Recommendations Related to Visitor and Movement Restrictions in Long-Term Care and Retirement Homes in Ontario during the COVID-19 Pandemic: Perspectives of Residents, Families, and Staff.

In Canada, long-term care and retirement home residents have experienced high rates of COVID-19 infection and death. Early efforts to protect residents included restricting all visitors as well as movement inside homes. These restrictions, however, had significant implications for residents' health and well-being. Engaging with those most affected by such restrictions can help us to better understand their experiences and address their needs. In this qualitative study, 43 residents of long-term care or retirement homes, family members and staff were interviewed and offered recommendations related to infection control, communication, social contact and connection, care needs, and policy and planning. The recommendations were examined using an ethical framework, providing potential relevance in policy development for public health crises. Our results highlight the harms of movement and visiting restrictions and call for effective, equitable, and transparent measures. The design of long-term care and retirement policies requires ongoing, meaningful engagement with those most affected.

Integration of hospital with congregate care homes in response to the COVID-19 pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need to improve the safety of the environments where we care for older adults in Canada. After providing assistance during the first wave, many Ontario hospitals formally partnered with local congregate care homes in a "hub and spoke" model during second pandemic wave onward. The objective of this article is to describe the implementation and longitudinal outcomes of residents in one hub and spoke model composed of a hospital partnered with 18 congregate care homes including four long-term care and 14 retirement or other congregate care homes. Intervention: Homes were provided continuous seven-day per week access to hospital support, including infection prevention and control (IPAC), testing, vaccine delivery and clinical support as needed. Any COVID-19 exposure or transmission triggered a same-day meeting to implement initial control measures. A minimum of weekly on-site visits occurred for long-term care homes and biweekly for other congregate care homes, with up to daily on-site presence during outbreaks. Outcomes: Case detection among residents increased following implementation in context of increased testing, then decreased post-immunization until the Omicron wave when it peaked. After adjusting for the correlation within homes, COVID-related mortality decreased following implementation (OR=0.51, 95% CI, 0.30-0.88; p=0.01). In secondary analysis, homes without pre-existing IPAC programs had higher baseline COVID-related mortality rate (OR=19.19, 95% CI, 4.66-79.02; p<0.001) and saw a larger overall decrease during implementation (3.76% to 0.37%-0.98%) as compared to homes with pre-existing IPAC programs (0.21% to 0.57%-0.90%). Conclusion: The outcomes for older adults residing in congregate care homes improved steadily throughout the COVID-19 pandemic. While this finding is multifactorial, integration with a local hospital partner supported key interventions known to protect residents.

Study protocol of a cluster-randomised controlled trial assessing a multimodal machine-based exercise training programme in senior care facilities over 6 months - the bestform study (best function of range of motion).

BACKGROUND: Physical functioning is a crucial factor for independence and quality of life in old age. The aim of the "bestform-Best function of range of motion" trial is to investigate the effects of a 6 months multimodal machine-based strength, coordination and endurance training on physical function, risk of falls and health parameters in older adults. METHODS: Bestform is a cluster-randomised trial including older adults ≥ 65 years living in senior care facilities in Southern Germany. Senior care facilities are randomly allocated to the control group with usual care (n ≥ 10 care facilities) and to the intervention group (n ≥ 10 care facilities), overall including ≥ 400 seniors. Residents belonging to the intervention group are offered a supervised machine-based exercise training programme twice weekly over 45-60 min over six months in small groups, while those in the usual care facilities will not receive active intervention. The primary outcome is the change in Short Physical Performance Battery over six months between groups. Secondary outcomes are change in risk of falling, fear of falling, number of falls and fall-related injuries, physical exercise capacity, handgrip strength, body composition, cardiac function, blood parameters, quality of life, risk of sarcopenia, activities of daily living, and cognition over three and six months. DISCUSSION: The bestform study investigates the change in physical function between seniors performing exercise intervention versus usual care over six months. The results of the study will contribute to the development of effective physical activity concepts in senior care facilities. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04207307. Registered December 2019.

Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study.

OBJECTIVE: We investigate the changes in the sociodemographic characteristics, clinical comorbidities, and transitions between care settings among residents of assisted living facilities. DESIGN: Repeated cross-sectional study. SETTING AND PARTICIPANTS: Linked, individual-level health system administrative data on residents of assisted living facilities in Ontario, Canada, from January 1, 2013, to December 31, 2019. METHODS: Counts and proportions were calculated to describe the sociodemographic characteristics and clinical comorbidities. Relative changes and trend tests were calculated to quantify the longitudinal changes in the characteristics of residents of assisted living facilities between 2013 and 2019. A Sankey plot was graphed to display transitions between different care settings (ie, hospital admission, nursing home admission, died, or remained in the assisted living facility) each year from 2013 to 2019. RESULTS: There was a 34% relative increase in the resident population size of assisted living facilities (56,9752019 vs 42,6002013). These older adults had a mean age of 87 years, and women accounted for nearly two-thirds of the population across all years. The 5 clinical comorbidities that had the highest relative increases were renal disease (24.3%), other mental health conditions (16.8%), cardiac arrhythmias (9.6%), diabetes (8.5%), and cancer (6.9%). Nearly 20% of the original cohort from 2013 remained in an assisted living facility at the end of 2019, and approximately 10% of that cohort transitioned to a nursing home in any year from 2013 to 2019. CONCLUSIONS AND IMPLICATIONS: Residents of assisted living facilities are an important older adult population that has progressively increased in clinical complexity within less than a decade. Clinicians and policy makers should advocate for the implementation of on-site medical care that is aligned with the needs of these older adults.

Defining the Assisted Living Sector in Canada: An Environmental Scan.

OBJECTIVES: In this study, we (1) identify the terms used to describe the assisted living sector and the legislation governing operation in all Canadian provinces and territories; (2) identify the cost estimates associated with residency in these homes; and (3) quantify the growth of the sector. DESIGN: Environmental scan. SETTING AND PARTICIPANTS: Internet searches of Canadian provincial and territorial government websites and professional associations were conducted in 2021 to retrieve publicly accessible sources related to the assisted living sector. METHODS: We synthesized data that identified the terms used to describe the sector in all provinces and territories, the legislation governing operation, financing, median fees per month for care, and growth of the sector from 2012 to 2020. Counts and proportions were calculated for some extracted variables. All data were narratively synthesized. RESULTS: The terms used to describe the assisted living sector varied across Canada. The terms "assisted living," "retirement homes," and "supportive living" were prevalent. Ontario was the only province to regulate the sector through an independent, not-for-profit organization. Ontario, British Columbia, and Alberta had some of the highest median fees for room, board, and care per month (range: $1873 to $6726). The licensed assisted living sector in Ontario doubled in size (768 in 2020 vs 383 in 2012), and there was a threefold increase in the number of corporate-owned chain assisted living facilities (465 in 2020 vs 142 in 2012). CONCLUSIONS AND IMPLICATIONS: The rapid growth of the assisted living sector that is primarily financed through out-of-pocket payments may indicate a rise in a two-tier system of housing and health care for older adults. Policymakers need better mechanisms, such as standardized reporting systems and assessments, to understand the needs of older adults who reside in assisted living facilities and inform the need for sector regulation and oversight.

Loneliness of residents in retirement homes during the COVID-19 crisis.

In their effort to prevent the spread of infections, retirement homes have been forced to limit physical interaction between residents and the outside world and to drastically reduce their residents' activities, decisions which are likely to increase loneliness in residents. To investigate this issue, we evaluated loneliness in patients with Alzheimer's disease (AD) living in retirement homes in France during the COVID-19 crisis. The study included 63 participants with mild AD. Participants were invited to complete the following statement "During the social distancing, I feel" with one of the three options: not at all alone, somewhat alone, or very alone. Most of the participants answered "somewhat alone", suggesting a significant level of loneliness during the crisis. While it serves to prevent infections, social distancing in retirement homes is likely to result in significant loneliness in residents. Because loneliness may increase cognitive decline in AD, it to pressing to prepare social programs/activities that promote contact between residents of retirement homes and the outside world as soon as the confinement is lifted.

Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study.

OBJECTIVE: We investigate whether older adults who were newly diagnosed with dementia (severity unspecified) and resided in an assisted living facility that offered a dementia care program had a lower rate of transition to a nursing home, compared to those who resided in an assisted living facility without such a program. DESIGN: Population-based retrospective cohort study. SETTING AND PARTICIPANTS: Linked, person-level health system administrative data on older adults who were newly diagnosed with dementia and resided in an assisted living facility in Ontario, Canada, from 2014 to 2019 (n = 977). METHODS: Access to a dementia care program in an assisted living facility (n = 57) was examined. Multivariable Cox proportional hazards regression with robust standard errors clustered on the assisted living facility was used to model the time to transition to a nursing home from the new dementia diagnosis. RESULTS: There were 11.8 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility with a dementia care program, compared with 20.5 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility without a dementia care program. After adjustment for relevant characteristics at baseline, older adults who resided in an assisted living facility with a dementia care program had a 40% lower rate of transition to a nursing home (hazard ratio 0.60, 95% confidence interval 0.44, 0.81), compared with those in an assisted living facility without such a program at any point during the follow-up period. CONCLUSIONS AND IMPLICATIONS: The rate of transition to a nursing home was significantly lower among older adults who resided in an assisted living facility that offered a dementia care program. These findings support the expansion of dementia care programs in assisted living facilities.

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.

Identifying hearing impairment and the associated impact on the quality of life among the elderly residing in retirement homes in Pretoria, South Africa.

BACKGROUND: Age-Related Hearing Loss (ARHL) is the most widespread sensory disorder in the elderly. Poor audiological support within retirement homes is one of the fundamental issues impacting the Quality of Life (QoL). OBJECTIVES: The objectives of this study were to: (1) Identify the presence of hearing impairment through a hearing screening test battery in a sample of elderly participants residing in three retirement homes. (2) Determine the psychological, communication-related and social impact of the hearing impairment on the QoL in a sample of elderly participants residing in retirement homes. METHOD: A prospective cross-sectional research design with quantitative methods of data analysis was used to obtain data from 70 elderly participants (mean age = 79 years, 79% were female). Ten of them used hearing aids. Hearing screening was conducted using otoscopy, tympanometry and air conduction screening (500 Hz-4 kHz). The World Health Organization Quality of Life (WHOQoL) questionnaire was adapted and utilised for the present study. RESULTS: Findings revealed that 77% of the sample obtained a refer result from the hearing screening protocol indicating a high presence of hearing impairment. Twenty-nine per cent (n = 16) of the participants felt depressed, worried and anxious because of their hearing loss and 20% of participants felt unaccepted by their significant others as a result of their hearing impairment. Hearing difficulties were significantly associated with a reduced QoL (p = 0.045). Eight of the 10 participants who wore hearing aids reported an overall improvement in QoL since receiving and utilising their hearing aids and 20% (n = 2) of hearing aid users reported challenges with maintaining their hearing aids. CONCLUSION: The findings of this study emphasised the need for an increased role for audiological services provided by audiologists within retirement homes, thereby contributing to an improved QoL.

[Digital transformation in residential old age institutions]. / Digitale Transformation im stationären Altersbereich.

BACKGROUND: Residential old age institutions are currently undergoing a digital transformation process, which is characterized by an orientation towards increasing digitalization of work processes as well as the institutional infrastructure. But what does the variety of technical solutions used in these old-age institutions look like and how is the digital transformation process assessed by the managers of these institutions? MATERIAL AND METHODS: The survey was carried out as a standardized online survey of residential old age homes throughout Switzerland. The respective managers were interviewed. The sample was made up of 466 institutions. RESULTS: Established technologies, such as television, contact and fall mats as well as software solutions in the administrative area are used almost everywhere, while robots for activating the clientele, gaming consoles or telemedical technologies are rarely used. Among those interviewed there were more people who saw advantages rather than disadvantages in the use of technical tools. The greatest obstacles that were perceived when introducing a new technology were the associated costs, a lack of employee skills and a nonexistent infrastructure. Multivariate analysis showed that the degree of digitalization in a facility depends not only on its size but above all on the technological affinity and rating of the senior staff. CONCLUSION: The degree of technology in old age institutions varies but overall it is rather sobering regarding the use of completely new technologies, such as robotics or telemedicine. Barriers to the increasing digital transformation were worked out from the survey and are discussed.

Sodium and Potassium Intake in Residents of Retirement Homes.

Excessive salt intake and its impact on health is a public health problem in many regions of the world. The currently estimated dietary intake of salt among free-living adults is well above the WHO recommendations. Over the years, the number of residents in retirement homes has increased. Besides this, the nutrition of elderly people may be affected by physiological changes that occur with aging. The question is whether residents of retirement homes receive a more balanced diet, or whether the trend of excessive salt consumption continues even among institutionalised elderly people. Salt and potassium intake were assessed by measuring sodium and potassium excretion over 24 h in urine collected from a sample of residents of three retirement homes in the Goriska region, Slovenia. The average salt intake was 8.3 (2.9) g/day, which was significantly higher (p < 0.001) in men than in women (10.1 (3.1) vs. 7.3 (2.2) g/day, respectively). The estimated total daily potassium intake was 2.6 (0.6) g/day in men and 2.0 (0.8) g/day in women (mean 2.2 (0.8) g/day). The ratio of sodium to potassium was 1.53 (0.48). The salt intake among residents of retirement homes in the Goriska region, especially in men, exceeds the WHO recommended daily intake of <5 g. The mean daily potassium intake was below the WHO recommendations of 3.5 g/day.

Assessment of Person-Centered Care in Gerontology Services: A new tool for healthcare professionals.

Background/Objective: Retirement homes and other gerontology services are frequently criticized due to their lack of flexibility and tailored attention, leading to homogeneous treatment which compromises patients' control of their lives. This study aims to develop and validate the first Spanish instrument for healthcare professionals to assess the degree of person-centered attention delivered by senior care centers. Method: A total of 844 healthcare professionals (mean age = 39.94 years old; SD = 10.56) with a mean of 6.56 years (SD = 6.15) of work experience participated in the study. The psychometric properties of the questionnaire developed were analyzed using both classical test theory and item response theory models. Results: The internal structure was unidimensional with an explained variance of 55.23%. Reliability was outstanding: internal consistency (α = .96, ω = .96) and test-retest (r = .88; ICC = .93). The total score was significantly correlated with two similar questionnaires, with associated variance of 58.83% and 55.20% respectively. Conclusions: The new instrument allows healthcare professionals to assess the level of person-centered care provided by gerontology centers with excellent reliability and validity.

Antecedentes/Objetivo: Las residencias y otros servicios gerontológicos son frecuentemente criticados por su falta de flexibilización y personalización en la atención, conduciendo a un trato uniforme que dificulta el control sobre sus vidas. El objetivo del trabajo es desarrollar y validar el primer instrumento de medida español que permite a los profesionales de la salud evaluar en qué medida se lleva a cabo en su centro una atención centrada en la persona. Método: Participaron en el estudio 844 profesionales de la salud (edad media = 39,94; DT = 10,56) con una experiencia media de 6,56 años (DT = 6,15). Las propiedades psicométricas del instrumento desarrollado se analizaron mediante modelos de Teoría Clásica de los Test y de Teoría de Respuesta a los Ítems. Resultados: La prueba resultó esencialmente unidimensional, con un primer factor que explica el 55,23% de la varianza. La fiabilidad es excelente, tanto la consistencia interna (α = 0,96, ω = 0,96) como la estabilidad (r = 0,88; ICC = 0,93). La puntuación total correlacionó significativamente con dos cuestionarios similares, obteniéndose una varianza asociada de 58,83% y 55,20%, respectivamente. Conclusiones: El nuevo instrumento desarrollado permite a los profesionales de la salud evaluar con excelente fiabilidad y validez el nivel de atención centrada en la persona de los centros gerontológicos.

Ontario's Retirement Homes and Long-Term Care Homes: A Comparison of Care Services and Funding Regimes.

ABSTRACTGrowing demand for beds in government-subsidized long-term care (LTC) homes in Ontario is causing long waitlists, which must be absorbed by other residential alternatives, including unsubsidized retirement homes. This study compares Ontario's LTC homes and retirement homes for care services provided, funding regimes, and implications of differential funding for seniors. Descriptive data for both types of homes were collected from public and proprietary sources regarding service offerings, availability, costs, and funding. Overlaps exist in the services of both LTC and retirement homes, particularly at higher levels of care. Although both sectors charge residents for accommodation, most care costs in LTC homes are publicly funded, whereas residents in retirement homes generally cover these expenses personally. Given waitlists in Ontario's LTC homes, many seniors must find residential care elsewhere, including in retirement homes. Several policy alternatives exist that may serve to improve equity of access to seniors' residential care.

Legislation governing tobacco use in Ontario's retirement homes.

Legislation banning smoking in public places is a key component of comprehensive tobacco control programs, yet residential facilities for aging adults are often exempt from such legislation. In Ontario, Canada, provincial legislation does not comprehensively safeguard retirement homes' residents and staff from tobacco-related health and safety concerns. This study provides a descriptive analysis of municipal-level bylaws in order to begin understanding the regulatory context of tobacco use in retirement homes in the Province. A stratified random sample of retirement homes (n = 75) was selected. A rubric was developed highlighting various components that a model policy would include, to allow for the independent review of municipal-level bylaws governing these 75 homes. Results indicate that 75% of retirement homes were located in areas without municipal-level tobacco legislation that addressed retirement homes. The remaining 25% (n = 19 retirement homes) were governed by eight different municipal-level bylaws, all of which lacked in overall comprehensiveness. Amending Ontario's regulatory framework to eliminate loopholes and include retirement homes, as well as the creation and modification of municipal-level legislation, will aid in safeguarding smokers and nonsmokers from the dangers of tobacco-related risks, including secondhand smoke, fires, igniting cigarettes while connected to oxygen, burns to skin, and damage to clothing and property.

Olfactory Dysfunction in Older Adults is Associated with Feelings of Depression and Loneliness.

Olfactory dysfunction is a common complaint among physician visits. Olfactory loss affects quality of life and impairs function and activities of daily living. The purpose of our study was to assess the degree of odor identification associated with mental health. Olfactory function was measured using the brief smell identification test. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression scale. Loneliness was assessed by the de Jong-Gierveld Loneliness Scale. Cognition was measured by a battery of 19 cognitive tests. The frequency of olfactory dysfunction in our study was ~40%. Older subjects had worse olfactory performance, as previously found. More loneliness was associated with worse odor identification. Similarly, symptoms of depression were associated with worse olfaction (among men). Although better global cognitive function was strongly associated with better odor identification, after controlling for multiple factors, the associations with depression and loneliness were unchanged. Clinicians should assess these mental health conditions when treating older patients who present with olfactory deficits.

Novas Formas de Morar: Repúblicas para Idosos / New ways of living: retirement homes

O acelerado envelhecimento populacional e o aumento da longevidade no Brasil trazem muitos problemas que afetam a população idosa. Em relação à questão da moradia, a falta de um cuidado familiar, assim como a insuficiência financeira, levam os idosos a procurar novas formas de morar. Passa então a existir uma preocupação quanto à manutenção de sua saúde e uma boa qualidade de vida. Atualmente não existem muitas políticas públicas voltadas à moradia de idosos especificamente. Este artigo tem o intuito de mostrar como a vida dos idosos em República pode ser prazerosa e vantajosa.

The accelerated aging and increased longevity in Brazil bring many problems that affect the elderly population. Regarding the issue of housing, the lack of family care and financials lead the elderly to seek new ways of living. Thus, there is a concern for maintaining both the health and the quality of life of these people. Currently there are not many public policies related to housing for the elderly specifically. This article aims to show how the lives of the elderly in the retirement home can be enjoyable and beneficial.