Safety First! Residential Group Climate and Antisocial Behavior: A Multilevel Meta-analysis.

A systematic review and multilevel meta-analysis was performed (28 studies and 313 effect sizes) on the relation between residential group climate (i.e., safety, atmosphere, repression, support, growth, structure) and antisocial behavior, including aggression and criminal recidivism. A systematic search was conducted in PsychINFO, ERIC, and OVID Medline up to February 2023. Results showed a small but significant association (r = .20) between residential group climate and antisocial behavior, equivalent to a 23% reduction of antisocial behavior in all clients receiving care in a residential facility with a therapeutic group climate. Moderator analyses showed that experienced safety was more strongly related to antisocial behavior (r = .30) than the other dimensions of group climate (.17 < r < .20), while the effect size was somewhat larger for adults (r = .24) than for youth (r = .15). We conclude that residential facilities should consider safety as a priority and should involve clients in a positive process of change through the development of a therapeutic environment and delivery of evidence-based treatment, addressing their needs from the perspective of rehabilitation.

Person-centered care as a tool to reduce behavioral and psychological symptoms in older adults with dementia living in residential care facilities.

Among older adults living in dementia residential care facilities (RCF) behavioral and psychological symptoms (BPSD) are common, affecting the quality of life (QOL) for the residents as well as being challenging for the staff. The person-centered care (PCC) approach addresses BPSD by giving trained staff mandate to focus on the relation and to adapt the encounter and the environment to increase QoL for the person with dementia. The aims with this study were to improve PCC, decrease BPSD and improve QOL among older persons with dementia living in RCFs, and to explore leaders' and healthcare staff's experiences of a PCC intervention. An educational program was implemented at two RCFs. Data was collected through questionnaires, from national quality registries and through focus group interviews. A significant increase in PCC and QOL at three months was seen. However, no significant difference in BPSD was seen. The interviews showed the importance of a trust-based relationship, and support from an active management to improve PCC, as well as changing old patterns and recognising competence among staff. Factors that affect implementation of PCC in RCF are discussed in the article.

Changes in Challenging Behaviors Accompanying Transition to a New Facility in Individuals with Intellectual Disabilities.

Challenging behavior (CB), the most common example being extreme self-injurious or aggressive/destructive behavior, is often observed as a major behavior issue in individuals with severe intellectual disabilities. This study investigated how CB changed among residents of a facility for people with disabilities before and after it was restructured from a traditional format single room shared by two to three individuals with approximately 20 residents lived together to a format featuring private areas with two rooms per resident and a unitcare system. Twenty-one residents of Care Home A, which was rebuilt in the new care format, were selected. Care staff completed a questionnaire one month before, one month after, and six months after residents moved to the new facility. Scores were compared among each time point. The results revealed significant reductions in residents' aggressive, stereotyped, and targeted behaviors, such as hitting their own head and fecal smearing. The major features of the restructured facility were a living space consisting of two private rooms per resident and a shift to unit care for the entire ward. These new features enabled residents to reduce destructive stimuli and made it easier to understand what to do in each private room.

Implementing recommended COVID-19 public health measures in the era of living with COVID-19: Experiences of residential aged care facility managers in New South Wales, Australia.

OBJECTIVES: To understand residential aged care facility (the facility) managers' perspectives on implementing public health measures (the measures) in their facilities in terms of barriers, facilitators and suggestions for improvement, after three years of the COVID-19 pandemic. METHODS: Nine managers of the facilities without an active COVID-19 outbreak across New South Wales, Australia, representing metropolitan and rural locations, diverse facility size and star quality rating were interviewed (April-June 2023) and data qualitatively analysed. RESULTS: Broader policy context, the need to balance the measures with resident well-being, facility-built infrastructure and mask fatigue were reported as barriers to implementation. Workplace policies, cultural embedding and local innovations were reported as facilitators. Suggested strategies included recommending the measures consistent with temporal COVID-19 risk; government agencies improving communication about the measures; mandatory staff vaccination; and simplified reporting requirements. CONCLUSIONS: We recommend that relevant government agencies develop a single source of formalised, endorsed, up-to-date advice for the sector-specific COVID-19 information and communications; streamline outbreak notification and reporting requirements; and improve consultation with the sector.

Balance-based exercise programs on balance in older adults with mild to moderate dementia: A critically appraised topic.

OBJECTIVE: It is well established that exercise programs including balanced-based exercises are practical and beneficial for cognitively healthy older adults. However, there is limited evidence to determine if these types of training regimens are effective for individuals with dementia. We conducted a critical appraisal to determine if the addition of balance-based exercise programs, compared with usual care at residential homes, improved balance in adults diagnosed with mild to moderate dementia. MATERIALS AND METHODS: Four databases were searched for randomized control trials implementing balanced-based exercise programs with individuals diagnosed with mild to moderate dementia. The articles were evaluated based on the Centre for Evidence Based Medicine level of evidence criteria and appraised using the PEDro scale. RESULTS: A comprehensive literature search revealed four studies relevant to the clinical question that fit the inclusion and exclusion criteria. All four studies indicated an improvement in balance following a weekly physical therapy program implementing balance-based exercises. CONCLUSIONS: There is sufficient evidence to suggest that the use of physical therapy programs that include balance-based exercises, performed 1-2 times a week over the course of 12-25 weeks, improves balance in elderly adults with mild to moderate dementia.

An unprecedented and large-scale support mission to assist residential care facilities during the COVID-19 pandemic.

Background: In March 2020, COVID-19 cases occurred in residential care facilities. To assist these facilities, the regional health agency of the Meurthe-et-Moselle administrative district ordered a support mission. Methods: Infection prevention and control mobile teams were formed under the coordination of the infection prevention and control department (IPCD) of a university hospital. Teams went to residential care facilities for the elderly, to facilities for people with disabilities (FPD) and independent living communities (ILC). They visited the facilities and met with the management and the ward staff to assess the situation and to identify any potential support needs. Results: Over two non-consecutive weeks, 104 residential care facilities were visited (9025 residents). If urgent needs were identified, the IPCD was directly informed by the teams to initiate an extensive assistance operation. Thereby, additional staff and equipment were provided for every facility in need. Although most of them had implemented good management to face the pandemic, four emergency field support operations took place in facilities with uncontrolled outbreaks. Conclusions: This is the first reported support action for residential care facilities during the pandemic in France. As no major outbreaks were noticed later, this mission was deemed a success and met the residential care facilities' needs for support. Many facilities have expressed the need to cooperate with infection prevention and control specialists in the future, both during outbreaks, also in routine daily practice. This report highlights the need to maintain support for residential care facilities and to implement a permanent collaboration between hospitals and residential care facilities.

Public health response following an iGAS outbreak in a residential aged care facility in Queensland.

Abstract: During an 18-day period, beginning in April 2020, three residents with invasive group A streptococcal infections (iGAS) were reported at a single residential aged care facility (RACF) in Brisbane's northern geographical region. All three cases were hospitalised with severe illness; two of the cases died as a result of the illness. The Metro North Public Health Unit (PHU) led the public health investigation and response, targeting infection control measures and offering chemoprophylaxis to all 142 staff and 119 residents at the facility. The outbreak was declared over in June, after 30 days of no new cases. Isolates from all three cases were shown to have identical strain typing, emm89. The benefits and challenges of implementing mass chemoprophylaxis in this setting are discussed.

Non-pharmacological interventions for neuropsychiatric symptoms of dementia in residential aged care settings: An umbrella review.

BACKGROUND: Prevalence of neuropsychiatric symptoms amongst people living with dementia in residential aged care is high. Their presence is associated with poorer quality of life for residents and higher burden of care for staff. Existing reviews have not focused on the evaluation of efficacy of non-pharmacological interventions in specific population settings (community vs. residential aged care). OBJECTIVES: To determine the efficacy of non-pharmacological interventions to manage neuropsychiatric symptoms of dementia in residential aged care settings. DESIGN: An umbrella review was conducted. DATA SOURCES: PubMed/Medline, Embase, Cochrane Library and Web of Science were searched for eligible reviews in December 2019, February 2020 and June 2021. METHODS: Two authors independently screened titles and abstracts, and assessed full-text reviews for eligibility. The quality of reviews was appraised with 'AMSTAR-2: A Measurement tool to assess systematic reviews'. Narrative summaries grouped findings by intervention domains. RESULTS: From 1362 systematic reviews identified, 26 met the inclusion criteria. Of these, 10 focused on person tailored interventions, six on sensory stimulation interventions, three on environmental interventions, three on exercise interventions, and four on multiple intervention types. Quality ratings identified reviews to be of mostly moderate quality (73%). The majority or reviews reported positive results but not all were statistically significant. Tailored interventions that included music and social elements appeared to be most beneficial for depressive symptoms and mood. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions. CONCLUSIONS: The findings of this umbrella review suggest that combining different types of interventions and tailoring them to the personal experiences of the resident is recommended. A more standardised approach for outcome measures used is vital to assess efficacy and allow comparison of future non-pharmacological interventions.

Factors affecting residential staff's role in supporting the sexuality of adults with intellectual disabilities.

BACKGROUND: For adults with intellectual disabilities living in a residential care facility, support staff, who are an integral part of their daily lives, can play an important role in supporting their sexuality. Even though multiple programmes exist, barriers remain when it comes to their application. This study aimed to identify factors affecting residential staff's perception of their role in supporting the sexuality of adults with intellectual disabilities living in a residential care facility as well as facilitators and barriers to that support. METHOD: Semi-structured interviews were conducted with 12 support staff. RESULTS: A thematic analysis revealed four factors, namely support staff's role, facilitators and barriers, sexuality of residents with intellectual disabilities and policies and regulations. CONCLUSION: Results illustrate the importance of expanding support staff's knowledge, clarifying procedures for implementing the support staff's role and establishing a clear practise framework.

[Person-centered care but living in a closed setting? The situation of closed residential facilities in Germany]. / Personenzentrierte Hilfen, aber geschlossen untergebracht? Zur Situation der geschlossenen Heime in Deutschland.

BACKGROUND: The United Nations Convention on the Rights of Persons with Disabilities and the Federal Participation Act state that all human beings have the right to choose where to live. This human right is compromised by the institutional limitations of the community psychiatric system, where persons with severe mental illnesses and with intensive support needs are often housed in closed (i.e. physically locked) living contexts. How can the concept of person-centered care help to solve this conflict? OBJECTIVE: Description of the nationwide situation of closed residential facilities and discussion of the person-centered approach as a solution to the problem of closed living contexts. METHODS: Summary of current knowledge on the structural and procedural data of closed residential facilities in Germany, which were collated within the framework of the "Coercive measures in the psychiatric care system-Collation and reduction" (ZIPHER) study. RESULTS: The empirical data indicate a great need for regionally based care of the target group and a lack of individual arrangements as alternatives to closed living contexts. The necessity for regional care obligations is highlighted by the example of Mecklenburg-Western Pomerania. CONCLUSION: The avoidance and reduction of closed accommodation can primarily be achieved by individual arrangements within the framework of person-centered and flexible proposal landscapes. For this the service providers of integration assistance, including the psychiatric hospitals, must be committed to the care of all people in their region. An appropriate accompaniment and refunding by the service provider are also necessary.

[Survey on the Attitudes and Concerns of Nursing Home Staff Regarding Assistance of Medication Administrations in Japan: A Questionnaire Survey].

Care workers at care facilities play an important role in providing medication-administration assistance, and in medication risk management. Nevertheless, research has not made clear the specific concerns that care workers have at work sites, as well as the extent of their burdens. Thus, we conducted a questionnaire survey from October 1 through October 31, 2014 for staff who provide medication-administration assistance at for-pay elderly person homes about the concrete concerns and burdens with regards to the assistance. A total of 1677 respondents were analyzed: 228 nurses and 1449 care workers. Results showed that the care workers had a variety of problems and issues. These included the fact that, since care workers are not medical profession, they were unable to answer questions that the facility residents asked about their medications; they had concerns regarding their own lack of awareness of the efficacies of medications, and as to whether certain drugs were inappropriate for certain patients with swallowing dysfunctions; they wondered whether drugs in tablet forms had to be crushed before administration. They also encountered pharmacological-related issues, including whether administration times and numbers failed to match the lifestyle patterns of facility residents, and so forth. It is presumed that, with active intervention of pharmacists within facilities, these issues could be resolved. Study results, thus, suggested the need for system creation whereby pharmacists can become deeply involved in medication-administration assistance along with the care workers within facilities.

[Improving support for HIV-positive elderly people in nursing homes]. / Mieux accompagner les personnes âgées séropositives en établissement d'hébergement.

The number of HIV-positive people requiring care in nursing homes is still low. However, there are obstacles to their admission or care in such institutions. Consequently, they often find themselves being cared for in a hospital setting. Anticipating the needs of these people will help to improve the care and support available and give rise to alternative residential facilities.

Concept synthesis of dignity in care for elderly facility residents.

BACKGROUND: Protecting the dignity of elderly residents of facilities and providing dignified care can be difficult. Although attempts have been made from several aspects, dignity is considered an area in which less real impact has been made in both theory and practice. OBJECTIVE: The objective of this study is to characterize the concept of dignity in care for elderly subjects in residential facilities from a practical perspective through concept synthesis. RESEARCH DESIGN: This study includes in-depth interviews with residents of elderly facilities and a literature review. PARTICIPANTS AND RESEARCH CONTEXT: A total of 12 residents of seven facilities in three prefectures in Japan were recruited via purposive sampling, and 27 interviews were conducted. Each digitally recorded interview was transcribed verbatim. The interview data were analyzed based on hermeneutic phenomenological research. The literature was searched using PubMed, CINAHL, and Web of Science with combinations of terms such as dignity, elderly, and residential facilities and then selected according to the predefined inclusion criteria. The descriptions about dignity in the included studies were divided into codes and compared with the results of the interviews. ETHICAL CONSIDERATIONS: This study was approved by the institutional review board of Nagoya University's Graduate School of Medicine. FINDINGS AND DISCUSSION: There were 1728 data codes for the interviews from which four themes were generated. In the literature review, 3716 titles were searched, and 28 articles were selected. Combining these results, five following themes and a conceptual matrix were obtained: individual dignity not affected by others; dignified care in a narrow sense; elements of the staff side; dignity in relation to family members, friends, society, and other residents; and dignity in relation to nursing care facilities and the nursing care system. CONCLUSION: According to the established matrix, we must consider the role of the care system, facility, family, and society in providing care with dignity and the individual dignity to residents and dignity in daily care.

Gait Analysis in Adults with Intellectual Disabilities Living in a Residential Facility.

BACKGROUND: Mobility limitations are of particular interest in people with intellectual disabilities. The aim of this study was to present feasibility and mean values of gait parameters in people with intellectual disability and it was hypothesized that several trials would be necessary to gain stable values for this cohort. MATERIAL AND METHODS: Thirty-two adults with intellectual disability living in a residential facility were asked to do four walks in both normal and fast speed conditions over an instrumented walkway. Mean values of gait parameters were calculated over two different trial combinations, with TC1&2 representing the mean value of trials 1 and 2, and TC1-4 representing the mean over all four trials. RESULTS: All participants (Mage  = 59.6 years; SD = 16.71) successfully performed the protocol. Gait parameters remained constant over all trials. No significant differences were found between the trial combination TC1&2 and trial combination TC1-4. CONCLUSION: Gait analysis was found to be feasible in people with intellectual disability. Overall, the present authors recommend performing two trials and to calculate the means of gait parameters over these two trials to gain stable values.

Risk factors for hip fracture in very old people: a population-based study.

SUMMARY: Knowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson's disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development. INTRODUCTION: The purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people. METHODS: In total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression. RESULTS: Participants had a mean age of 89.3 ± 4.7 years; 65.8% were women, 36.8% lived in residential care facilities, 33.6% had dementia, and 20.4% had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1%) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR] = 8.57; 95% confidence interval [CI], 1.90-38.71), Parkinson's disease (HR = 5.12; 95% CI, 1.82-14.44), currently smoking (HR = 4.38; 95% CI 2.06-9.33), delirium in the previous month (HR = 2.01; 95% CI, 1.15-3.49), underweight (body mass index <22; HR = 1.74, 95% CI, 1.09-2.77), and age (HR = 1.09; 95% CI, 1.04-1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR = 0.37; 95% CI, 0.15-0.91), but only for those with bilateral hip prostheses. CONCLUSIONS: Seven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.

Comparison of a traditional and non-traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement.

BACKGROUND: Dementia residential facilities can be described as traditional or non-traditional facilities. Non-traditional facilities aim to utilise principles of environmental design to create a milieu that supports persons experiencing cognitive decline. This study aimed to compare these two environments in rural Australia, and their influence on residents' occupational engagement. METHODS: The Residential Environment Impact Survey (REIS) was used and consists of: a walk-through of the facility; activity observation; interviews with residents and employees. Thirteen residents were observed and four employees interviewed. Resident interviews did not occur given the population diagnosis of moderate to severe dementia. Descriptive data from the walk-through and activity observation were analysed for potential opportunities of occupational engagement. Interviews were thematically analysed to discern perception of occupational engagement of residents within their facility. RESULTS: Both facilities provided opportunities for occupational engagement. However, the non-traditional facility provided additional opportunities through employee interactions and features of the physical environment. Interviews revealed six themes: Comfortable environment; roles and responsibilities; getting to know the resident; more stimulation can elicit increased engagement; the home-like experience and environmental layout. These themes coupled with the features of the environment provided insight into the complexity of occupational engagement within this population. CONCLUSION: This study emphasises the influence of the physical and social environment on occupational engagement opportunities. A non-traditional dementia facility maximises these opportunities and can support development of best-practice guidelines within this population.

Older adult drivers living in residential care facilities.

Residential care facilities (RCF) provide assistance to older adults who cannot live independently, but it is unclear whether these residents have retired from driving. Here, we characterize older adults living in RCFs who still drive from a national cross-sectional survey of residents (2010 National Survey of Residential Care Facilities), representing ~733,000 adults living in RCFs such as assisted living facilities and personal care homes. Key resident characteristics were health, function, mobility and community activity indicators, which could be associated with increased driving risk. Of 8,087 residents, 4.5% (95%CI=3.9-5.1) were current drivers. Many drivers were older than 80 years (74%, 95%CI=67-79), in very good health (31%, 95%CI=25-38) or good health (35%, 95%CI=29-42), and had a median of two medical conditions. Most were independent with activities of daily living, though some needed assistance with walking and used gait devices. Given these results, RCF staff and healthcare providers need a heightened awareness of factors associated with driving risk to promote safety of older drivers and provide resources for likely transition to other transportation.

Test-retest reliability and agreement of physical fall risk assessment tools in adults with intellectual disabilities.

BACKGROUND: Physical decline and high rates of inactivity lead to an increased risk of falling in the intellectual disability (ID) population. It is important therefore to develop interventions to prevent falls and to develop valid and reliable assessment tools, which are suitable for use with people with ID. Targeting the most important fall risk factors such as strength, balance and gait measurement is important, yet there is a paucity of previous research on testing the feasibility and reliability of strength, balance and gait assessments with people with ID. AIMS: The aims of this study are (i) to describe the test-retest reliability and agreement [standard error of measurement (SEM)] of slightly adapted fall risk assessments and (ii) to describe the test-retest reliability and SEM of these tests in younger and older age groups and mild/moderate and severe/profound ID-level groups. METHODS: Residents of a German residential facility for people with ID were asked to take part. The study has a test-retest design, whereby all participants were tested twice, with 7 days in-between the first (T1) and second (T2) testing days. The 'timed up and go', '30-second chair stand', 'handgrip' and 'Romberg balance test' were all performed. Intraclass correlation coefficient (ICC) (2,1) values and SEM were calculated for the full sample, two age groups (split at the age of 60 years) and mild/moderate and severe/profound ID-level groups. RESULTS: A total of 37 residents with a mean age of 59.3 years (standard deviation = 17.7) performed the tests on both testing days. Mainly moderate to excellent ICC values were found for all tests for the full sample and in all groups (0.59-0.97). Different SEM values were found for full sample and sub-groups. CONCLUSION: Strength, balance and gait assessment tools, which are easy to use and understand, were found to be reliable in adults with ID. The SEM is most important for interpreting the real effects of an intervention. Further analyses will be required to gain more information about the SEM in different age groups or ID-level groups.

Violent behavior of patients living in psychiatric residential facilities: a comparison of male patients with different violence histories.

People with severe mental disorders and a history of violence are often seen as a difficult-to-manage segment of the population. In addition, this group is usually characterized by a high risk of crime recidivism, and poor compliance with community and aftercare programs. To investigate a sample of male patients living in Residential Facilities (RFs) with a history of violent behavior against people and to compare their characteristics with those of never-violent residents; to analyze the associations between aggressive behaviors in the last two years and a history of previous violence; and, to assess the predictors of aggressive behaviors. This study is part of a prospective observational cohort study which involved 23 RFs in Northern Italy. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered, and standardized assessments were administered to each participant. Also a detailed assessment of aggressive behaviors in the past two years was carried out. The study involved 268 males: 81 violent and 187 never-violent. Compared to never-violent patients, violent patients were younger, with a higher proportion of personality disorders, and have displayed an increased number of aggressive behaviors in the last two years. The presence of a history of violent behavior in the past significantly increases the probability of committing aggressive acts in the future.

Change in quality of life of people with dementia recently admitted to long-term care facilities.

AIM: To assess which factors are associated with change in quality of life of people with dementia who have recently been admitted to long-term care facilities. BACKGROUND: Many people with dementia will be admitted to long-term care facilities at some point during their disease. It is currently unknown which factors are associated with improvement and/or deterioration of quality of life immediately following admission. DESIGN: An observational and longitudinal survey. METHODS: Data on 343 people with dementia who have been recently admitted to long-term care facilities across eight European countries were collected between November 2010-April 2012. Quality of life was assessed by people with dementia and their proxies using the 'Quality of Life-Alzheimer's Disease scale'. Explanatory variables included cognitive status, comorbidities, activities of daily living, depressive symptoms and neuropsychiatric symptoms. Descriptive and multilevel regression analyses were performed. RESULTS: Better cognitive abilities at baseline were associated with a decrease in self-reported quality of life. Greater dependency and more depressive symptoms at baseline were associated with declined proxy-reported quality of life. Furthermore, an increased dependency and an increase of depressive symptoms between baseline and follow-up were associated with a decreased proxy-reported quality of life. On an individual level, three groups were identified, namely people whose quality of life: (1) decreased; (2) stayed the same; and (3) increased. CONCLUSION: Cognitive functioning, functional rehabilitation and treatment of depressive symptoms should receive special attention. However, quality of life of people with dementia does not necessarily decrease after institutionalization.