Prevalence and incidence of pressure injuries among nursing home residents with darker skin tones: A prospective cohort study.

AIM: To measure the prevalence and incidence of nursing home-acquired pressure injuries in older adults residing in Sri Lankan nursing homes. BACKGROUND: Pressure injury prevalence and incidence are indicators of safety and quality of care. A significant portion of the global population has a skin color dominated by the presence of melanin. Yet, the number of nursing home residents with darker skin tones who develop pressure injuries in nursing homes is relatively unknown. DESIGN: Prospective multisite cohort study conducted in nine nursing homes in Sri Lanka. The sample comprised 210 residents aged ≥60 years old. METHODS: Semi structured observations and chart audits were used to gather data from July to October 2023. Head-to-toe visual skin assessment to check for nursing home- acquired pressure injuries, Braden pressure injury risk scale and Fitzpatrick skin tone assessments were conducted on all recruited residents at baseline. All recruited residents were followed-up weekly for 12 weeks until detection of a new pressure injury, death, discharge, or transfer. RESULTS: Pressure injury point prevalence at baseline was 8.1% (17/210). Cumulative incidence was 17.1% (36/210). Incidence density was 15.8 per 1000 resident weeks. Most nursing home-acquired pressure injuries were located on the ankle at baseline (29.4%; 5/17) and in the follow-up period (27.8%; 10/36). Stage I pressure injuries were most common: 58.8% (10/17) and 44.4% (16/36) at baseline and during follow-up respectively. CONCLUSIONS: About one in six nursing home residents developed a new pressure injury over the 12-week follow-up period. Despite staff and resource constraints, there remains a need to focus on the prevention of pressure injuries in Sri Lankan nursing homes. CLINICAL RELEVANCE: Studies on the burden of pressure injuries among darker skin tone nursing home residents are lacking and the current evidence available are predominantly from Western countries. The findings of this study highlight the need of targeted preventive measures for nursing home residents with darker skin tones.

Cost-effectiveness analysis of health tapestry, a complex primary care program for older adults: a post-hoc analysis.

BACKGROUND: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. METHODS: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. RESULTS: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. CONCLUSION: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site.

Age-appropriate elder care recipients? Care manager's categorisation practices in intraprofessional case conferences.

Age categories are related to perceptions and norms concerning appropriate behaviour, appearances, expectations, and so forth. In Sweden, municipal home care and residential care are commonly referred to as "elder care", primarily catering to individuals in their 80s or 90s. However, there is no set age limit reserving these services for an older age group. In intra-professional case conferences, care managers convene with colleagues to discuss care needs and eligibility for elder care services. Despite their significance, these conferences have received limited scholarly attention. The aim of this study was to analyse how care managers categorise persons based on age in intra-professional case conferences when discussing care needs and appropriate support to meet these needs. The study utilised data from 39 audio-recorded case conferences involving the discussion of 137 different cases, which were analysed using discourse analysis. Our findings showed that chronological age was frequently made relevant and applied in discussions about the appropriateness of usual elder care services. Four themes emerged, representing how the care managers implicitly and explicitly categorised clients of different chronological ages as typical/normal or atypical/deviant in these discussions: the "too young", the "not-so-old", the "old", and the "extraordinarily old". The findings contribute to research on ageing by demonstrating that, in an elder care context, being categorised as atypical/deviant (in terms of being younger) may be more beneficial than being seen as a normal or older elder care recipient. This underscores the importance of further research on the impact of informal age categorisations of clients on actual decisions about welfare services.

Clinical leadership in nursing homes: A qualitative study of healthcare professionals' perspectives on concept and characteristics.

AIM(S): To conceptualise and identify characteristics of clinical leadership in the nursing home setting. DESIGN: A qualitative study using semi-structured focus group interviews and a thematic analysis. METHODS: Five semi-structured focus group interviews were conducted with 41 healthcare professionals from nursing and other healthcare disciplines working in nursing homes (such as nurse assistants, licensed practical nurses, registered nurses (RNs), occupational therapists, recreational therapists, psychologists and gerontologists). Qualitative thematic content analysis of the gathered data was done. RESULTS: Clinical leaders in nursing homes can be defined as passionate healthcare professionals providing person-centred care with strong communication skills. They are clinical experts in their field and motivated to engage in lifelong learning. They are team players with informal leadership skills. They are visionary, committed, resilient and responsive. Awareness of the definition and the main characteristics of clinical leadership is necessary to facilitate the identification, support and development of healthcare professionals. Focussing on the development of competencies, training courses and monitoring and assessment methods is necessary to improve the evidence of clinical leadership in nursing homes.

No playing around with robots? Ambivalent attitudes toward the use of Paro in elder care.

This paper explores the ways in which health care professionals, family carers, and older persons expressed attitudes and opinions on using Paro, a social robot designed to stimulate patients with dementia. Thereafter, we critically evaluate existing prejudicial views toward Paro users to provide recommendations for its future use. Using an exploratory qualitative interview method, we recruited a total of 67 participants in Switzerland. They included 23 care professionals, 17 family carers, and 27 older persons. Data obtained were analyzed thematically. Study findings present general agreement that Paro is an appealing and beneficial social robot, but it is not a tool that everyone feels comfortable with. Because it is perceived as "child play," it would be demeaning for competent adults to play with such things. Consequently, Paro is appropriate only for persons with dementia. These findings brought forth ethical concerns about deception, infantilization, and respecting older persons' dignity. The idea of who is an appropriate Paro user led to our discussions on predicting future Paro users. The meaning of using social robotics in nursing homes can be conditioned by a rigid interpretation of adulthood and playful behavior. To protect future selves when one is living with dementia from prejudices, it may be useful for older persons and their loved ones to plan their future care situations to ensure that they are treated in accordance with their delineated decisions.

Using the TrueLoo Smart Device to Record Toileting Sessions in Older Adults: Retrospective Validation and Acceptance Study.

BACKGROUND: Because of the relationship between independent living and activities of daily living, care teams spend significant time managing assisted living residents' toileting problems. Recently, the TrueLoo was developed as a connected toilet seat to automatically log and monitor toileting sessions. OBJECTIVE: This study aimed to demonstrate the validity of the TrueLoo to (1) record and identify toileting sessions with regard to stool and urine events; (2) compare the results with the person-reported, standard-of-care methods; and (3) establish metrics of user acceptability and ease of use in a assisted living facility population. METHODS: We used two phases: (1) initial development of the TrueLoo algorithms to accurately identify urine and stool events and (2) evaluation of the algorithms against person-reported, standard-of-care methods commonly used in assisted living facilities. Phase 2 analyzed data over a 3-day period from 52 devices. Participants' age ranged from 63 to 101 (mean 84, SD 9.35) years. Acceptability and ease-of-use data were also collected. RESULTS: Regarding the development of the TrueLoo algorithm for urine assessment, sensitivity and specificity of 96% and 85% were observed when evaluating a gold-standard labeled data set, respectively (F1-score=0.95). For stool, sensitivity and specificity of 90% and 79% were observed, respectively (F1-score=0.85). Regarding the TrueLoo algorithm in assisted living settings, classification performance statistics for urine assessment revealed sensitivity and specificity of 84% and 94%, respectively (F1-score=0.90), and for stool, 92% and 98%, respectively (F1-score=0.91). Throughout the study, 46 person-reported instances of urine were documented, compared with 630 recorded by the TrueLoo. For stool events, 116 person-reported events were reported, compared with 153 by the TrueLoo. This indicates that person-reported events were captured 7% (46/630) of the time for urine and 76% (116/153) of the time for stool. Overall, 45% (32/71) of participants said that the new toilet seat was better than their previous one, 84% (60/71) reported that using the TrueLoo was easy, and 99% (69/71) said that they believed the system could help aging adults. Over 98% (69/71) of participants reported that they would find alerts related to their health valuable and would be willing to share this information with their doctor. When asked about sharing information with caregivers, 66% (46/71) reported that they would prefer the TrueLoo to send information and alerts to their caregiver, as opposed to the participant having to personally communicate those details. CONCLUSIONS: The TrueLoo accurately recorded toileting sessions compared with standard-of-care methods, successfully establishing metrics of user acceptability and ease of use in assisted living populations. While additional validation studies are warranted, data presented in this paper support the use of the TrueLoo in assisted living settings as a model of event monitoring during toileting.

Evaluating community-embedded elder care: A case study of supply and demand in Hangzhou, China.

INTRODUCTION: With China's urbanization and demographic shifts significantly affecting elder care, this study examines the alignment of community-based elder care services in Hangzhou's Hemu Community. It addresses the gap in understanding how these services meet the needs of an aging population in a rapidly changing social context. METHODS: A comprehensive mixed-methods approach was utilized, involving interviews with community residents, observations of elder care service operations and thorough document analysis. The objective was to evaluate the adequacy, utilization and satisfaction levels concerning these elder care services. RESULTS: The research identified that, although the services generally meet the community's needs, there are notable challenges in content specificity, quality assurance and promotional efforts. These challenges lead to resistance among older adults. Additionally, issues with service visibility and the lack of robust feedback mechanisms were noted. CONCLUSION: This study highlights the critical need for a cooperative strategy involving government, community organizations, social entities and businesses in enhancing elder care services. It suggests that improvements in service visibility, content quality and targeted promotion are crucial to address the evolving needs of the aging population and to reduce reluctance in service utilization.

Association between workplace interpersonal relationships and psychological distress among care workers at elder care facilities.

BACKGROUND: As the number of older people requiring care continues to increase across the globe, maintaining care workers' mental health is an important task for all countries. This study examines the association between interpersonal relationships at work and psychological distress among care workers at elder care facilities in Japan. METHODS: This study was a secondary data analysis of cross-sectional data. There were 406 participants who were analyzed. Questions consisted of demographic variables, psychological distress, interpersonal problems in the workplace, and intention to improve interpersonal relationships. Psychological distress was evaluated using the Japanese version of the K6 scale. Factors related to psychological distress were identified by logistic regression analysis. RESULTS: Prevalence of psychological distress was 53.2%. Care workers experiencing interpersonal problems in the workplace were 5.95 (95% CI: 3.82-9.43) times more likely to experience psychological distress than care workers without such problems. Moreover, those who displayed an intention to improve their interpersonal relationships were 0.33 times (95% CI: 0.15-0.71) less likely to experience psychological distress than those who did not. CONCLUSIONS: This study found there is a strong association between workplace interpersonal relationships and psychological distress among care workers at elder care facilities. Therefore, experiencing interpersonal problems in the workplace may be a risk factor for psychological distress, and displaying an intention to improve one's interpersonal relationships may attenuate psychological distress.

Research on the assignment of elderly care service personnel with time window constraints.

As the population continues to age, there is a growing need for elderly care services. In China, home care is widely embraced as a preferred method of caring for the elderly, and it has a promising commercial outlook. The strategic allocation of Elderly Care Service Personnel (ECSP) is a crucial component of the operational procedures for home care services. By strategically assigning elderly service personnel, it is possible to enhance the satisfaction and simultaneously minimize expenses. The issue of rationalizing the assignment of ECSP in the face of restricted resources is a genuine challenge that requires a solution, given the many types of elderly service demands and the skill requirements and time limits of certain projects. This study presents a strategy for assigning personnel on an hourly basis, taking into account time frame limits. This method involves several steps. Firstly, it involves assessing the specific service needs of the elderly, including the required door-to-door service time, service level, and gender preferences. Secondly, it calculates the service satisfaction and service operation cost of the Home Care Service Platform (HCSP) separately. Finally, it constructs a multi-objective elderly service personnel assignment method. This method aims to minimize the ECSP 's travel time and wasted time, maximize the satisfaction of the elderly by considering priority levels and ECSP scores, and minimize the operation cost of the HCSP. A model is developed to assign ECSP for elderly individuals, with the goal of minimizing travel time and wasted time, maximizing elderly satisfaction by considering priority and service personnel rating, and minimizing operating costs for the HCSP. Additionally, if there are unserved elderly individuals, an optimized path model is constructed using a cross-modified genetic algorithm to obtain the optimal matching result. Ultimately, an arithmetic example is employed to demonstrate the practicality and efficiency of the strategy put forth in this research. The findings demonstrate that the model presented in this research possesses distinct advantages in comparison to other conventional models.

Can an AI-carebot be filial? Reflections from Confucian ethics.

This article discusses the application of artificially intelligent robots within eldercare and explores a series of ethical considerations, including the challenges that AI (Artificial Intelligence) technology poses to traditional Chinese Confucian filial piety. From the perspective of Confucian ethics, the paper argues that robots cannot adequately fulfill duties of care. Due to their detachment from personal relationships and interactions, the "emotions" of AI robots are merely performative reactions in different situations, rather than actual emotional abilities. No matter how "humanized" robots become, it is difficult to establish genuine empathy and a meaningful relationship with them for this reason. Even so, we acknowledge that AI robots are a significant tool in managing the demands of elder care and the growth of care poverty, and as such, we attempt to outline some parameters within which care robotics could be acceptable within a Confucian ethical system. Finally, the paper discusses the social impact and ethical considerations brought on by the interaction between humans and machines. It is observed that the relationship between humans and technology has always had both utopian and dystopian aspects, and robotic elder care is no exception. AI caregiver robots will likely become a part of elder care, and the transformation of these robots from "service providers" to "companions" seems inevitable. In light of this, the application of AI-augmented robotic elder care will also eventually change our understanding of interpersonal relationships and traditional requirements of filial piety.

Physical restraints in nursing homes: A qualitative study with multiple stakeholders.

AIM: This study aims to understand the perceptions regarding physical restraints of the elder-care professional's stakeholders. DESIGN: A qualitative methodology was employed. METHODS: Semi-structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. RESULTS: Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework.

Immigration enforcement and the institutionalization of elderly Americans.

This paper examines the relationship between immigration enforcement and institutionalization rates of the elderly. Exploiting the staggered implementation of the Secure Communities (SC) immigration enforcement program across U.S. counties from 2008 through 2014, we show that SC led to a 0.26 percentage points (6.8 percent) increase in the likelihood that Americans aged 65 and above live in an institution. Supportive of supply shocks in the household services market as a central mechanism, we find that the elderly who are most likely to purchase domestic worker services are also the most likely to move into nursing homes following the implementation of SC. Additionally, we find suggestive evidence of significant reductions in the work hours of housekeepers, personal care aides, and home health workers hinting at the critical role of negative supply shocks in occupations that facilitate aging in community.

The willingness and influencing factors to choose institutional elder care among rural elderly: an empirical analysis based on the survey data of Shandong Province.

BACKGROUND: The ageing of the population has become an escalating problem in China, which has led to an increasing demand for healthcare throughout society. The care services of elderly institutions, as a more mature way of aging, can alleviate various social problems brought about by ageing to a certain extent. The aim of this paper is to explore the degree of acceptance of institutional care by rural elderly people in Shandong Province and the factors that influence whether rural elderly people accept institutional care services. METHODOLOGY: Based on the theory of planned behavior, an analytical framework was constructed for the willingness of rural elderly people to receive nursing services from elderly care institutions. Using survey data from 192 rural elderly people in Shandong Province, descriptive statistics, binary logistic regression, and horizontal comparative analysis methods were used to analyze the willingness of rural elderly people to provide for the elderly and its influencing factors. RESULT: Only 17.71% of respondents expressed willingness to receive services from elderly care institutions. Among them, education level, trust in elderly care institutions, and support from adult children have a significant positive impact on whether rural elderly people receive nursing services from elderly care institutions; The number of children, the level of understanding of elderly care institutions, neighbors' choices of elderly care methods, and their ability to contribute to the family have a significant negative impact on whether rural elderly people receive nursing services from elderly care institutions. There are significant differences in the willingness and influencing factors of rural elderly people to provide for the elderly among different regions. CONCLUSION: The non-acceptance of institutional care by rural older people is a general phenomenon rather than a sample characteristic, thus justifying the supplementary status of institutional care services. The pension intention of the rural elderly in Shandong Province is obviously affected by personal will factors, and the influencing factors are various. The traditional concept of old-age care in Shandong province has a strong path-dependent effect on the choice of the rural elderly. There is heterogeneity in the willingness and influencing factors of the rural elderly in different regions and countries. Based on this, this paper puts forward the following suggestions: strengthen the spiritual and cultural construction of residents; The government should pay attention to the correct guidance of public opinion; And increase pension subsidies. It is hoped that reduce the burden of national elderly care through these suggestions.

Residents in Institutions for Older Adults: Characteristics and their Relationship with the Institution / Residentes em Instituições para Idosos: Características e sua Relação com a Instituição / Residentes en Instituciones para Personas Mayores: Características y su Relación con la Institución

Abstract Population aging and the reduction in the availability of family caregivers have driven the demand for care for older adults in long-term care facilities (LTCF). This study aimed to characterize the sociodemographic, functional, cognitive and emotional aspects of residents of philanthropic LTCF in a medium-sized Brazilian city. This study also sought to correlate variables in residents' life and their levels of depression and cognitive performance. Cognitive (MMSE and ACE-R) and mood screening instruments (GDS-15) and a guided interview were applied to 78 residents. Generally, residents were White, single/widowed, independent women showing depressive symptoms (52%) and cognitive impairment (74%). Most participants reported satisfaction with the care offered by the LTCF, but this satisfaction was negatively correlated with the depression score. This profile suggests the need for an institutional arrangement that considers the needs of residents and promotes their quality of life.

Resumo O envelhecimento populacional e a redução de disponibilidade de cuidadores familiares têm impulsionado a procura pelo atendimento de pessoas idosas em instituições de longa permanência (ILPI). Este estudo buscou caracterizar aspectos sociodemográficos, funcionais, cognitivos e emocionais de residentes de ILPI filantrópicas de uma cidade brasileira de médio porte. Também buscou-se correlacionar variáveis do contexto de vida dos residentes e seus níveis de depressão e desempenho cognitivo. Foram aplicados instrumentos de rastreio cognitivo (MEEM e ACE-R) e de humor (EDG-15), além de um roteiro de entrevista em 78 residentes. Em geral, os residentes eram mulheres, brancas, solteiras/viúvas, independentes, apresentando sintomas depressivos (52%) e declínio cognitivo (74%). A maioria referiu satisfação com o atendimento ofertado pelas ILPI, mas essa satisfação se correlacionou negativamente com o escore de depressão. Esse perfil sugere a necessidade de um arranjo institucional que leve em conta as necessidades dos residentes e favoreça sua qualidade de vida.

Resumen El envejecimiento de la población y la reducción de la disponibilidad de cuidadores familiares han impulsado la búsqueda de atención para las personas mayores en instituciones de larga permanencia (ILPI). Este estudio buscó caracterizar los aspectos sociodemográficos, funcionales, cognitivos y emocionales de los residentes en ILPI filantrópicas en una ciudad brasileña de tamaño medio. También se intentó correlacionar variables del contexto de vida de los residentes con sus niveles de depresión y rendimiento cognitivo. Se aplicaron una guía de entrevista y herramientas de evaluación cognitiva (MEEM y ACE-R) y de humor (EDG-15) a 78 residentes. La mayoría de los participantes eran mujeres, blancas, solteras/viudas e independientes, con síntomas depresivos (52%) y declive cognitivo (74%). Aunque la mayoría expresó satisfacción con la atención ofrecida por las ILPI, esta satisfacción se correlacionó negativamente con el puntaje de depresión. Se sugiere la necesidad de un diseño institucional que considere las necesidades de los residentes y favorezca su calidad de vida.

Identifying Predictors of Nursing Home Admission by Using Electronic Health Records and Administrative Data: Scoping Review.

Background: Among older adults, nursing home admissions (NHAs) are considered a significant adverse outcome and have been extensively studied. Although the volume and significance of electronic data sources are expanding, it is unclear what predictors of NHA have been systematically identified in the literature via electronic health records (EHRs) and administrative data. Objective: This study synthesizes findings of recent literature on identifying predictors of NHA that are collected from administrative data or EHRs. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were used for study selection. The PubMed and CINAHL databases were used to retrieve the studies. Articles published between January 1, 2012, and March 31, 2023, were included. Results: A total of 34 papers were selected for final inclusion in this review. In addition to NHA, all-cause mortality, hospitalization, and rehospitalization were frequently used as outcome measures. The most frequently used models for predicting NHAs were Cox proportional hazards models (studies: n=12, 35%), logistic regression models (studies: n=9, 26%), and a combination of both (studies: n=6, 18%). Several predictors were used in the NHA prediction models, which were further categorized into sociodemographic, caregiver support, health status, health use, and social service use factors. Only 5 (15%) studies used a validated frailty measure in their NHA prediction models. Conclusions: NHA prediction tools based on EHRs or administrative data may assist clinicians, patients, and policy makers in making informed decisions and allocating public health resources. More research is needed to assess the value of various predictors and data sources in predicting NHAs and validating NHA prediction models externally.

Critical healthcare for older adults post Hurricane Ian in Florida, United States.

We highlight critical public healthcare inadequacies for older adult populations resulting in fatalities after Hurricane Ian. We summarize whether a fatality was a result of the storm directly, indirectly, or not at all. Massive destruction from Ian eliminated critical life-sustaining health care for the week following the hurricane. This disproportionately affected the older adult population, with most elder deaths attributed to a lack of some form of health care. To prevent further unnecessary deaths following a disaster event, we recommend that public health policy practitioners, medical practitioners, and state officials consider how to provide managed opt-in emergency care services, mobile elderly care until restoration of power and services, and revisions to community-based critical care provider building codes to include generators and fuel. We offer this viewpoint to generate discussion among public health and emergency planners.

Trustful conversations: a qualitative interview study on older patients' experiences of the intervention Proactive healthcare in a Swedish primary care setting.

AIM: To explore older patients' experiences of the intervention Proactive healthcare for frail elderly persons. BACKGROUND: Previous research has indicated that continuity and good access to primary care can improve satisfaction in older people seeking care. However, little is known about the older patients' experiences in taking part of interventions aiming to enhance the care. METHODS: Individual interviews were conducted with 24 older patients who participated in the intervention Proactive healthcare for frail elderly persons, selected from nine Swedish primary care centres. Interviews were analysed using qualitative content analysis. FINDINGS: Older patients' experiences of the intervention involved five manifest categories: Ways of naming the elder care team, covering the older patients' lack of understanding regarding their connection to the team, and the need for clarity on this and on how the specialised care provided differed from conventional care; Availability, indicating how older patients associated easy access and a direct telephone number with a team nurse available at certain times with a sense of security; The importance of relations, covering how patients appreciated continuity in their personal and professional conversations with staff; A feeling of safety and trust, stressing the value of older persons attach to being given enough time, to be listened to and being recognised as people; and Finiteness of life, which refers to the difficulty of having end-of-life conversations and the need for experienced staff with personal knowledge of the patients. The latent theme Trustful conversations was created to give a deeper meaning to the content of the categories.Trustful conversations, created through good personal knowledge of patients and continuity of contact, engender a feeling of safety in older patients. Using elder care teams could result in a better quality of care, with increased satisfaction and feelings of security among patients, and a reduction in healthcare needs.

Survey on the Acceptance of Ambient Sensors in Solo and Older Couple-Only Households in Japan.

For this study, an online survey was conducted to discover the preferences of older adults when they used sensors in their households, rather than the preferences of the researchers who developed them. The sample size was 400 Japanese community-dwelling people aged 65 years and older. The numbers of samples for men and women, household composition (single-person/couple-only household), and younger senior (younger than 74 years old) and older senior (older than 75 years old) were equally assigned. The survey results showed that "informational security" and "constancy of life" were considered more important than other factors when installing sensors. Furthermore, looking at the results regarding the type of sensors that face resistance, we found that both cameras and microphones were evaluated as facing slightly strong resistance, while doors/windows, temperature/humidity, CO2/gas/smoke, and water flow were evaluated as not facing such strong resistance. The elderly who are likely to need sensors in the future also have various attributes, and the introduction of ambient sensors in elderly households may be further advanced by recommending applications that are easy to introduce based on the attributes of the target population, rather than discussing all of them in general.

Can home care work be organized to promote health among the workers while maintaining productivity? An investigation into stakeholders' perspectives on organizational work redesign concepts based on the Goldilocks Work principles.

BACKGROUND: Due to the aging population, the need for home care services is increasing in most Western countries, including Norway. However, the highly physical nature of this job could contribute to make recruiting and retaining qualified home care workers (HCWs) challenging. This issue may be overcome by adopting the Goldilocks Work principles, aiming at promoting workers' physical health by determining a "just right" balance between work demands and recovery periods while maintaining productivity. The aim of this study was to 1) gather suggestions from home care employees on suitable organizational (re)design concepts for promoting HCWs' physical health and 2) have researchers and managers define actionable behavioral aims for the HCWs for each proposed (re)design concept and evaluate them in the context of the Goldilocks Work principles. METHODS: HCWs, safety representatives, and operation coordinators (n = 14) from three Norwegian home care units participated in digital workshops led by a researcher. They suggested, ranked, and discussed redesign concepts aimed at promoting HCWs' health. The redesign concepts were subsequently operationalized and evaluated by three researchers and three home care managers. RESULTS: Workshop participants suggested five redesign concepts, namely "operation coordinators should distribute work lists with different occupational physical activity demands more evenly between HCWs", "operation coordinators should distribute transportation modes more evenly between HCWs", "Managers should facilitate correct use of ergonomic aids and techniques", "HCWs should use the stairs instead of the elevator", and "HCWs should participate in home-based exercise training with clients". Only the first two redesign concepts were considered to be aligned with the Goldilocks Work principles. A corresponding behavioral aim for a "just right" workload was defined: reduce inter-individual differences in occupational physical activity throughout a work week. CONCLUSIONS: Operation coordinators could have a key role in health-promoting organizational work redesign based on the Goldilocks Work principles in home care. By reducing the inter-individual differences in occupational physical activity throughout a work week, HCWs' health may be improved, thus reducing absenteeism and increasing the sustainability of home care services. The two suggested redesign concepts should be considered areas for evaluation and adoption in practice by researchers and home care services in similar settings.

Work as Overload or Enhancement for Family Caregivers of Older Adults: Assessment of Experienced Well-Being Over the Day.

Objective: This study examines work and care patterns and their association with experienced well-being over the course of the day and tests a moderating effect of gender. Background: Many family and unpaid caregivers to older adults face dual responsibilities of work and caregiving. Yet little is known about how working caregivers sequence responsibilities through the day and their implications for well-being. Method: Sequence and cluster analysis is applied to nationally representative time diary data from working caregivers to older adults in the U.S. collected by the National Study of Caregiving (NSOC) (N=1,005). OLS regression is used to test the association with well-being and a moderating effect of gender. Results: Among working caregivers, five clusters emerged, referred to as: Day Off, Care Between Late Shifts, Balancing Act, Care After Work, and Care After Overwork. Among working caregivers, experienced well-being was significantly lower among those in the Care Between Late Shifts and Care After Work clusters relative to those in the Day Off cluster. Gender did not moderate these findings. Conclusion: The well-being of caregivers who split time between a limited number of hours of work and care is comparable to those who take a day off. However, among working caregivers balancing full-time work - whether day or night - with care presents a strain for both men and women. Implications: Policies that target full-time workers who are balancing care for an older adult may help increase well-being.