Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: Analysis from 106 nursing homes in 12 Asia-Pacific and European countries.

PURPOSE: There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty. METHODS: Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0-2 (non-frail), 3-6 (frail) and 7-14 (most-frail). Data were analyzed using descriptive statistics. RESULTS: Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %). CONCLUSIONS: One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.

Assessment of Quality of Life for Elderly Residents: A Cross Sectional Study in Nursing Home Settings / Evaluación de la calidad de vida de los residentes de edad avanzada: un estudio transversal en entornos de hogares de ancianos

Abstract Objective: We aim to assess the quality of life of older individuals living in nursing homes. Methodology: A descriptive cross-sectional study was conducted on institutionalized elderly individuals for over three months. The sample size of the study was 260 and Non-randomized convenience sampling was used. The study excluded participants with cognitive impairment, severe medical conditions, physical limitations, communication barriers, severe pain, recent surgery, acute illness, or psychiatric disorders. Ethical approval was obtained, and participants were given informed consent. The study took place in various nursing homes in Lahore in June and July 2023, for the analysis of data Statistical Package for Social Sciences (SPSS version 22) was used, employing frequency distribution, mean, standard deviation, and correlation. Results: The Pearson Correlation coefficient of 0.459 suggests a significant positive correlation between these variables (p < 0.01). This correlation is evident in both directions: Quality of life (QoL) score to Mini Mental Scale and vice versa. Conclusion: While assessing the QoL in elderly inhabitants of nursing residences, cognitive impairment, and high Body mass index (BMI) appeared to influence the overall QoL.

Resumen Objetivo: Nuestro objetivo es evaluar la calidad de vida de las personas mayores que viven en residencias de ancianos. Metodología: Se realizó un estudio descriptivo transversal en ancianos institucionalizados durante más de tres meses. El tamaño de la muestra del estudio fue de 260 y se utilizó un muestreo de conveniencia no aleatorizado. El estudio excluyó a los participantes con deterioro cognitivo, afecciones médicas graves, limitaciones físicas, barreras de comunicación, dolor intenso, cirugía reciente, enfermedad aguda o trastornos psiquiátricos. Se obtuvo la aprobación ética y los participantes dieron su consentimiento informado. El estudio se llevó a cabo en varias residencias de ancianos de Lahore en junio y julio de 2023. Para el análisis de los datos se utilizó Statistical Package for Social Sciences (SPSS versión 22), empleando distribución de frecuencias, media, desviación estándar y correlación. Resultados: El coeficiente de correlación de Pearson de 0,459 sugiere una correlación positiva significativa entre estas variables (p < 0,01). Esta correlación es evidente en ambas direcciones: puntuación de calidad de vida a Escala Mini-Mental y viceversa. Conclusión: Al evaluar la calidad de vida de los ancianos que viven en residencias, el deterioro cognitivo y un índice de masa corporal (IMC) elevado parecen afectar la calidad de vida general.

A Longitudinal Examination of Post-COVID-19 Mortality in Residents in Long-Term Care Homes.

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.

Extensivist: improving the delivery of enhanced health in older people's care homes.

BACKGROUND: Older people living in care homes are often frail and clinically complex. The Enhanced Health in Care Homes (EHCH) framework supports organisational and clinical strategies to deliver good care, promoting proactive person-centred care by whole system collaboration. We evaluate the impact of a new role, the Extensivist, in the delivery of EHCH for older people living in care homes. AIMS: To evaluate implementation processes and the clinical utility of the Extensivist in older people care homes in the London borough of Southwark. METHODS: The Extensivist (Band 8a Advanced Nurse Specialist skilled in frail older people) was embedded within the care home general practitioners (GP) service for a 2-year pilot (2019-2021). Implementation processes were evaluated. Impact of the Extensivist role was evaluated by the number of Comprehensive Geriatric Assessment (CGA) completed, interventions and other clinical activity performed as well as qualitative case studies and semistructured feedback from care home workers and professionals. RESULTS: The Extensivist feasibly delivered CGA and implemented intervention plans. The role iteratively developed to support wider aspects of care including advance care planning (ACP) and training. Challenges included building trust, the time-consuming nature of CGA, ACP and coordinated communication. Case studies and semistructured feedback indicated the role was considered valuable in the delivery of clinical care, supporting residents, families, care homes and GPs and as a resource for education for care home workers. CONCLUSIONS: The Extensivist is a valuable resource and a linchpin in the delivery of EHCH framework in care homes for older adults in Southwark. Further evaluations to assess reproducibility in other areas of the UK are warranted.

Association between delayed outbreak identification and SARS-CoV-2 infection and mortality among long-term care home residents, Ontario, Canada, March to November 2020: a cohort study.

BackgroundLate outbreak identification is a common risk factor mentioned in case reports of large respiratory infection outbreaks in long-term care (LTC) homes.AimTo systematically measure the association between late SARS-CoV-2 outbreak identification and secondary SARS-CoV-2 infection and mortality in residents of LTC homes.MethodsWe studied SARS-CoV-2 outbreaks across LTC homes in Ontario, Canada from March to November 2020, before the COVID-19 vaccine rollout. Our exposure (late outbreak identification) was based on cumulative infection pressure (the number of infectious resident-days) on the outbreak identification date (early: ≤ 2 infectious resident-days, late: ≥ 3 infectious resident-days), where the infectious window was -2 to +8 days around onset. Our outcome consisted of 30-day incidence of secondary infection and mortality, based on the proportion of at-risk residents with a laboratory-confirmed SARS-CoV-2 infection with onset within 30 days of the outbreak identification date.ResultsWe identified 632 SARS-CoV-2 outbreaks across 623 LTC homes. Of these, 36.4% (230/632) outbreaks were identified late. Outbreaks identified late had more secondary infections (10.3%; 4,437/42,953) and higher mortality (3.2%; 1,374/42,953) compared with outbreaks identified early (infections: 3.3%; 2,015/61,714; p < 0.001, mortality: 0.9%; 579/61,714; p < 0.001). After adjustment for 12 LTC home covariates, the incidence of secondary infections in outbreaks identified late was 2.90-fold larger than that of outbreaks identified early (OR: 2.90; 95% CI: 2.04-4.13).ConclusionsThe timeliness of outbreak identification could be used to predict the trajectory of an outbreak, plan outbreak measures and retrospectively provide feedback for quality improvement, with the objective of reducing the impacts of respiratory infections in LTC home residents.

Nursing home leader response during COVID-19: a qualitative descriptive study about use of external resources during the pandemic.

BACKGROUND: US nursing homes were ground zero for COVID-19 and nursing home leaders faced multiple challenges to keep residents and staff safe. Understanding the leader's role and their use of external resources to rapidly respond to the pandemic is important to better prepare for the next infectious disease outbreak emergency. The purpose of this study is to describe Missouri nursing home leaders' use of external resources to manage challenges encountered during the pandemic. METHODS: This qualitative descriptive study uses data from semi-structured interviews conducted with leaders from 24 Midwestern nursing homes between March 2022 and March 2023. Interviews were transcribed verbatim and analyzed using Dedoose software. Directed content analysis, guided by Donabedian's Structure, Process, Outcome framework, was used for analysis. Interviews were conducted as part of a larger mixed-methods study focused on developing knowledge and recommendations to improve US nursing homes' capacity to respond to infectious disease outbreaks. RESULTS: Forty-three interviews were conducted across the 24 homes. Participants included administrators (n = 24), nurse leaders (n = 19), and infection preventionists (n = 16). Six sub-categories of external resources/support were used by leaders to manage challenges during the pandemic:1) corporate support and communications, 2) statewide resources, 3) community-based resources, 4) health care coalitions focused on emergency response planning, 5) existing affiliations with local organizations i.e., hospitals, and 6) community members and families. Corporate support was a primary resource; however, it was limited to chain-based homes. Leaders from standalone homes seemed most reliant on statewide agencies, existing affiliations, and other community-based resources due to their lack of corporate connections. Health care coalitions were few, but when available, helped nursing homes prepare for the pandemic onset. Family and community members were vital despite being off-site from nursing homes at the pandemic onset. CONCLUSION: Leaders played a pivotal role in accessing and using external resources to manage challenges during the pandemic. Statewide and community-based agencies and existing affiliations were particularly critical for standalone homes who otherwise had little to no means of support. Federal, state and local agencies must consider opportunities to build multi-agency regional collaborations, local health care coalitions and community-based partnerships that include nursing homes as member. Finally, community members and family were important in providing support, thus closing visitation is a double-edged sword that needs careful, future consideration.

Modified Oral Health Assessment Tool (M-OHAT) for Residential Aged Care: A Co-Design Protocol.

Background: Older adults in residential aged care facilities (RACFs) experience disproportionate levels of poor oral health relative to other groups in the general population, affecting their physical and mental wellbeing. The Oral Health Assessment Tool (OHAT) is a validated and widely used dental assessment tool; however, recent systematic reviews have identified shortcomings with respect to its measurement properties. Objective: The objective of this protocol is to provide a detailed overview of a multidisciplinary qualitative study that aims to (a) co-design and develop a modified OHAT for RACFs and (b) inform the development of an OHAT training package and implementation strategies. Methods: This study will utilize a co-design methodology with aged care residents, caregivers, staff members, and health professionals. The co-design workshops will: (1) investigate the barriers to and enablers of optimal oral healthcare in RACFs; and (2) co-design a modified version of the Oral Health Assessment Tool and a referral to treatment pathway that is appropriate for use in RACFs. The co-design workshops will facilitate group discussion and involve interactive activities using, for example, mind mapping and Sticky Notes. Qualitative data (transcripts and artefacts from co-design activities) will be analyzed in NVivo using an inductive codebook thematic analysis, specifically a template analysis. Conclusion: The findings of this study will inform a modified OHAT (M-OHAT), as well as future study phases regarding training and implementation strategies. It is expected that the M-OHAT will have enhanced usability and relevance to RACFs, facilitating the identification of poor oral health and timely referral to dental treatment.

Generating and translating evidence for safe and effective medication management in aged care homes.

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.

Cycle Threshold Values of SARS-CoV-2 RT-PCR during Outbreaks in Nursing Homes: A Retrospective Cohort Study.

Backgound/Objectives: Cycle threshold (Ct) values of SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) tests are associated with infectivity and viral load, and they could be an aid in forecasting the evolution of SARS-CoV-2 outbreaks. The objective was to know the Ct values related to the incidence and reinfection of SARS-CoV-2 in successive outbreaks, which took place in nursing homes in Castellon (Spain) during 2020-2022, and to test its usefulness as an instrument of epidemic surveillance in nursing homes. METHODS: a retrospective cohort design with Poisson regression and multinomial logistic regression were used. RESULTS: We studied four nursing home SARS-CoV-2 outbreaks, and the average infection rate, reinfection rate, and case fatality were 72.7%, 19.9%, and 5.5%, respectively; 98.9% of residents were vaccinated with three doses of a mRNA SARS-CoV-2 vaccine. Ct values for first infections and reinfections were 27.1 ± 6.6 and 31.9 ± 5.4 (p = 0.000). Considering Ct values ≥ 30 versus <30, residents with reinfections had Ct values higher than residents with a first infection, an adjusted relative risk of 1.66 (95% Confidence interval 1.10-2.51). A sensitivity analysis confirmed these results. CONCLUSIONS: Reinfection and SARS-CoV-2 vaccination (hybrid immunity) could protect against severe disease better than vaccination alone. High Ct values suggest lower transmission and severity. Its value can be useful for surveillance and forecasting future SARS-CoV-2 epidemics.

Ownership Matters: Not-for-Profit Chain Nursing Homes Have Higher Utilization of Agency Nursing Staff.

Nursing homes (NHs) have long struggled with nurse shortages, leading to a greater reliance on agency nurses. The purpose of this study was to examine the impact of NH ownership on agency nurse utilization. Data were derived from multiple sources, including the Payroll-Based Journal and NH Five-Star Facility Quality Reporting System (n: 38,550 years: 2020-2022). A 2-part logistic regression model with 2-way fixed effects (state and year) was used to assess the association of ownership and agency nurse utilization. Model 1 compared facilities with and without agency nurse use, while Model 2 focused on NHs using agency nurses, examining high utilization (top 10%). The dependent variables were agency nurse utilization ratios for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs). The primary independent variable was ownership/chain affiliation: for-profit chain (FPC), for-profit independent (FPI), not-for-profit chain (NFPC), and not-for-profit independent (NFPI). Model 1 showed that NFPC facilities had higher odds of using agency RNs (OR = 1.65), LPNs (OR = 1.53), and CNAs (OR = 1.38) compared to NFPI facilities (all P < .001), while FPC facilities also had increased odds for RNs (OR = 1.43), LPNs (OR = 1.30), and CNAs (OR = 1.15) (all P < .001). Model 2 indicated that NFPC, FPC, and FPI facilities were more likely to be high utilizers (top 10%) of agency nurses, with NFPC facilities having the highest odds across all categories. Pairwise comparisons showed that NFPC had the highest utilization of agency RNs and LPNs compared to other ownership groups. These results highlight the significant impact of NH ownership on staffing practices, suggesting that ownership type influences agency nurse utilization.

Insights into the associated risk factors of malnutrition among nursing home residents: A longitudinal study.

BACKGROUND & AIMS: Malnutrition often remains undetected in older persons, leading to increased health problems and comorbidity, prolonged hospital stays and readmissions. In 2020, data from the interRAI Home Care (interRAI HC) instrument was used to determine malnutrition status according to some of the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The interRAI HC instrument showed to be effective as a screening tool for the risk of malnutrition. The goal of the present study is to use the interRAI Long Term Care Facilities (interRAI LTCF) instrument for nursing home residents to identify factors related to older people's health that are significantly associated with the development of malnutrition. METHODS: This study analyzes data collected in the period 2019-2023 from nursing home residents, 65 or older, with a follow-up period of 1 year. After applying the GLIM criteria to the available interRAI LTCF data, a cross-sectional sample a longitudinal sample were analyzed by means of bivariate analysis. Factors included in the bivariate analysis were based in previous studies and expert opinion. Unadjusted and adjusted regression models were built to explore associations between several potential risk factors and nutritional status. RESULTS: The sample consisted of 5598 older people with a mean age of 83.98 ± 7.30 years old and 71.2 % being female. Most people needed extensive assistance with activities of daily living (70.9%) and had at least a mild cognitive impairment (63.9%). According to the GLIM definition using the interRAI items, 8.43% of the residents were malnourished and 4.67% of the residents became malnourished over the period of 1 year. The final adjusted logistic regression yielded significant odds ratios for seven determinants: age (O.R. 1.03; C.I.: 1.01; 1.04), depressive symptoms (O.R.: 1.32; 1.01; 1.73), assistance needed for walking (O.R. 1.49; C.I.: 1.13; 1.95), wandering behavior (O.R. 1.16; C.I.: 1.01; 1.33), falls (O.R. 1.17; C.I.: 1.02; 1.35), visual impairment (O.R. 1.22; C.I.: 1.05; 1.42) and diabetes (protective factor - O.R.: 0.67; C.I.: 0.46; 0.98). CONCLUSIONS: The study showed the main risk factor for malnourishment in nursing home residents, such as age, depressions, assistance for walking, wandering and visual impairment. These significant factors can be used to identify people at risk of malnourishment. Periodically screening residents with the interRAI LTCF can help identify malnourished residents or residents at risk of malnourishment.

Systematic review in relation to support of diversity in nursing homes.

Introduction: Given the increasing global population of older adults, it is essential and inevitable that healthcare centers and nursing homes address and accommodate diversity in their support systems as interventions for healthy aging. The active aging and the inclusion of all people regardless of their religion, origin, and/or sexual orientation is essential to create a climate of safety. Discrimination must be addressed from all angles, at the social level, at the business level and by all workers in nursing homes. Methodology and results: This study provides a comprehensive review of existing literature to systematize information on diversity among older adults in healthcare centers and nursing homes. Out of 1.458 articles identified, 10 were analyzed in depth, revealing that addressing diversity among older adults is crucial to overall mental and physical healthy aging. The findings underscore the need for a multidisciplinary approach and effective management through the Person-Centered Care Model (PCCM). Discussion and conclusion: This study highlights the critical role of the Person-Centered Care Model (PCCM) in addressing diversity in aging needs. It highlights the necessity of tailoring care based on individual life histories and experiences. Additionally, it calls for the implementation of inclusive policies in nursing homes and emphasizes the need for professional training on diversity to ensure these facilities are safe and supportive for all residents.

Prediction of Social Engagement in Long-Term Care Homes by Sex: A Population-Based Analysis Using Machine Learning.

The objective of this study was to use population-based clinical assessment data to build and evaluate machine-learning models for predicting social engagement among female and male residents of long-term care (LTC) homes. Routine clinical assessments from 203,970 unique residents in 647 LTC homes in Ontario, Canada, collected between April 1, 2010, and March 31, 2020, were used to build predictive models for the Index of Social Engagement (ISE) using a data-driven machine-learning approach. General and sex-specific models were built to predict the ISE. The models showed a moderate prediction ability, with random forest emerging as the optimal model. Mean absolute errors were 0.71 and 0.73 in females and males, respectively, using general models and 0.69 and 0.73 using sex-specific models. Variables most highly correlated with the ISE, including activity pursuits, cognition, and physical health and functioning, differed little by sex. Factors associated with social engagement were similar in female and male residents.

Enhancing social interaction in nursing homes through public tabletop displays: A field study of R2S.

The prevalence of social isolation among nursing home residents highlights the need for innovative solutions to enhance their social interactions and wellbeing. Despite extensive efforts over recent decades to develop in-room systems or public applications under caregivers' supervision, there remains a gap in designing public social technologies that can be integrated into residents' daily lives. Furthermore, the challenges associated with low adoption and the complexities of evaluating such technologies in public care settings have limited our understanding of their impact on residents' social activities and experiences. To address this, our study introduces R2S, a tabletop display system designed to encourage older adults to view, share, and discuss news articles collaboratively in public care environments. A 6-week field trial was conducted in a Dutch care home to investigate the influence on residents' daily social activities, R2S's utilization, and residents' perceived user experiences and social emotions. The results reveal that R2S can generally promote daily social interactions among residents, even altering their long-established social habits. Five usage patterns of social technologies within public care environments were identified to provide insights into designing systems in comparable contexts. The participants reported a highly positive user experience with the system. Although their affective social benefits were not significant, they substantially outweighed the affective costs. These findings not only deepen the understanding of how technology can enhance social interaction in public care settings but also provide insights to inform the design and implementation of related technologies in the future.

Feasibility of Implementing Dementia Collaborative Coaching into Routine Care in Nursing Homes.

OBJECTIVES: The study evaluated the feasibility of implementing Dementia Collaborative Coaching (DCC) into the routine workflow of speech-language pathologists (SLPs) working in nursing homes (NHs). DCC is an intervention delivered by SLPs to train nursing assistants (CNAs) in communication strategies to support people living with dementia (PLWD). METHODS: We assessed the feasibility of identifying eligible PLWD; estimated intervention fidelity; evaluated suitability of outcome measures; and determined the preliminary impact on behavioral and psychological symptoms of distress (BPSD) among PLWD. SLPs completed a semi-structured interview to collect further acceptability data. RESULTS: Four SLPs in four NHs completed DCC with 10 CNAs and 15 eligible PLWD that they appropriately identified from their caseloads. SLPs conducted 90 DCC sessions with 64% fidelity and billed Medicare for all sessions. The outcome measure of Minimum Data Set item E0200B: Rejection of Care did not vary enough to be useful, but positive changes were noted on the Cohen-Mansfield Agitation Inventory, t(14) = 10.51, p < .001, Cohen's d = 2.76. Interviews further indicated feasibility. CONCLUSIONS: It is feasible to implement DCC into the workflow of SLPs in NHs. CLINICAL IMPLICATIONS: Given the feasibility and preliminary positive impacts, SLPs could consider implementing DCC in routine care.

Association Between Nursing Home Five-Star Ratings and Consumer Satisfaction.

OBJECTIVE: Consumers can currently access the Centers for Medicare and Medicaid Services Five-Star Quality Rating System when they choose a nursing home (NH). However, the system does not incorporate NH consumers' opinions. Without having access to satisfaction or quality-of-life measures, consumers could make uninformed decisions. This study aims to investigate the association between five-star ratings and family/resident satisfaction scores. DESIGN: Secondary data analysis was used. SETTING AND PARTICIPANTS: A unique, NH-level dataset of Ohio NHs that contains star ratings, satisfaction scores, and NH characteristics was constructed (N = 701). Data were drawn from the 2018 star rating data, 2018 Ohio Nursing Home Family Satisfaction Survey, 2017 Ohio Nursing Home Resident Satisfaction Survey, 2017 Ohio Biennial Survey of Long-Term Care Facilities, and the Certification and Survey Provider Enhanced Reports. METHODS: Chi-square and logistic regression analyses were conducted controlling other NH characteristics. RESULTS: Chi-square results showed consumer satisfaction and star ratings were correlated, but imperfectly related. Regression results found that NHs with higher family satisfaction score received significantly higher star ratings across all domains except the quality-measure star rating. For each 1% point increase in the family satisfaction score, the probability of being a 4 or 5 overall star NH increases by 1.1% point (P < .01), and being a 4 or 5 health inspection star NH increases by 1.2% points (P < .01). NHs with higher resident satisfaction score received significantly higher star ratings. For every 1% point increase in the resident satisfaction score, the probability of being a 4 or 5 star NH increases by 0.7% point (P < .05) across all star ratings. CONCLUSIONS AND IMPLICATIONS: Early studies found little relationship between five-star ratings and consumer satisfaction scores. This study found consumer satisfaction is associated, although imperfectly, with star ratings. This highlights the need to publicly report NH consumer perspectives to help them make informed care decisions.

Engaging nursing home residents in clinical research: insights from a patient advisory board, a patient advocate, and a study team.

BACKGROUND: Patient and Public Involvement (PPI) is increasingly recognized as an essential aspect of clinical research, particularly for ensuring relevancy and impact of research to those most affected. This study addresses the gap in involving older patients, particularly nursing home residents, in the research process by exploring motivations, expectations, and experiences of nursing home residents in Bremen, Germany, involved in PPI for developing a clinical trial on polypharmacy. METHODS: Two Patient Advisory Boards (PABs) were established in nursing homes as part of the INVOLVE-Clin project. A Patient Advocate (PA) facilitated communication between nursing home residents and researchers. A qualitative case study approach was employed, involving semi-structured interviews and group discussions with nursing home residents and researchers. Data was analyzed using structured qualitative content analysis. RESULTS: The study found varied motivations and expectations between nursing home residents and researchers. Nursing home residents valued the social interaction and the opportunity to voice their health concerns, while researchers aimed to incorporate patients' perspectives into study design. The PA was considered crucial in facilitating communication between nursing home residents and researchers. Challenges included the complexity of the study topic and the need for methodological adjustments to suit nursing home residents´ cognitive abilities. Generally, PAB participation was experienced to provide mental stimulation and increased confidence among nursing home residents in discussing their medication management. The PAB's influence led to the decision not to conduct a polypharmacy study. DISCUSSION: The findings underscore the importance of flexible approaches to PPI, particularly when involving older nursing home residents. Methodological adjustments, such as tailoring content and structure of PABs, and the inclusion of additional boards for diverse perspectives, are vital for effective involvement. The study also highlights the need for ongoing innovation in PPI methods to ensure meaningful engagement of older patients in clinical research. CONCLUSION: This study contributes essential insights into the practical implementation of PPI with nursing home residents, highlighting the need for patient-centric approaches that recognize their unique challenges and contributions. These findings are critical for shaping scientifically robust but also socially relevant and impactful research, especially in an aging society.

This study looked at how nursing home residents in two nursing homes in Bremen, Germany, feel about being part of health research. It focused on their reasons for joining, what they hoped to get out of it, and their experiences. The study used two groups, called Patient Advisory Boards (PABs), in these nursing homes. An important part of making this work was having someone called a Patient Advocate, who talked to the nursing home residents and communicated their perspectives to the research team. Researchers talked to the residents and other researchers through interviews and group discussions. The study found that nursing home residents and researchers had different reasons for being involved. The nursing home residents enjoyed the chance to talk with others and share their health worries, while the researchers wanted to make sure the study considered the views of older patients. There were some challenges for both, researchers and nursing home residents. The topic of the study, which was about using many different medicines (polypharmacy), was complex. Nursing home residents would need easier methods to take part. Nonetheless, being part of the PABs was experienced to be good by the nursing home residents. It helped them think more about their health and feel more confident talking about their medicines. The study shows that when including nursing home residents in health research, it's important to think about their specific needs to ensure meaningful engagement.

Health care utilization at the end of life in Parkinson's disease: a population-based register study.

BACKGROUND: Knowledge of health care utilization at the end of life in Parkinson's disease (PD) is sparse. This study aims to investigate end of life health care utilization, characterized by emergency room (ER) visits, receipt of specialized palliative care (SPC), and acute hospital deaths in a Swedish population-based PD cohort. METHODS: We conducted a retrospective cohort study on deceased patients (≥ 18 years) with a PD diagnosis during their last year of life (n = 922), based on health care-provider data from Region Stockholm´s data warehouse, for the study period 2015-2021. Univariable and multivariable logistic regression analyses tested associations and adjusted Odds ratios (aORs) were calculated. RESULTS: During the last month of life, approx. half of the cohort had emergency room (ER) visits and risk of frailty (measured by Hospital Frailty Risk Score) significantly predicted these visits (aOR, 3.90 (2.75-5.55)). In total, 120 people (13%) received SPC during their last three months of life, which positively associated with risk for frailty, (aOR, 2.65 (1.43-4.94, p = 0.002). In total, 284 people (31%) died in acute hospital settings. Among community-dwellers, male gender and frailty were strongly associated with acute hospital deaths (aOR, 1.90 (1.15-3.13, p = 0.01) and 3.70 (1.96-6.98, p < 0.0001)). CONCLUSIONS: Rates of ER visits at end of life and hospital deaths were relatively high in this population-based cohort. Considering a high disease burden, referral to SPC at end of life was relatively low. Sex-specific disparities in health care utilization are apparent. Identifying people with high risk for frailty could assist the planning of optimal end-of-life care for people with PD.

Community Preferences for Allied Health Services in Residential Aged Care.

INTRODUCTION: Exploring health consumer preferences in care is an essential foundational, and ongoing activity, when designing and delivering models of care. We undertook a study to explore: (i) what allied health (AH) services are most important to health consumers and (ii) how health consumers expect to access these services in residential aged care (RAC) to determine consumer priorities in future AH models of care in RAC. METHODS: A mixed method study was conducted with aged care residents and community members (friends or family of residents/people who believe they may use RAC services). The study comprised two focus-group activities where participants were asked to (1) rank the AH services most important to them and then (2) categorise how they would prefer to access each AH service. Focus group members used card sort methods (Q-methodology) to aid prioritisation, categorisation and discussion. Card sorting data were analysed using inverted factor analysis and descriptive statistics. Qualitative focus group data were deductively coded using a coding structure created by the research team informed by quantitative results. RESULTS: Data were collected from 16 participants who formed five focus groups in a community forum. The analysis revealed three factors, that represented shared meaning amongst groups of participants (viewpoints) regarding prioritisation of AH services: 'Prioritising urgent needs', 'Prioritising long-term healthy habits and lifestyle', and 'Prioritising social well-being'. Data from the card sort activity, which related to 'how health consumers expect to access AH services', were also categorised into three categories: 'It is always provided', 'A professional will assess my need' and 'I or my family will ask for this service if I need it'. Participants wanted most AH services to be provided regularly, with some such as 'Exercise and rehabilitation' and 'Meaningful activity' to be provided up to one hour every day. CONCLUSION: Consumers value a range of AH services and have an expectation that these will be provided in RAC on a regular basis. To ensure consumers make informed preferences regarding the future of services in RAC, health systems need to trial innovative AH models of care and embed consumer evaluation.

Association Between Organizational Context and Resident Pain in Assisted Living: A Repeated Cross-Sectional Study.

OBJECTIVES: Resident pain has been a common quality challenge in congregate care for older adults, and organizational context may explain variations in resident pain beyond resident-level factors. Most studies have focused on nursing homes (NHs), largely neglecting assisted living (AL). AL residents are at similar risk for pain as NH resident, but with AL providing fewer services and staffing resources. Our objective was to examine whether organizational context in AL was associated with resident pain during the first two waves of the COVID-19 pandemic. METHODS: This repeated cross-sectional study linked AL home surveys, collected in COVID-19 waves 1 (March-June 2020) and 2 (October 2020-February 2021) from a key contact, to administrative Resident Assessment Instrument-Home Care (RAI-HC) records in these homes. Surveys assessed preparedness for COVID-19 outbreaks, availability of a registered nurse or nurse practitioner, direct care staff shortages, decreased staff morale, COVID-19 outbreaks, confinement of residents to their rooms, supporting video calls with physicians, facilitating caregiver involvement. The dependent variable (moderate daily pain or pain of a severe intensity) and resident covariates came from the RAI-HC. Using general estimating equations, adjusted for repeated resident assessments and covariates, we assessed whether AL organizational context was associated with resident pain during the pandemic. RESULTS: We included 985 residents in 41 facilities (wave 1), and 1134 residents in 42 facilities (wave 2). Pain prevalence [95% confidence interval] decreased non-significantly from 20.6% [18.6%-23.2%] (March-June 2019) to 19.1% [16.9%-21.6%] (October 2020-February 2021). Better preparedness (odds ratio = 1.383 [1.025-1.866]), confinement of residents to their rooms (OR = 1.616 [1.212-2.155]), availability of a nurse practitioner (OR = 0.761 [0.591-0.981]), and staff shortages (OR = 0.684 [0.527-0.888]) were associated with resident pain. CONCLUSIONS: AL organizational context factors were associated with resident pain. Policy and management interventions can and must address such factors, providing potentially powerful levers for improving AL resident quality of care.