[Care of patients in nursing homes, what stumbling blocks and stepping for general practitioners? A qualitative study]. / Prise en charge des patients en Ehpad, quels freins et leviers pour le médecin généraliste ? Une étude qualitative.

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.

Prevalence of tuberculosis in homes for the aged and orphanages of a district in Kerala, India.

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.

Prevalence and associations of provision of nursing home visits and home visits by early-career specialist general practitioners.

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.

Pharmacists working in residential aged care: a survey of pharmacist interest and perceived preparedness.

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.

Global Leadership Initiative on Malnutrition criteria in older adults who are institutionalized: Agreement with the Subjective Global Assessment and its impact on 5-year mortality.

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.

Who speaks my language? Linguistic diversity among people living in Australian residential aged care facilities.

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.

Evaluation of an Infection surveillance program in residential aged care facilities in Victoria, Australia.

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.

Food, nutrition and the dining experience in aged care settings: Findings of a nationwide survey.

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.

Behavioral and psychological symptoms of dementia in the long-term care setting: assessment of aged adults and intervention for caregivers.

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.

Developing a list of core competencies for medical aspects of healthcare delivery in care homes: scoping review and Delphi process.

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.

'There's something they can do': Educating aged care staff about the trajectory of dementia, palliative care and the Namaste Care™ program: A mixed methods study.

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.

Preconceito contra pessoa idosa LGBTQIA+ em Instituições de Longa Permanência para Idosos (ILPI): uma revisão de escopo / Prejudice against the older LGBTQIA+ population in Long-Term Care Facilities (LTC): a scoping review

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.

Learning from the covid-19 outbreaks in long-term care facilities: a systematic review.

BACKGROUND: The COVID-19 pandemic has devastatingly affected Long-Term Care Facilities (LTCF), exposing aging people, staff members, and visitors. The world has learned through the pandemic and lessons can be taken to adopt effective measures to deal with COVID-19 outbreaks in LTCF. We aimed to systematically review the available evidence on the effect of measures to minimize the risk of transmission of COVID-19 in LTCs during outbreaks since 2021. METHODS: The search method was guided by the preferred reporting items for systematic reviews (PRISMA) and the reporting guideline synthesis without meta-analysis (SWiM) in systematic reviews. The search was performed in April 2023. Observational and interventional studies from the databases of PubMed, Web of Science, Scopus, Cochrane Systematic Reviews, CINAHL, and Academic Search were systematically reviewed. We included studies conducted in the LTCF with outbreaks that quantitatively assess the effect of non-pharmacological measures on cases of COVID-19. Two review authors independently reviewed titles for inclusion, extracted data, and undertook the risk of bias according to pre-specified criteria. The quality of studies was analyzed using the Joanna Briggs Institute Critical Appraisal. RESULTS: Thirteen studies were included, with 8442 LTCF experiencing COVID-19 outbreaks and 598 thousand participants (residents and staff members). Prevention and control of COVID-19 infection interventions were grouped into three themes: strategic, tactical, and operational measures. The strategic measures reveal the importance of COVID-19 prevention and control as LTCF structural characteristics, namely the LTCF size, new admissions, infection control surveillance, and architectural structure. At the tactical level, the lack of personal and long staff shifts is related to COVID-19's spread. Operational measures with a favorable effect on preventing COVID-19 transmission are sufficient. Personal protective equipment stock, correct mask use, signaling, social distancing, and resident cohorting. CONCLUSIONS: Operational, tactical, and strategic approaches may have a favorable effect on preventing the spread of COVID-19 in LTCFs experiencing outbreaks. Given the heterogeneous nature of the measures, performing a meta-analysis was not possible. Future research should use more robust study designs to explore similar infection control measures in LTCFs during endemic situations with comparable outbreaks. TRIAL REGISTRATION: The protocol of this systematic review was registered in PROSPERO (CRD42020214566).

Unsafe care in residential settings for older adults: a content analysis of accreditation reports.

Residents of aged care services can experience safety incidents resulting in preventable serious harm. Accreditation is a commonly used strategy to improve the quality of care; however, narrative information within accreditation reports is not generally analysed as a source of safety information to inform learning. In Australia, the Aged Care Quality and Safety Commission (ACQSC), the sector regulator, undertakes over 500 accreditation assessments of residential aged care services against eight national standards every year. From these assessments, the Aged Care Quality and Safety Commission generates detailed Site Audit Reports. In over one-third (37%) of Site Audit Reports, standards relating to Personal and Clinical Care (Standard 3) are not being met. The aim of this study was to identify the types of resident Safety Risks that relate to Personal and Clinical Care Standards not being met during accreditation or re-accreditation. These data could inform priority setting at policy, regulatory, and service levels. An analytical framework was developed based on the World Health Organization's International Classification for Patient Safety and other fields including Clinical Issue (the issue related to the incident impacting the resident, e.g. wound/skin or pain). Information relating to safety incidents in the Site Audit Reports was extracted, and a content analysis undertaken using the analytical framework. Clinical Issue and the International Classification for Patient Safety-based classification were combined to describe a clinically intuitive category ('Safety Risks') to describe ways in which residents could experience unsafe care, e.g. diagnosis/assessment of pain. The resulting data were descriptively analysed. The analysis included 65 Site Audit Reports that were undertaken between September 2020 and March 2021. There were 2267 incidents identified and classified into 274 types of resident Safety Risks. The 12 most frequently occurring Safety Risks account for only 32.3% of all incidents. Relatively frequently occurring Safety Risks were organisation management of infection control; diagnosis/assessment of pain, restraint, resident behaviours, and falls; and multiple stages of wounds/skin management, e.g. diagnosis/assessment, documentation, treatment, and deterioration. The analysis has shown that accreditation reports contain valuable data that may inform prioritization of resident Safety Risks in the Australian residential aged care sector. A large number of low-frequency resident Safety Risks were detected in the accreditation reports. To address these, organizations may use implementation science approaches to facilitate evidence-based strategies to improve the quality of care delivered to residents. Improving the aged care workforces' clinical skills base may address some of the Safety Risks associated with diagnosis/assessment and wound management.

Transforming aged care with virtual reality: How organisational culture impacts technology adoption and sustained uptake.

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.

The experience of entering residential aged care: The views of residents, family members and staff-an Appreciative Inquiry.

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.

Depressive symptoms and associated factors in elderly residents of Homes for the Aged / Síntomas depresivos y factores asociados en personas mayores que viven en una institución de cuidados a largo plazo / Sintomas depressivos e fatores associados em idosos residentes em instituição de longa permanência

O objetivo deste artigo é identificar a prevalência de sintomas depressivos e fatores associados em pessoas maiores que vivem em instituições de cuidados de longo prazo (ILPI). Trata-se de um estudo epidemiológico com desenho transversal composto por indivíduos de 60 anos ou mais, de ambos os sexos, residentes nas três ILPI públicas da cidade de São Paulo - SP. A coleta de dados foi realizada de julho de 2016 a fevereiro de 2019, por meio de um questionário, onde se verificaram aspectos sociodemográficos; vermelho de apoio e condições de saúde.Para detectar sintomas depressivos foi utilizado o Inventário de Depressão de Beck (BDI) e o estado cognitivo foi avaliado por meio do Mini-Exame do Estado Mental (MEEM).O presente estudo associa uma prevalência de sintomas de depressão em 75,7% dos entrevistados. . , com prevalência do sexo masculino (39,4%). Hubo associação significativa entre os sintomas depressivos e as variáveis: dor (p=0,006) e limitações de movimento (p=0,003). Com base na apresentação, é necessário criar e implementar políticas públicas e acompanhamento desses pacientes, que permitam o tratamento e prevenção dessas condições variáveis.

O objetivo deste artigo é identificar a prevalência de sintomas depressivos e fatores associados em pessoas maiores que vivem em instituições de cuidados de longo prazo (ILPI). Trata-se de um estudo epidemiológico com desenho transversal composto por indivíduos de 60 anos ou mais, de ambos os sexos, residentes nas três ILPI públicas da cidade de São Paulo - SP. A coleta de dados foi realizada de julho de 2016 a fevereiro de 2019, por meio de um questionário, onde se verificaram aspectos sociodemográficos; vermelho de apoio e condições de saúde.Para detectar sintomas depressivos foi utilizado o Inventário de Depressão de Beck (BDI) e o estado cognitivo foi avaliado por meio do Mini-Exame do Estado Mental (MEEM).O presente estudo associa uma prevalência de sintomas de depressão em 75,7% dos entrevistados. . . , com prevalência do sexo masculino (39,4%). Hubo associação significativa entre os sintomas depressivos e as variáveis: dor (p=0,006) e limitações de movimento (p=0,003). Com base na apresentação, é necessário criar e implementar políticas públicas e acompanhamento desses pacientes, que permitam o tratamento e prevenção dessas condições variáveis.

O objetivo desse artigo é identificar a prevalência de sintomas depressivos e fatores associados em idosos residentes em instituições de longa permanência (ILPIs). Trata-se de um estudo epidemiológico com delineamento transversal composto por indivíduos com idade igual ou superior a 60 anos, de ambos os sexos, residentes nas dez ILPIs públicas do município de São Paulo - SP. A coleta de dados foi realizada no período de julho de 2016 a fevereiro de 2019, por meio de um questionário, onde foram verificados os aspectos sociodemográficos; rede de apoio e as condições de saúde. Para detecção de sintomas depressivos foi utilizada o Inventário de Depressão de Beck (IDB) e o estado cognitivo foi avaliado pelo Mini-Exame do Estado Mental (MEEM). O presente estudo identificou uma prevalência de sintomas de depressão em 75,7% dos entrevistados, com predomínio do sexo masculino (39,4%). Houve associação significante entre sintomas depressivos e as variáveis: de dor (p=0,006) e limitação do movimento (p=0,003). Através do que foi observado, se faz necessário a criação e implementação de políticas públicas e o acompanhamento desses pacientes, que possibilitem o tratamento e a prevenção dessas condições variáveis.

"Crack on": a qualitative study of care home managers experiences and responses to system-led setbacks during the crisis of the COVID-19 Pandemic in England.

OBJECTIVES: To explore care home managers' experiences of systems working with various organisations, including statutory, third sector and private, during the second wave of the COVID-19 pandemic from Sept 2020 to April 2021 DESIGN: An exploratory qualitative interview study using a systems theory approach focussing on the intersections of relationship interdependencies with other organisations. SETTING: Conducted remotely with care home managers and key advisors who had worked since the start of the pandemic in/with care homes for older people across the East Midlands, UK. PARTICIPANTS: 8 care home managers and 2 end-of-life advisors who participated during the second wave of the pandemic from Sept 2020. A total of 18 care home managers participated in the wider study from April 2020 to April 2021 RESULTS: Four organisational relationship interdependencies were identified: care practices, resources governance and wise working. Managers identified changes in their care practices as a shift towards the normalisation of care, with an emphasis on navigating pandemic restrictions to fit the context. Resources such as staffing, clinical reviews, pharmaceutical and equipment supplies were challenged, leading to a sense of precarity and tension. National polices and local guidance were fragmented, complex and disconnected from the reality of managing a care home. As a response a highly pragmatic reflexive style of management was identified which encompassed the use of mastery to navigate and in some cases circumvent official systems and mandates. Managers' experience of persistent and multiple setbacks were viewed as negative and confirmed their views that care homes as a sector ere marginalised by policy makers and statutory bodies. CONCLUSIONS: Interactions with various organisations shaped the ways in which care home managers responded to and sought to maximise residents and staff well-being. Some relationships dissolved over time, such as when local business and schools returned to normal obligations. Other newly formed relationships became more robust including those with other care home managers, families, and hospices. Significantly, most managers viewed their relationship with local authority and national statutory bodies as detrimental to effective working, leading to a sense of increased mistrust and ambiguity. Respect, recognition and meaningful collaboration with the care home sector should underpin any future attempts to introduce practice change in the sector.

Determinants of physical, psychological, and social well-being in older adults: a cross-sectional study in senior care facilities of Pakistan (2019/20).

BACKGROUND: Published research on senior care facilities in Pakistan is scarce and no large-scale study has been conducted to assess factors affecting well-being of older adults in these facilities. This study, therefore, investigated the effects of relocation autonomy, loneliness, and satisfaction with services along with socio-demographic characteristics on physical, psychological, and social well-being of older residents living in senior care facilities of Punjab, Pakistan. METHODS: This cross-sectional study collected data from 270 older residents living in 18 senior care facilities across 11 districts of Punjab, Pakistan from November 2019 to February 2020 using multistage random sampling. Existing reliable and valid scales were used to collect information from older adults related to relocation autonomy (Perceived Control Measure Scale), loneliness (de Jong-Gierveld Loneliness Scale), satisfaction with service quality (Service Quality Scale), physical and psychological well-being (General Well-Being Scale), and social well-being (Duke Social Support Index). A psychometric analysis of these scales was carried out followed by three separate multiple regression analyses to predict physical, psychological, and social well-being from socio-demographic variables and key independent variables (relocation autonomy, loneliness, and satisfaction with service quality). RESULTS: The results of multiple regression analyses showed that the models predicting physical (R2 = 0.579), psychological (R2 = 0.654), and social well-being (R2 = 0.615) were statistically significant (p < 0.001). Number of visitors was a significant predictor of physical (b = 0.82, p = 0.01), psychological (b = 0.80, p < 0.001), and social (b = 2.40, p < 0.001) well-being. Loneliness significantly predicted physical (b = -0.14, p = 0.005), psychological (b = -0.19, p < 0.001), and social (b = -0.36, p < 0.001) well-being. Control over relocation process significantly predicted physical (b = 0.56, p < 0.001) and psychological (b = 0.36, p < 0.001) well-being. Satisfaction with services significantly predicted physical (b = 0.07, p < 0.001) and social (b = 0.08, p < 0.001) well-being. CONCLUSION: Pragmatic, equitable and cost-effective interventions are needed to improve the wellbeing of older residents living in senior care facilities. Friendly behavior of mobilizing staff and adjusted residents to facilitate new residents, therapeutic interventions such as relocation support programs, reminiscence therapy and intergenerational support, and increasing their exposure and connection to the outside world, can raise their physical, psychological, and social well-being.

'It's like home' - A small-scale dementia care home and the use of technology: A qualitative study.

AIM: To explore the experiences of residents, families and staff in the establishment of a new small-scale home model of care for people living with dementia. BACKGROUND: New and innovative small-scale models of care have the potential to improve outcomes for older people, especially those with dementia, who experience high rates of cognitive impairment in traditional residential aged care homes in Australia. DESIGN: A qualitative descriptive study. METHODS: Semi-structured interviews with 14 guests, family and staff of a new small-scale dementia home named 'Kambera House' in the Australian Capital Territory were conducted between July 2021 when the home opened and August 2022. Data were analysed using reflexive thematic analysis and reported according to the COREQ guidelines. RESULTS: Two guests with mild-to-moderate dementia, five family and seven staff members participated in the study. The data revealed high satisfaction with Kambera House, generating five themes. Falls detection technology in the home provided a sense of safety, enabling more time for person-centred care. Free, everyday technology connected the home with families as part of an overall community of care where staff were empowered to maximize choice and dignity of risk of guests living in the home. This contributed to the sense of community, rather than an institution, where the conditions of work supported the conditions of care, and were embedded in a culture of responsiveness, change and flexibility. CONCLUSION: Kambera House represents a successful example of a new small-scale dementia home. Technology played an important background role in improving overall safety and flexibility as part of a model of care which demonstrated positive experiences for guests and families by being responsive to their individual needs. IMPACTS: Small-scale homes for people with dementia offer an alternative model that may provide more individualized, person-centred care compared with the traditional institutionalized care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.