Caregiver Involvement and Concerns with Care of Residents of Assisted Living before and during the COVID-19 Pandemic.

INTRODUCTION: Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care - especially during the COVID-19 pandemic and especially in assisted living (AL) homes, where resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, little research is available on caregiver involvement and concerns with care of AL residents prior to and during waves 1 and 2 of the COVID-19 pandemic. This study addressed this important knowledge gap. METHODS: This prospective cohort study used baseline and follow-up online surveys with primary caregivers to AL residents in Western Canada who were 65 years or older and had lived in the AL home for at least 3 months before Mar 1, 2020. Surveys assessed the following outcomes in the 3 months prior to and during waves 1 and 2 of the pandemic: sociodemographics, 5 ways of visiting or communicating with residents, involvement in 16 care tasks, concerns with 9 resident physical/mental health conditions, perceived lack of resident access to 7 care services, and whether caregivers felt well informed and involved with resident care. RESULTS: Based on 386 caregiver responses, in-person visits dropped significantly in wave 1 of the pandemic and so did caregiver involvement in nearly all care tasks. While these rates increased in wave 2, most did not return to pre-pandemic levels. Correspondingly, caregiver concerns (already high before the pandemic) substantially increased in wave 1 and stayed high in wave 2. These were particularly elevated among caregivers who did not feel well informed/involved with resident care. CONCLUSIONS: Restricted in-person visiting disrupted resident care and was associated with worse perceptions of resident health and well-being. Continued caregiver involvement in resident care and communication with caregivers even during lockdowns is key to mitigating these issues.

The impact of COVID-19 on relationships between family/friend caregivers and care staff in continuing care facilities: a qualitative descriptive analysis.

BACKGROUND: The COVID-19 pandemic and related public health measures added a new dynamic to the relationship between caregivers and care staff in congregate care settings. While both caregivers and staff play an important role in resident quality of life and care, it is common for conflict to exist between them. These issues were amplified by pandemic restrictions, impacting not only caregivers and care staff, but also residents. While research has explored the relationship between caregivers and care staff in long-term care and assisted living homes, much of the research has focused on the caregiver perspective. Our objective was to explore the impact of COVID-19-related public health measures on caregiver-staff relationships from the perspective of staff in long-term care and assisted living homes. METHODS: We conducted 9 focus groups and 2 semi-structured interviews via videoconference. RESULTS: We identified four themes related to caregiver-staff relationships: (1) pressure from caregivers, (2) caregiver-staff conflict, (3) support from caregivers, and (4) staff supporting caregivers. CONCLUSIONS: The COVID-19 pandemic disrupted long-standing relationships between caregivers and care staff, negatively impacting care staff, caregivers, and residents. However, staff also reported encouraging examples of successful collaboration and support from caregivers. Learning from these promising practices will be critical to improving preparedness for future public health crises, as well as quality of resident care and life in general.

Caregivers' Concerns About Assisted Living Residents' Mental Health During the COVID-19 Pandemic: A Cross-Sectional Survey Study.

Family or friend caregivers' concerns about assisted living (AL) residents' mental health are reflective of poor resident and caregiver mental health. COVID-19-related visiting restrictions increased caregiver concerns, but research on these issues in AL is limited. Using web-based surveys with 673 caregivers of AL residents in Western Canada, we assessed the prevalence and correlates of moderate to severe caregiver concerns about residents' depressed mood, loneliness, and anxiety in the 3 months before and after the start of the COVID-19 pandemic. Caregiver concerns doubled after the start of the pandemic (resident depressed mood: 23%-50%, loneliness: 29%-62%, anxiety: 24%-47%). Generalized linear mixed models identified various modifiable risk factors for caregiver concerns (e.g., caregivers' perception that residents lacked access to counseling services or not feeling well informed about and involved in resident care). These modifiable factors can be targeted in efforts to prevent or mitigate caregiver concerns and resident mental health issues.

Helping Older Residents Remain in Subsidized Housing: Predictive Validity of the Live Well at Home-Rapid Screen (LWAH-RS) in a Real-World Application.

Common Bond Communities (CBC) is a nonprofit organization that provides housing for low-income individuals and families. CBC utilized the Live Well at Home-Rapid Screen (LWAH-RS) to identify the risks for nursing home admission or assisted living entry among housing residents aged 60 or above. Drawing data from 842 assessments, we studied how well the LWAH-RS predicted moves to nursing homes or assisted living settings. Cox regression models showed that the LWAH-RS did predict which residents would move to a care setting. Every 1-point higher in the LWAH-RS assessment score was associated with a 38% higher risk of moving to a higher-level care facility due to health issues. Given this demonstrated predictive validity in a real-world setting, we suggest more systematic approaches for housing practitioners to combat low assessment completion rates and unclear protocols for actions based on the scores.

Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada.

BACKGROUND: Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program. METHODS: We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program. RESULTS: There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not. CONCLUSIONS: A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities.

Physical activity level, fear of falling and quality of life: a comparison between community-dwelling and assisted-living older adults.

BACKGROUND: Physical activity (PA), fear of falling (FOF) and quality of life (QOL) are very important constructs in geriatrics. The interplay among these constructs may vary between community-dwelling and assisted-living older adults. However, studies comparing the wellbeing of community-dwelling older adults with those residing in the assisted-living facilities (ALFs) are rather rare especially from developing countries. This study was aimed at comparing PA, FOF and QOL between assisted-living and community-dwelling older adults and also determining the correlations amongst the constructs for each group. METHODS: This cross-sectional survey involved consecutively sampled 114 older adults (≥65 years, ambulant and well-oriented in time, place and person) residing in conveniently selected ALFs (11.3% males) and adjoining communities (54.1% males). PA, FOF and QOL were evaluated using the Physical Activity Scale for the Elderly, the Modified Fall Efficacy Scale and the Short-form Health Survey (SF-36) questionnaire respectively. Data was analysed using descriptive statistics, analysis of covariance and Spearman rank-order correlation test at 0.05 level of significance. RESULTS: Participants from the ALFs had significantly lower domain and overall PA (F=5.6-103.34; p< 0.05) and QOL (F=11.12-118.05; p< 0,05) scores than community-dwelling groups. FOF was significantly more prevalent in assisted-living group (p< 0.05). There were significant positive correlations (p< 0.05) between each pair of PA, FOF and QOL for both assisted-living and community-dwelling groups. CONCLUSIONS: Older adults in the ALFs had lower PA and QOL scores with higher prevalence of FOF than their community-dwelling counterparts. Significant relationships existed between PA, FOF and QOL for participants in either group. Present results may be suggesting that ageing in place ensures better health outcomes than institutionalised ageing. Whenever possible, older adults should therefore be encouraged to age in place rather than moving into ALFs.

Use of alternative care sites during the COVID-19 pandemic in the city of Buenos Aires, Argentina.

OBJECTIVES: In large cities, where a large proportion of the population live in poverty and overcrowding, orders to stay home to comply with isolation requirements are difficult to fulfil. In this article, the use of alternative care sites (ACSs) for the isolation of patients with confirmed COVID-19 or persons under investigation (PUI) in the City of Buenos Aires during the first wave of COVID-19 are described. STUDY DESIGN: This is a cross-sectional study. METHODS: All patients with COVID-19 and PUI with insufficient housing resources who could not comply with orders to stay home and who were considered at low clinical risk in the initial triage were referred to refurbished hotels in the City of Buenos Aires (Ciudad Autónoma de Buenos Aires [CABA]). ACSs were divided into those for confirmed COVID-19 patients and those for PUI. RESULTS: From March to August 2020, there were 58,143 reported cases of COVID-19 (13,829 of whom lived in slums) in the CABA. For COVID-19 positive cases, 62.1% (n = 8587) of those living in slums and 21.4% (n = 9498) of those living outside the slums were housed in an ACS. In total, 31.1% (n = 18,085) of confirmed COVID-19 cases were housed in ACSs. In addition, 7728 PUI were housed (3178 from the slums) in an ACS. The average length of stay was 9.0 ± 2.5 days for patients with COVID-19 and 1.6 ± 0.7 days for PUI. For the individuals who were housed in an ACS, 1314 (5.1%) had to be hospitalised, 56 were in critical care units (0.22%) and there were 27 deaths (0.1%), none during their stay in an ACS. CONCLUSIONS: Overall, about one-third of all people with COVID-19 were referred to an ACS in the CABA. For slum dwellers, the proportion was >60%. The need for hospitalisation was low and severe clinical events were rare. This strategy reduced the pressure on hospitals so their efforts could be directed to patients with moderate-to-severe disease.

REducing SEDENTary Behavior Among Mild to Moderate Cognitively Impaired Assisted Living Residents: A Pilot Randomized Controlled Trial (RESEDENT Study).

Older adults in assisted living spend most of their day in sedentary behaviors, which may be detrimental to cognitive function. The primary purpose of this pilot study was to assess the feasibility of using a prompting device to reduce sitting time with light walking among older adults with mild to moderate cognitive impairment residing in an assisted living setting. A secondary purpose was to examine the effectiveness of the intervention on the residents' cognitive function, physical function, and quality of life. The participants (n = 25, mean age = 86.7 [5.3] years) were assigned in clusters into a two-arm 10-week single-site pilot randomized controlled trial. The intervention group was prompted with a watch to interrupt sedentary behaviors and partake in 10 min of light physical activity (i.e., walking) three times a day after a meal. The assessments included hip-worn accelerometers (Actical) and diaries, the Alzheimer's disease assessment scale-cognitive, Timed Up and Go, and the short-form 36 health survey. Adherence was high, as there were no dropouts, and over 70% of the participants completed over 80% of the prescribed physical activity bouts. Significant effects favoring the intervention were shown for all outcomes.

Staff members' prioritisation of care in residential aged care facilities: a Q methodology study.

BACKGROUND: When healthcare professionals' workloads are greater than available resources, care activities can be missed, omitted or delayed, potentially leading to adverse patient outcomes. Prioritisation, a precursor to missed care, involves decision-making about the order of care task completion based on perceived importance or urgency. Research on prioritisation and missed care has predominantly focused on acute care settings, which differ from residential aged care facilities in terms of funding, structure, staffing levels, skill mix, and approaches to care. The objective of this study was to investigate how care staff prioritise the care provided to residents living in residential aged care. METHODS: Thirty-one staff members from five Australian residential aged care facilities engaged in a Q sorting activity by ranking 34 cards representing different care activities on a pre-defined grid from 'Least important' (- 4) to 'Most important' (+ 4). Concurrently, they participated in a think-aloud task, verbalising their decision-making processes. Following sorting, participants completed post-sorting interviews, a demographics questionnaire and semi-structured interviews. Q sort data were analysed using centroid factor analysis and varimax rotation in PQMethod. Factor arrays and data from the think-aloud task, field notes and interviews facilitated interpretation of the resulting factors. RESULTS: A four-factor solution, representing 22 participants and 62% of study variance, satisfied the selection criteria. The four distinct viewpoints represented by the solution were: 1. Prioritisation of clinical care, 2. Prioritisation of activities of daily living, 3. Humanistic approach to the prioritisation of care, and 4. Holistic approach to the prioritisation of care. Participants' prioritisation decisions were largely influenced by their occupations and perceived role responsibilities. Across the four viewpoints, residents having choices about their care ranked as a lower priority. CONCLUSIONS: This study has implications for missed care, as it demonstrates how care tasks deemed outside the scope of staff members' defined roles are often considered a lower priority. Our research also shows that, despite policy regulations mandating person-centred care and the respect of residents' preferences, staff members in residential aged care facilities tend to prioritise more task-oriented aspects of care over person-centredness.

Perspectives of residents and staff regarding food choice in residential aged care: A qualitative study.

AIMS AND OBJECTIVES: To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff. BACKGROUND: Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self-determination, sense of autonomy and quality of life. DESIGN: This study used an exploratory descriptive qualitative approach guided by self-determination theory. METHOD: A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In-depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study. RESULTS: Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well-being. CONCLUSIONS: This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities. RELEVANCE TO CLINICAL PRACTICE: Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.

Health workers perception on telemedicine in management of neuropsychiatric symptoms in long-term care facilities: Two years follow-up.

The management of neuropsychiatric symptoms is a challenge in long-term care facilities. Our objective was to assess the perception of telemedicine, as a useful tool to connect staff to specialized units. In this multicenter prospective study, 90 patients from ten facilities benefited from 180 sessions over two years. The primary outcome was the perception of telemedicine evaluated through semi-structured interviews at baseline and two years later. Our results revealed positive perceptions of telemedicine, confirmed after two years of real-life experience with its use. Not only do staff members believe that telemedicine is not a downgraded version of medicine, but they also believe that it could improve the quality of care. They expressed a very positive sense of recognition of their professional qualifications and indicated their need to be involved in change processes to ensure successful implementation and better adherence to telemedicine as a service.

[Assisted living facilities in inpatient and outpatient settings]. / Wohn- und Hausgemeinschaften in stationären und ambulanten Settings.

BACKGROUND AND OBJECTIVE: Assisted living (AL) facilities for older people in need of support in outpatient and inpatient settings differ from nursing homes due to the orientation towards autonomy of the residents and the normality of living and everyday routines, very similar to living at home. The conceptual framework, here defined as AL, is characterized by a homelike small-scale environment and the keeping of one's own household and manageability. The presence of personnel in a new personal mix supports qualities, such as social participation, meaningful activities and functional support. The study examined how this frame of reference impacts the quality of life of residents and reflects the perspectives of further development of housing options. MATERIAL AND METHODS: Over a period of 9 months (2006-2007) 8 AL facilities with 73 residents and a classical nursing home with 18 residents were examined in terms of behavioral competence, subjective well-being, perceived quality of life and objective environment. Established multidimensional person and environment-related assessment instruments were applied. Specific organizational questions were explored through qualitative interviews. RESULTS: Despite a formal inpatient or outpatient classification, the residents living in AL facilities showed significantly higher values for well-being and showed significantly less agitated, challenging behavior compared to the nursing home. In particular, people with dementia benefited from the specific quality of AL, which is reflected in relevant dimensions. CONCLUSION: The findings indicate that AL represents a concept that can be used as a basis for new housing offers and a new type of care infrastructure. It provides connecting factors to the leading principle of shared responsibility.

The relation between falls and medication use among elderly in assisted living facilities.

PURPOSE: Many elderly are concerned about falling transfer to assisted living facilities (ALF). Previous literatures studied the medication use and falls in the community, hospitals, or nursing homes, with scanty data about ALF. Therefore, the aim of the current case-control study was to assess the relation between medication use and falls among elderly in ALF. METHODS: A matched case-control study was conducted. The study was conducted in ALF in Cairo, Egypt. The study participants were 188 individuals; they were subdivided into two groups: fallers and nonfallers; timed up and go test (TUGT) was performed by all subjects. Medication data were collected according to the fall risk-increasing drugs list and the list of drugs that cause or worsen orthostatism. Other fall risk factors, as suggested by American Geriatric Society, were assessed. RESULTS: The use of vasodilators, diuretics, alpha blockers, opioids, antipsychotics, and sedative hypnotics were more common in fallers than in nonfallers (P < 0.001, P = 0.03, P < 0.001, P = 0.013, P < 0.001, and P < 0.001, respectively). Vasodilators, alpha blockers, and antipsychotics were significant predictors of falls even after adjustment for the possible confounding factors. Vasodilators, alpha blockers, opioids, sedative hypnotics, and recent dose changes in oral hypoglycemics were significant predictors of higher TUGT after adjustment for the possible confounding factors. CONCLUSION: The current study supported the risk of psychotropic and cardiovascular medications, with especial emphasis on vasodilators, alpha blockers, and antipsychotics, with raising concern about opioids, sedative hypnotics, and recent dose change in oral hypoglycemics.

Literature on Wearable Technology for Connected Health: Scoping Review of Research Trends, Advances, and Barriers.

BACKGROUND: Wearable sensing and information and communication technologies are key enablers driving the transformation of health care delivery toward a new model of connected health (CH) care. The advances in wearable technologies in the last decade are evidenced in a plethora of original articles, patent documentation, and focused systematic reviews. Although technological innovations continuously respond to emerging challenges and technology availability further supports the evolution of CH solutions, the widespread adoption of wearables remains hindered. OBJECTIVE: This study aimed to scope the scientific literature in the field of pervasive wearable health monitoring in the time interval from January 2010 to February 2019 with respect to four important pillars: technology, safety and security, prescriptive insight, and user-related concerns. The purpose of this study was multifold: identification of (1) trends and milestones that have driven research in wearable technology in the last decade, (2) concerns and barriers from technology and user perspective, and (3) trends in the research literature addressing these issues. METHODS: This study followed the scoping review methodology to identify and process the available literature. As the scope surpasses the possibilities of manual search, we relied on the natural language processing tool kit to ensure an efficient and exhaustive search of the literature corpus in three large digital libraries: Institute of Electrical and Electronics Engineers, PubMed, and Springer. The search was based on the keywords and properties to be found in articles using the search engines of the digital libraries. RESULTS: The annual number of publications in all segments of research on wearable technology shows an increasing trend from 2010 to February 2019. The technology-related topics dominated in the number of contributions, followed by research on information delivery, safety, and security, whereas user-related concerns were the topic least addressed. The literature corpus evidences milestones in sensor technology (miniaturization and placement), communication architectures and fifth generation (5G) cellular network technology, data analytics, and evolution of cloud and edge computing architectures. The research lag in battery technology makes energy efficiency a relevant consideration in the design of both sensors and network architectures with computational offloading. The most addressed user-related concerns were (technology) acceptance and privacy, whereas research gaps indicate that more efforts should be invested into formalizing clear use cases with timely and valuable feedback and prescriptive recommendations. CONCLUSIONS: This study confirms that applications of wearable technology in the CH domain are becoming mature and established as a scientific domain. The current research should bring progress to sustainable delivery of valuable recommendations, enforcement of privacy by design, energy-efficient pervasive sensing, seamless monitoring, and low-latency 5G communications. To complement technology achievements, future work involving all stakeholders providing research evidence on improved care pathways and cost-effectiveness of the CH model is needed.

[Relocations of older persons with intellectual disability : A quantitative analysis]. / Umzüge von älteren Menschen mit geistiger Behinderung : Eine quantitative Analyse.

BACKGROUND: Relocation from the familiar living environment is a particularly risky transition event for old people with intellectual disability (ID); however, a change of environment has the potential to maintain or improve a person's social participation and self-determination in old age. The research project MUTIG aimed to analyze the frequency and destination of moving home of old persons with ID (≥50 years) in Westphalia for the years 2014 and 2015. MATERIAL AND METHODS: The investigation was based on a secondary analysis of administrative data of all persons over 50 years who received any kind of social aid for integration from the Regional Association of Westphalia-Lippe. For each individual the address and support arrangements at the beginning and the end of the years 2014 and 2015 were compared. RESULTS: Approximately 5% of older people with ID changed address per year. People who moved to nursing homes had previously primarily lived in larger institutions or larger community-based group homes. The number of older persons with ID moving into or out of supported living arrangements was approximately equal. CONCLUSION: Older persons with ID should also be able to move to smaller supported settings and these settings should provide long-lasting living perspectives (aging in place). The pulling effect that nursing homes exert on residents in residential institutions or larger group homes is critically discussed.

[In which residential settings do older persons with intellectual disability live? : A quantitative comparison of age groups for Westphalia-Lippe]. / In welchen Wohnsettings leben ältere Menschen mit geistiger Behinderung? : Ein quantitativer Vergleich von Altersgruppen für Westfalen-Lippe.

BACKGROUND: The number of aged persons with intellectual disability (ID) in Germany is increasing; however, reliable data on the residential settings in which they live are missing. The aim of this study was to estimate how adults with ID of different age groups are distributed over the various residential settings using the example of Westphalia-Lippe. MATERIAL AND METHODS: Administrative data on all adults with ID who received aid for social integration were statistically analyzed. Data on persons with ID in long-term nursing homes were collected via telephone interviews and questionnaires. Finally, the results were merged to obtain a comprehensive overview for Westphalia-Lippe. RESULTS: In Westphalia-Lippe aged persons with ID (≥65 years) rarely live independently but mostly with family members or in supported living arrangements. They are living in larger community-based homes or in residential institutions more frequently than younger persons with ID and one fifth have been living in nursing homes for a comparatively long period of time. CONCLUSION: Older persons with ID have so far hardly benefited from the increasing residential options for supported living. All forms of services and residential arrangements for persons with ID have to adapt to the changing needs for support in old age. Long-term nursing homes should not mutate into places where people spend the complete phase of old age.

Intraindividual Changes in Ambulation Associated With Falls in a Population of Vulnerable Older Adults in Long-Term Care.

OBJECTIVE: To examine how intraindividual changes in ambulation characteristics may be used to predict falls. DESIGN: Longitudinal study design. SETTING: Assisted living facility. PARTICIPANTS: Ambulatory older adults (N=26; mean age, 79y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Continuous measure of average weekly ambulation characteristics (time and distance walked, speed, path measures [eg, path time and distance, number of paths (where a path is at least 60s of uninterrupted walking separated by at least a 30-s stop)]), accounting for weekly changes in these ambulation characteristics on an individual level over time along with falls (yes/no) and cognitive impairment (CI) (measured by the Montreal Cognitive Assessment). RESULTS: In hierarchical linear models accounting for intraindividual changes in ambulation characteristics over the 8-month course of the study and level of CI, path distance (odds ratio, 1.02; P≤.001) was associated with an increased risk of a fall. In the short-term, intraindividual changes in path distance were associated with a fall within the 4-week interval the change was noted. Path distance had fair sensitivity (.74) and specificity (.66) to a fall (area under the curve, .70). CONCLUSIONS: Study findings suggest that falls may have specific predictors, specifically that older adults with CI are more likely to fall when walking continuously with little/no breaks. Interventions focused on reducing path-associated fatigue may effectively reduce fall incidence in this population.

Dentition, nutritional status and adequacy of dietary intake among older residents in assisted living facilities.

OBJECTIVE: We examined the relationships between dentition, nutritional status and dietary intakes of energy, protein and micronutrients among older people in assisted living facilities in Helsinki. BACKGROUND: Poor dentition is associated with malnutrition. Less is known about how dentition is associated with detailed nutrient intakes in institutionalised older people. MATERIALS AND METHODS: This cross-sectional study assessed 343 participants (mean age 83 years). Dentition was assessed by trained ward nurses and divided into edentulous participants without dentures (group 1), edentulous participants with removable dentures (group 2) and those with any natural teeth (group 3). Nutritional status was assessed by Mini Nutritional Assessment (MNA). The energy, protein and nutrient intakes were calculated from detailed 1-day food diaries and compared with the recommendations of the Finnish National Nutrition Council as a measure of dietary adequacy. Assessment included also participants' cognitive and functional status. RESULTS: Of the participants, 8.2, 39.1 and 52.8% were in groups 1, 2 and 3, respectively. Altogether 22% were malnourished according to MNA. Group 1 had the poorest nutritional status. A large proportion of participants consumed less than the recommended amounts of energy, protein or micronutrients. Half of the participants consumed <60 g/day of protein. The intake of protein was significantly lower in group 1 than in other two groups. CONCLUSION: Malnutrition and inadequate protein intake were very common and associated with dentition among older people with multiple disabilities in assisted living facilities. Assessment of dental status should be part of good nutritional care in long-term care.

Robot deployment in long-term care : Case study on using a mobile robot to support physiotherapy.

BACKGROUND: Healthcare systems in industrialized countries face the challenge of providing care for a growing number of elderly people. Information technology has the possibility of facilitating this process by providing support for nursing staff and improving the well-being of the elderly through a variety of support systems. OBJECTIVE: Little is known about the challenges that arise from the deployment of technology in care settings; however, the integration of technology into care is one of the core determinants of successful support. This article presents the challenges and options associated with the integration of technology into care using the example of a mobile robot to support physiotherapy for elderly people with cognitive impairment in the European project Spatio-Temporal Representations and Activities for Cognitive Control in Long-Term Scenarios (STRANDS). RESULTS AND DISCUSSION: This article presents the technical challenges associated with the introduction of robots in the context of care as well as the perspectives of physiotherapists involved and an overview of information and experiences gained. It is hoped that this will provide useful information for the work of researchers and practitioners wishing to integrate robotic aids into the caregiving process.

[Well-Being in old age ­ content validity of the Ryff Scale for residents of nursing homes and assisted living facilities]. / Wohlbefinden im Alter. Die Inhaltsvalidität der Ryff-Skala für BewohnerInnen von Pflegeheimen und betreuten Wohneinrichtungen.

BACKGROUND: Well-being is an important but rarely assessed outcome of care. The Ryff Scale of Psychological Well-Being measures this concept, but was not designed specifically for residents of assisted living facilities and nursing homes. AIM: To create a variant of this scale for the elderly in nursing homes and assisted living facilities in German speaking regions and to determine its content validity. METHOD: A study was conducted in Salzburg using the Delphi method, which consisted of two rounds containing 56 experts working in nursing homes and assisted living facilities. Suggestions for improvements were obtained by means of open-end questions. Acceptance of the items was rated on a 4-point Likert-scale. Items were accepted if a minimum of 80 % of the experts agreed at least partially. During the qualitative analysis the statements of the experts were compared and summarised into codes and categories. RESULTS: In the first round (response rate: 34.6 %) 38 items out of 54 items were modified. The revised questionnaire received approval (≥ 80 %) for all items in the second round (response rate: 64.7 %). The experts criticised the phrasing of some items and also aspects of well-being, which in their opinion, are not relevant for the elderly in need of care anymore (e. g. performance of obligations). CONCLUSION: A modified scale was developed which was deemed appropriate by the experts for residents of nursing homes and assisted living facilities. This scale now requires psychometric testing.