Oral health and oral health-related quality of life among older adults receiving home health care services: A scoping review.

OBJECTIVE: To map the literature on subjective and objective oral health indicators and oral health-related quality of life (OHRQoL) in older adults receiving home health care services (HHCS). BACKGROUND: The proportion of older adults in need of HHCS will increase in the coming years. Previous studies indicate that frail and dependent older adults are at increased risk for oral diseases, due to challenges with daily oral hygiene and regular access to dental services. MATERIALS AND METHODS: Four databases were searched in November 2020 for relevant literature. Search terms included a comprehensive list of terms for adults 65 years or older receiving HHCS, clinical and subjective oral health indicators, and OHRQoL. The literature was reviewed based on inclusion and exclusion criteria. RESULTS: Of the 3114 sources identified, 18 were included. Data on oral diseases and symptoms among older adults receiving HHCS were limited and heterogeneous. Overall, older adults often lacked some of their natural teeth and often had removable dentures that needed repair. In addition, plaque, caries, xerostomia, and chewing and swallowing problems were common among the population group. Data on OHRQoL were scarce and indicated a positive association with a higher number of present teeth, while decayed teeth, root remnants, and dry mouth had substantial negative impacts on the daily activities of older adults receiving HHCS. CONCLUSION: This scoping review show that older adults above 65 years receiving HHCS generally have poor oral health status and that there is a knowledge gap regarding their OHRQoL.

'Whose role is it anyway?' Experiences of community nurses in the delivery and support of oral health care for older people living at home: a grounded theory study.

BACKGROUND: Older people who receive care at home are likely to require support with oral health care. Community nurses, who are also referred to as district or home care nurses, have an important role with this population. This is because they are the healthcare professionals who are most likely to encounter this population, who may also not be receiving regular dental care or oral health promotion. However, few studies have explored community nursing experiences in the delivery and support of oral healthcare for older people living at home. METHODS: A grounded theory approach was used to explore experiences of community nurses in the delivery and support of oral health care for older people living at home. Fifteen practising community nurses from the United Kingdom participated in one-to-one semi-structed interviews from May 2021 to December 2021. These interviews were audio-recorded, transcribed verbatim and analysed using constant comparative analysis. Ethical approval was obtained for this study prior to data collection. RESULTS: Four categories emerged from the data to support development of the core phenomena. These four categories were: (1) Education, in relation to what community nurses knew about oral health, (2) Practice, with regards to how community nurses delivered oral health care to older people in their own home, (3) Confidence, with consideration to the extent to which this supported or impeded community nurses in providing oral healthcare to older people and (4) Motivation, in terms of the extent to which community nurses thought they could or should influence future practice improvement in the area. The core category was (C) Uncertainty as it was both present and central across all four categories and related to community nursing understanding about their specific role, and the role of other professionals, with reference to oral health of their patients. CONCLUSIONS: This study reveals community nurses' uncertainty in providing oral healthcare to older adults at home. Emphasising comprehensive and continuous oral health education can boost nurses' confidence in patient support. Interprofessional collaboration and clear role definitions with oral health professionals are crucial for improving oral health outcomes in this vulnerable population.

Evaluation of a co-designed educational e-resource about oral health for community nurses: study protocol.

BACKGROUND: Oral health is a crucial aspect of health and wellbeing for older people. Poor oral health has been found to significantly increase the risk of chronic health conditions and poor quality of life for older people. Nurses practicing in the community are well-placed to provide oral health care to older people in their own homes, yet there has been little research in this field to develop accessible support for them to do so. Previous literature, reviewed in an earlier phase of this work, revealed that there has, historically, been a paucity of oral health care education for nurses and very few educational resources have been developed in this field. METHODS: This study will evaluate an educational e-resource which has been co-designed by service users, carers and clinicians. In the first phase of research, evidence of promise will be evaluated by analysing quantitative data on community nurses' oral health attitudes and self-efficacy for oral health assessments of older people. In the second phase of research, facilitators and barriers to community nurses' provision of oral health care to older people and the acceptability of the educational e-resource will be evaluated. DISCUSSION: This research will investigate the potential of an educational e-resource to improve community nurses' capabilities to deliver oral health care to older people in their own homes. This research will inform both future intervention design and understanding of community nurses' knowledge and attitudes about oral health care. Facilitators and barriers to provision of this care for older people will also be explored.

Palliative care in home health care services and hospitals - the role of the resource nurse, a qualitative study.

BACKGROUND: The role of the resource nurse aims at bridging the gap between the specialist nurses and the nurses who work in non-specialist wards. The role is established internationally and used in a wide area of clinical settings. The resource nurse is promoting evidence-based practice. Patients with life limiting conditions including cancer and other chronic diseases will likely need palliative care during the trajectory of illness. Due to the complexity of palliative care, both interprofessional help and cooperation between levels of healthcare are considered necessary. AIM: The aim of this study was to explore the perceptions and experiences related to the role of the resource nurse in palliative care in the setting of home health care services and hospitals in Norway, from the perspectives of the resource nurses and the ward nurses. DESIGN: The study has an explorative design with a qualitative approach. METHODS: Eight individual interviews were conducted. Audiotaped interview material was transcribed verbatim and the data were analysed using systematic text condensation. The encoded data material provided the basis for writing analytical texts that in turn resulted in meaningful descriptions of the different categories. RESULTS: Four resource nurses and four ward nurses participated in individual interviews. Analysis of the data yielded three categories: 1. Expectations of better competence in the ward. 2. Expectations of better cooperation between professions and different levels of healthcare services. 3. Improvements and hindrances. CONCLUSION: The resource nurse role is underutilized due to heavy workload and inefficient organization of care. Improvements such as sufficient time resources, support from the ward nurse and cooperation with staff nurses, the resource nurses' role could contribute to increased competence and cooperation interprofessionally and between levels of healthcare.

Comparison of the caregivers' and community health professionals' views on home health care services for disabled older adults: a cross-sectional study in Beijing, China.

BACKGROUND: In an era of an increasingly ageing society, part of healthcare for older adults can be provided in patients' homes, and the need for home health care services (HHCSs) is increasing. This study sought to determine whether a gap exists between the views of community health professionals and the caregivers of disabled older adults towards HHCSs in Beijing, China. METHODS: A cross-sectional study with two comparative questionnaire surveys was conducted in Beijing, China. One survey was administered to the caregivers of disabled older adults, and the other was administered to health professionals in community health service institutions (CHSIs). T-tests and Wilcoxon signed-rank tests were used to explore potential differences between the views of caregivers and community health professionals towards HHCSs. RESULTS: We received 370 valid questionnaires from caregivers and 224 questionnaires from health professionals. Of the 370 caregivers, 314 (84.9%) were willing to apply for HHCSs for the older adults, but only 20.5% (N = 76) received HHCSs. Over 80% of the caregivers accepted out-of-pocket costs less than 100 yuan per visit. Caregivers' demands on home nursing services were significantly higher than those of health guidance services (Z = - 7.725, P < 0.001). Most of the 224 health professionals chose "health professionals' personal safety cannot be guaranteed" as a problem limiting the provision of HHCSs (N = 151, 40.8%). The health professionals' attitudes towards home nursing services were significantly less positive than those towards health guidance services (Z = - 10.081, P < 0.001). For home nursing services, health professionals' attitude scores were lower than the caregivers' demand scores (Z = - 4.960, P < 0.001), while for health guidance services, health professionals' attitude scores were higher than the caregivers' demand scores (Z = - 8.373, P < 0.001). CONCLUSIONS: Gaps exist between the views of caregivers and health professionals on HHCSs. Compared to health professionals with a higher willingness to provide health guidance services, caregivers need home nursing services. Feasible policies should be implemented to safeguard the rights and interests of health professionals, and qualified health professionals should be trained for HHCSs.

Crossing knowledge boundaries: health care providers' perceptions and experiences of what is important to achieve more person-centered patient pathways for older people.

BACKGROUND: Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Current research in the field highlights person-centered care as crucial; however, how to implement and enact this ideal in practice and thus achieve more person-centered patient pathways remains unclear. The aim of this study was to explore health care providers' (HCPs') perceptions and experiences of what is important to achieve more person-centered patient pathways for older people. METHODS: This was a qualitative study. We performed individual semistructured interviews with 20 HCPs who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. RESULTS: A thematic analysis resulted in five themes which outline central elements of the HCPs' perceptions and experiences relevant to achieving more person-centered patient pathways: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathway; and 5) ambiguity toward checklists and practice implementation. CONCLUSIONS: The findings can assist stakeholders in understanding factors important to practicing person-centered transitional care for older people. Through collaborative knowledge sharing the participants developed a more shared understanding of how to achieve person-centered patient pathways. The importance of assuming a shared responsibility and a more holistic understanding of the patient pathway by merging different ways of knowing was highlighted. Checklists incorporating the What matters to you? question and the mapping of the patient journey were important tools enabling the crossing of knowledge boundaries both between HCPs and between HCPs and the older patients. Home care providers were perceived to have important knowledge relevant to providing more person-centered patient pathways implying a central role for them as knowledge brokers during the patient's journey. The study draws attention to the benefits of focusing on the older patients' way of knowing the patient pathway as well as to placing what matters to the older patient at the heart of transitional care.

Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach.

BACKGROUND: The general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services. METHOD: This study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis. RESULTS: The inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues. CONCLUSIONS: This study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.

The association among knowledge of and confidence in home health care services, acculturation, and family caregivers' relationships to older adults of Mexican descent.

The purposes of this study were to examine the relationships among knowledge of and confidence in health care services (HHCS), acculturation, characteristics of family caregivers of Mexican descent, and differences by caregivers' relationship (spouse or adult child). A sample of Mexican-descent older adults and their caregivers was recruited (n = 74 dyads) in Arizona. Each participant completed questionnaires on knowledge, confidence, and acculturation. There were moderate but significant associations among higher Anglo Orientation with Knowledge and with Confidence. Fear of HHCS was positively associated with higher Anglo Orientation and English Language Preference; and negatively associated with Mexican Orientation and Spanish Language Preference. For Spouse caregivers, Fear of HHCS was positively correlated with higher Anglo Orientation and English Language Preference; for Offspring caregivers, Fear of HHCS was negatively correlated with Mexican Orientation and Spanish Language Preference. Results support assessing caregiver cohort and socio-cultural context to decrease HHCS use disparities by Mexican-descent caregiving families.

Estimation of service length with the machine learning algorithms and neural networks for patients who receiving home health care.

The main purpose of the study is to develop an estimation model using machine learning algorithms and to ensure the effective and efficient implementation of home health care service planning in hospitals with these algorithms. The necessary approvals for the study were obtained. The data set was created by obtaining patient data (except for data such as Turkish Republic identification number) from 14 hospitals providing Home Health Care Services in the city of Diyarbakir. The data set was subjected to necessary pre-processing and descriptive statistics were applied. For the estimation model, Decision Tree, Random Forest and Multi-layer Perceptron Neural Network algorithms were used. It was found that the number of days of home health care service, which the patients received, varied depending on their age and gender. It was observed that the patients were generally in the disease groups that required Physiotherapy and Rehabilitation treatments. It was determined that the length of service for patients can be predicted with a high reliability rate (Multi-Layer Model Acc: 90.4%, Decision Tree Model Acc: 86.4%, Random Forest Model Acc: 88.5%) using machine learning algorithms. In the light of the findings and data patterns obtained in the study, it is thought that effective and efficient planning will be made in terms of health management. In addition, it is believed that estimating the average length of service for patients will contribute to strategic planning of human resources for health, and to reducing medical consumables, drugs and hospital expenses.

Patient-Centered Integrated Model of Home Health Care Services in South Korea (PICS-K).

Introduction: As South Korea is fast becoming an aging society, the need for integrated care of the elderly has increased. 'Community Integrated Care Initiatives' have been implemented by the Ministry of Health and Welfare. However, home healthcare is insufficient to meet this need. Description: The National Health Insurance Service (NHIS) launched the initiative, 'Patient-Centered Integrated model of Home Health Care Services in South Korea (PICS-K)'. Its purpose is to coordinate home healthcare providers by establishing a home health care support center (HHSC) in public hospitals starting in 2021. The PICS-K has six main features: integration of primary care-hospital-personal care-social services through a consortium, HHSC in hospitals with primary care collaboration, increased accessibility, interdisciplinary team (IDT), patient-centeredness, and education. Discussion: Integrating healthcare, personal care, and social services at multiple levels is necessary. Accordingly, platforms to share participant information and service records, and institutional payment system reforms are required. Conclusion: In public hospitals, the HHSC supported primary care, which provides home healthcare. The model combined community healthcare and social services to accomplish the aging-in-place of the homebound population by focusing on their needs. This model will be applicable to other regions in Korea.

Longitudinal associations between time-varying insomnia symptoms and all-cause health care services utilization among middle-aged and older adults in the United States.

OBJECTIVE: To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults. DATA SOURCES: The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States. STUDY DESIGN: This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals. DATA COLLECTION/EXTRACTION METHODS: We extracted longitudinal data from 2002 through 2018 waves of the HRS. PRINCIPAL FINDINGS: Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms. CONCLUSIONS: The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.

Os planos de saúde e a cobertura de home care / Health insurance and home care coverage

As solicitações de cobertura para home care estão entre as mais complexas discussões hoje existentes no universo jurídico dos planos de saúde. A partir de um estudo normativo-jurisprudencial, o presente artigo tem como objetivo examinar os serviços de saúde domiciliares à luz das coberturas dos contratos de planos de saúde. Com esta meta, passa por diversos tópicos inerentes a este assunto, incluindo determinados fenômenos jurídicos e sociais que ajudam a entendê-lo, assim como o regime jurídico que regula a matéria. Na sequência, o artigo foca os serviços domiciliares, com ênfase naqueles que, à luz das normas aplicáveis, são considerados como de cobertura obrigatória. Após, comenta também a complexidade terminológica que envolve o tema. Ao final, passa ao exame da jurisprudência existente sobre planos de saúde e cobertura para serviços domiciliares, com destaque para os recentes precedentes que, na opinião dos autores, adotam uma posição mais aceitável e razoável, capaz de representar um verdadeiro ponto de equilíbrio a esta temática tão controvertida.

Demands for home care coverage are stirring the most complex discussions currently existing in the legal universe of health insurance contracts. Based on a normative-jurisprudential study, this essay's scope examines home health care services in light of the coverage of health insurance contracts. With this goal, several topics on the subject are dealt with, including certain juridical and social phenomena that facilitate its understanding, as well as the legal regime that regulates this matter. It follows focusing on home health care services, with emphasis on those that, in light of the applicable regulatory standards, are considered to be of compulsory coverage. Next, the terminological complexity that involves this subject is also commented. At the end, the existing jurisprudence regarding health care insurances and the coverage for home health care services is examined, highlighting recent precedents that, in the authors' opinion, adopt an acceptable and reasonable position, capable of representing a true balance point for this controversial matter.

Uso de dispositivos de micronebulización en adultos mayores en un programa de hospitalización domiciliaria / Use of micro-nebulization equipment devices in older adults in an inpatient program home

La atención médica domiciliaria es una estrategia que permite evitar infecciones asociadas al cuidado de la salud en individuos con deficiencias inmunológicas como los adultos mayores. Se realizó una investigación de tipo descriptivo-longitudinal, en la que se tuvieron en cuenta condiciones relacionadas con el dispositivo de micronebulización como: el tiempo de uso, el lavado del dispositivo y su almacenamiento. Con respecto al terapeuta se tuvo en cuenta: lavado de manos y aplicación del protocolo de limpieza y desinfección. Se realizaron dos tomas de muestra a diecisiete dispositivos de micronebulización individual de adultos mayores pertenecientes al programa de hospitalización domiciliaria de Forja Empresas Ltda, a los quince y treinta días de uso después de la entrega del dispositivo en dos momentos: antes y después del procedimiento de la terapia respiratoria. Se identificaron ocho microorganismos en la primera toma de muestra que se clasificaron como flora transitoria y diecinueve microorganismos en la segunda, en la que se encontró flora residente, transitoria y potencialmente patógena. En relación al protocolo de limpieza y desinfección, realizado por los terapeutas, se observó modificaciones al protocolo establecido por Forja Empresas Ltda, sin embargo dicho protocolo no incluye el lavado de manos, punto indispensable para la atención del paciente. Se hace necesario brindarles información oportuna a los pacientes, familiares y/o cuidadores sobre el almacenamiento adecuado del dispositivo con el fin de evitar presencia de microorganismos que pueden afectar la salud de los adultos mayores.

Home health care is a strategy that allows avoiding infections associated with health care of individuals with immune deficiencies such as older adults. A descriptive-longitudinal investigation was conducted, which took into account conditions related to the micro-nebulization equipment device such as: its time of use, cleansing, and storage. With respect to the therapist, it was taken into account: hand washing and implementation of the protocol of cleaning and disinfection. Two different samples were taken to seventeen individual micro-nebulization equipment devices of older adults belonging to the program of home hospitalization of Forging Companies Ltd., after fifteen and thirty days of use after the delivery of the device in two times: before and after the respiratory procedure. Eight microorganisms were identified in the first portion of the sample that were classified as transitory flora and nineteen microorganisms in the second one, where resident, transient, and potentially pathogenic flora was found. In relation to the protocol of cleaning and disinfection carried out by the therapists. Changes to the protocol established by Forging Companies Ltd. were observed; however, this protocol does not include the washing of hands, which is a vital point for patient care. It is necessary to provide patients, family members and/or caregivers with timely information about the proper storage of the device in order to avoid the presence of microorganisms that can affect the health of older adults.