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BACKGROUND: COVID-19 disease affected the cognitive level of institutionalized patients in nursing homes, especially in the older subjects regardless of gender. This study aims to assess cognitive impairment using the Mini-Mental State Examination (MMSE) before and after COVID-19 infection, and to determine whether these changes varied based on gender. METHODS: A pre- and post-COVID-19 study was conducted, involving 68 geriatric patients (34 men and 34 women) from two nursing homes. Cognitive impairment was assessed using the MMSE. RESULTS: COVID-19 infection had a notable impact on the cognitive health of older adults residing in nursing homes, primarily attributed to the social isolation they experienced. This effect was more pronounced in older individuals. A comparison of the MMSE results by gender before and after contracting COVID-19 revealed significant differences in attention and calculation, with women obtaining the worst score before the virus. However, following their recovery from the virus, men demonstrated significantly lower scores in time and space orientation and evocation. CONCLUSION: COVID-19 has led to a decline in cognitive functioning, significantly worsening the mental state of older individuals, even after recovery from the virus. Consequently, it is crucial to implement proactive measures to prevent isolation and safeguard the cognitive well-being of this vulnerable population.
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COVID-19 , Disfunción Cognitiva , Casas de Salud , Humanos , Masculino , Femenino , COVID-19/psicología , COVID-19/epidemiología , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Disfunción Cognitiva/diagnóstico , Pruebas de Estado Mental y Demencia , Hogares para Ancianos , Cognición/fisiología , Aislamiento Social/psicología , Factores SexualesRESUMEN
OBJECTIVE: Falls are the leading cause of hospital transfer from residential aged care homes (RACHs). However, many falls do not result in significant injury, and ageing patients are exposed to complications while hospitalised. Inreach services are designed to reduce hospital transfer by providing care, support and assessment to residents at the RACH. This study evaluated a pilot inreach program targeting ageing patients following a fall. METHODS: We conducted a prospective, mixed methods evaluation of a 5-month (May-September 2022) pilot implementation across 108 government-funded RACHs within a single health-care network in Melbourne, Australia. RESULTS: A total of 123 residents (median [interquartile range] age: 88 [82, 94] years, female: 49%) were included in the intervention. The majority (n = 116, 94%) of residents were managed onsite and required no further investigation (n = 80, 69%) or treatment (n = 63, 54%). Among the seven residents referred to the emergency department (ED), two received hospital admission and five were transferred back to residential care. In the 7 days following referral to the intervention, four additional residents were referred to the ED and one received hospital admission. Qualitative feedback (n = 40) included specific comments relating to themes of general satisfaction (n = 20, 50%), compliments for staff (n = 16, 40%) and acknowledgement of comprehensiveness (n = 9, 23%). CONCLUSIONS: Implementation of a specialised fall assessment team to complement an existing geriatric-led RACH assessment service meant that a high rate of eligible residents were managed onsite, with very low need for subsequent hospitalisation. Residents, family members and caregivers expressed high rates of satisfaction with the service.
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Objetivo: Identificar as mudanças surgidas como resultado das medidas implementadas em Instituições de Longa Permanecia para Idosos para a prevenção do contágio pelo novo coronavírus SARS-CoV-2 no município de Teresina no Estado do Piauí. Método: Trata-se de um estudo transversal de natureza quantitativa com os gestores de quatro instituições na cidade de Teresina no Piauí, realizada por meio de um formulário, estruturado e eletrônico, na plataforma Google Forms. Resultados: Foram implementados protocolos preventivos em todas as instituições, com foco em medidas de segurança para os idosos e focando em condutas de higiene, de forma unanime a obrigatoriedade do uso de máscara e suspensão de visitas. Conclusões: Foram analisadas quatro Instituições de Longa Permanência para Idosos e de acordo com os dados coletados as instituições passaram por processo de adaptação as necessidades que surgem para melhorar a qualidade de vida dos idosos institucionalizados.(AU)
Objective: To identify the changes that have arisen as a result of measures implemented in Long Stay Institutions for the Elderly for the prevention of contagion by the new SARS-CoV-2 coronavirus in the municipality of Teresina, State of Piauí. Method: This is a cross-sectional study of a quantitative nature with managers of four institutions in the city of Teresina, Piauí, carried out through a structured and electronic form, on the Google Forms platform. Results: Preventive protocols were implemented in all institutions, focusing on safety measures for the elderly and focusing on hygiene behaviors, unanimously the mandatory use of masks and suspension of visits. Conclusions: Four long-stay institutions for the elderly were analyzed and, according to the data collected as institutions, they underwent an adaptation process as needed to improve the quality of life of institutionalized elderly.(AU)
Objetivos: Identificar los cambios que han surgido como resultado de las medidas implementadas en Instituciones de Larga Estancia para Personas Mayores para la prevención del contagio por el nuevo coronavirus SARS-CoV-2 en el municipio de Teresina, Estado de Piauí. Método: Se trata de un estudio transversal de carácter cuantitativo con responsables de cuatro instituciones de la ciudad de Teresina, Piauí, realizado a través de un formulario estructurado y electrónico, en la plataforma Google Forms. Resultados: Se implementaron protocolos preventivos en todas las instituciones, enfocándose en las medidas de seguridad para los adultos mayores y enfocados en las conductas higiénicas, por unanimidad el uso obligatorio de mascarillas y suspensión de visitas. Conclusiones: Se analizaron cuatro instituciones de larga estancia para ancianos que, de acuerdo con los datos recolectados como instituciones, se sometieron a un proceso de adaptación según fue necesario para mejorar la calidad de vida de los ancianos institucionalizados.(AU)
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Anciano , Anciano de 80 o más Años , Asistencia a los Ancianos , COVID-19 , Hogares para AncianosRESUMEN
BACKGROUND: Hospital-based residential aged-care support service teams typically consist of doctors and nurses who provide hospital substitutive care to aged-care residents. There is limited literature evaluating the pharmacist's role in such aged-care support teams. OBJECTIVE: To analyse the effect of residential aged-care support service pharmacist-led medication reviews on polypharmacy, drug burden index, potentially inappropriate medications, and potential prescribing omissions for aged-care residents. METHODS: Residents referred to a residential aged-care support service pharmacist for medication review over a 12-month period were included. The pharmacist communicated medication-related problems and recommendations to the resident's general practitioner and residential aged-care support service medical practitioner. Residents' medication histories were obtained at baseline and one-month postintervention. The number of medications and their associated drug burden indices were compared using paired t-tests; potentially inappropriate medications and potential prescribing omissions were compared using Wilcoxon's signed rank test. KEY FINDINGS: Of 175 residents (mean age 84 years) referred for pharmacist-led medication review, 146 had postintervention evaluation after one-month (median 29 days). Mean number of medications reduced from 12.47 at baseline to 11.84 postintervention (mean difference (95% CI): 0.63(0.33-0.93), P < .001). Mean drug burden index score reduced from 1.54 at baseline to 1.37 postintervention (mean difference (95% CI): 0.17(0.10-0.24), P < .001). More residents experienced a decrease in inappropriate medications (median (IQR) pre: 2(1-3), post: 1(0-2), P < .001) and prescribing omissions (median (IQR) pre: 0(0-1), post: 0(0-0), P = .003) compared with those that had an increase. CONCLUSIONS: Medication reviews performed by pharmacists embedded in hospital-based residential aged-care support services may improve medication prescribing. Further research into such preventative health service models is required.
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Prescripción Inadecuada , Farmacéuticos , Polifarmacia , Rol Profesional , Humanos , Anciano de 80 o más Años , Femenino , Masculino , Anciano , Farmacéuticos/organización & administración , Prescripción Inadecuada/prevención & control , Hogares para Ancianos/organización & administración , Pautas de la Práctica Farmacéutica , Lista de Medicamentos Potencialmente Inapropiados , Servicio de Farmacia en Hospital/organización & administraciónRESUMEN
Due to increased dependency and health needs, the follow-up of the patients in nursing home (NH) by general practitioners (GP) is difficult, in a context of an aging population and declining medical density. This study sought to describe facilitating or limiting factors faced by GP in Drôme, Isère and Savoy in their NH patients' follow-up and to collect suggestions for improvement. A qualitative study, with phenomenological analysis, was identified factors linked to patients (complexity, specific needs, Doctor-patient relationship affected, ethical considerations), to physicians (to conjugate his office activity with visits and emergencies) and to NH (cooperation with information sharing amongst professional microcosm, their representations by GP). The Covid pandemic revived questions about the meaning of care but revealed adaptive work reveals the challenges GP face at NH, as well as prospects for improvment.
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Médicos Generales , Humanos , Anciano , Relaciones Médico-Paciente , Casas de Salud , Instituciones de Cuidados Especializados de Enfermería , Investigación CualitativaRESUMEN
BACKGROUND: India accounts for one fourth of the TB burden globally. One of the objectives of the National Strategic Plan is to achieve 90% notification rate of all TB cases. Screening of high risk groups is one of the important components towards achieving this objective. Inmates of homes for the aged and orphanages are at higher risk of having TB infection and disease. Hence this study was conducted with the objective of identifying the prevalence of TB among inmates of homes for the aged and orphanages. METHODS: A cross sectional study was done in homes for the aged and orphanages of Kollam district of Kerala in India. Sample size was estimated as 466. Cluster sampling using probability proportionate to size was used. There were 32 homes for the aged, from which 5 were selected. Out of 43 orphanages 8 were selected. Inmates were screened using a questionnaire. Those with any of the symptoms suggestive of TB were examined by a pulmonologist in a camp conducted at the institute. Those who needed further evaluation were brought to Government Medical College, Kollam/other nearest government health setting. All those who were detected to be having tuberculosis, were guided and given the care as per the NTEP treatment protocol. Permission was taken from the Collector of Kollam district. Informed written consent from the study subjects/legally accepted representative and assent were taken. RESULTS: 533 inmates were assessed from homes for the aged. The mean age was 56.70 (SD - 17.40). Five new TB patients were identified during the study. Of this three patients had extra-pulmonary and two were pulmonary TB. Eight patients were receiving treatment for TB at the time of study already, seven of which were pulmonary and one was extra-pulmonary. So the prevalence of TB in homes for the aged was 13/533 ie 2.43% (95%CI - 1.36 to 4.03%) or 2430/lakh. A higher percentage of inmates with tuberculosis were females, stayed in dormitory, had only primary education, had history of contact with TB and were undernourished compared to inmates without tuberculosis. We screened 478 children in orphanages of Kollam district. There were no children less than 5 years. Most of the children were in the age group of 10-15 years (62.1%). Nine children (1.9%) had history of contact with TB. One child had a previous history of TB. There was only one child who was suspected to have Tuberculosis, She was evaluated by a pediatrician and Tuberculosis was ruled out. CONCLUSION: The prevalence of TB in inmates of homes for the aged is much higher than the general population. This highlights the need for a more active case detection in such institutions, especially in the context of the country marching towards TB elimination. The absence of tuberculosis among children in orphanages is a positive indicator that the community is moving in the direction of TB elimination.
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Orfanatos , Tuberculosis , Anciano , Femenino , Niño , Humanos , Adolescente , Persona de Mediana Edad , Masculino , Prevalencia , Estudios Transversales , Hogares para Ancianos , Tuberculosis/diagnóstico , India/epidemiologíaRESUMEN
Objetivo: Analisar o efeito da Capacidade Intrínseca na mortalidade de 30 meses em residentes idosos de Instituição de Longa Permanência. Metodologia: Estudo de coorte prospectivo realizado de julho de 2020 a dezembro de 2022 com análise de sobrevivência de idosos residentes de ILPIs brasileiras. Na avaliação inicial (M0) foram avaliados 209 idosos residentes quanto aos dados demográficos e clínicos (doenças diagnosticadas e medicações utilizadas); capacidade intrínseca segundo ICOPE nos domínios cognição, psicológico, audição, visão, vitalidade e locomotor; capacidade funcional pelas atividades básicas de vida diária (índice de Katz) e fragilidade (escala FRAIL). Após 30 meses, foi avaliada a ocorrência de óbito. Resultados: Em M0, a média da idade dos residentes era de 82 anos (±11,21), 65,07% eram do sexo feminino, 94,26% de cor branca e 88,04% tinham multimorbidade. Apresentaram alteração em quatro ou mais domínios da capacidade intrínseca 54,07% (n = 113) dos residentes, sendo o domínio mais alterado a locomoção (82,78%). Eram totalmente dependentes para as atividades básicas de vida diária 43,54% dos idosos, e 42,58% eram frágeis. Após 30 meses de acompanhamento, 33,49% (n = 70) dos idosos evoluíram para óbito. Na análise da sobrevida para óbito, houve associação estatisticamente significativa do evento com alteração em quatro ou mais domínios da capacidade intrínseca (p = 0,044). Conclusão: a alteração de quatro ou mais domínios da capacidade intrínseca está associada com óbito em residentes de ILPI. (AU)
Objective: To analyze the impact of intrinsic capacity on 30-month mortality among older adults living in long-term care facilities (LTCFs). Methods: Prospective cohort study with survival analysis conducted from July 2020 to December 2022 among older adults living in Brazilian LTCFs. At baseline (T0), 209 older residents were evaluated for demographic profile, clinical data (diagnosed diseases and current medications), intrinsic capacity according to ICOPE (cognitive capacity, psychological capacity, hearing capacity, visual capacity, vitality, and locomotor capacity domains), functional capacity (Katz Index of Independence in Activities of Daily Living), and frailty (FRAIL scale). At 30 months, mortality in the sample was assessed. Results: At T0, the mean age of residents was 82 (SD, 11.21) years; 65.07% were female, 94.26% were white, and 88.04% had multimorbidity. Overall, 54.07% (n = 113) of residents exhibited changes in four or more domains of intrinsic capacity, with locomotor capacity being the most commonly impaired domain (82.78%); 43.54% were completely dependent for basic activities of daily living, and 42.58% were frail. At 30-month follow-up, 33.49% (n = 70) of residents had died. Survival analysis revealed a statistically significant association between death and impairment in four or more domains of intrinsic capacity (p = 0.044). Conclusion: Impairment in four or more domains of intrinsic capacity is associated with death in LTCF residents. (AU)
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Humanos , Anciano , Anciano de 80 o más Años , Mortalidad , Hogares para Ancianos/estadística & datos numéricos , EnvejecimientoRESUMEN
OBJECTIVE: To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early-career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs. METHODS: A cross-sectional study. DESIGN: A questionnaire-based study. SETTING: Australian general practice. PARTICIPANTS: Early-career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania. MAIN OUTCOME MEASURES: Current provision of NHV and HV. RESULTS: NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major-city practice, was strongly associated with performing NHV as an early-career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early-career specialist GP. On multivariable analyses, these were no longer statistically significant. CONCLUSION: Early-career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV.
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Médicos Generales , Visita Domiciliaria , Casas de Salud , Humanos , Estudios Transversales , Femenino , Masculino , Casas de Salud/estadística & datos numéricos , Médicos Generales/estadística & datos numéricos , Visita Domiciliaria/estadística & datos numéricos , Encuestas y Cuestionarios , Prevalencia , Servicios de Salud Rural/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Australia , TasmaniaRESUMEN
BACKGROUND: Pharmacists involvement in residential aged care facilities has traditionally been limited to that of an external contractor providing medication reviews, or medication supply. AIM: To explore Australian pharmacists' interest and perceived preparedness to work as on-site pharmacists in residential aged care. METHOD: National cross-sectional anonymous online survey open for two weeks (September 17th to October 1st 2022) consisting of Likert-type, multiple choice and multiple selection questions. Australian pharmacists were recruited using a broad advertising strategy which included social and traditional media platforms, and snowball sampling. Data were collected on pharmacist self-reported interest and perceived preparedness to work as on-site aged care pharmacists in residential aged care. Data were analysed using descriptive statistics. RESULTS: Responses were received from 720 participants, 643 were eligible. Most participants were female (n = 466, 73%) and mean (SD) age was 43.5 (SD 12.5) years. Over half the participants were interested or extremely interested in working as an on-site aged care pharmacist (56%, n = 360), and agreed or strongly agreed (n = 475, 76%) that they felt prepared to work as an on-site aged care pharmacist. Most pharmacists felt prepared to engage in a variety of roles within the facilities (> 73% for each role), including resident and system level roles, and the majority agreed they felt prepared to engage with stakeholders, including general practitioners (93%) and medical specialists (86%). CONCLUSION: Pharmacists reported they are interested and feel prepared to work as on-site aged care pharmacists. These findings will inform the roll-out of this new model of care to enhance multidisciplinary collaboration in residential aged care.
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Hogares para Ancianos , Farmacéuticos , Anciano , Humanos , Femenino , Adulto , Masculino , Estudios Transversales , Australia/epidemiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: This study aimed to assess the prevalence of malnutrition according to Subjective Global Assessment (SGA), Mini Nutritional Assessment-Full Form (MNA-FF), and different combinations of the Global Leadership Initiative on Malnutrition (GLIM) criteria in older adults who are institutionalized, and the impact of malnutrition on 5-year mortality. METHODS: Nutrition status was assessed by the SGA, MNA-FF, and 15 GLIM criteria combinations. The Katz scale was used to assess the level of dependence. The SGA was considered the reference method, and the agreement (Kappa test), sensitivity, and specificity values were calculated for each GLIM criteria combination. The variables associated with 5-year mortality were assessed using multivariate logistic regression models. RESULTS: One hundred eleven participants (mean age: 81y; interquartile range: 76.0-87.0; 90.9% women) were included; the prevalence of malnutrition according to the SGA and MNA-FF were 49.5% (n = 55) and 8.1% (n = 9), respectively. The prevalence of malnutrition varied from 1.8% to 36.0% considering GLIM combinations. Eight GLIM criteria combinations had a fair agreement with SGA (κ: 0.21-0.40), and two had sensitivity >80%. Regarding mortality, 43 participants (38.7%) died within 5 years. Malnutrition according to the SGA (odds ratio [OR]: 2.82; 95% confidence interval [CI]: 1.06-7.46) and the Katz scale score (OR: 4.64; 95% CI:1.84-11.70) were independent predictors of mortality. CONCLUSION: The prevalence of malnutrition varied according to the assessment tools. Malnutrition diagnosed by the SGA, but not by the GLIM criteria or MNA-FF, was associated with 5-year mortality in older adults who were institutionalized.
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OBJECTIVES: Australia's migration programs mean that an increasing number of people living in residential aged care (RAC) were born in a non-main English-speaking country (NMESC) and have a preferred language other than English (LOTE). This study describes the number of such residents in aged care facilities in Australia and discusses the implications for their care. METHODS: This study presents a secondary analysis of the Australian Institute of Health and Welfare (AIHW) National Aged Care Data Clearinghouse 2020-2021 to examine the country of birth and preferred language of people living in RAC in each state and territory and the number of residents who are lone speakers of their language in their facility. RESULTS: Less than half (45 per cent) of the residents born in a NMESC had a preferred LOTE. Of those, 50 per cent spoke Italian, Greek or Cantonese. At least 60 other preferred languages were recorded, the majority with very few speakers. Australia-wide, more than one in five residents with a preferred top 20 LOTE are the lone speaker of their language in their facility. The proportion of lone speakers is highest in Tasmania, the ACT and Queensland. CONCLUSIONS: Understanding the extent of language diversity, location and linguistic isolation of people living in RAC is essential for planning to ensure residents with a preferred LOTE receive high-quality, individualised care. There is a need for consistent and timely data collection about the diversity of aged care residents and workers in this sector.
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Hogares para Ancianos , Lenguaje , Humanos , Australia , Anciano , Femenino , Masculino , Barreras de Comunicación , Diversidad Cultural , Emigrantes e Inmigrantes/psicología , Casas de Salud , MultilingüismoRESUMEN
BACKGROUND: Infection surveillance is a key element of infection prevention and control activities in the aged care sector. In 2017, a standardised infection surveillance program was established for public residential aged care services in Victoria, Australia. This program will soon be expanded to a national level for all Australian residential aged care facilities. It has not been evaluated since its inception. METHODS: The current study aimed to evaluate the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Aged Care Infection Indicator Program (ACIIP), to understand its performance and functionality. A mixed methods evaluation was performed using the Updated Guidelines for Evaluating Public Health Surveillance Systems developed by the United States Centers for Disease Control and Prevention as a framework. VICNISS staff who coordinate and manage the ACIIP were invited to participate in interviews. Residential aged care staff who use the program were invited to participate in a survey. Document analysis was also performed. RESULTS: Four VICNISS staff participated in the interviews and 38 aged care staff participated in the survey. The ACIIP is stable and able to be adapted quickly to changing definitions for infections. Users found the system relatively easy to use but have difficulties after the long intervals between data entry year on year. VICNISS staff provide expert guidance which benefits users. Users appreciated the benefit of participating and many use the data for improving local practice. CONCLUSIONS: The ACIIP is a usessful state-wide infection surveillance program for aged care. Further development of data validation, IT system capacity and models for education and user support will be required to support future scalability.
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Infección Hospitalaria , Estados Unidos , Humanos , Anciano , Victoria/epidemiología , Centers for Disease Control and Prevention, U.S. , Escolaridad , Hogares para AncianosRESUMEN
OBJECTIVES: To understand resident, family and staff perspectives of older people's transition to residential aged care and initiatives that support this transition. METHODS: A qualitative Appreciative Inquiry was undertaken with residents, family members and staff in residential aged care. It included semistructured interviews (n = 40), three focus groups (n = 17) and an organisational summit (n = 72). Each stage sought to build on the previous one, deepening understanding of the issues experienced and identifying positive strategies for change. Data were analysed thematically using framework analysis. RESULTS: The transition experience was characterised by grief and guilt felt by family members and the challenges they faced in participating in a decision to admit a relative to residential aged care. Residents found the transition challenging but stressed the need to adjust to the situation. Family members struggled with trusting others to provide appropriate care and both residents and relatives reported challenges in communicating with staff. Initiatives were recommended by the organisational summit to assist in the transition to residential aged care. These included developing a service navigator role, co-designing new systems and resources with residents and relatives, and ensuring more consistent staffing. CONCLUSIONS: Improved communication strategies and resources are needed to support the resident's identity, build trust in the organisation and support transition to residential aged care. Staff should continue to value the contribution family members play in the life of the resident and the culture of the aged care community.
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Hogares para Ancianos , Casas de Salud , Anciano , Humanos , Investigación Cualitativa , Grupos Focales , FamiliaRESUMEN
OBJECTIVE: To evaluate outcomes of education about the dementia illness trajectory and Namaste Care™ program on aged care staff's knowledge, attitudes, self-perceived skills and competence. METHODS: A convergent mixed methods research design was adopted to compare the results of quantitative and qualitative data following an education intervention. Nurses and aged care staff (n = 35) undertook 2 × 2 h training sessions over 3 days. Data were collected pre- and post-intervention using three validated surveys. Qualitative data were collected through interviews and a focus group. Thematic analysis was used to generate themes. Quantitative and qualitative data were integrated and compared during interpretation and discussion of the findings. RESULTS: Significant improvements in knowledge, attitudes and skills survey scores from already published data were confirmed by the qualitative findings in this study. Three key themes were derived from the data, comprising dementia-related education and knowledge changes, recognising the benefits of the Namaste Care™ program, and the importance of changing practice. CONCLUSIONS: Dementia education using the Namaste Care™ program enabled staff to identify gaps in knowledge and skills within their own practice. Staff perceived that the Namaste Care™ program can be a driver for practice change including palliative care to improve quality of life for people living in the advanced stages of dementia.
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Demencia , Cuidados Paliativos , Humanos , Anciano , Calidad de Vida , Grupos FocalesRESUMEN
OBJECTIVES: Virtual reality (VR) is not a common leisure activity in aged care, despite pilot studies demonstrating its value as a tool to combat inactivity and loneliness. This study investigated the organisational enablers and barriers to sustained uptake of VR among aged care staff and organisations, who may lack familiarity or confidence with the technology. METHODS: Creative methods were adopted to co-design and develop a VR implementation toolkit tailored specifically for aged care staff. Three aged care homes in South-East Queensland participated, with 15 residents and seven staff engaging in up to four VR sessions facilitated by the research team. Participant observation of the VR sessions was complemented by interviews with aged care staff and residents. RESULTS: Guided by Normalisation Process Theory, a reflexive thematic analysis identified four key themes: (1) Positively Appreciating the VR Experience, (2) Staff VR Champions and the Importance of Personal Use and Experimentation with VR, (3) Management Support and (4) Technical Challenges. CONCLUSIONS: Our results indicate benefits and challenges of VR use in aged care, offering valuable insights into the factors that can lead to the long-term success of VR-based leisure activities for aged care. Providing time and resources for a VR champion to experiment and learn about the technology is critical. The development of an online implementation toolkit, based on our learning from this project, also provides aged care stakeholders with the evidence-based resources needed to ensure the successful implementation of VR-based leisure programs.
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Cultura Organizacional , Realidad Virtual , Anciano , Humanos , Hogares para Ancianos , QueenslandRESUMEN
OBJECTIVE: Previous research on food, nutrition and dining practices in Australian residential aged care (RAC) homes has been based on a limited sample of single-home or multiple-home providers, but a nationwide study has not been conducted. The aim of this study was to provide a preliminary overview of current food, nutrition and dining practices across Australian RAC facilities using a nationwide survey. METHODS: A survey was distributed to Australian RAC homes in August-September 2020, as part of the National Congress on Food, Nutrition and the Dining Experience in Aged Care (February 2021). The survey, administered via an online portal, consisted of 38 semistructured questions including yes/no or multiple-choice responses, free text, frequency scales and number entry. Six key topics were explored, including 'food service system and environment', 'catering style', 'menu planning and evaluation', 'nutrition planning and requirements', 'nutrition-related screening and assessment' and 'training and additional information', which were informed by the Australian Government Department of Health and reflected the interests of the Congress. RESULTS: The final sample included 292 respondents (204 individual homes and 88 multiple-home proprietors) representing 1152 homes and 125,393 residents, encompassing approximately 43% of RAC homes (of a possible 2671) and 57% of residents (of a possible 219,965) in Australia. Survey respondents representing RAC homes included service managers, catering managers, Chief Executive Officers, cooks, chefs, dietitians or staff from other roles within homes. A number of potential areas of need were identified, included increasing the autonomy of residents to select the foods they desire, increasing the variety and choice (including timing) of meals, enhancing the dining environments in homes to stimulate food intake and increasing staff training and the number of trained chefs in homes, so that meals are prepared which address diverse nutritional needs of residents. CONCLUSIONS: This study provides insight into the food service and mealtime practices of over a third of Australian RAC homes. The findings of this survey may help to identify key targets for intervention to improve the food, nutrition and quality of life of aged care residents.
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Servicios de Alimentación , Calidad de Vida , Anciano , Humanos , Australia , Hogares para Ancianos , Estado Nutricional , Encuestas y Cuestionarios , ComidasRESUMEN
Resumo Objetivo Realizar a validação de critério e de constructo da Morse Fall Scale - versão brasileira (MFS-B) para pessoas idosas institucionalizadas. Método Estudo metodológico de validação aninhado a um estudo longitudinal. A pesquisa foi desenvolvida em duas Instituições de Longa Permanência para Idosos (ILPIs), com 172 pessoas idosas. Os dados foram coletados por meio da avaliação direta da pessoa idosa e dados do prontuário. A análise foi realizada pela estatística descritiva e inferencial pela curva ROC, sensibilidade, especificidade, correlação de Pearson e Análise Fatorial Exploratória e Confirmatória. Resultados A melhor estimativa para predizer a queda foi no ponto de corte 45 pontos da MFS-B para pessoas idosas institucionalizadas, com sensibilidade de 93,3% e especificidade de 58,9%. Quando analisada a confiabilidade de MFS-B com a exclusão do item "terapia endovenosa/dispositivo endovenoso salinizado ou heparinizado" - "TE/DSH" houve melhora da confiabilidade (α≥0,700) e essa exclusão também foi aprovada na Análise Fatorial Exploratória e Confirmatória. Conclusões Os resultados apontam para uma boa capacidade de predição de queda pela MFS-B para pessoas idosas institucionalizadas, com melhor acurácia quando excluído o item "TE/DSH". Esses resultados fundamentaram a adaptação da MFS-B para cinco itens de avaliação, sendo essa denominada MFS-B/ILPI.
Abstract Objective To validate the criterion and construct of the Morse Fall Scale - Brazilian version (MFS-B) for institutionalized older adults. Method Methodological validation study nested within a longitudinal study. The research was conducted in two Homes for the Aged (ILPIs), involving 172 older individuals. Data were collected through direct assessment of the older adult and chart data. Analysis was performed using descriptive and inferential statistics including ROC curve, sensitivity, specificity, Pearson correlation, and Exploratory and Confirmatory Factor Analysis. Results The best estimate for predicting falls was at the cutoff point of 45 points on the MFS-B for institutionalized older adults, with a sensitivity of 93.3% and specificity of 58.9%. When analyzing the reliability of the MFS-B with the exclusion of the item "intravenous therapy/saline or heparin flush catheter" - "IV therapy/SHFC" reliability improved (α≥0.700), and this exclusion was also supported by Exploratory and Confirmatory Factor Analysis. Conclusions The results indicate a good predictive ability of the MFS-B for institutionalized older adults, with improved accuracy when excluding the item "IV therapy/SHFC". These findings supported the adaptation of the MFS-B to five assessment items, referred to as MFS-B/ ILPI.
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Humanos , Anciano , Anciano de 80 o más Años , Estudio de Validación , Anciano , Factores de Riesgo , Salud del Anciano Institucionalizado , Seguridad del PacienteRESUMEN
Due to the progressive need for care, older adults with dementia are at risk of becoming institutionalized. Caregivers of these patients are tasked with the challenge of controlling behavioral and psychological symptoms without sufficient knowledge and are therefore at greater risk of developing physical and mental health problems. In this context, psychoeducational interventions can help greatly toward improving caregiver well-being. Objective: to investigate the prevalence of behavioral and psychological symptoms of dementia (BPSD) in aged residents of long-term care facilities (LTCFs), to determine the prevalence of burden and common mental disorders in caregivers, and to assess the effects of a psychoeducational intervention. Methods: an intervention study was performed at LTCFs for aged people. The following instruments were used: Self-Reporting Questionnaire and Zarit Burden Interview for caregivers; and the MMSE, Katz Index, Clinical Dementia Rating scale and Neuropsychiatry Inventory-Questionnaire for older adults. Results: Of the 72 aged residents assessed, 52 (72.2%) were female and mean age was 82.3 (±8.14) years. The most prevalent neuropsychiatric symptoms were euphoria and elation (74%), followed by agitation and aggression (74%). Of the 54 caregivers, 49 (90.7%) were women and mean age was 33.9 (±10.8) years. Overall, 33.3% screened positive for common mental disorder and 36.1% for burden/overload. A statistically significant association was found between burden and working in philanthropic institutions (p=0.003) and also between burden and presence of common mental disorder or otherwise (p=0.001). After the psychoeducational intervention, 42.8% reported reduced burden. Conclusion: The residents presented neuropsychiatric symptoms. Caregivers showed burden and common mental disorders, especially in philanthropic institutions. It was observed a reduction in burden of caregivers with psychoeducational intervention, showing the importance of this strategy.
Em razão do aumento progressivo da necessidade de cuidados, idosos com demência apresentam risco de institucionalização. Os cuidadores desses pacientes são desafiados a controlar os sintomas comportamentais e psicológicos da demência sem o conhecimento adequado e, como resultado, estão em maior risco de adoecimento físico e emocional. Nesse contexto, a intervenção psicoeducacional contribui significativamente para a melhoria do bem-estar do cuidador. Objetivo: Investigar a prevalência de sintomas comportamentais e psicológicos na demência em idosos de instituições de longa permanência, verificar a prevalência de sobrecarga e transtorno mental comum nos cuidadores e avaliar os efeitos de uma intervenção psicoeducacional. Métodos: Estudo de intervenção realizado em instituições de longa permanência para idosos. Os instrumentos utilizados foram: Self-Reporting Questionnaire e Zarit Burden Interview para os cuidadores e o Miniexame do Estado Mental, Katz Index, Clinical Dementia Rating e Neuropsychiatry Inventory-Questionnaire para os idosos. Resultados: Dos 72 idosos, 52 (72,2%) eram mulheres, com média de idade de 82,3 (±8,14) anos. Os sintomas neuropsiquiátricos mais prevalentes foram: euforia e elação (74%) e agitação e agressividade (74%). Dos 54 cuidadores, 49 (90,7%) eram mulheres, com média de idade de 33,9 (±10,8) anos. Apresentaram rastreio positivo para transtorno mental comum 33,3% e para sobrecarga 36,1%. Foi encontrada associação estatisticamente significativa entre sobrecarga e trabalhar em instituições filantrópicas (p=0,003), assim como entre a sobrecarga e ter ou não transtorno mental comum (p=0,001). Após a intervenção psicoeducacional, 42,8% apresentaram redução da sobrecarga. Conclusão: Os residentes apresentaram sintomas neuropsiquiátricos. Os resultados dos cuidadores indicaram a presença de sobrecarga e outras manifestações em saúde mental, principalmente em instituições filantrópicas, além de demonstrar a importância de intervenções psicoeducativas voltadas aos cuidadores, considerando que foram observados efeitos na redução da sobrecarga para o grupo intervenção.
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BACKGROUND: Care home residents live with frailty and multiple long-term conditions. Their medical management is complex and specialised. We set out to develop a list of core competencies for doctors providing medical care in long-term care homes. METHODS: A scoping review searched MEDLINE, EMBASE and CAB Abstracts, supplemented by grey literature from the Portal of Online Geriatrics Education and the International Association of Geriatrics and Gerontology, looking for core competencies for doctors working in care homes. These were mapped to the UK nationally mandated Generic Professional Competencies Framework. A Delphi exercise was conducted over three rounds using a panel of experts in care homes and medicine of older people. Competencies achieving 80% agreement for inclusion/exclusion were rejected/accepted, respectively. RESULTS: The scoping review identified 22 articles for inclusion, yielding 124 competencies over 21 domains. The Delphi panel comprised 23 experts, including 6 geriatricians, 4 nurses, 3 general practitioners, 2 advanced clinical practitioners, 2 care home managers, and one each of a patient and public representative, palliative care specialist, psychiatrist, academic, physiotherapist and care home audit lead. At the end of three rounds, 109 competencies over 19 domains were agreed. Agreement was strongest for generic competencies around frailty and weaker for sub-specialist knowledge about specific conditions and competencies related to care home medical leadership and management. CONCLUSION: The resulting competencies provide the basis of a curriculum for doctors working in long-term care homes for older people. They are specialty agnostic and could be used to train general practitioners or medical specialty doctors.
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Fragilidad , Geriatría , Humanos , Anciano , Competencia Clínica , Curriculum , Rol de la Enfermera , Técnica DelphiRESUMEN
Resumo Na população idosa, pessoas LGBTQIA+ representam um dos grupos mais propensos a depender de serviços de cuidados formais, devido à vulnerabilidade socioeconômica. Contudo, o preconceito enraizado na sociedade, inclusive em profissionais da saúde e da assistência social, resulta em um modelo de atendimento cis-heteronormativo em Instituições de Longa Permanência para Idosos (ILPI). O objetivo deste artigo é investigar, descrever e analisar a produção científica sobre o preconceito contra pessoas idosas LGBTQIA+ em ILPI. Revisão de escopo com buscas nas bases de dados AgeLine, Portal de Periódicos CAPES, SciELO, Portal USP e HeinOnline, sem limite temporal. Dos 642 artigos iniciais, 31 compõem a amostra final. Foram identificadas quatro categorias e 11 subcategorias que delimitam atores, causas, efeitos e soluções encontradas nas pesquisas. A falta de preparo das equipes das ILPI e o histórico de preconceito durante a vida leva a comunidade LGBTQIA+ a temer a institucionalização e desejar um ambiente amigável ou exclusivo. A capacitação das equipes das ILPI torna-se imprescindível, assim como a necessidade de criação de legislações de proteção a essa população com base em pesquisas populacionais e locais.
Abstract Among older people, LGBTQIA+ persons represent one of the groups most likely to depend on formal care services because of socio-economic vulnerability. However, the prejudice rooted in society, including health and social care professionals, result in a cis-heteronormative model of care delivery in Long-Term Care Facilities for older persons (LTC). The aim of this article is to investigate, describe and analyse the scientific production on prejudice against the older LGBTQIA+ population in LTC. Scoping review based on searches in the following databases: AgeLine, Portal de Periódicos CAPES, SciELO, Portal USP and HeinOnline. No time limit was set. Of the initial 642 articles, 31 were selected to comprise the sample. Four categories and 11 subcategories were identified. These covered agents, causes, effects, and solutions found in the research. The lack of preparation of the LTC staff and the history of prejudice during life leads the LGBTQIA+ community to fear institutionalisation, when the desire is to have a friendly or exclusive environment. Training of LTC staff is essential, in addition to the need to create legislation to protect this population based on local surveys.