies are tailored to their needs. [ABSTRACT FROM AUTHOR]

The most adverse outcomes of the COVID-19 pandemic include high post-infection mortality among long-term care (LTC) home residents. Research about mortality over a longer period after contracting COVID-19 and in different pandemic years is limited. In the current study, we examined outcomes for 1,596 LTC residents from the day of a positive COVID-19 test until January 31, 2023. We reported all-cause mortality 30 days after contracting COVID-19 and monthly throughout the follow-up, up to 35 months after the pandemic start. We also examined mortality among 2,724 residents residing in the same LTC homes, with no history of COVID-19 during the same period. The results underscored a large number of deaths in the first month post-infection, with 30-day mortality substantially decreasing over the years—from 28% (95% CI [24.3, 31.8]) among residents contracting COVID-19 in 2020, to 8.3% (95% CI [7.4, 9.2]) in the 2022 cohort. Observed over longer periods, monthly mortality among residents with a COVID-19 history was similar to mortality in the No-COVID residents, and no evidence was found of increased mortality risk in the COVID group beyond the first post-infection month. We discuss mortality in LTC during the pandemic and a continuing need to reduce mortality in the acute phase of COVID-19. [ABSTRACT FROM AUTHOR]

Objective Data Sources/Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To examine the association of Medicaid home‐ and community‐based services (HCBS) expenditures on the home care workforce.We use two national, secondary data sources from 2008 to 2019: state‐level Medicaid HCBS expenditures and the American Community Survey, in which we identify direct care workers in the home (i.e., home care workers), defined as nursing, psychiatric, and home health aides or personal care aides working in home health care services, individual and family services, and private households.Our key explanatory variable is HCBS expenditures per state per year. To estimate the association between changes in Medicaid HCBS expenditures and the workforce size, hourly wages and hours worked, we use negative binomial, linear, and generalized ordered logit regression, respectively. All models include demographic and socioeconomic characteristics, the number of potential HCBS beneficiaries (individuals with a disability and income under the federal maximum income eligibility limits), indicators for minimum wage and/or overtime protections for direct care workers, wage pass‐through policies, and state and year fixed effects.We exclude states with incomplete reporting of expenditures.States' HCBS expenditures increased between 2008 and 2019 after adjusting for inflation and the number of potential HCBS beneficiaries. Yet, home care workers' wages remained stagnant at $11–12/h. We find no association between changes in Medicaid HCBS expenditures and wages. For every additional $1 million in Medicaid HCBS expenditures, the expected number of workers increases by 1.2 and the probability of working overtime increased (0.0015% points; p < 0.05). Results are largely robust under multiple sensitivity analyses.We find no evidence of a statistically significant relationship between changes in state‐level changes in Medicaid HCBS expenditures and worker wages but do find a significant, but small, association with hours worked and workforce size. [ABSTRACT FROM AUTHOR]

Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21–1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02–1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03–1.33) and renal failure (OR = 1.63, 95% CI = 1.42–1.86), high fall risk (OR = 2.67, 95% CI = 2.30–3.10), and being bedridden (OR = 6.55, 95% CI = 5.48–7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15–2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally. [ABSTRACT FROM AUTHOR]

Background: Rehabilitation can help long-term care (LTC) residents with dementia maintain their independence. However, many residents do not receive rehabilitation. This study aimed to identify the barriers and facilitators to providing rehabilitation for LTC residents with dementia and propose practical interventions for overcoming them. Methods: Using a phenomenological research design, we conducted a qualitative study involving 17 privately owned LTC homes in Nova Scotia, Canada. Data were collected through individual interviews and a focus group with residents with dementia (n = 3), family members (n = 4), rehabilitation providers (n = 6), and other staff (n = 3). We analyzed the data using inductive thematic content analysis and mapped the results onto the socioecological framework and the Behaviour Change Wheel (BCW) to classify and analyze barriers and facilitators to rehabilitation. The APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) in the BCW were used to identify feasible interventions and policies linked to the identified barriers and facilitators. Results: Barriers at the intrapersonal level included communication difficulties, comorbidities, and lack of motivation among residents. Interpersonal factors encompassed the availability of family support and lack of interdisciplinary practice. Policy/environmental factors involved limited resources, complex admission processes, low staff ratios, and restrictive restraint policies. Enhancing communication, reducing the use of restraints, promoting interdisciplinary practice, and increasing accessibility to activity spaces and equipment will improve the provision of rehabilitation for the residents. Conclusion: Enhancing the capabilities, opportunities, and motivations of all actors in LTC homes can potentially minimize these barriers. Interventions such as staff training on effective communication and dementia care, promoting person-centred and meaningful activities, and improving interdisciplinary collaboration are crucial. Policy measures to improve hospital-to-LTC transitions, increase volunteer involvement, educate families and communities, and recruit more staff are recommended. Addressing these barriers through targeted interventions and policy changes can significantly improve rehabilitation provision for residents with dementia in LTC settings. [ABSTRACT FROM AUTHOR]

Background Trials of interventions to prevent or treat delirium in older adults resident in long-term care settings (LTC) report heterogenous outcomes, hampering the identification of effective management strategies for this important condition. Our objective was to develop international consensus among key stakeholders for a core outcome set (COS) for future trials of interventions to prevent and/or treat delirium in this population. Methods We used a rigorous COS development process including qualitative interviews with family members and staff with experience of delirium in LTC; a modified two-round Delphi survey; and virtual consensus meetings using nominal group technique. The study was registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative (https://www.comet-initiative.org/studies/details/796). Results Item generation identified 22 delirium-specific outcomes and 32 other outcomes from 18 qualitative interviews. When combined with outcomes identified in our earlier systematic review, and following an item reduction step, this gave 43 outcomes that advanced to the formal consensus processes. These involved 169 participants from 12 countries, and included healthcare professionals (121, 72%), researchers (24, 14%), and family members/people with experience of delirium (24, 14%). Six outcomes were identified as essential to include in all trials of interventions for delirium in LTC, and were therefore included in the COS. These are: 'delirium occurrence'; 'delirium related distress'; 'delirium severity'; 'cognition including memory', 'admission to hospital' and 'mortality'. Conclusions This COS, endorsed by the American Delirium Society and the European and Australasian Delirium Associations, is recommended for use in future clinical trials evaluating delirium prevention or treatment interventions for older adults residing in LTC. [ABSTRACT FROM AUTHOR]

The Swiss Federal Council has formulated a policy requiring each canton to establish housing conducive to independent living during old age. Maintaining the independence of older adults at home rather than transitioning to more expensive institutional care has gained traction. This study investigates the heterogeneity of strategies arising from the autonomy granted to each canton. Using mandatory statistics from the Swiss Federal Statistical Office for 2020 on 1550 institutions for the elderly and 2546 at-home care providers, we rank the 26 cantons by permanent and temporary care and support, distinguishing between at-home and institutional care. We use univariate regressions to explain differences and perform efficiency analyses of the respective systems. We find that the French- and Italian-speaking cantons prioritise at-home care, while the German-speaking regions rely more on institutional care. The analyses reveal an inefficient stationary approach in German-speaking cantons, which often places elderly individuals with minimal care needs in institutions. Conversely, with an ambulatory approach favouring independence, cantons like Vaud and Valais prioritize counselling and at-home services, deferring entry into institutions and allowing for short convalescence stays. Our findings are relevant for governmental infrastructure planning and the property owners, investors, and property managers involved in senior housing decisions. [ABSTRACT FROM AUTHOR]

Background/objective: Older patients from long-term care hospitals (LTCHs) presenting to emergency departments (EDs) exhibit a higher prevalence of frailty than those from the community. However, no study has examined frailty in patients from LTCHs in the ED. This study compared frailty in older patients from LTCHs and the community. Methods: We retrospectively analyzed data from the EDs of three university hospitals between 1 August and 31 October 2023, involving 5908 patients (515 from LTCHs and 5393 from the community). The Korean version of the Clinical Frailty Scale (CFS-K) was used to assess individuals aged 65 and older. We compared clinical characteristics, frailty, length of stay (LOS), and diagnosis between patients from LTCHs (LTCH group) and the community (community group). Results: Among ED patients, 55.0% and 35.2% in the LTCH and the community groups, respectively, were frail (p < 0.001). Of these, 71.7% in the LTCH group were hospitalized compared with 53.1% in the community group (p = 0.001). The odds ratio for in-hospital mortality was 4.910 (95% CI 1.458–16.534, p = 0.010) for frail LTCH patients and 3.748 (95% CI 2.599–5.405, p < 0.001) for frail community patients, compared to non-frail patients. Conclusions: Patients from LTCHs with frailty had higher hospital admission rates and increased in-hospital mortality compared to those in the community at the same frailty level. This study offers essential insights into the characteristics of older patients in LTCHs for healthcare administrators and medical staff worldwide. [ABSTRACT FROM AUTHOR]

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

Systematic assessments of interprofessional collaboration barriers and enablers in long-term care settings are critical for delivering person-centered healthcare. However, research on factors influencing interprofessional collaboration in long-term care settings is limited. For this study, 65 healthcare professionals across multiple facilities experienced in long-term care in Japan participated in online focus group discussions and individual interviews to discuss cases. The qualitative data were analyzed using qualitative content analysis. Seven themes emerged: coordination, the need for care manager training, hierarchy among healthcare professionals, specialization but not the mind-set of overspecialization, casual conversations, electronic group communication tools, and excessive fear of personal information protection. These findings highlight the need to develop coordinator roles and for interprofessional education on the proper approach to personal information protection laws. Furthermore, daily casual conversations, the use of online platforms, and the prevention of patients being left behind due to overspecialization are required. [ABSTRACT FROM AUTHOR]

Aim: To compare the subgingival microbiota of patients receiving supportive periodontal care (SPC) with and without subgingival instrumentation, over 2 years. Materials and Methods: This study was a randomized clinical trial that included 62 participants (50.97 ± 9.26 years old; 40 females) who completed non‐surgical periodontal therapy. Participants were randomly assigned to receive oral prophylaxis with oral hygiene instructions alone (test) or in combination with subgingival instrumentation (control) during SPC. Pooled subgingival biofilm samples were obtained from four sites per patient at SPC baseline and at 3, 6, 12, 18, and 24 months. Real‐time polymerase chain reaction was used for absolute quantification of Eubacteria and the target bacteria Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Data were analysed using generalized estimating equations, taking into consideration the clustering of observations within individuals. Results: No significant differences were found between the experimental groups regarding the mean counts of Eubacteria and target bacteria, as well as the periodontal parameters at the sampled sites. Although significant variability in bacterial counts was present during SPC, all counts after 2 years were not statistically different from those at baseline. Bacterial counts were associated with the presence of plaque, bleeding on probing, mean probing depth ≥3 mm, and follow‐up period. Conclusions: SPC with or without subgingival instrumentation can result in comparable subgingival microbiological outcomes. Clinical trial registration: clinicaltrials.gov: NCT01598155 (https://clinicaltrials.gov/study/NCT01598155?intr=supragingival%20control&rank=4#study-record-dates). [ABSTRACT FROM AUTHOR]

Background and Objectives Advance directives (ADs) are based on state-specific statutes that vary in structure, terminology, and options. This variability leads to inconsistent end-of-life (EOL) care for patients who have executed an AD in 1 state but fall ill in another state. This study revisits a 2002 article that identified considerable differences in ADs to determine whether ADs have become more uniform. Research Design and Methods ADs from all 50 states and the District of Columbia were examined to determine the frequency of document types and seven key issues. The results were compared to the 2002 study using nonparametric approaches. Mean numbers of key issues were compared using t -tests and 1-way analysis of variance. Results Consistent with 2002, 3 states in 2023 provide statutes for a healthcare power of attorney (HCPOA). However, states offering a combined HCPOA, and living will (LW), deemed an advance directive for healthcare (ADHC), increased from 13 to 30. Between both studies, Long-Term Care increased significantly in LW and ADHC, whereas Artificial Sustenance significantly increased in LW. Despite the rising prevalence of Alzheimer's in the United States, only 10% of states included this issue in 2023. Discussion and Implications Despite evolving healthcare trends, minimal revisions have been made to ADs since 2002. This lack of uniformity can cause confusion regarding the proper understanding of EOL wishes. The authors recommend that the Uniform Act for Advance Directives be revisited to promote greater uniformity in ADs and ensure that individuals' preferences are understood and respected across different states. [ABSTRACT FROM AUTHOR]

Purpose: This scoping review aims to identify evidence on older adults' acceptance of PA VR games in LTC facilities, describe research designs used, define key acceptance concepts, and identify knowledge gaps for future research. Materials and methods: Following Arksey and O'Malley's framework, data from published and unpublished articles (Jan 2000–May 2023) were collected. Twelve databases and additional sources were searched for studies on LTC residents (≥65 years), PA video games (including VR and console games), acceptance, and attitudes. Data extraction included article details, design, population, intervention, outcomes, and limitations. Results: Five studies met inclusion criteria from 1628 initial titles. They assessed acceptance of PA VR games among older adults in LTC facilities, showing varying levels of acceptance. Most studies used analytical designs, including RCTs. Key concepts of VR acceptance were poorly defined, with only one study using a validated TAM questionnaire. Knowledge gaps highlight the need for further research to understand PA VR acceptance among older adults in LTC facilities. Conclusion: Validated acceptance questionnaires are needed in study of VR acceptance by older adults. Use of qualitative and quantitative methods can enhance understanding of technology acceptance, alongside exploration of individual, environmental, and age-related factors. Detailed reporting of VR interventions is recommended to comprehend acceptance factors. Implications for Rehabilitation: Enhancing engagement: We suggest that physical activity (PA) virtual reality (VR) games can improve engagement among long-term care (LTC) residents. By providing a novel approach to rehabilitation, PA VR games have the potential to increase motivation and participation, leading to improved outcomes. Promoting physical and cognitive stimulation: VR games offer opportunities for both physical and cognitive stimulation. By integrating these games into rehabilitation programs, we can provide a more engaging and interactive experience for individuals undergoing rehabilitation. This can contribute to motor skills development, balance training, cognitive function, and overall well-being. Addressing barriers to rehabilitation: Traditional rehabilitation approaches may face various barriers, such as lack of interest, adherence issues, or limited resources. The use of VR games can help overcome some of these barriers by offering a more enjoyable and accessible rehabilitation experience. This is particularly beneficial for individuals with mobility limitations or those residing in LTC facilities. In summary, our study highlights the potential of incorporating VR games into rehabilitation settings. By implementing these findings, we can improve the acceptance and efficiency of rehabilitation practices, leading to better rehabilitation outcomes for individuals. [ABSTRACT FROM AUTHOR]

Background: The need for effective non-pharmaceutical infection prevention measures such as contact tracing in pandemics remains in care homes, but traditional approaches to contact tracing are not feasible in care homes. The CONTACT intervention introduces Bluetooth-enabled wearable devices (BLE wearables) as a potential solution for automated contact tracing. Using structured reports and reports triggered by positive COVID-19 cases in homes, we fed contact patterns and trends back to homes to support better-informed infection prevention decisions and reduce blanket application of restrictive measures. This paper reports on the evaluation of feasibility and acceptability of the intervention prior to a planned definitive cluster randomised trial of the CONTACT BLE wearable intervention. Methods: CONTACT was a non-randomised mixed-method feasibility study over 2 months in four English care homes. Recruitment was via care home research networks, with individual consent. Data collection methods included routine data from the devices, case report forms, qualitative interviews (with staff and residents), field observation of care, and an adapted version of the NoMaD survey instrument to explore implementation using Normalisation Process Theory. Quantitative data were analysed using descriptive statistical methods. Qualitative data were thematically analysed using a framework approach and Normalisation Process Theory. Intervention and study delivery were evaluated against predefined progression criteria. Results: Of 156 eligible residents, 105 agreed to wear a device, with 102 (97%) starting the intervention. Of 225 eligible staff, 82% (n = 178) participated. Device loss and damage were significant: 11% of resident devices were lost or damaged, ~ 50% were replaced. Staff lost fewer devices, just 6%, but less than 10% were replaced. Fob wearables needed more battery changes than card-type devices (15% vs. 0%). Structured and reactive feedback was variably understood by homes but unlikely to be acted on. Researcher support for interpreting reports was valued. Homes found information useful when it confirmed rather than challenged preconceived contact patterns. Staff privacy concerns were a barrier to adoption. Study procedures added to existing work, making participation burdensome. Study participation benefits did not outweigh perceived burden and were amplified by the pandemic context. CONTACT did not meet its quantitative or qualitative progression criteria. Conclusion: CONTACT found a large-scale definitive trial of BLE wearables for contact tracing and feedback-informed IPC in care homes unfeasible and unacceptable — at least in the context of shifting COVID-19 pandemic demands. Future research should co-design interventions and studies with care homes, focusing on successful intervention implementation as well as technical effectiveness. Trial registration: ISRCTN registration: 11204126 registered 17/02/2021. [ABSTRACT FROM AUTHOR]

ABSTRACT The prominence of person‐centred care has been widely recognised in recent decades. In England, care governance frameworks prioritise the views and wishes of individual people receiving support. Despite workforce development initiatives linked to this agenda, there remains no consensus on the meaning of person‐centred care in the English care sector. An actor‐centred study explored understandings of person‐centred care from the perspective of care workers and managers working with older people in residential and community care. Analysis of interviews with 20 participants led to development of a typology based on the beliefs, values and practices of the interviewees. The three typological groups interpreted person‐centred care within their own distinctive philosophies: Nurturing Mental Health, Nurturing Agency and Nurturing Intimacy. The findings offer fresh insight into the ways an abstract concept is understood within the context of day‐to‐day practice with older people. Existing workforce development guidance encourages professionals to understand person‐centred care by enacting a series of wide‐ranging, desirable outcomes, which is potentially confusing for those working on the front line. This study shows, instead of trying to be all things to all people, staff emphasise a few specific outcomes and values in enacting person‐centred care, reflecting nuances in their overall understanding of older people's well‐being. [ABSTRACT FROM AUTHOR]

This qualitative systematic review aimed to identify and appraise the available qualitative evidence on the attitudes, beliefs, and values of the long-term care workforce towards palliative care. These attributes are important antecedents of behaviour in care provision. The qualitative findings were synthesized into two statements: 'Staff in long-term care facilities understand the importance of clear communication and family engagement for optimal palliative and end-of-life care (PEoLC)', and 'Staff in long-term care facilities deliver palliative and end-of-life care (PEoLC) that is both functional and interpersonal, while managing competing system, professional, and emotional demands.' Key findings showed favourable attitudes in key aspects of PEoLC. Beliefs were consistent with the broader healthcare literature on dying and death, and values favourably aligned with contemporary understandings of palliative care. The review's key findings extend the understanding of workforce attributes beyond knowledge of palliative care and show recognition of broader holistic domains of PEoLC that staff strive to address. Strategies for education and training that enable staff to promote these core holistic values are recommended. [ABSTRACT FROM AUTHOR]

Objective: Medicaid‐funded long‐term services and supports are increasingly provided through home‐ and community‐based services (HCBS) to promote continued community living. While an emerging body of evidence examines the direct benefits and costs of HCBS, there may also be unexplored synergies with Medicare‐funded post‐acute care (PAC). This study aimed to provide empirical evidence on how the use of Medicaid HCBS influences Medicare PAC utilization among the dually enrolled. Data Sources: National Medicare claims, Medicaid claims, nursing home assessment data, and home health assessment data from 2016 to 2018. Study Design: We estimated the relationship between prior Medicaid HCBS use and PAC (skilled nursing facilities [SNF] or home health) utilization in a national sample of duals with qualifying index hospitalizations. We used inverse probability weights to create balanced samples on observed characteristics and estimated multivariable regression with hospital fixed effects and extensive controls. We also conducted stratified analyses for key subgroups. Data Extraction Methods: The primary sample included 887,598 hospital discharges from community‐dwelling duals who had an eligible index hospitalization between April 1, 2016, and September 30, 2018. Principal Findings: We found HCBS use was associated with a 9 percentage‐point increase in the use of home health relative to SNF, conditional on using PAC, and a meaningful reduction in length of stay for those using SNF. In addition, in our primary sample, we found HCBS use to be associated with an overall increase in PAC use, given that the absolute increase in home health use was larger than the absolute decrease in SNF use. In other words, the use of Medicaid‐funded HCBS was associated with a shift in Medicare‐funded PAC use toward home‐based settings. Conclusion: Our findings indicate potential synergies between Medicaid‐funded HCBS and increased use of home‐based PAC, suggesting policymakers should cautiously consider these dynamics in HCBS expansion efforts. [ABSTRACT FROM AUTHOR]

Background: Research shows that voice--the communication of ideas, concerns, and perspectives by employees to those in positions to instigate changes--is related to job satisfaction, retention, and organizational improvement. Nevertheless, health care professionals often do not exercise voice. Although researchers have explored the barriers registered nurses working in hospitals experience in expressing their voices, there has been a notable lack of attention in research and practice to the voice of certified nursing assistants working in long-term care settings. Purposes: Ensuring that certified nursing assistants can exercise voice is essential for the welfare and well-being of this occupational group and critical for the success of their organizations. Therefore, we explore the barriers certified nursing assistants encounter that hinder them from exercising voice. Methodology: We conducted seven focus groups in which 24 Dutch certified nursing assistants participated. Results: The results show that respondents were not always willing to exercise voice, which stemmed primarily from negative prior experiences with exercising voice. Respondents were further not always able to exercise voice, as the conditions under which they had to do so were unfavorable. Finally, respondents sometimes lacked the necessary skills to convey their ideas, concerns, and perspectives effectively. Practice Implications: Our findings indicate that health care managers must address multiple factors if they wish to enhance the voice of certified nursing assistants. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? Are varying levels of access to family support, measured based on spousal presence and residential proximity to children, associated with key modifiable risk factors for dementia, among older adults with cognitive impairment? • What is the main finding of this study? In this longitudinal study of Americans aged 50 and older who were living with cognitive impairment, those with limited family support, characterized by distant children and no spouse, displayed a significantly higher percentage of smoking, depressive symptoms, and social isolation. Importantly, a consistent gradient relationship was observed, showing that as family support became more distant, the percentage of dementia risk factors increased. • What is the meaning of the finding? Policies that support family caregivers and encourage the maintenance of close family ties and social support should be promoted to improve the health and well-being of this vulnerable population with cognitive impairment. Cognitive impairment poses considerable challenges among older adults, with the role of family support becoming increasingly crucial. This study examines the association of children's residential proximity and spousal presence with key modifiable risk factors for dementia in cognitively impaired older adults. We analyzed 14,600 individuals (35,165 observations) aged 50 and older with cognitive impairment from the Health and Retirement Study (1995–2018). Family support was categorized by spousal presence and children's residential proximity. Modifiable risk factors, including smoking, depressive symptoms, and social isolation, were assessed. Associations between family support and the modifiable risk factors were determined using mixed-effects logistic regressions. A significant proportion of older adults with cognitive impairment lacked access to family support, with either no spouse (46.9%) or all children living over 10 miles away (25.3%). Those with less available family support, characterized by distant-residing children and the absence of a spouse, had a significantly higher percentage of smoking, depressive symptoms, and social isolation. Moreover, we revealed a consistent gradient in the percentage of the risk factors by the degree of family support. Relative to older adults with a spouse and co-resident children, those without a spouse and with all children residing further than 10 miles displayed the highest percentage of the risk factors. These findings were robust to various sensitivity analyses. Family support from spouses and nearby children serves as a protective factor against modifiable dementia risk factors in cognitively impaired older adults. Policies that strengthen family and social support may benefit this population. [ABSTRACT FROM AUTHOR]

Background: Burnout among health care workers is growing among long-term care staff, with various repercussions. Research about how rehabilitation therapists (occupational, physical, and speech) perceive and experience burnout in such settings is limited. Understanding these experiences with burnout in long-term care is necessary to address burnout. This study investigated rehabilitation therapists' perceptions of and experiences with burnout while working in long-term care. Method: The researcher used a qualitative interpretive approach to guide audio-recorded and transcribed interviews. The data were analyzed through coding and then themes were developed. Results: Six themes emerged: causes of stress and burnout, individual ways of managing stress and burnout, systemic changes for managing stress and burnout, COVID-19 and mental health, the definition of burnout, and change over time in work experience. Discussion: Rehabilitation therapists should feel empowered to advocate for policies that reduce burnout in the workplace. One policy all of the participants acknowledged was that productivity expectations were unrealistic. Future research, advocacy, and policy should address systemic and organizational factors related to burnout to relieve the related consequences. [ABSTRACT FROM AUTHOR]

Context: Prolonged management of critical illnesses in long-term acute care hospitals (LTACH) makes serious illness communication (SIC), a clinical imperative. SIC in LTACH is challenging as clinicians often lack training and patients are typically unable to participate—making caregivers central. Objectives: This qualitative descriptive study characterized caregiver engagement in SIC encounters, while considering influencing factors, following the implementation of Ariadne Labs' SIC training at a LTACH in the Northeastern United States. Methods: Clinicians' documented SIC notes (2019-2020) were analyzed using directed content analysis. Codes were grouped into four categories generated from two factors that influence SIC—evidence of prognostic understanding (yes/no) and documented preferences (yes/no)—and caregiver engagement themes identified within each category. Results: Across 125 patient cases, 251 SIC notes were analyzed. In the presence of prognostic understanding and documented preferences, caregivers acted as upholders of patients' wishes (29%). With prognostic understanding but undocumented preferences, caregivers were postponers of healthcare decision-making (34%). When lacking prognostic understanding but having documented preferences, caregivers tended to be searchers, intent on identifying continued treatment options (13%). With poor prognostic understanding and undocumented preferences, caregivers were strugglers, having difficulty with the clinicians or family unit over healthcare decision-making (21%). Conclusion: The findings suggest that two factors—prognostic understanding and documented preferences—are critical factors clinicians can leverage in tailoring SIC to meet caregivers' SIC needs in the LTACH setting. Such strategies shift attention away from SIC content alone toward factors that influence caregivers' ability to meaningfully engage in SIC to advance healthcare decision-making. [ABSTRACT FROM AUTHOR]

Introduction: Long-term care (LTC) refers to care and support services that are required by individuals who lack the ability to perform important daily routines and may be dependent on others for personal, social, and medical needs over a sustained period of time. LTC may be broadly categorized into formal and informal care, where formal care is provided by professionals who are compensated to provide these services and informal care captures the care services provided without compensation by family members, friends, or other unpaid individuals. Areas covered: In this narrative review, we identify and synthesize evidence to evaluate the cost of long-term care while balancing the needs of caregivers. We searched Embase and EconLit for studies published from 2010 to November 2023. Our search strategy used a combination of keywords such as 'long-term care,' 'caregiver burden,' 'caregiver support,' 'cost of care,' and 'caregiver wellbeing.' We include both formal and informal LTC, as well as predictors of caregiver wellbeing. Expert commentary: This review highlights the global variability in LTC costs and the significant burden on caregivers, emphasizing the need for policy interventions and comprehensive insurance schemes. Future research should focus on standardized assessment tools, intervention effectiveness, and integrating caregiver support into healthcare models, ensuring holistic and sustainable LTC solutions. [ABSTRACT FROM AUTHOR]