Factors associated with nursing home direct care professionals' turnover intent during the COVID-19 pandemic.

OBJECTIVE: To identify factors related to turnover intent among direct care professionals in nursing homes during the pandemic. METHODS: Cross-sectional study with surveys administered via an employee management system to 809 direct care professionals (aides working in nursing homes). Single items assessed COVID-19-related work stress, preparedness to care for residents during COVID-19, job satisfaction, and intent to remain in job. A two-item scale assessed quality of organizational communication. RESULTS: Path analysis demonstrated that only higher job satisfaction was associated with a higher likelihood of intent to remain in job. Higher quality of employer communication and greater preparedness were also associated with higher job satisfaction, but not with intent to remain. Higher quality communication and greater preparedness mediated the negative impact of COVID-19-related work stress on job satisfaction. CONCLUSION: Provision of high-quality communication and training are essential for increasing job satisfaction and thus lessening turnover intent in nursing homes.

Long-Distance Caregivers: What are Their Experiences with Formal Care Providers?

OBJECTIVES: Extensive literature has documented the experiences of informal caregivers and their interactions with formal care providers, yet this research is almost entirely limited to caregivers who live near their care-recipients. This study aims to describe long-distance caregivers' (LDC) experiences (e.g., satisfaction and challenges) with formal care providers. Subgroup differences were examined based on the care-recipient's (CR) dementia status and residential setting (community versus residential care). METHODS: Data were collected from 296 LDCs (Mage = 56.64, SD = 12.40) categorized into four subgroups based on CR dementia status and residential setting. Participants rated their overall satisfaction, satisfaction with communication and information, and described challenges faced in their interactions with formal care providers. RESULTS: Challenges related to formal care providers were significantly greater and satisfaction significantly lower among LDCs of CRs in residential care, irrespective of dementia status, when compared to LDCs of CRs in the community. CONCLUSIONS: This study provides insights into the experiences of a growing segment of the caregiver population managing care from a distance, specifically in their interactions with formal care providers. CLINICAL IMPLICATIONS: The results of this study point to the possible necessity for the development of novel interventions to improve and enhance communication and collaboration between FCPs and informal caregivers.

A Substance Misuse Intervention Program in Postacute Care: Who Declines Participation?

OBJECTIVES: Alcohol and substance misuse has been under-acknowledged and underidentified in older adults. However, promising treatment approaches exist (e.g., brief interventions) that can support older adults with at-risk alcohol and substance use. Postacute rehabilitation settings of Skilled Nursing Facilities (SNFs) can offer such programs, but little is known about patient characteristics that are associated with the likelihood of participating in interventions offered in postacute rehabilitation care. Thus, the objective of this study was to identify individual patient characteristics (predisposing, enabling, and need-related factors) associated with participation in a brief alcohol and substance misuse intervention at a SNF. METHODS: This cross-sectional study analyzed medical record data of postacute care patients within a SNF referred to a substance misuse intervention. Participants were 271 patients with a history of substance misuse, 177 of whom enrolled in the intervention and 94 refused. Data collected upon patient admission were used to examine predisposing, enabling, and need-related factors related to likelihood of program participation. RESULTS: Older age and ethnic minority status were associated with a reduction in likelihood to participate, while widowhood increased the likelihood of participation. CONCLUSION: Upon referral to a substance misuse intervention, clinicians in SNFs should be cognizant that some patients may be more likely to refuse intervention, and additional efforts should be made to engage patients at-risk for refusal.

The efficacy of a video-based intervention to reduce ageism among long-term services and supports staff.

Research has shown that ageism can act as a barrier to both quality of life and quality of care delivery within the continuum of residential care settings. Anti-ageism interventions have the hefty task of improving attitudes and behaviors toward aging and older adults. The purpose of this study was to examine whether a one-hour video-based intervention designed to address ageism could decrease self-reported ageist attitudes and behaviors among staff members of long-term service and support settings. This cross-sectional study used data collected from 265 staff members of aging services organizations. The study examined ageist attitudes and behaviors at pre-intervention, and at two follow-up points: immediately after the intervention and three-month post-intervention. Results demonstrated that internalized aging anxiety significantly decreased from pre-intervention to the immediate follow-up and stayed stable at the 2nd follow-up. Results showed that ageist behaviors significantly decreased over the three-month study period and that participants were able to identify specific actions they had taken as a result of the video intervention. The study suggests that a low-cost, short video-based intervention on ageism can improve ageism-related attitudes and behaviors among staff in long-term services and supports settings.

Dementia-Focused Person-Directed Care Training With Direct Care Workers in Nursing Homes: Effect on Symptom Reduction.

The majority of older adult nursing home residents have dementia and are at risk of not having their care needs met, largely due to communication deficits. Promoting comfort and minimizing distress for these residents is important. Direct care workers (DCW) and clinical staff completed a 6-day training on a person-directed care (PDC) model-a model guided by the needs of the individual that focuses on empowering DCW to understand and support resident preferences and remaining abilities supported by relationship development and consistent staffing. A retrospective comparison was conducted of residents in two PDC communities with matched residents (n = 72) and three traditional communities (n = 72) on functional and clinical outcomes over a 6-month period. A two-way analysis of variance showed a significant interaction between group and time, where only those in the PDC group had a decreased number of clinical symptoms (e.g., pain, depression, agitation) over time. This study found support for the benefit of PDC on clinical outcomes of interest over time. PDC training for DCW and clinical staff promotes quality care and the reduction of clinical symptoms, leading to improved quality of life. [Journal of Gerontological Nursing, 46(8), 7-11.].

A population study of correlates of social participation in older adults with age-related vision loss.

OBJECTIVE: To examine personal characteristics, disease-related impairment variables, activity limitations, and environmental factors as correlates of social participation in older adults with vision loss guided by the World Health Organization's International Classification of Functioning, Disability and Health Model. DESIGN: Baseline data of a larger longitudinal study. SETTING: Community-based vision rehabilitation agency. SUBJECTS: A total of 364 older adults with significant vision impairment due to age-related macular degeneration. MAIN MEASURES: In-person interviews assessing social participation (i.e. frequency of social support contacts, social/leisure challenges faced due to vision loss, and of social support provided to others) and hypothesized correlates (e.g. visual acuity test, Functional Vision Screening Questionnaire, ratings of attachment to house and neighborhood, environmental modifications in home). RESULTS: Regression analyses showed that indicators of physical, social, and mental functioning (e.g. better visual function, fewer difficulties with instrumental activities of daily living, fewer depressive symptoms) were positively related to social participation indicators (greater social contacts, less challenges in social/leisure domains, and providing more support to others). Environmental factors also emerged as independent correlates of social participation indicators when functional variables were controlled. That is, participants reporting higher attachment to their neighborhood and better income adequacy reported having more social contacts; and those implementing more environmental strategies were more likely to report greater challenges in social and leisure domains. Better income adequacy and living with more people were related to providing more social support to others. CONCLUSION: Environmental variables may play a role in the social participation of older adults with age-related macular degeneration.

Sensory impairments and their associations with functional disability in a sample of the oldest-old.

PURPOSE: Research focusing on the consequences of sensory impairments for the everyday competence of the oldest-old is emerging. The two main goals of this study were to document the prevalence of self-reported vision, hearing, and dual sensory impairment and to explore associations of these impairments with functional disability in near-centenarians and centenarians. METHODS: Centenarians and near-centenarians (N = 119; average age = 99) were recruited, with about 80% living in the community. In-person interviews included self-ratings of vision and hearing impairment and functional disability conceptualized as having difficulties performing personal and instrumental activities of daily livings (PADLs and IADLs). RESULTS: Based on self-report ratings, 17% of participants were classified as having a visual impairment only, 18% as having a hearing impairment only, and 38% with both a visual and hearing impairment (dual sensory impairment). Regression analyses demonstrated that having a vision impairment only and being dual sensory impaired were the strongest predictors of functional disability. They were associated with higher levels of functional disability over and above higher levels of depressive symptomatology, interference of health with desired activities, and living in a nursing home. CONCLUSIONS: Sensory impairments-especially dual sensory impairment-are prevalent in the oldest-old. Having dual sensory impairment or a single visual impairment among other factors are strongly associated with less-optimal everyday functioning in the oldest-old.

Organizational Factors Associated with Certified Nursing Assistants' Job Satisfaction during COVID-19.

Given the instability of the nursing home (NH) certified nursing assistant (CNA) workforce and the challenging demands during COVID-19, it is important to understand the organizational factors that are correlated with job satisfaction which is a major predictor of CNA turnover. The purpose of this study was to determine the associations between quality of supervisor relationships, organizational supports, COVID-19 work-related stressors, and job satisfaction among CNAs in NHs. The results indicate that CNAs who reported a more optimal relationship with their supervisors, felt appreciated for the job they do and worked in NHs with lower COVID-19 resident infection rates tended to report higher rates of job satisfaction. The COVID-19 work-related stressors of increased workload demands and understaffing were associated with lower rates of job satisfaction. The study has practical implications for employers regarding how to support CNAs to improve job satisfaction especially during a crisis.

Challenges faced by older adults with vision loss: a qualitative study with implications for rehabilitation.

OBJECTIVE: To provide an in-depth assessment of challenges faced by older adults with recent vision loss and to determine changes in the nature of these challenges over time for the purpose of informing the design of vision rehabilitation services. DESIGN: Longitudinal, qualitative study with three time points. SETTING: Vision rehabilitation agency. SUBJECTS: Three hundred and sixty-four older adults aged 65 with significant vision impairment due to age-related macular degeneration. INTERVENTIONS: In-person interviews conducted at baseline, one year and two years and coded using a qualitative analytical approach. MAIN MEASURES: Open-ended questions assessing challenges faced due to vision loss in functional, social and psychological life domains. RESULTS: Almost all participants reported a wide variety of challenges across all three domains with the most variety in the functional domain. Over a two-year period, functional challenges (e.g. using transportation) increased, social challenges (e.g. recognizing people) remained stable, and psychological challenges (e.g. negative affect) decreased overall. CONCLUSIONS: Although functional challenges are predominant, social and psychological challenges are quite common and need to be addressed in vision rehabilitation. Rehabilitation planning should also consider that vision-related challenges can change over time.

Job Resignation in Nursing Homes During the COVID-19 Pandemic: The Role of Quality of Employer Communication.

Limited research has examined coronavirus disease 2019 (COVID-19)-related work stressors experienced by nursing home (NH) employees and how these stressors may impact employees' decision to resign when taking organizational factors into account. Thus, the purpose of this study was to investigate whether quality of employer communication related to COVID-19 and staff preparedness to care for residents with COVID-19 can mediate the effects of COVID-19-related stressors on NH employees' (N = 1,730) decision to resign. Results from path analyses indicate that higher quality of communication and more optimal preparedness mediated the relationship between COVID-19-related stressors and likelihood of resignation. Specifically, higher levels of COVID-19-related stressors were indirectly associated with reduced likelihood of resigning through the paths of more optimal communication and preparedness. Findings underscore the importance of effective employer communication during emergencies in NHs.

Interventions to Reduce the Impact of Client Death on Home Care Aides: Employers' Perspectives.

For home care agencies and aides, the death of clients has important, yet often unrecognized, workforce implications. While research demonstrates that client death can cause grief and job insecurity for aides, we currently lack home care agencies' perspectives on this issue and approaches to addressing it. This study uses key informant interviews with leaders from a diverse sample of eight New York City home care agencies to explore facilitators and barriers to agency action. We found that agencies engaged primarily in a range of informal, reactive practices related to client death, and relatively few targeted and proactive efforts to support aides around client death. While leaders generally acknowledged a need for greater aide support, they pointed to a lack of sustainable home care financing and policy resources to fund this. We recommend increased funding to support wages, paid time off, and supportive services, and discuss implications for future research.

Participation in a Substance Misuse Intervention in Post-acute Care Is Associated With More Optimal Rehabilitation Outcomes.

BACKGROUND AND OBJECTIVES: Alcohol and substance misuse is prevalent among older adults, yet underdiagnosed and undertreated. More substance misuse intervention programs specifically designed for older adults and offered in various settings are needed. This project's objectives were to (a) provide a detailed description of a Geriatric Substance Abuse Recovery Program (GSARP) designed and implemented at post-acute rehabilitation units of a skilled nursing facility and (b) report findings of a study conducted to evaluate if GSARP participation among post-acute care patients with substance misuse issues can optimize rehabilitation outcomes (i.e., being discharged home vs. another setting). RESEARCH DESIGN AND METHODS: A pretest-posttest study design with data obtained from patients' electronic medical record upon facility admission, during post-acute stay, and after discharge (N = 271). Based on Andersen's model of health care utilization, we investigated which predisposing factors (e.g., ethnicity), enabling factors (e.g., cognition and social support), and need-related factors (e.g., activities of daily living functioning), as well as health behaviors (e.g., GSARP participation) predicted likelihood of being discharged home versus another discharge setting. RESULTS: Patients participating in the GSARP and patients who received social support from family members and friends during their post-acute stay were more likely to be discharged home. Patients with severe cognitive impairment were less likely to be discharged home. DISCUSSION AND IMPLICATIONS: The GSARP eliminates some common barriers often encountered in the screening and delivery process of substance misuse interventions for older adults. Findings support the effectiveness of the GSARP in optimizing rehabilitation outcomes for older adults with substance misuse issues.

Predictors of Rehospitalization in Post-Acute Rehabilitation among Different Ethnic Groups.

OBJECTIVES: Previous research has shown that ethnicity may play a role in increased risk for hospital readmission during a post-acute rehabilitation care (PARC) stay. However, little is known about risk factors influencing discharge status from PARC settings among different ethnic groups. Hence, the aim of our study was to investigate the relationship of individual characteristics (eg, sex, neighborhood quality) and health behavior (use of rehabilitation services) with rehospitalization across ethnic groups of older adult patients who received post-acute rehabilitation for a cardiovascular disease at a skilled nursing facility (SNF). DESIGN: Retrospective study with data extraction from electronic medical records (EMRs) at admission and discharge. SETTING: SNF. PARTICIPANTS: The sample consisted of 520 post-acute rehabilitation patients (96 Hispanics, 172 African Americans, and 252 Whites) 60 years or older with an admitting condition of a circulatory-related disease. MEASUREMENTS: Sociodemographic and health-related variables, and discharge status (rehospitalized or home). RESULTS: For the Hispanic sample, lower community quality was associated with a greater likelihood of being rehospitalized. For African Americans, having no social support, higher levels of admission functional dependency, and shorter length of stay were significantly associated with a higher likelihood of being rehospitalized. For the group of White participants, the following variables emerged as risk factors for rehospitalization: being male, lower admission cognitive functioning, higher levels of admission depressive symptomatology, and shorter length of stay. CONCLUSIONS/IMPLICATIONS: Individual characteristics and health behaviors that are risk factors for rehospitalization during a post-acute stay vary across ethnic groups. Hence, the study provides insights for PARC clinicians into specific patient characteristics to be aware of as risk factors for less optimal patient outcomes.

The effects of telehealth use for post-acute rehabilitation patient outcomes.

Introduction Previous research has shown that home telehealth services can reduce hospitalisations and emergency department visits and improve clinical outcomes among older adults with chronic conditions. However, there is a lack of research on the impact of telehealth (TH) use on patient outcomes in post-acute rehabilitation settings. The current study examined the effects of TH for post-acute rehabilitation patient outcomes (i.e. discharge setting and change in functional independence) when controlling for other factors (e.g. cognitive functioning). Methods For this retrospective study, electronic medical records (EMRs) of 294 patients who were discharged from a post-acute rehabilitation unit at a skilled nursing facility were reviewed. Only patients with an admitting condition of a circulatory disease based on ICD-9 classification were included. Main EMR data extracted included use of TH, cognitive functioning, admission and discharge functional independence, and discharge setting (returning home vs. returning to acute care/re-hospitalisation). Results Results from a regression analysis showed that although TH use was unrelated to post-acute rehabilitation care transition, it was significantly related to change in functional independence. Patients who used TH during their stay had significantly more improvement in functional independence from admission to discharge when compared to those who did not use TH. Discussion Findings indicate that TH use during post-acute rehabilitation has the potential to improve patient physical functioning.

Depressive symptoms in the oldest-old: The role of sensory impairments.

BACKGROUND: While a fair amount of research has investigated the impact of sensory impairments on the mental health of young older adults (65-79 years of age), only a few studies have focused on the associations of sensory impairments with mental health outcomes in the oldest-old (80 years and older). To close this gap, this study examined the separate and combined effects of self-reported vision and hearing impairment for depressive symptoms in a sample of oldest-old individuals, controlling for other mental health risks (e.g., functional disability, health interference, and loneliness). METHODS: Centenarians and near-centenarians (N = 119; average age = 99) were recruited from the community and geriatric healthcare organizations. In-person interviews were conducted at participants' place of residence. RESULTS: Vision impairment and its interaction with hearing impairment as well as functional disability, health interference with desired activities, and loneliness were significant predictors of depressive symptoms in hierarchical regression analyses. Hearing impairment alone was not associated with depressive symptoms, but follow-up analyses clarifying the interaction effect showed that individuals with poor vision had the highest levels of depressive symptoms, if they had a concurrent hearing impairment. Thus, a concurrent presence of poor vision and poor hearing resulted in an increased vulnerability for depressive symptoms. CONCLUSIONS: Given that a majority of oldest-old has sensory impairments which can result in mental health issues, it is important to facilitate this population's access to vision and audiological treatment and rehabilitation.

Use of an Exercise Technology in Post-Acute Care of a Skilled Nursing Facility: A Feasibility Study.

OBJECTIVES: Use of exercise technologies has benefits for community-dwelling older adults in terms of improved gait and balance. But research on the feasibility of use of exercise technologies in various geriatric health care settings is lacking. Hence, the current study examined the feasibility of implementing an exercise technology intended to augment rehabilitation in patients receiving post-acute care (PAC) in a skilled nursing facility (SNF). We focused on 3 indicators of feasibility: extent of usage (including predictors of more intense use), patients' acceptability of the technology, and limited efficacy. DESIGN: Cross-sectional study with data from patients' electronic medical records (EMR), exercise technology portal, and patient interviews. SETTING: SNF. PARTICIPANTS: A sample of post-acute patients (n = 237). MEASUREMENTS: Sociodemographic and health-related variables, time spent using the technology, and 8 items of the Physical Activity Enjoyment Scale (PACES). RESULTS: Average time spent using the technology varied greatly (range, 1-460 minutes). A regression analysis showed that patients who had a longer length of stay (ß = .01, P < .05) and were younger (ß = -0.01, P < .05) spent significantly more time using the technology. Acceptability of technology was high among patients. Finally, patients who used the technology had lower 30-day rehospitalization rates. CONCLUSION: Exercise technology is feasible to use in supporting rehabilitation in patients receiving PAC in a SNF and seems to have beneficial effects.

Perceived overprotection: support gone bad?

OBJECTIVE: This article focuses on the effects of perceived overprotection, a potentially problematic aspect of receiving support, on the ability to adjust to a chronic impairment, specifically, age-related vision loss. Perceived overprotection is an especially critical issue in this population of chronically ill older adults because of the safety issues associated with vision impairment and because perceptions on the part of the older adult that the support providers are overprotective may lead to excess disability. METHODS: Participants were 584 older men and women with age-related vision impairment who applied for services at a vision rehabilitation agency. Path analysis was used to examine the effects of perceived overprotection on two positive indicators of adjustment: vision-specific adaptation and environmental mastery. Moreover, antecedents of perceived overprotection were examined. RESULT: Higher levels of perceived overprotection were associated with less optimal adjustment to age-related vision loss, with lower scores on measures of vision-specific adaptation and environmental mastery. Higher levels of functional disability and instrumental support received were associated with higher levels of perceived overprotection. DISCUSSION: Findings indicate that support providers of older adults with visual impairment as well as vision rehabilitation service providers need to be aware of the detrimental impact of perceived overprotection.

Intensity of Occupational Therapy Utilization in Nursing Home Residents: The Role of Sensory Impairments.

OBJECTIVES: Unaddressed functional limitations in nursing home (NH) residents can lead to unnecessary, excess disability that negatively affects residents' quality of life. In order to enhance functioning, NH residents can receive rehabilitation such as occupational therapy (OT). However, little is known about factors that may aid or hinder full therapy utilization in NH residents. Hence, our study investigated sensory impairments (vision and hearing) and other important health-related variables (eg, cognitive functioning) as predictors of intensity of OT utilization. DESIGN: Retrospective study with data extraction from electronic medical records (EMRs). SETTING: Skilled nursing facility. PARTICIPANTS: A sample of newly admitted NH residents (N = 121). MEASUREMENTS: Single items for sociodemographic variables and clinician-rated extent of sensory difficulties (hearing and vision) as well as pain presence based on Minimum Data Set (MDS 3.0) assessments in EMRs. MDS 3.0 scales assess cognitive functioning, depressive symptoms, and functional dependency. Total hours of OT received during 90 days postadmission to the NH were extracted from the EMRs. RESULTS: A regression analysis demonstrated that better admission hearing and cognitive functioning, fewer admission depressive symptoms, and higher admission functional dependence were associated with more intense OT utilization-more hours used-over a 90-day period. CONCLUSION: This study emphasizes the importance of assessing and addressing hearing difficulties and depression in NH residents in order to optimize utilization of beneficial OT services and to promote most optimal independent functioning and quality of life.

Anxiety and depression in patients with advanced macular degeneration: current perspectives.

Age-related macular degeneration (AMD) - despite advances in prevention and medical treatment options - remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD.