[Interventions for functionally dependent adults and their caregivers during the COVID-19 pandemic]

The COVID-19 pandemic has affected the world population, especially people from social groups in a situation of greater vulnerability among people with some functional dependency. Therefore, the aim of this review was to describe interventions during the pandemic to preserve general health, maintain function and independence, and prevent COVID-19 infection for functionally dependent adults (FDA). A systematic search in databases was carried out. Titles and abstracts of each publication were reviewed for relevance. Full-text articles were accessed by two independent reviewers. The information found was classified into three categories: 1) FDA during the COVID-19 pandemic, 2) FDA during the COVID-19 pandemic according to a specific condition (neurological conditions, sensory disabilities/impairments, and cognitive impairment), and 3) Older adults with functional dependence. The FDAs have faced difficulties and barriers during the COVID-19 pandemic. Strengthening strategies such as telerehabilitation is suggested to avoid deterioration or aggravation of the functionality of dependent people.

Rates of Hospital-Based Care among Older Adults in the Community and Residential Care Facilities: A Repeated Cross-Sectional Study

OBJECTIVE

We examine annual rates of emergency department (ED) visits, hospital admissions, and alternate levels of care (ALC) days (ie, the number of days that an older adult remained in hospital when they could not be safely discharged to an appropriate setting in their community) among older adults.

DESIGN

Repeated cross-sectional study.

SETTING AND PARTICIPANTS

Linked, individual-level health system administrative data on community-dwelling persons, home care recipients, residents of assisted living facilities, and residents of nursing homes aged 65 years and older in Ontario, Canada, from January 1, 2013, to December 31, 2019.

METHODS

We calculated rates of ED visits, hospital admissions, and ALC days per 1000 individuals per older adult population per year. We used a generalized linear model with a gaussian distribution, log link, and year fixed effects to obtain rate ratios.

RESULTS

There were 1,655,656 older adults in the community, 237,574 home care recipients, 42,600 older adults in assisted living facilities, and 94,055 older adults in nursing homes in 2013; there were 2,129,690 older adults in the community, 281,028 home care recipients, 56,975 older adults in assisted living facilities, and 95,925 older adults in nursing homes in 2019. Residents of assisted living facilities had the highest rates of ED visits (1260.692019 vs 1174.912013), hospital admissions (482.632019 vs 480.192013), and ALC days (1905.572019 vs 1443.032013) per 1000 individuals. Residents of assisted living facilities also had significantly higher rates of ED visits [rate ratio (RR) 3.30, 95% CI 3.20, 3.41), hospital admissions (RR 6.24, 95% CI 6.01, 6.47), and ALC days (RR 25.68, 95% CI 23.27, 28.35) relative to community-dwelling older adults.

CONCLUSIONS AND IMPLICATIONS

The disproportionate use of ED visits, hospital admissions, and ALC days among residents of assisted living facilities may be attributed to the characteristics of the population and fragmented licensing and regulation of the sector, including variable models of care. The implementation of interdisciplinary, after-hours, team-based approaches to home and primary care in assisted living facilities may reduce the potentially avoidable use of ED visits, hospital admissions, and ALC days among this population and optimize resource allocation in health care systems.

Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study

OBJECTIVE

We investigate the changes in the sociodemographic characteristics, clinical comorbidities, and transitions between care settings among residents of assisted living facilities.

DESIGN

Repeated cross-sectional study.

SETTING AND PARTICIPANTS

Linked, individual-level health system administrative data on residents of assisted living facilities in Ontario, Canada, from January 1, 2013, to December 31, 2019.

METHODS

Counts and proportions were calculated to describe the sociodemographic characteristics and clinical comorbidities. Relative changes and trend tests were calculated to quantify the longitudinal changes in the characteristics of residents of assisted living facilities between 2013 and 2019. A Sankey plot was graphed to display transitions between different care settings (ie, hospital admission, nursing home admission, died, or remained in the assisted living facility) each year from 2013 to 2019.

RESULTS

There was a 34% relative increase in the resident population size of assisted living facilities (56,9752019 vs 42,6002013). These older adults had a mean age of 87 years, and women accounted for nearly two-thirds of the population across all years. The 5 clinical comorbidities that had the highest relative increases were renal disease (24.3%), other mental health conditions (16.8%), cardiac arrhythmias (9.6%), diabetes (8.5%), and cancer (6.9%). Nearly 20% of the original cohort from 2013 remained in an assisted living facility at the end of 2019, and approximately 10% of that cohort transitioned to a nursing home in any year from 2013 to 2019.

CONCLUSIONS AND IMPLICATIONS

Residents of assisted living facilities are an important older adult population that has progressively increased in clinical complexity within less than a decade. Clinicians and policy makers should advocate for the implementation of on-site medical care that is aligned with the needs of these older adults.

Caregiver Involvement and Concerns with Care of Residents of Assisted Living before and during the COVID-19 Pandemic

INTRODUCTION

Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care - especially during the COVID-19 pandemic and especially in assisted living (AL) homes, where resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, little research is available on caregiver involvement and concerns with care of AL residents prior to and during waves 1 and 2 of the COVID-19 pandemic. This study addressed this important knowledge gap.

METHODS

This prospective cohort study used baseline and follow-up online surveys with primary caregivers to AL residents in Western Canada who were 65 years or older and had lived in the AL home for at least 3 months before Mar 1, 2020. Surveys assessed the following outcomes in the 3 months prior to and during waves 1 and 2 of the pandemic: sociodemographics, 5 ways of visiting or communicating with residents, involvement in 16 care tasks, concerns with 9 resident physical/mental health conditions, perceived lack of resident access to 7 care services, and whether caregivers felt well informed and involved with resident care.

RESULTS

Based on 386 caregiver responses, in-person visits dropped significantly in wave 1 of the pandemic and so did caregiver involvement in nearly all care tasks. While these rates increased in wave 2, most did not return to pre-pandemic levels. Correspondingly, caregiver concerns (already high before the pandemic) substantially increased in wave 1 and stayed high in wave 2. These were particularly elevated among caregivers who did not feel well informed/involved with resident care.

CONCLUSIONS

Restricted in-person visiting disrupted resident care and was associated with worse perceptions of resident health and well-being. Continued caregiver involvement in resident care and communication with caregivers even during lockdowns is key to mitigating these issues.

Remote infection control assessments in long-term care facilities during COVID-19 pandemic in Texas, 2020

BACKGROUND

The Texas Department of State Health Services (DSHS) Healthcare Safety Unit (HCSU) conducts remote infection control assessments (tele-ICARs) in long-term care facilities (LTCFs) to evaluate COVID-19 infection prevention and control (IPC) knowledge and practices using a standardized assessment tool. Tele-ICARs are used to gauge different IPC measures specific to SARS-CoV-2 and are either proactive--conducted prior to identified cases--or responsive to an outbreak, which is defined as a new SARS-CoV-2 infection in any staff or any facility-onset infection in a resident. State and local partners use findings from the assessments to aid LTCFs by providing targeted and timely resources and support to mitigate identified gaps.

METHODS

Data from tele-ICARs conducted between March 1 and October 30, 2020 were analyzed to assess major gaps across LTCF types. A major gap was defined as 10% or more of facilities not satisfying a specific IPC measure, excluding missing data. Gaps were also assessed by tele-ICAR type: proactive or responsive. Fisher's exact tests and univariate logistic regression were used to characterize significant associations between major IPC gaps and LTCF or tele-ICAR type.

RESULTS

DSHS conducted tele-ICARs in 438 LTCFs in Texas during 8 months; 191 were nursing homes/skilled nursing facilities (NH/SNFs), 206 were assisted living facilities (ALFs) and 41 were other settings. Of the assessments, 264 were proactive and 174 responsive. Major gaps identified were: (1) 22% did not have a preference for alcohol-based hand sanitizer (ABHS) over soap and water; (2) 18.1% were not aware of the contact time for disinfectants in use; (3) 17.9% had not stopped resident communal dining; (4) 16.8% did not audit hand hygiene and PPE compliance; and (5) 11.8% had not stopped inter-facility group activities and extra-facility field trips. When restricting analyses to proactive tele-ICARs, one additional gap was identified: 11.1% of facilities lacked a dedicated space to care for or cohort residents with confirmed SARS-CoV-2 infection. Significantly more ALFs than NH/SNFs had not suspended resident communal dining (P < .001) nor identified a dedicated space to cohort residents with confirmed SARS-CoV-2 infection (P < .001). Significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR reported a preference for ABHS over soap and water (P = .008) and reported suspending communal dining (P < .001) and group activities (P < .001). Also, significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR had identified a dedicated space to cohort residents with confirmed SARS-CoV-2 (P = .009).

CONCLUSIONS

Increased facility education and awareness of federal and state guidelines for group activities and communal dining is warranted in Texas, emphasizing the importance of social distancing for preventing the transmission of SARS-CoV-2 in LTCFs, particularly ALFs. CDC recommendations for ABHS versus hand washing should be emphasized, as well as the importance of monitoring and auditing HCP hand hygiene and PPE compliance. Facilities may benefit from additional education and resources about disinfection, to ensure proper selection of disinfectants and understanding of the contact time required for efficacy. Analysis by tele-ICAR type suggests facilities may benefit from identifying space for dedicated COVID-19 units in advance of an outbreak in their facility. Conducting tele-ICARs in LTCFs enables public health agencies to provide direct and individualized feedback to facilities and identify state-wide opportunities for effective interventions in response to SARS-CoV-2.

Preventing COVID-19 in assisted living facilities: An impossible task pending vaccination roll out

Here, we aimed to describe the clinical outcomes of the residents of a long-term care facility during its closure to visitors and suppliers in response to the first COVID-19 pandemic from February 23 to June 22, 2020, and the results of the facility-wide SARS-CoV-2 testing of residents and staff in June 2020 before its partially reopening. Seventy-four residents and 53 members of staff were included in the present study. The staff underwent nasopharyngeal swab tests for SARS-CoV-2, and both the staff and residents underwent serological tests to detect IgG antibodies against SARS-CoV-2. The results of all of the tests were negative. Conversely, 94% of residents and 38% members of the staff were tested positive to the nasopharyngeal swab tests during the second COVID-19 pandemic wave (data collected from November 1 to November 30, 2020). Our experience suggests that, in the presence of a life-threatening pandemic such as SARS-CoV-2 infection, the prompt use of restrictive procedures can prevent the spread and progression of disease in assisted living facilities in the short term but may fail in the long term, especially when the prevalence of the COVID-19 greatly increased outside the facility enhancing the risk of import the disease from outside. SARS-CoV-2 vaccination of residents and staff members would contribute to control/limit the prevalence and the spread of the virus.

Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada

Background

Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program.

Methods

We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program.

Results

There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not.

Conclusions

A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02400-w.

Use of alternative care sites during the COVID-19 pandemic in the city of Buenos Aires, Argentina

Objectives

In large cities, where a large proportion of the population live in poverty and overcrowding, orders to stay home to comply with isolation requirements are difficult to fulfil. In this article, the use of alternative care sites (ACSs) for the isolation of patients with confirmed COVID-19 or persons under investigation (PUI) in the City of Buenos Aires during the first wave of COVID-19 are described.

Study design

This is a cross-sectional study.

Methods

All patients with COVID-19 and PUI with insufficient housing resources who could not comply with orders to stay home and who were considered at low clinical risk in the initial triage were referred to refurbished hotels in the City of Buenos Aires (Ciudad Autónoma de Buenos Aires [CABA]). ACSs were divided into those for confirmed COVID-19 patients and those for PUI.

Results

From March to August 2020, there were 58,143 reported cases of COVID-19 (13,829 of whom lived in slums) in the CABA. For COVID-19 positive cases, 62.1% (n = 8587) of those living in slums and 21.4% (n = 9498) of those living outside the slums were housed in an ACS. In total, 31.1% (n = 18,085) of confirmed COVID-19 cases were housed in ACSs. In addition, 7728 PUI were housed (3178 from the slums) in an ACS. The average length of stay was 9.0 ± 2.5 days for patients with COVID-19 and 1.6 ± 0.7 days for PUI. For the individuals who were housed in an ACS, 1314 (5.1%) had to be hospitalised, 56 were in critical care units (0.22%) and there were 27 deaths (0.1%), none during their stay in an ACS.

Conclusions

Overall, about one-third of all people with COVID-19 were referred to an ACS in the CABA. For slum dwellers, the proportion was >60%. The need for hospitalisation was low and severe clinical events were rare. This strategy reduced the pressure on hospitals so their efforts could be directed to patients with moderate-to-severe disease.

Health workers perception on telemedicine in management of neuropsychiatric symptoms in long-term care facilities: Two years follow-up

The management of neuropsychiatric symptoms is a challenge in long-term care facilities. Our objective was to assess the perception of telemedicine, as a useful tool to connect staff to specialized units. In this multicenter prospective study, 90 patients from ten facilities benefited from 180 sessions over two years. The primary outcome was the perception of telemedicine evaluated through semi-structured interviews at baseline and two years later. Our results revealed positive perceptions of telemedicine, confirmed after two years of real-life experience with its use. Not only do staff members believe that telemedicine is not a downgraded version of medicine, but they also believe that it could improve the quality of care. They expressed a very positive sense of recognition of their professional qualifications and indicated their need to be involved in change processes to ensure successful implementation and better adherence to telemedicine as a service.

Staff members' prioritisation of care in residential aged care facilities: a Q methodology study

BACKGROUND

When healthcare professionals' workloads are greater than available resources, care activities can be missed, omitted or delayed, potentially leading to adverse patient outcomes. Prioritisation, a precursor to missed care, involves decision-making about the order of care task completion based on perceived importance or urgency. Research on prioritisation and missed care has predominantly focused on acute care settings, which differ from residential aged care facilities in terms of funding, structure, staffing levels, skill mix, and approaches to care. The objective of this study was to investigate how care staff prioritise the care provided to residents living in residential aged care.

METHODS

Thirty-one staff members from five Australian residential aged care facilities engaged in a Q sorting activity by ranking 34 cards representing different care activities on a pre-defined grid from 'Least important' (- 4) to 'Most important' (+ 4). Concurrently, they participated in a think-aloud task, verbalising their decision-making processes. Following sorting, participants completed post-sorting interviews, a demographics questionnaire and semi-structured interviews. Q sort data were analysed using centroid factor analysis and varimax rotation in PQMethod. Factor arrays and data from the think-aloud task, field notes and interviews facilitated interpretation of the resulting factors.

RESULTS

A four-factor solution, representing 22 participants and 62% of study variance, satisfied the selection criteria. The four distinct viewpoints represented by the solution were: 1. Prioritisation of clinical care, 2. Prioritisation of activities of daily living, 3. Humanistic approach to the prioritisation of care, and 4. Holistic approach to the prioritisation of care. Participants' prioritisation decisions were largely influenced by their occupations and perceived role responsibilities. Across the four viewpoints, residents having choices about their care ranked as a lower priority.

CONCLUSIONS

This study has implications for missed care, as it demonstrates how care tasks deemed outside the scope of staff members' defined roles are often considered a lower priority. Our research also shows that, despite policy regulations mandating person-centred care and the respect of residents' preferences, staff members in residential aged care facilities tend to prioritise more task-oriented aspects of care over person-centredness.

[Assisted living facilities in inpatient and outpatient settings]

BACKGROUND AND OBJECTIVE

Assisted living (AL) facilities for older people in need of support in outpatient and inpatient settings differ from nursing homes due to the orientation towards autonomy of the residents and the normality of living and everyday routines, very similar to living at home. The conceptual framework, here defined as AL, is characterized by a homelike small-scale environment and the keeping of one's own household and manageability. The presence of personnel in a new personal mix supports qualities, such as social participation, meaningful activities and functional support. The study examined how this frame of reference impacts the quality of life of residents and reflects the perspectives of further development of housing options.

MATERIAL AND METHODS

Over a period of 9 months (2006-2007) 8 AL facilities with 73 residents and a classical nursing home with 18 residents were examined in terms of behavioral competence, subjective well-being, perceived quality of life and objective environment. Established multidimensional person and environment-related assessment instruments were applied. Specific organizational questions were explored through qualitative interviews.

RESULTS

Despite a formal inpatient or outpatient classification, the residents living in AL facilities showed significantly higher values for well-being and showed significantly less agitated, challenging behavior compared to the nursing home. In particular, people with dementia benefited from the specific quality of AL, which is reflected in relevant dimensions.

CONCLUSION

The findings indicate that AL represents a concept that can be used as a basis for new housing offers and a new type of care infrastructure. It provides connecting factors to the leading principle of shared responsibility.

Recreational Activity in Assisted Living Communities: A Critical Review and Theoretical Model

BACKGROUND AND OBJECTIVES

This paper critically reviewed the scientific literature on recreational activity (RA) behaviors in assisted living (AL) communities.

RESEARCH DESIGN AND METHODS

A search of three databases yielded 70 quantitative, qualitative, and observational articles that met criteria for inclusion.

RESULTS

AL residents participated in various types of RA, however, did so infrequently. Individual, interindividual, environmental, and relocation factors influenced RA behaviors, and participation may relate to positive consequences for residents and AL communities. This review identified multiple limitations in the literature related to construct definitions, measurement protocols, and incomplete or absent theoretical frameworks.

DISCUSSION AND IMPLICATIONS

To address these limitations, the current review proposes a multivariate measurement model and an interdisciplinary theoretical model of factors relating to RA, consistent with an ecological framework. The proposed models appreciate individual psychological factors that influence the multiple facets of human choice and behavior, as well as the interaction between individuals and the unique sociophysical environment of AL. This paper concludes with recommendations for future research, emphasizing studies that have applied implications for practice and policy.

Care Arrangements of Older Adults: What They Prefer, What They Have, and Implications for Quality of Life

BACKGROUND AND OBJECTIVES

Meeting individual preferences for long-term services and supports (LTSS) is a policy priority that has implications for quality of care. Evidence regarding preferences is sparse. In addition, little is known regarding whether preferences and care arrangements match for those receiving care, and implications for quality of life.

RESEARCH DESIGN AND METHODS

A random sample (n = 1,783 in 2012) of National Health and Aging Trends Study participants were asked the best care option for someone 80+ who needs help with personal care and mobility. Analyses examine variations in care preferences, the relationship of preferences to care arrangements, and the association of matched preference and care arrangements to quality of life indicators.

RESULTS

Care preferences vary by demographics. Equal proportions (3 in 10) of older adults chose assisted living or continuing care retirement communities (CCRC), care in own home with family help, and care in own home with paid help, as the best options. Persons in assisted living/CCRC settings were significantly more likely to choose this option as best. Only 1 in 3 older persons receiving care are in arrangements that match preferences. No association with quality of life indicators was found.

DISCUSSION AND IMPLICATIONS

Aging in place remains the care preference of a majority, but close to one-third chose assisted living/CCRC, suggesting preferences are evolving. Aligning care preferences and arrangements is a policy goal, but many do not achieve a match and there remain gaps in understanding trajectories in preferences and care arrangements and implications for quality of life.

[Relocations of older persons with intellectual disability : A quantitative analysis]

BACKGROUND

Relocation from the familiar living environment is a particularly risky transition event for old people with intellectual disability (ID); however, a change of environment has the potential to maintain or improve a person's social participation and self-determination in old age. The research project MUTIG aimed to analyze the frequency and destination of moving home of old persons with ID (≥50 years) in Westphalia for the years 2014 and 2015.

MATERIAL AND METHODS

The investigation was based on a secondary analysis of administrative data of all persons over 50 years who received any kind of social aid for integration from the Regional Association of Westphalia-Lippe. For each individual the address and support arrangements at the beginning and the end of the years 2014 and 2015 were compared.

RESULTS

Approximately 5% of older people with ID changed address per year. People who moved to nursing homes had previously primarily lived in larger institutions or larger community-based group homes. The number of older persons with ID moving into or out of supported living arrangements was approximately equal.

CONCLUSION

Older persons with ID should also be able to move to smaller supported settings and these settings should provide long-lasting living perspectives (aging in place). The pulling effect that nursing homes exert on residents in residential institutions or larger group homes is critically discussed.

[In which residential settings do older persons with intellectual disability live? : A quantitative comparison of age groups for Westphalia-Lippe]

BACKGROUND

The number of aged persons with intellectual disability (ID) in Germany is increasing; however, reliable data on the residential settings in which they live are missing. The aim of this study was to estimate how adults with ID of different age groups are distributed over the various residential settings using the example of Westphalia-Lippe.

MATERIAL AND METHODS

Administrative data on all adults with ID who received aid for social integration were statistically analyzed. Data on persons with ID in long-term nursing homes were collected via telephone interviews and questionnaires. Finally, the results were merged to obtain a comprehensive overview for Westphalia-Lippe.

RESULTS

In Westphalia-Lippe aged persons with ID (≥65 years) rarely live independently but mostly with family members or in supported living arrangements. They are living in larger community-based homes or in residential institutions more frequently than younger persons with ID and one fifth have been living in nursing homes for a comparatively long period of time.

CONCLUSION

Older persons with ID have so far hardly benefited from the increasing residential options for supported living. All forms of services and residential arrangements for persons with ID have to adapt to the changing needs for support in old age. Long-term nursing homes should not mutate into places where people spend the complete phase of old age.

From Research to Application: Supportive and Therapeutic Environments for People Living With Dementia

The evidence about the role the designed and built environment plays in supporting individuals living with dementia has been steadily mounting for almost 40 years. Beginning with the work of M. Powell Lawton at the Weiss Pavilion at the Philadelphia Geriatric Center, there are now dozens of researchers who are exploring how the environment can be either supportive and therapeutic, indeed even serving as a prosthetic for various changes in cognition, or be a barrier to independent functioning and high quality of life. Two recent literature reviews published on the impact of environmental factors and characteristics on individuals living with dementia clearly delineate evidence that the environment can have a therapeutic or a debilitating impact on individuals living with dementia. Rather than duplicate these excellent reviews, this article puts the knowledge gleaned from this research into the shifting context that is long-term care. This article begins with an exploration of the evolution of approaches to the design of spaces for individuals living with dementia from traditional or medical models, to special care units (SCUs), to person-centered care (PCC), which is the organizing theme of this supplemental issue. A novel, person-centered way of conceptualizing the domains of environmental systems is then presented and used as the framework for structuring recommendations and creating supportive and therapeutic environments for individuals living with dementia. Although there are distinct pathophysiological and behavioral manifestations of different forms of dementia, there is almost no evidence that suggests alternative environmental characteristics are better for one type of dementia over another. Thus, this article will refer to "individuals living with dementia" as opposed to Alzheimer's disease or other specific forms of dementia. Further, this article only addresses residential environments: homes in the community, independent and assisted living residences and nursing homes. It does not address other settings, such as hospitals or hospice, or work and public community spaces, such as stores. It is recognized that individuals living with dementia do spend time in all these spaces, and fortunately, there is growing interest in creating more dementia-friendly communities, but they will not be addressed in this article. Most of the research that has been done has focused on shared residential settings, so that will be the primary focus on this article.

State Regulatory Approaches for Dementia Care in Residential Care and Assisted Living

Purpose

This policy study analyzed states' residential care and assisted living (RC/AL) regulations for dementia care requirements. Estimates suggest that at least half of RC/AL residents have dementia, and 22% of settings provide or specialize in dementia care. Residents with dementia might benefit from regulations that account for specific behaviors and needs associated with dementia, making states' RC/AL regulations address dementia care an important policy topic.

Design and Methods

This study examined RC/AL regulations in all 50 states and the District of Columbia for regulatory requirements on five topics important to the quality of life of RC/AL residents with dementia: pre-admission assessment, consumer disclosure, staffing types and levels, administrator training, and physical environment.

Results

Sixteen states license or certify dementia care units within RC/AL settings. All states had at least one dementia care requirement, though only four states had requirements for all five of the topics reviewed. Most states addressed administrator training, consumer disclosure, and physical environment, 17 addressed staffing types and levels, and 14 addressed pre-admission assessment for dementia. Thus, most states rely on general RC/AL regulations to cover dementia care policies and practices.

Implications

This policy study provides a resource for researchers who do cross-state studies of dementia care in RC/AL settings and state policymakers who are updating RC/AL regulations, including those responding to a 2014 Centers for Medicare and Medicaid Services rule change.

Changes in malnutrition and quality of nutritional care among aged residents in all nursing homes and assisted living facilities in Helsinki 2003-2011

BACKGROUND

While nutritional problems have been recognized as common in institutional settings for several decades, less is known about how nutritional care and nutrition has changed in these settings over time.

OBJECTIVES

To describe and compare the nutritional problems and nutritional care of residents in all nursing homes (NH) in 2003 and 2011 and residents in all assisted living facilities (ALF) in 2007 and 2011, in Helsinki, Finland.

METHODS

We combined four cross-sectional datasets of (1) residents from all NHs in 2003 (N=1987), (2) residents from all ALFs in 2007 (N=1377), (3) residents from all NHs in 2011 (N=1576) and (4) residents from all ALFs in 2011 (N=1585). All participants at each time point were assessed using identical methods, including the Mini Nutritional Assessment (MNA).

RESULTS

The mean age of both samples from 2011 was higher and a larger proportion suffered from dementia, compared to earlier collected samples. A larger proportion of the residents in 2011 were assessed either malnourished or at-risk for malnutrition, according to the MNA, than in 2003 (NH: 93.5% vs. 88.9%, p<0.001) and in 2007 (ALF: 82.1% vs. 78.1%, p=0.007). The use of nutritional, vitamin D and calcium supplements, and snacks between meals was significantly more common in the 2011 residents, compared to the respective earlier samples.

CONCLUSIONS

In 2011, institutionalized residents were more disabled and more prone to malnourishment than in 2003 or 2007. Institutions do seem to be more aware of good nutritional care for vulnerable older people, although there is still room for improvement.

The Interplay of Genetics, Behavior, and Pain with Depressive Symptoms in the Elderly

PURPOSE OF STUDY

About 25% of older adults suffer from depressive symptoms. Commonly studied candidate genes associated with depression include those that influence serotonin (SLC6A4), dopamine (COMT), or neuroplasticity (BDNF, NTRK3). However, the majority of candidate gene studies do not consider the interplay of genetics, demographic, clinical, and behavioral factors and how they jointly contribute to depressive symptoms among older adults. The purpose of this study was to gain a more comprehensive understanding of depressive symptoms among older adults.

DESIGN AND METHODS

In this descriptive study, demographic, behavioral, and clinical characteristics (age, gender, comorbidities, volunteering, physical activity, pain, and fear of falling) were obtained via interview of 114 residents in a continuing care retirement community. Peripheral whole blood was collected for DNA extraction. We examined common single nucleotide polymorphisms (SNPs) in the aforementioned genes using path analyses.

RESULTS

SNPs in the NTRK3 gene, pain, physical activity, and fear of falling were directly associated with depressive symptoms in older adults. Those who had polymorphisms in the NTRK3 gene, pain, fear of falling, and were less physically active were more likely to exhibit depressive symptoms. None of the SNPs in SLC6A4, COMT, or BDNF genes were significantly associated with depressive symptoms.

IMPLICATIONS

Our use of a path analysis to examine a biopsychosocial model of depressive symptoms provided the opportunity to describe a comprehensive clinical picture of older adults at risk for depressive symptoms. Thus, interventions could be implemented to identify older adults at risk for depressive symptoms.

Robot deployment in long-term care : Case study on using a mobile robot to support physiotherapy

BACKGROUND

Healthcare systems in industrialized countries face the challenge of providing care for a growing number of elderly people. Information technology has the possibility of facilitating this process by providing support for nursing staff and improving the well-being of the elderly through a variety of support systems.

OBJECTIVE

Little is known about the challenges that arise from the deployment of technology in care settings; however, the integration of technology into care is one of the core determinants of successful support. This article presents the challenges and options associated with the integration of technology into care using the example of a mobile robot to support physiotherapy for elderly people with cognitive impairment in the European project Spatio-Temporal Representations and Activities for Cognitive Control in Long-Term Scenarios (STRANDS).

RESULTS AND DISCUSSION

This article presents the technical challenges associated with the introduction of robots in the context of care as well as the perspectives of physiotherapists involved and an overview of information and experiences gained. It is hoped that this will provide useful information for the work of researchers and practitioners wishing to integrate robotic aids into the caregiving process.

A systematic review of studies investigating the care of stroke survivors in long-term care facilities

PURPOSE

The burden of stroke is immense, with approximately 30 million stroke survivors globally. Approximately one-quarter of residents in long-term care (LTC) facilities are stroke survivors. This review aims to integrate the existing knowledge from the literature and elucidate themes around the care of stroke survivors in LTC facilities.

METHOD

A systematic search was performed in PubMed, Ovid MEDLINE, the Cochrane Library and CINAHL. Articles that met the eligibility criteria were selected. Synthesis of results according to similar themes was performed.

RESULTS

A total of 1920 articles were screened for eligibility, of which 22 met the eligibility criteria. Of the 22 articles selected, five and 17 articles comprised interventional and observational studies, respectively. Three themes were identified: rehabilitation, stroke specific care and secondary stroke drug prevention. These were found to be lacking within LTC facilities. There is also a dearth of interventional studies in stroke survivors from LTC facilities.

CONCLUSIONS

The care of stroke survivors in LTC facilities is lacking in rehabilitation, stroke specific care and secondary stroke prevention. This needs to be addressed through conducting further research to build a strong body of evidence to influence change in the care of this vulnerable group of patients. Implications for Rehabilitation Care of stroke survivors in long-term care facilities Stroke survivors make up almost a quarter of residents in long-term care facilities. They suffer from functional impairments and many other disabilities as a result of more severe stroke, precluding them from living in their own homes. Rehabilitation, stroke-specific care and secondary stroke prevention for stroke survivors are lacking in long-term care facilities despite strong evidence showing benefits for these interventions in stroke survivors living in the community. Interventions to address the unmet need in stroke survivors living in long-term care facilities are vital for optimal care of this vulnerable group of patients.

Validation of an integral conceptual model of frailty in older residents of assisted living facilities

OBJECTIVE

The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities.

METHODS

Between June 2013 and May 2014 seven assisted living facilities were contacted. A total of 221 persons completed the questionnaire on life-course determinants, frailty (using the Tilburg Frailty Indicator), self-reported chronic diseases, and adverse outcomes disability, quality of life, health care utilization, and falls. Adverse outcomes were analyzed with sequential (logistic) regression analyses.

RESULTS

The integral model is partially validated. Life-course determinants and disease(s) affected only physical frailty. All three frailty domains (physical, psychological, social) together affected disability, quality of life, visits to a general practitioner, and falls. Contrary to the model, disease(s) had no effect on adverse outcomes after controlling for frailty. Life-course determinants affected adverse outcomes, with unhealthy lifestyle having consistent negative effects, and women had more disability, scored lower on physical health, and received more personal and informal care after controlling for all other predictors.

CONCLUSION

The integral model of frailty is less useful for predicting adverse outcomes of residents of assisted living facilities than for community-dwelling older persons, because these residents are much frailer and already have access to healthcare facilities.

PRACTICAL IMPLICATIONS

The present study showed that a multidimensional assessment of frailty, distinguishing three domains of frailty (physical, psychological, social), is beneficial with respect to predicting adverse outcomes in residents of assisted living facilities.

Couples' Social Careers in Assisted Living: Reconciling Individual and Shared Situations

PURPOSE OF THE STUDY

Despite important connections between relationships, health, and well-being, little is known about later-life couples' daily lives and experiences, especially those who are frail. Our aim was to advance knowledge by gaining an in-depth understanding of married and unmarried couples' intimate and social relationships in assisted living (AL) and by generating an explanatory theory.

DESIGN AND METHODS

Using Grounded Theory Methods, we build on past research and analyze qualitative data from a 3-year mixed-methods study set in eight diverse AL settings located in the state of Georgia. Data collection included participant observation and informal and formal interviews yielding information on 29 couples, 26 married and 3 unmarried.

RESULTS

Defined by their relationships with one another and those around them, couples' experiences were variable and involved a process of reconciling individual and shared situations. Analysis affirms and expands an existing typology of couples in AL. Our conceptual model illustrates the multilevel factors influencing the reconciliation process and leading to variation. Findings highlight the strengths and burdens of late-life couplehood and have implications for understanding these intimate ties beyond AL.

IMPLICATIONS

Intimate and social relationships remain significant in later life. Strategies aimed at supporting couples should focus on individual and shared situations, particularly as couples' experience physical and cognitive decline across time.

Employee influenza vaccination in residential care facilities

BACKGROUND

The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities.

METHODS

The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study's objectives.

RESULTS

Facility size, director's educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates.

CONCLUSION

Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies.