Ideação suicida e risco de depressão entre idosos residentes em instituições de longa permanência / Ideación suicida y riesgo de depresión entre adultos mayores residentes en establecimientos de larga estadía / Suicidal ideation and risk of depression among older adults residing in long-stay institutions

Objetivo: identificar o estado depressivo e ideação entre idosos em Instituições de Longa Permanência dos municípios da região do Seridó/RN, Brasil. Método: estudo transversal e descritivo, desenvolvido entre os meses de agosto a novembro de 2020, nas Instituições de Longa Permanência para Idosos. Resultados: a amostra final foi composta por 45 idosos, predominando idosos do sexo feminino, com idade maior ou igual a 80 anos, solteiros, não alfabetizados, brancos, aposentados e com tempo de institucionalização maior do que 1 ano. Observou-se um maior quantitativo do sexo feminino, 64,4% com idade maior ou igual a 80 anos. Quanto ao estado depressivo, visto que houve significância e as variáveis "grau de depressão" e "ideação suicida" com p-valor < 0,1 (p-valor = 0,07). Considerações finais: observa-se uma considerável ocorrência de graus de depressão e ideação suicida na população estudada.

Objetivo: identificar el estado depresivo y la ideación entre las personas mayores residentes en los Establecimientos de Larga Estadía de los municipios de la región de Seridó/RN, Brasil. Método: estudio transversal y descriptivo, desarrollado entre los meses de agosto y noviembre de 2020, en los Establecimientos de Larga Estadía para Adultos Mayores. Resultados: la muestra final fue compuesta por 45 adultos mayores, predominantemente del sexo femenino, con edad igual o superior a 80 años, solteros, analfabetos, blancos, jubilados y con tiempo de institucionalización superior a 1 año. Se observó un mayor número de mujeres, 64,4%, con 80 años o más. En cuanto al estado depresivo, hubo significación y las variables "grado de depresión" e "ideación suicida" con p-valor < 0,1 (p-valor = 0,07). Consideraciones finales: se observa una considerable ocurrencia de grados de depresión e ideación suicida en la población estudiada.

Objective: to identify the depressive state and ideation among older adults in Long-Stay Institutions in the cities of the Seridó/RN region, Brazil. Method: cross-sectional and descriptive study, developed between the months of August and November 2020, in the Long Stay Institutions for Older Adults. Results: the final sample was composed of 45 older adults, predominantly females, aged 80 years old or more, single, non-literate, white, retired and with a time of institutionalization longer than 1 year. We observed a higher number of females, 64.4%, aged 80 years or older. As for the depressive state, there was significance and the variables "degree of depression" and "suicidal ideation" with p-value < 0.1 (p-value = 0.07). Final considerations: a considerable occurrence of degrees of depression and suicidal ideation is observed in the population studied

Trends in the Use of Residential Settings Among Older Adults.

OBJECTIVES: As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time. METHODS: A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRFs), and nursing facilities using 3 data sources: the Medicare Current Beneficiary Survey (MCBS), 2008 and 2013; the Health and Retirement Study (HRS), 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated the age-standardized prevalence of older adults by setting, functional limitations, and comorbidities and tested for health characteristics changes relative to the baseline year (2002). RESULTS: The proportion of older adults in traditional housing increased over time, relative to baseline (p < .05), while the proportion of older adults in CBRFs was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < .05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < .05). DISCUSSION: The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on noninstitutional LTSS.

Separate and Unequal: A Time to Reimagine Dementia.

The rapid emergence of COVID-19 has had far-reaching effects across all sectors of health and social care, but none more so than for residential long-term care homes. Mortality rates of older people with dementia in residential long-term care homes have been exponentially higher than the general public. Morbidity rates are also higher in these homes with the effects of government-imposed COVID-19 public health directives (e.g., strict social distancing), which have led most residential long-term care homes to adopt strict 'no visitor' and lockdown policies out of concern for their residents' physical safety. This tragic toll of the COVID-19 pandemic highlights profound stigma-related inequities. Societal assumptions that people living with dementia have no purpose or meaning and perpetuate a deep pernicious fear of, and disregard for, persons with dementia. This has enabled discriminatory practices such as segregation and confinement to residential long-term care settings that are sorely understaffed and lack a supportive, relational, and enriching environment. With a sense of moral urgency to address this crisis, we forged alliances across the globe to form Reimagining Dementia: A Creative Coalition for Justice. We are committed to shifting the culture of dementia care from centralized control, safety, isolation, and punitive interventions to a culture of inclusion, creativity, justice, and respect. Drawing on the emancipatory power of the imagination with the arts (e.g., theatre, improvisation, music), and grounded in authentic partnerships with persons living with dementia, we aim to advance this culture shift through education, advocacy, and innovation at every level of society.

Health conditions of potential risk for severe Covid-19 in institutionalized elderly people.

The objective of this study was to identify the health conditions considered potential risk factors for severe Covid-19 and analyze its association with the BMI of elderly people living in Long-Term Care Facilities (LTCF). This is a descriptive and cross-sectional study, with a quantitative approach, carried out in eight LTCF in the Metropolitan Region of Natal, Rio Grande do Norte, with a population of 267 elderly people, between the months of February and December 2018. The Elderly Health Handbook was used to collect data on sociodemographic, health and risk factors. The Pearson's Chi-square test and odds ratio were used for the analysis. A higher frequency of low weight was observed in elderly people with cognitive impairment (24.6%), and overweight in those hypertensive (23.3%) and diabetics (12.9%). BMI was associated with the age group of 80 years or over, hypertension and diabetes (p = 0.013; p < 0.001; p = 0.001). Hypertensive elderly people were more likely to have low weight when compared to non-hypertensive individuals (RC = 3.6; 95% CI 1.5-8.6). The institutionalized elderly individuals present health conditions that may contribute to the occurrence of adverse outcomes in case of infection by Covid-19. The importance of protective measures for this population must be reinforced, in view of the devastating action of this disease in these institutions.

Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect.

In Hong Kong, about 15% of older people (aged 80 and above) live in care homes, one of the highest proportions in the world. During the spread of severe acute respiratory syndrome in 2003, the crude fatality rate for older people in care homes that were infected was 72%. After taking the advice of a team of international experts, the Hong Kong Government implemented comprehensive preventive measures to cope with the future epidemics. This commentary evaluates the effectiveness of these measures in coping with both influenza outbreaks and COVID-19 and suggests the lessons learnt are relevant to both developed and less developed countries? Lockdown in care homes is very effective under two conditions. Healthcare workers must wear surgical masks in the care home. Hospitals must adopt a strict policy to prevent virus transmission by discharged patients. Care homes situated within high-rise residential towers are particularly vulnerable to COVID-19 transmission; their residents can more easily be infected by asymptomatic carriers from the community. Airborne virus can also be transmitted more swiftly in care homes with open-plan layouts. Lockdown had been shown to significantly reduce influenza outbreaks in care homes. On the other hand, lockdown causes loneliness to residents. Care homes allow residents to move freely within the care home though with the risk of spreading the virus by resident who is an asymptomatic carrier. Finally, lockdown may cause family members to have guilty feelings. Family members can only make video call or window visit to residents.

Aplicação da estimulação cognitiva no cuidado ao idoso institucionalizado com demência / Application of cognitive stimulation in the care of institutionalized elderly people with dementia / Aplicación de la estimulación cognitiva en el cuidado de personas mayores institucionalizadas con demência

Objetivo: identificar as evidências científicas sobre os cuidados de enfermagem aos idosos institucionalizados com demência. Método: trata-se de uma revisão integrativa da literatura, com a utilização da estratégia PICo. Foram incluídos estudos publicados no intervalo de 2009 a 2018, nas bases de dados LILACS, CINAHL, a MEDLINE e a SCOPUS. Os artigos tiveram sua análise de qualidade realizada a partir do instrumento Mixed Methods Appraisal Tool. Resultado: de 6.144 textos inicialmente obtidos foram selecionados 7 artigos, sendo 54% publicados em 2010 e 14% no ano de 2016. As intervenções identificadas estão relacionadas à prática de atividades físicas e de estimulação cognitiva, as quais demonstram ser bastante positivas no cuidado ao idoso com demência, pois permite estimular funções cerebrais ainda preservadas, promovendo uma melhora na sua qualidade de vida. Conclusão: a maioria das intervenções identificadas podem ser aplicadas pela equipe multiprofissional e podem ser associadas, quando necessário, aos recursos farmacológicos

Objective: to identify the scientific evidence on nursing care for institutionalized elderly people with dementia. Method: this is an integrative literature review, using the PICo strategy. Studies published from 2009 to 2018 were included in the LILACS, CINAHL, MEDLINE and SCOPUS databases. The articles were analyzed for quality using the Mixed Methods Appraisal Tool. Result: of 6,144 texts initially obtained, 7 articles were selected, 54% of which were published in 2010 and 14% in 2016. The identified interventions are related to the practice of physical activities and cognitive stimulation, which prove to be quite positive in the care of the child. elderly with dementia, as it allows to stimulate brain functions still preserved, promoting an improvement in their quality of life. Conclusion: most of the identified interventions can be applied by the multiprofessional team and can be associated, when necessary, with pharmacological resources

Objetivo: identificar la evidencia científica sobre el cuidado de enfermería para personas mayores institucionalizadas con demencia. Método: esta es una revisión de literatura integradora, utilizando la estrategia PICo. Los estudios publicados de 2009 a 2018 se incluyeron en las bases de datos LILACS, CINAHL, MEDLINE y SCOPUS. La calidad de los artículos se analizó utilizando la Herramienta de evaluación de métodos mixtos. Resultado: de 6.144 textos obtenidos inicialmente, se seleccionaron 7 artículos, el 54% de los cuales se publicaron en 2010 y el 14% en 2016. Las intervenciones identificadas están relacionadas con la práctica de actividades físicas y la estimulación cognitiva, que resultan ser bastante positivas en el cuidado del niño. ancianos con demencia, ya que permite estimular las funciones cerebrales aún preservadas, promoviendo una mejora en su calidad de vida. Conclusión: la mayoría de las intervenciones identificadas pueden ser aplicadas por el equipo multiprofesional y pueden asociarse, cuando sea necesario, con recursos farmacológicos

A puertas cerradas: La vejez en instituciones en Buenos Aires y el Interior: 1850-1950 / Behind closed doors: Old age in institutions in Buenos Aires and in the country: 1850-1950

Un aspecto clave de la historia de la vejez es el de la asistencia a los ancianos pobres, enfermos o sin familia, sobre todo durante el siglo XIX y principios del XX que constituyen la edad de oro del asilo de ancianos. Partiendo de esa constatación y de los principales problemas historiográficos involucrados, se propone como objetivo principal reconstruir la oferta de instituciones existentes y la proporción de personas atendidas. Para ello explora, en primer lugar las posibilidades y límites de las escasas fuentes estadísticas disponibles. En segundo término, propone una comparación exploratoria con el interior del país y con la asistencia a otros grupos de edad, en particular los niños. Tanto por la centralidad de los procesos históricos involucrados (crecimiento urbano, impacto de la inmigración, desarrollo de políticas sociales), como por la consecuente disponibilidad de fuentes, el caso porteño constituye el eje central de la indagación. (AU)

Female Pakistani carers' views on future formal and informal care for their older relatives in Norway.

BACKGROUND: The aging of Pakistani immigrants in Norway raises questions related to their increased need for care and help from relatives, as well as those concerning what future formal and informal care and healthcare accessibility for older immigrants may look like. The hidden nature of family caregiving means that the circumstances of carers, their views and their dilemmas related to future care are largely invisible. In this study, we explored female Pakistani carers' views of future care and healthcare accessibility for their older relatives in Norway. METHODS: Our data included interviews with family carers between the ages of 23 and 40 years old, living in Oslo, Norway. We recruited ten family carers, out of which eight were daughters and two were daughters-in-law. Interviews were conducted by the first author in Urdu or English and were recorded and transcribed verbatim. RESULTS: Our findings revealed several factors that influenced participants' perceptions about formal and informal caregiving, which can be organised into the following themes: 1) caring for family in Norway as in Pakistan, 2) worries about being 'dropped off' at a care home, 3) concerns about being cared for by outsiders, 4) questions about what other people might say and 5) adhering to society's expectations of a 'good' carer. CONCLUSION: Family carers' traditional views of filial piety do not entirely determine the use of or access to healthcare services of their older relatives. There is a need to develop culturally sensitive healthcare systems so that immigrant families and their carers have more options in choosing care in old age, which in turn will ease their families' care burden. Healthcare professionals and policymakers should not assume that immigrant families will take care of their own older members but should instead secure adequate support for older immigrants and their family carers.

Becoming or Remaining Agitated: The Course of Agitation in People with Dementia Living in Care Homes. The English Longitudinal Managing Agitation and Raising Quality of Life (MARQUE) Study.

Care home residents with dementia often have accompanying agitation. We investigated agitation's course at 5 time-points in 1,424 people with dementia over 16 months in 86 English care homes. We categorized baseline agitation symptoms on the Cohen-Mansfield Agitation Inventory (CMAI) into none (CMAI = 29; 15%), subclinical (CMAI = 30-45; 45%), or clinically-significant (CMAI > 45; 40%). 88% of those with no agitation at baseline remained free of clinically-significant agitation at all follow-ups. Seventy percent of those exhibiting clinically-significant agitation at baseline had clinically-significant agitation at some follow-ups. Over a 16-month observation period, this study finds many care home residents with dementia never develop clinically significant agitation and interventions should be for treatment not prevention.

COVID-19 and distance socializing between people living in a residential facility and caregivers in the context of a visitors ban

SUMMARY OF THE REQUEST: The objective of this rapid response is to spotlight various ways that are being used or that could potentially be used to foster social interactions between caregivers and vulnerable people at a time when no visits are allowed at hospitals, residential and long-term care centres, seniors' residences and at intermediary resources and family-type resources. METHODOLOGY: Review methods: The data came from a variety of sources: PubMed, Google Scholar, Google (websites). Various combinations of key words, in English and French, were used. For example: Proches aidants (proches, caregivers); Hébergement (long-term care, nursing homes, youth protection services, Ehpad); Isolement, isolement social, distanciation sociale, confinement, distance; Personnes âgées, incapacités, hospitalisation (elderly, older, disabled, hospitalized); Communication, vidéoconférence; Coronavirus, covid-19. TECHNOLOGY: o A study published in 2017 shows that digital communication technologies such as the Internet could promote social connectivity, thereby reducing the rate of social isolation and loneliness. In Quebec, 92% of households had a residential Internet connection in 2018; however, among people aged 65 and over, this percentage was only 81%. In addition, Internet access in hospitals, residential and long-term care centres, seniors' residences and at intermediary resources and family-type resources may be limited. Considering that digital literacy levels and access to tools vary widely, there is a part of the population for whom technological means are not available. It is appropriate to coach some people in order to facilitate their use of technology (as suggested above). It is important to provide access to a computer, tablet or smartphone to people who do not have these devices so that they can get in touch with their loved ones. COMMUNICATION BETWEEN INSTITUTIONS (FACILITIES) AND CAREGIVERS: Institutions (facilities) may glean some ideas from the following suggestions: Keep loved ones up to date on the situation by using listserv emails. Set up a telephone line to provide a recorded report on the current operation of the facility and update it frequently (e.g., every day). Assign someone to act as a primary contact who can be easily reached by a resident's loved ones. This contact person needs to communicate frequently with a designated loved one to provide updates on the resident's status, particularly if the resident is unable to communicate on his/her own. Share general information or news releases via the Facebook page of the institution or facility. SUPPORT SERVICES FOR ISOLATED PEOPLE AND THEIR LOVED ONES: Consideration should be given to some of the support services as a way of helping isolated people counter the harmful effects of their isolation; these include: Telephone helplines. Online cognitive-behavioural therapy to reduce loneliness and promote psychological well-being in people living in a residential facility. Telephone support services that are normally available to caregivers continue to remain accessible during the current crisis. Examples include: National Dementia Helpline (Australia). Centre de soutien entr'Aidants (Quebec). Ligne info-aidants par l'appui.org (Quebec). There are also online support services for caregivers. For example: Canadian Caregiver Network, for the loved ones of people suffering from dementia.

COVID-19 et la socialisation à distance entre les personnes hébergées et les proches aidants en contexte d'interdiction de visite / COVID-19 and long-distance socialization between residents and caregivers in the context of a visit ban

RÉSUMÉ DE LA DEMANDE: L'objectif de cette réponse rapide est de mettre en évidence les différentes manières qui sont utilisées ou qui pourraient potentiellement être utilisées pour favoriser les interactions sociales entre les soignants et les personnes vulnérables à un moment où aucune visite n'est autorisée dans les hôpitaux, les résidences et les établissements de longue durée. centres de soins de longue durée, résidences pour personnes âgées et ressources intermédiaires et ressources de type familial. MÉTHODOLOGIE: Méthodes d'examen: Les données provenaient de diverses sources: PubMed, Google Scholar, Google (sites Web). Diverses combinaisons de mots clés, en anglais et en français, ont été utilisées. Par exemple: Proches aides (proches, soignants); Hébergement (soins de longue durée, maisons de soins infirmiers, services de protection de la jeunesse, Ehpad); Isolement, isolement social, distanciation sociale, confinement, distance; Personnes âgées, incapacités, hospitalisation (personnes âgées, âgées, handicapées, hospitalisées); Communication, vidéoconférence; Coronavirus (COVID-19. TECHNOLOGIE: o Une étude publiée en 2017 montre que les technologies de communication numérique comme Internet pourraient promouvoir la connectivité sociale, réduisant ainsi le taux d'isolement social et de solitude. Au Québec, 92% des ménages avaient une connexion Internet résidentielle en 2018; cependant, chez les personnes de 65 ans et plus, ce pourcentage n'était que de 81%. De plus, l'accès à Internet dans les hôpitaux, les centres de soins de longue durée et résidentiels, les résidences pour personnes âgées et les ressources intermédiaires et les ressources de type familial peut être limité. Étant donné que les niveaux d'alphabétisation numérique et l'accès aux outils varient considérablement, il existe une partie de la population pour laquelle les moyens technologiques ne sont pas disponibles. Il convient de coacher certaines personnes afin de faciliter leur utilisation de la technologie (comme suggéré ci-dessus). Il est important de donner accès à un ordinateur, une tablette ou un smartphone aux personnes qui ne disposent pas de ces appareils afin qu'elles puissent entrer en contact avec leurs proches. COMMUNICATION ENTRE LES INSTITUTIONS (INSTALLATIONS) ET LES AIDANTS: Les institutions (installations) peuvent glaner des idées parmi les suggestions suivantes: Tenez vos proches au courant de la situation en utilisant les courriels de la liste de diffusion. Mettre en place une ligne téléphonique pour fournir un rapport enregistré sur le fonctionnement actuel de l'installation et le mettre à jour fréquemment (par exemple, tous les jours). Attribuer à quelqu'un le rôle de principal contact facilement accessible par les proches d'un résident. Cette personne-ressource doit communiquer fréquemment avec un être cher désigné pour fournir des mises à jour sur le statut du résident, en particulier si le résident est incapable de communiquer par lui-même. Partagez des informations générales ou des communiqués de presse via la page Facebook de l'institution ou de l'établissement. SERVICES DE SOUTIEN POUR LES PERSONNES ISOLÉES ET LEURS AIMÉS: Il faudrait envisager certains des services de soutien comme moyen d'aider les personnes isolées à contrer les effets néfastes de leur isolement; il s'agit notamment: Des lignes d'assistance téléphonique. Thérapie cognitivo-comportementale en ligne pour réduire la solitude et promouvoir le bien-être psychologique des personnes vivant dans un établissement résidentiel. Les services de soutien téléphonique qui sont normalement disponibles pour les aidants naturels restent accessibles pendant la crise actuelle. Exemples: National Dementia Helpline (Australie). Centre de soutien entr'Aidants (Québec). Ligne info-aidants par l'appui.org (Québec). Il existe également des services d'assistance en ligne pour les soignants. Par exemple: Canadian Caregiver Network, pour les proches des personnes atteintes de démence.

A clinical audit of oral anticoagulant therapy in aged care residents with atrial fibrillation.

Background Atrial fibrillation (AF) is a risk factor for stroke in older people. Oral anticoagulants can reduce stroke risk but they are commonly under prescribed in the elderly, often due to concerns regarding the risk of bleeding. Prescribing in aged care residents may also be further complicated by associated geriatric conditions such as dementia and risk of falls. Systematic assessment of stroke and bleed risk can help identify people with AF expected to benefit from anticoagulant therapy and optimise prescribing. Objective The aim of this study was to assess the prescribing of anticoagulants in elderly aged care residents in accordance with Australian guideline recommendations. Setting Nineteen aged care facilities across southeast Queensland. Method A clinical audit of anticoagulant therapy in aged care residents was conducted. Main outcome measure Information was collected from the records of residents with non-valvular AF to assess the risk of stroke and bleeding and compare this prescribing to current evidence-based guidelines for anticoagulation in AF. Results A total of 1754 residents were screened with 359 (20.4%) identified to have a diagnosis of non-valvular AF. There were 356 (99.2%) residents with non-valvular AF and a sufficiently high risk of stroke to warrant the use of an anticoagulant. Of these, 172 (48.3%) were prescribed an oral anticoagulant and 40 (11.2%) residents had a documented decision not to prescribe oral anticoagulants in their records. The majority of residents prescribed anticoagulation were receiving non-vitamin K antagonists (76.8%). The prescribed dose was consistent with recommendations for 44.8% of residents prescribed oral anticoagulant therapy. Conclusion Many residents with non-valvular AF and significant risk of stroke were not receiving oral anticoagulation despite a lack of documented reason for non-prescribing. Non-vitamin K antagonists were widely prescribed but dosing of these agents could still be improved. There remains a need to improve anticoagulant prescribing for aged care residents and optimise stroke prevention in this population.

Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study.

PURPOSE: To examine the prevalence of residents receiving proton pump inhibitors (PPIs) for evidence-based indications in a large sample of Italian nursing homes (NHs) and to assess the predictors of potentially inappropriate prescriptions. METHODS: This study was conducted in a sample of Italian long-term care NHs. Information on drug prescription, diseases, and socio-demographic characteristics of NH residents was collected three times during 2018. Appropriate use of PPI was defined in accordance with the strongest evidence-based indications and the Italian criteria for PPI prescription. RESULTS: Among the 2579 patients recruited from 27 long-term care NHs, 1177 (45.6%) were receiving PPIs; 597 (50.7%) were taking them for evidence-based indications. Corticosteroids, anticoagulants, and mean number of drugs were the most important predictors of inappropriate PPIs prescriptions. NH residents receiving ≥13 drugs had about 10 times the risk of receiving a PPI than those taking 0 to 4 drugs. Similarly, residents with more comorbidity had about 2.5 times the risk of receiving a PPI than those in better health. The prevalence of residents inappropriately treated with PPI in individual NHs varied widely, ranging from 22% to 63%. CONCLUSIONS: Number of drugs, comorbidity, corticosteroids, and anticoagulants are the most important predictors of the inappropriate use of PPI in NHs. The wide variability between NHs in the appropriate use of PPIs suggests the need for thorough drug review in this fragile and vulnerable population. Prescribing patterns linked to evidence-based guidelines and national recommendations are essential for rational, cost-effective use of PPIs.

[Health and survival in Icelandic nursing homes 2003 - 2014, before and after the setting of stricter criteria for nursing home admission in December 2007].

INTRODUCTION: Many factors influence the nursing needs and survival of nursing home residents, including the admission criteria. The aim of the study was to compare health, survival and predictors for one- and two-year survival of people entering Icelandic nursing homes between 2003-2007 and 2008-2014. MATERIAL AND METHODS: Retrospective, descriptive, comparative study. The data was obtained from a Directorate of Health database for all interRAI assessments of Icelandic nursing homes from January 1, 2003, to December 31, 2014 (N = 8487). RESULTS: There was a significant difference in the health and survival of new nursing home residents before and after December 31, 2007. In the latter period, the mean age was 82.7 years. In the previous period, it was 82.1 years, and the prevalence of Alzheimer's disease, ischemic heart disease, heart failure, diabetes and COPD increased between the periods. One-year survival decreased from 73.4% to 66.5%, and two-year survival decreased from 56.9% to 49.1%. The strongest mortality risk factors were heart failure and chronic obstructive pulmonary disease, as well as high scores on the CHESS scale and ADL long scale. CONCLUSION: After 2007, new residents were older, in poorer health, and their life expectancy was shorter than for those moving to nursing homes before that. The results suggest that the aim of the regulatory change was achieved, i.e., to prioritise those in worst health. Their care needs may therefore be different and greater than before.

Trends in the utilisation of aged care services in Australia, 2008-2016.

BACKGROUND: Aged care support services in Australia are delivered through home care packages, permanent residential care, respite care and transition care. This study aimed to determine age and gender specific incidence rates of aged care service utilisation in Australia between 2008-09 and 2015-16. METHODS: This is a population-based epidmiological study of people accessing aged care services in Australia. The trends and characteristics of people (over the age of 65 years old) accessing aged care services in Australia were evaluated, using data (2008-09 and 2015-16) from the Australian Institute of Health and Welfare and Australian Bureau of Statistics. The yearly utilisation incidence rates (per 1000 people) per service type were calculated and changes in incidence rate ratios (IRR) of service utilisation for the study period were estimated using Poisson regression models. RESULTS: The proportion of older Australians aged ≥65 years who used aged care services remained similar between 2008-09 (5.4%, N = 208,247) and 2015-16 (5.6%, N = 248,669). However, the incidence use of specific services changed during the study period. Specifically, admissions into permanent residential care decreased (from 23.8/1000 people in 2008-09 to 19.6/1000 in 2015-16, at a IRR of 0.84/year, p < 0.001) but increased for transition care (from 4.3/1000 in 2008-09 to 6.6/1000 in 2015-16, at a IRR of 1.57/year, p < 0.001) and home care packages (from 8.04/1000 in 2008-09 to 12.0/1000 per 1000 in 2015-16, at a IRR of 1.52/year, p < 0.001). Between 2008-09 and 2015-16, the greatest changes in IRR were observed in males aged 80-89 years accessing transition care (IRR = 1.68/year, p < 0.001). A higher proportion of people aged between 80-89 years (≥45%), females (≥60%), Australia born (≥ 60%) and English speakers (≥80%) used all the service types. CONCLUSIONS: Patterns of service utilisation for aged care services changed over the study period with a decrease in incidence of individuals accessing permanent residential care but increased for other service types. This finding reflects changes in attitudes regarding ageing in place and policies. These findings are helpful to inform key stakeholders on service planning to further improve quality of the aged-care services in Australia.

Effects of ß-hydroxy-ß-methylbutyrate (HMB) supplementation in addition to multicomponent exercise in adults older than 70 years living in nursing homes, a cluster randomized placebo-controlled trial: the HEAL study protocol.

BACKGROUND: Evidence supports the fact that multicomponent exercise and HMB supplementation are, separately, effective in improving older adult's health and palliate functional metabolic diseases in older people. However, the true effect of HMB supplementation combined with a tailored exercise program in frail older adults is still unknown. Thus, the aim of the HEAL (HMB + Exercise = Adults Living longer) study is to assess the effects of the combination of a daily multicomponent exercise and resistance training (VIVIFRAIL program) intervention in addition to HMB supplementation on older adults' health. METHODS/DESIGN: A 24-week cluster randomized, double-blind, placebo-controlled study will be conducted on 104 adults ≥70 years. Nursing homes will be randomized to either of four groups: Ex-HMB (exercise intervention with HMB), Ex-Plac (exercise intervention with placebo), NoEx-HMB (no exercise intervention with HMB), and Controls (No exercise and no HMB). Intervention groups which include exercise will complete the individualized multicomponent (strength, balance and cardiovascular exercises) training program VIVIFRAIL. Intervention groups which include HMB supplementation will receive a 3 g/daily dose of free acid HMB in powder form. The primary outcome measure is the functional capacity. Secondary outcome measures are muscle strength and power, frailty and fall risk, body composition, biochemical analyses and cardiometabolic risk factor, disability and comorbidity, cognitive function and depression. DISCUSSION: The findings of the HEAL study will help professionals from public health systems to identify cost-effective and innovative actions to improve older people's health and quality of life, and endorse exercise practice in older adults and people living in nursing homes. TRIAL REGISTRATION: NCT03827499 ; Date of registration: 01/02/2019.