Assessing the Potential of Technology to Describe Resident and Staff Interactions in Assisted Living Facilities.

PURPOSE: Falls are a significant financial burden and health hazard for residents in assisted living facilities (ALFs). However, limited capacity to observe residents has hindered understanding of resident-staff interactions within rooms. The current study aimed to describe nurse-resident interactions using data from a remote technology combining computer vision and staff location tracking. METHOD: Eighty-three staff working at an urban ALF with 215 residents were trained at the initiation of the study. Remote surveillance devices were installed in 32 residences and staff and resident interactions were tracked over 170 days. RESULTS: Staff visited residents an average of 20.7 times per day for short durations (mean = 1.08 minutes). Urgent alert response times averaged 3.0 minutes, with faster response times through the mobile application (mean = 2.7 minutes) compared to in-person (mean = 3.3 minutes) response. CONCLUSION: By better understanding staff activity patterns in ALFs, this study has the potential to improve fall prevention and care for residents in ALFs. [Journal of Gerontological Nursing, 50(7), 7-11.].

Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises?

BACKGROUND: COVID-19 and resulting health system and policy decisions led to significant changes in healthcare use by nursing homes (NH) residents. It is unclear whether healthcare outcomes were similarly affected among older adults in assisted living (AL). This study compared hospitalization events in AL and NHs during COVID-19 pandemic waves 1 through 4, relative to historical periods. METHODS: This was a population-based, repeated cross-sectional study using linked clinical and health administrative databases (January 2018 to December 2021) for residents of all publicly subsidized AL and NH settings in Alberta, Canada. Setting-specific monthly cohorts were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. Monthly rates (per 100 person-days) of all-cause hospitalization, hospitalization with delayed discharge, and hospitalization with death were plotted and rate ratios (RR) estimated for period (pandemic wave vs historical comparison), setting (AL vs NH) and period-setting interactions, using Poisson regression with generalized estimating equations, adjusting for resident and home characteristics. RESULTS: On March 1, 2020, there were 9,485 AL and 14,319 NH residents, comparable in age (mean 81 years), sex (>60% female) and dementia prevalence (58-62%). All-cause hospitalization rates declined in both settings during waves 1 (AL: adjusted RR 0.60, 95%CI 0.51-0.71; NH: 0.74, 0.64-0.85) and 4 (AL: 0.76, 0.66-0.88; NH: 0.65, 0.56-0.75) but unlike NHs, AL rates were not significantly lower during wave 2 (and increased 27% vs NH, January 2021). Hospitalization with delayed discharge increased in NHs only (during and immediately after wave 1). Both settings showed a significant increase in hospitalization with death in wave 2, this increase was larger and persisted longer for AL. CONCLUSIONS: Pandemic-related changes in hospitalization events differed for AL and NH residents and by wave, suggesting unique system and setting factors driving healthcare use and outcomes in these settings in response to this external stress.

Using the TrueLoo Smart Device to Record Toileting Sessions in Older Adults: Retrospective Validation and Acceptance Study.

BACKGROUND: Because of the relationship between independent living and activities of daily living, care teams spend significant time managing assisted living residents' toileting problems. Recently, the TrueLoo was developed as a connected toilet seat to automatically log and monitor toileting sessions. OBJECTIVE: This study aimed to demonstrate the validity of the TrueLoo to (1) record and identify toileting sessions with regard to stool and urine events; (2) compare the results with the person-reported, standard-of-care methods; and (3) establish metrics of user acceptability and ease of use in a assisted living facility population. METHODS: We used two phases: (1) initial development of the TrueLoo algorithms to accurately identify urine and stool events and (2) evaluation of the algorithms against person-reported, standard-of-care methods commonly used in assisted living facilities. Phase 2 analyzed data over a 3-day period from 52 devices. Participants' age ranged from 63 to 101 (mean 84, SD 9.35) years. Acceptability and ease-of-use data were also collected. RESULTS: Regarding the development of the TrueLoo algorithm for urine assessment, sensitivity and specificity of 96% and 85% were observed when evaluating a gold-standard labeled data set, respectively (F1-score=0.95). For stool, sensitivity and specificity of 90% and 79% were observed, respectively (F1-score=0.85). Regarding the TrueLoo algorithm in assisted living settings, classification performance statistics for urine assessment revealed sensitivity and specificity of 84% and 94%, respectively (F1-score=0.90), and for stool, 92% and 98%, respectively (F1-score=0.91). Throughout the study, 46 person-reported instances of urine were documented, compared with 630 recorded by the TrueLoo. For stool events, 116 person-reported events were reported, compared with 153 by the TrueLoo. This indicates that person-reported events were captured 7% (46/630) of the time for urine and 76% (116/153) of the time for stool. Overall, 45% (32/71) of participants said that the new toilet seat was better than their previous one, 84% (60/71) reported that using the TrueLoo was easy, and 99% (69/71) said that they believed the system could help aging adults. Over 98% (69/71) of participants reported that they would find alerts related to their health valuable and would be willing to share this information with their doctor. When asked about sharing information with caregivers, 66% (46/71) reported that they would prefer the TrueLoo to send information and alerts to their caregiver, as opposed to the participant having to personally communicate those details. CONCLUSIONS: The TrueLoo accurately recorded toileting sessions compared with standard-of-care methods, successfully establishing metrics of user acceptability and ease of use in assisted living populations. While additional validation studies are warranted, data presented in this paper support the use of the TrueLoo in assisted living settings as a model of event monitoring during toileting.

Excess Deaths in Assisted Living and Nursing Homes during the COVID-19 Pandemic in Alberta, Canada.

OBJECTIVES: Assisted living (AL) is a significant and growing congregate care option for vulnerable older adults designed to reduce the use of nursing homes (NHs). However, work on excess mortality in congregate care during the COVID-19 pandemic has primarily focused on NHs with only a few US studies examining AL. The objective of this study was to assess excess mortality among AL and NH residents with and without dementia or significant cognitive impairment in Alberta, Canada, during the first 2 years of the COVID-19 pandemic, relative to the 3 years before. DESIGN: Population-based, retrospective cohort study. SETTING AND PARTICIPANTS: Residents who lived in an AL or NH facility operated or contracted by the Provincial health care system to provide publicly funded care in Alberta between January 1, 2017, and December 31, 2021. METHODS: We used administrative health care data, including Resident Assessment Instrument - Home Care (RAI-HC, AL) and Minimum Data Set 2.0 (RAI-MDS 2.0, NHs) records, linked with data on residents' vital statistics, COVID-19 testing, emergency room registrations, and hospital stays. The outcome was excess deaths during COVID-19 (ie, the number of deaths beyond that expected based on pre-pandemic data), estimated, using overdispersed Poisson generalized linear models. RESULTS: Overall, the risk of excess mortality [adjusted incidence rate ratio (95% confidence interval)] was higher in ALs than in NHs [1.20 (1.14-1.26) vs 1.10 (1.07-1.13)]. Weekly peaks in excess deaths coincided with COVID-19 pandemic waves and were higher among those with diagnosed dementia or significant cognitive impairment in both, AL and NHs. CONCLUSIONS AND IMPLICATIONS: Finding excess mortality within both AL and NH facilities should lead to greater focus on infection prevention and control measures across all forms of congregate housing for vulnerable older adults. The specific needs of residents with dementia in particular will have to be addressed.

Know the resident: Unlocking value and positive outcomes in assisted living nursing.

None.

Does Assisted Living Provide Assistance And Promote Living?

Assisted living has promised assistance and quality of living to older adults for more than eighty years. It is the largest residential provider of long-term care in the United States, serving more than 918,000 older adults as of 2018. As assisted living has evolved, the needs of residents have become more challenging; staffing shortages have worsened; regulations have become complex; the need for consumer support, education, and advocacy has grown; and financing and accessibility have become insufficient. Together, these factors have limited the extent to which today's assisted living adequately provides assistance and promotes living, with negative consequences for aging in place and well-being. This Commentary provides recommendations in four areas to help assisted living meet its promise: workforce; regulations and government; consumer needs and roles; and financing and accessibility. Policies that may be helpful include those that would increase staffing and boost wages and training; establish staffing standards with appropriate skill mix; promulgate state regulations that enable greater use of third-party services; encourage uniform data reporting; provide funds supporting family involvement; make community disclosure statements more accessible; and offer owners and operators incentives to facilitate access for consumers with fewer resources. Attention to these and other recommendations may help assisted living live up to its name.

Attitudes towards Technology: Insights on Rarely Discussed Influences on Older Adults' Willingness to Adopt Active Assisted Living (AAL).

BACKGROUND: European research policy promotes active assisted living (AAL) to alleviate costs and reach new markets. The main argument for massive investments in AAL is its potential to raise older adults' Quality of Life and enhance their freedom, autonomy, mobility, social integration, and communication. However, AAL is less widely spread in older adults' households than expected. RESEARCH AIM: We investigate how the variable "technology acceptance" is connected to socio-economic-, social, health, "personal attitude towards ageing", and "Quality of life" variables. METHOD: We conducted a study in Vienna between 2018 and 2020, questioning 245 older adults (M = 74, SD = 6.654) living in private homes. We calculated multivariate models regressing technology acceptance on the various exploratory and confounding variables. RESULTS: Experiencing an event that made the person perceive their age differently changed the attitude towards using an assistive technological system. Participants perceived technology that is directly associated with another human being (e.g., the use of technology to communicate with a physician) more positively. CONCLUSION: Older adults' attitudes towards technology may change throughout their lives. Using major events in life as potential entry points for technology requires awareness to avoid reducing the lives of older adults to these events. Secondly, a certain human preference for "human technology" may facilitate abuse if technology is given a white coat, two eyes, a nose, and a mouth that may falsely be associated with a natural person. This aspect raises the ethical issue of accurate information as a significant precondition for informed consent.

Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living.

Importance: Resident-to-resident aggression in assisted living facilities can result in physical and psychological harm, but its prevalence is unknown. Objective: To estimate the prevalence of resident-to-resident aggression, including physical, verbal, and sexual, among residents in assisted living facilities. Design, Setting, and Participants: This study used cross-sectional, observational data from a clinical trial, in which residents of assisted living facilities were monitored for events over a 1-month period. All residents of 14 large facilities randomly selected from 2 geographic locations (N = 1067), except those receiving hospice care (n = 11), were invited to participate; 93 died or moved prior to enrollment. There were 33 family and resident refusals; 930 residents were enrolled. Data were collected between May 30, 2018, and August 11, 2022. Main Outcomes and Measures: The data are from a clinical trial testing the effectiveness of an intervention to reduce resident-to-resident aggression. In addition, the study was designed to assess prevalence using the Time 1 (baseline) data, using a probability sample of facilities to allow for this analysis. Resident-to-resident aggression was identified using a mixed-method, case-finding strategy involving 6 sources: (1) cognitively capable resident reports regarding 22 possible events, (2) direct care staff report, (3) staff member reports collected from event-reporting forms, (4) research assistant observation of events in real time, (5) facility accident or incident reports, and (6) resident records. Results: The prevalence of resident-to-resident aggression among the 930 participants (mean [SD] age, 88.0 [7.2] years; 738 women [79.4%]) during the past month was estimated to be 15.2% (141 of 930 residents; 95% CI, 12.1%-18.8%). The most common forms of aggression included verbal (11.2% [104 of 930 residents; 95% CI, 8.8%-14.2%]), physical (41 of 930 residents; 4.4% [95% CI, 3.1%-6.3%]), sexual (0.8% [7 of 930 residents; 95% CI, 0.4%-1.6%]), and other (70 of 930 residents; 7.5% [95% CI, 5.5%-10.2%]). These categories are not mutually exclusive as residents could be involved with more than 1 type of aggressive behavior. Conclusions and Relevance: In this cross-sectional, observational prevalence study, resident-to-resident aggression in assisted living facilities was highly prevalent. Verbal aggression was the most common form, and physical aggression also occurred frequently. The effects of resident-to-resident aggression can be both morbid and mortal; therefore, intervention research is needed to prevent it and to treat it when it occurs.

Assisted living residents with dementia: Disparities in mental health services pre and during COVID-19.

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

Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement.

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

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022.

CONTEXT: Assisted living facility (ALF) residents are especially vulnerable to SARS-CoV-2 infection due to the age and comorbidities of the resident population and the social nature of these facilities. OBJECTIVE: To collate all New York State Department of Health guidance and regulations to control transmission of SARS-CoV-2 infection within ALFs from March 2020 through December 2022 and to include US Food and Drug Administration COVID-19 testing and vaccine authorizations. DESIGN: A narrative chronological review of all New York State Department of Health guidance. RESULTS: Documents and associated guidance and regulations are divided into 4 sections: (1) lockdown until COVID-19 vaccine emergency use authorization; (2) COVID-19 vaccine authorization until phased reopening; (3) phased reopening, vaccination requirements, and booster vaccination; (4) the period of the bivalent booster. CONCLUSION: Controlling the spread of SARS-CoV-2 within ALFs required a multifactorial approach that included stringent infection control measures, testing, and vaccination and careful attention to the social structure and support systems within ALFs. The SARS-CoV-2 pandemic highlighted the complexity of controlling spread of an easily transmissible respiratory pathogen in assisted living communities and the need to structure infection control programs within the diverse ALFs that provide care for our aging population.

Do-Not-Hospitalize Orders in Assisted Living Facilities: Direct Care Workers' Perspectives.

PURPOSE: To gather sufficient qualitative data to create an intervention that would prevent direct care workers (DCWs) from sending residents with do-not-hospitalize (DNH) orders to the hospital. METHOD: This was a qualitative study with eight participants that included a descriptive survey followed by semi-structured interviews. RESULTS: DCWs were unfamiliar with DNH orders and their thinking on end-of-life care was binary (hospice or hospital) and protocol driven. However, supportive leaders were able to help DCWs problem-solve these complicated scenarios. Results were mixed on whether having a RN on site was helpful. CONCLUSION: DCWs may benefit from having access to a nurse with palliative care experience when making decisions about residents with DNH orders. [Journal of Gerontological Nursing, 50(4), 11-15.].

Evacuation and Health Care Outcomes Among Assisted Living Residents After Hurricane Irma.

Importance: Evacuation has been found to be associated with adverse outcomes among nursing home residents during hurricanes, but the outcomes for assisted living (AL) residents remain unknown. Objective: To examine the association between evacuation and health care outcomes (ie, emergency department visits, hospitalizations, mortality, and nursing home visits) among Florida AL residents exposed to Hurricane Irma. Design, Setting, and Participants: Retrospective cohort study using 2017 Medicare claims data. Participants were a cohort of Florida AL residents who were aged 65 years or older, enrolled in Medicare fee-for-service, and resided in 9-digit zip codes corresponding to US assisted living communities with 25 or more beds on September 10, 2017, the day of Hurricane Irma's landfall. Propensity score matching was used to match evacuated residents to those that sheltered-in-place based on resident and AL characteristics. Data were analyzed from September 2022 to February 2024. Exposure: Whether the AL community evacuated or sheltered-in-place before Hurricane Irma made landfall. Main Outcomes and Measures: Thirty- and 90-day emergency department visits, hospitalizations, mortality, and nursing home admissions. Results: The study cohort included 25 130 Florida AL residents (mean [SD] age 81 [9] years); 3402 (13.5%) evacuated and 21 728 (86.5%) did not evacuate. The evacuated group had 2223 women (65.3%), and the group that sheltered-in-place had 14 556 women (67.0%). In the evacuated group, 42 residents (1.2%) were Black, 93 (2.7%) were Hispanic, and 3225 (94.8%) were White. In the group that sheltered in place, 490 residents (2.3%) were Black, 707 (3.3%) were Hispanic, and 20 212 (93.0%) were White. After 1:4 propensity score matching, when compared with sheltering-in-place, evacuation was associated with a 16% greater odds of emergency department visits (adjusted odds ratio [AOR], 1.16; 95% CI, 1.01-1.33; P = .04) and 51% greater odds of nursing home visits (AOR, 1.51; 95% CI, 1.14-2.00; P = .01) within 30 days of Hurricane Irma's landfall. Hospitalization and mortality did not vary significantly by evacuation status within 30 or 90 days after the landfall date. Conclusions and Relevance: In this cohort study of Florida AL residents, there was an increased risk of nursing home and emergency department visits within 30 days of Hurricane Irma's landfall among residents from communities that evacuated before the storm when compared with residents from communities that sheltered-in-place. The stress and disruption caused by evacuation may yield poorer immediate health outcomes after a major storm for AL residents. Therefore, the potential benefits and harms of evacuating vs sheltering-in-place must be carefully considered when developing emergency planning and response.

Recommendations for Next Steps in Our Understanding of Use of Antipsychotics Among Older People in the Post-Acute Long-Term Care Environments: Article 3 of 3.

This article is the third installment of a multi-part series on the history and usage of antipsychotics in older people living in nursing and assisted living facilities. This article presents next steps and recommendations for appropriate usage of antipsychotics in the older population based on the lead author's early drafts, submitted to the editors prior to his untimely death, of this series and on his consultations with the coauthors. Dr Levenson emphasized in his focus on next steps related to antipsychotic use: that all providers should review the history of antipsychotic use and recognize clinically legitimate alternative explanations for the findings. His conclusions were that "off label" usage should not be a reason to exclude the appropriate use of antipsychotics. His overall recommendations to clinicians are to assess and diagnose the underlying cause of the problem, understand the treatment options and select the best one to address the clinical problem and/or the symptom if the problem cannot be fully resolved, and to focus on all medications, not just antipsychotics, in a patient's regimen to aid in a comprehensive understanding of the assessment and inform therapeutic recommendations.

Quality of life in assisted living facilities for seniors: A descriptive exploratory study.

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

Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account.

IMPORTANCE: Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care. OBJECTIVE: To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures. DESIGN: Cross-sectional online survey with descriptive data. PARTICIPANTS: Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media. RESULTS: Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not. CONCLUSIONS AND RELEVANCE: Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.

'My pet can't come with me': Pets as a barrier against moving into supported accommodation.

OBJECTIVE: To determine the impact of pet ownership on older people's decision to move to supported accommodation. METHODS: Online survey. RESULTS: Older Australians who were current or past pet owners were invited to complete an online survey, with 193 participants providing valid data. Almost two-thirds of the respondents who said they did not intend to move in the foreseeable future (n = 85) said their pet was an important reason. When asked to rate which factors would be hardest to come to terms with if they had to move because they needed more assistance in future, three groups emerged: the first group (37%) thought the impact on their pet of moving would not be difficult and the pet was not an important reason for staying in their current home. The second group (36%) were the opposite; they believed there would be a negative impact on their pet if they moved and the pet was an important reason for them to stay. The final group (27%) thought their pet was not an important reason to stay in their current location but if they did have to move, the impact on the pet would be quite difficult. No one fell into the category of identifying that their pet was an important reason to stay but having to move would have no impact on the animal. CONCLUSIONS: Many older people think about their pets when making a decision to move house, including considering whether a move to supported accommodation will be difficult for their pet. A perceived absence of pet-friendly supported accommodation may be contributing to sub-optimal decision-making by older people.

The Moral and Gender Implications of Measures Used to Modulate the Mobility of People With Dementia Living in Residential Care Environments: A Scoping Review.

BACKGROUND AND OBJECTIVES: Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can violate human rights and affect the quality of life. This review aims to summarize the literature on what is known about measures used to modulate the life-space mobility of residents with dementia living in a residential care environment. Furthermore, moral and sex and gender considerations were explored. RESEARCH DESIGN AND METHODS: A scoping review framework was referenced to summarize the literature. A total of 5 databases were searched: PubMed, Embase, CINAHL, SCOPUS, and Web of Science. The studies for eligibility using the Rayyan screening tool. RESULTS: A total of 30 articles met the inclusion criteria. A narrative description of the findings of the articles is presented across 3 themes: (1) measures and strategies used to modulate the life-space mobility; (2) moral aspects; and (3) sex and gender considerations. DISCUSSION AND IMPLICATIONS: Various measures are used to modulate the life-space mobility of people with dementia living in residential care facilities. Research exploring the sex and gender differences of people with dementia is lacking. With a focus on human rights and quality of life, measures used to restrict or support mobility must support the diverse needs, capacity, and dignity of people with dementia. Noting the capacity and diversity of people with dementia will require society and public space to adopt strategies that promote safety and mobility to support the quality of life of people with dementia.

[The relationship between participation and space in residential care facilities for older people]. / Das Verhältnis von Partizipation und Raum in stationären Altenhilfeeinrichtungen.

BACKGROUND: Participation has been a key issue in gerontology, geriatric care policy and practice for several years now. The relationship between participation and space plays a role in the discussion about community orientation. So far, little attention has been paid to the relationship between participation and space within residential care facilities for older people. MATERIAL AND METHODS: Qualitative data from two studies on residential care facilities for older people were secondarily analyzed by a "supra-analysis" and using qualitative content analysis with respect to participation in relation to space and space in relation to participation. RESULTS: Almost all levels of the participation ladder considered can be found with respect to the co-design of spaces, although residents with dementia are granted fewer opportunities for participation. In addition, spaces can create conditions for participation through their arrangement. Reciprocal relationships are condensed in processes of space appropriation, design and planning. If there is no access to these processes, self-determined everyday life is limited. CONCLUSION: The results contribute to a spatially related development of participation concepts because they show in which spatial contexts participation is produced in institutional settings through the interaction of different actors and how it is distributed spatially. In order to promote participation in institutions, it is important to reflect on existing possibilities for spatial appropriation, design and planning against the background of institutional framework conditions.