Futuro del cuidado gerontológico de enfermería. Perspectiva de futuros usuarios / The future of gerontologic nursing care. Next users' view

Objetivos: El cuidado institucionalizado de personas mayores es una realidad en España. Muchos hijos acompañan a sus padres en esa experiencia de vida y conforman su propia opinión. El objeto del estudio es conocer esa opinión, proponiendo una mirada hacia el futuro cuidado que ellos podrán recibir, partiendo de la opinión que tienen del cuidado actual que reciben sus padres. Metodología: La metodología utilizada es cualitativa, mediante entrevistas en profundidad y análisis de contenido, en una muestra integrada por hijos/as de residentes de dos centros residenciales de la ciudad de Jaén. Resultados: El resultado es que aceptan el modelo de cuidados actual para sus padres, salvo por algunas cuestiones que podrían mejorar, pero no lo admiten para sí mismos. Conclusiones: Se concluye que es necesaria la evolución de la asistencia, a través de la domiciliación y la especialización del cuidado (AU)

Objectives: The nursing home care of the elderly is a reality in Spain. Many of them are accompanied by their children in this life experience, whom create their own opinion. Knowing the children opinion including a future perspective is the main purpose of the research, on the basis of their current opinion of caring. Methods: A qualitative survey is used, with in-depth interviews and content analysis. The sample was selected from two nursing homes in the city of Jaen. Results: The main outcome was than they are satisfied with this kind of caring but not for themselves. Conclusions: We conclude that elderly care needs moving to home and through care specialization (AU)

Provision and related factors of end-of-life care in elderly housing with care services in collaboration with home-visiting nurse agencies: a nationwide survey.

BACKGROUND: Japan has the largest population of older adults in the world; it is only growing as life expectancy increases worldwide. As such, solutions to potential obstacles must be studied to maintain healthy, productive lives for older adults. In 2011, the Japanese government has started a policy to increase "Elderly Housing with Care Services (EHCS)", which is one of a private rental housing, as a place where safe and secure end-of-life care can be provided. The government expect for them to provide end-of-life care by collaborating with the Home-Visit Nursing Agencies (HVNA). The purpose of this study is to clarify the situation of the end-of-life care provision in EHCS in collaboration with HVNA and to examine the factors that associate with the provision of the end-of-life care in EHCS. METHODS: A two-stage nationwide survey (fax and mail surveys) were conducted. Of the 5,172 HVNA of the National Association for Visiting Nurse Services members, members from 359 agencies visited EHCS. Logistic regression analysis was conducted with the provision of end-of-life care to EHCS in 2017 as the dependent variable, and the following as independent variables: characteristics of HVNA and EHCS; characteristics of residents; collaborations between HVNA and EHCS; and the reasons for starting home-visit nursing. RESULTS: Of the 342 HVNA who responded to the collaborations with EHCS, 21.6% provided end-of-life care. The following factors were significantly associated with the provision of end-of-life care to inmates in elderly care facilities: being affiliated with a HVNA, admitting many residents using long-term care insurance, collaborating with each other for more than three years, and started visiting-nurse services after being requested by a resident's physician. CONCLUSIONS: This study clarified the situation of the provision of end-of-life care in EHCS in collaboration with HVNA and the related factors that help in providing end-of-life care in EHCS.

Subjective social isolation or loneliness in older adults residing in social housing in Ontario: a cross-sectional study.

BACKGROUND: Older adults face greater risk of social isolation, but the extent of social isolation among low-income older adults living in social housing is unknown. This study aims to explore the rate of, and risk factors contributing to, subjective social isolation or loneliness among older adults in social housing. METHODS: We conducted a cross-sectional study of data collected from a community program held in the common rooms of 55 social housing buildings in 14 communities across Ontario, Canada, from May 2018 to April 2019. Participants were program attendees aged 55 years and older who resided in the buildings. Program implementers assessed social isolation using the 3-Item Loneliness Scale from the University of California, Los Angeles and risk factors using common primary care screening tools. We extracted data for this study from the program database. We compared the rate of social isolation to Canadian Community Health Survey data using a 1-sample χ2 test, and evaluated associations between risk factors and social isolation using univariate and multivariate logistic regressions. RESULTS: We included 806 residents in 30 buildings for older adults and 25 mixed-tenant buildings. Based on the 3-Item UCLA Loneliness Scale, 161 (20.0%) of the 806 participants were socially isolated. For those aged 65 and older, the rate of social isolation was nearly twice that observed in the same age group of the general population (36.1% v. 19.6%; p < 0.001). Risk factors were age (65-84 yr v. 55-64 yr adjusted odds ratio [OR] 1.99, 95% confidence interval [CI] 1.01-3.93), alcohol consumption (adjusted OR 2.45, 95% CI 1.09-5.54), anxiety or depression (adjusted OR 6.05, 95% CI 3.65-10.03) and income insecurity (adjusted OR 2.10, 95% CI 1.24-3.53). Protective factors were having at least 1 chronic cardiometabolic disease (adjusted OR 0.44, 95% CI 0.24-0.80), being physically active (adjusted OR 0.47, 95% CI 0.30-0.73) and having good to excellent general health (adjusted OR 0.60, 95% CI 0.39-0.90). INTERPRETATION: The high rate of social isolation in low-income older adults living in social housing compared with the general population is concerning. Structural barriers could prevent engagement in social activities or maintenance of social support, especially for older adults with income insecurity and anxiety or depression; interventions are needed to reduce subjective social isolation in this population.

La estructura de los hogares de las personas mayores en América Latina y el Caribe

[RESUMEN]. Objetivo. Analizar las pautas de convivencia de la población de 60 años o más que reside en hogares priva-dos en 23 países de América Latina y el Caribe. Métodos. Estudio transversal realizado con base en los microdatos censales más recientes disponibles en Integrated Public Use Microdata Series (IPUMS)-International, la mayoría de ellos correspondientes a la ronda censal de 2010. Se calcularon y se compararon, para cada país y por sexo, el número medio de convivientes, su distribución por edad y las relaciones de parentesco que se establecen entre ellos. Se compararon, por país y por sexo, el promedio de convivientes en función del nivel de escolaridad y del estado civil. Resultados. El promedio del número de personas con las que convive la gente mayor difiere entre países. Oscila entre dos personas en países como Argentina, Puerto Rico y Uruguay, y cuatro o más personas en países como Honduras y Nicaragua. Esta diferencia resulta de la mayor o menor presencia de personas jóvenes, hijos y otros familiares en el hogar. El número de convivientes disminuye con el mayor nivel de escolaridad, salvo en Cuba y en Puerto Rico, donde no se observan diferencias. En general, las mujeres mayores viven en hogares con menos personas que los hombres, aunque no es el caso de las personas solteras o divorciadas. Conclusiones. La convivencia con hijos y otros familiares es habitual en la Región. Las diferencias entre países y por nivel educativo muestran que la familia juega un papel importante en la protección social de la vejez en los países menos desarrollados y en los grupos menos escolarizados.

[ABSTRACT]. Objective. Analyze cohabitation patterns in the population over 60 years of age living in private households in 23 countries in Latin America and the Caribbean. Methods. Cross-sectional study based on the most recently available census microdata from the Integrated Public Use Microdata Series (IPUMS, International), corresponding mainly to the 2010 census. Average number of household members, age distribution, and family relationships were calculated and compared for each country and by sex. The average number of household members was compared, by country and by sex, in relation to level of schooling and marital status. Results. The average number of people that older people live with differs between countries, ranging from two or less in countries such as Argentina, Puerto Rico, and Uruguay, to four or more in countries such as Honduras and Nicaragua. This difference depends on a greater or lesser presence of young adults, children, and other family members in the household. The number of household members declines with a higher level of schooling, except in Cuba and Puerto Rico, where no differences are observed. In general, older women live in households with fewer people than men, although this is not the case for unmarried or divorced people. Conclusions. In the Region, it is common for older persons to live with children and other family members. The differences between countries and by educational level show that the family plays an important role in social protection of the elderly in less developed countries and in the least educated groups.

[RESUMO]. Objetivo. Analisar os padrões de convivência da população de 60 anos ou mais que reside em moradias particulares em 23 países da América Latina e do Caribe. Métodos. Estudo transversal realizado com base nos microdados censitários mais recentes disponíveis no Integrated Public Use Microdata Series (IPUMS)-International, na maior parte correspondente à etapa cen-sitária de 2010. O número médio de coabitantes, sua distribuição por idade e as relações de parentesco estabelecidas entre eles foram calculados e comparados para cada país e por sexo. A média de coabitantes em função do nível de escolaridade e do estado civil foi comparada por país e por sexo. Resultados. A média do número de pessoas com quem os idosos convivem difere entre países. Oscila entre 2 pessoas em países como Argentina, Porto Rico e Uruguai e 4 ou mais pessoas em países como Honduras e Nicarágua. Essa diferença resulta da maior ou menor presença de jovens, filhos e outros familiares em casa. Quanto maior o nível de escolaridade, menor o número de coabitantes, exceto em Cuba e em Porto Rico, onde não são observadas diferenças. Em geral, as mulheres idosas vivem em moradias com menos pessoas que os homens, embora não seja o caso das pessoas solteiras ou divorciadas. Conclusões. A convivência com filhos e outros familiares é habitual na Região. As diferenças entre países e por nível educacional mostram que a família desempenha um papel importante na proteção social da velhice nos países menos desenvolvidos e nos grupos menos escolarizados.

Paciente con Alzheimer en fase moderada y su familia: análisis bibliográfico de un caso clínico / Patient with Alzheimer in moderate phase and his family: bibliographic analysis of a clinical case

Presentación del caso: Paciente de 76 años residente en un centro geriátrico, con Alzheimer en fase moderada, que manifiesta agitación y estrés ante una situación incómoda. Ante la aparición de estos cambios conductuales, tanto la enfermera a su cuidado como la familia desconocen cómo actuar. Objetivos: Identificar, con base en la literatura científica, las intervenciones de enfermería más efectivas para manejar y prevenir cambios conductuales en una persona con Alzheimer en fase moderada y valorar la integración familiar en dichas estrategias de cuidado. Revisión bibliográfica: Se realizó una búsqueda bibliográfica en las bases de datos CINAHL y PubMed, seleccionándose 7 artículos. Resultados: Se han identificado cuatro tipos de intervenciones de enfermería para el manejo y prevención de cambios conductuales: sensitivas, ambientales, físicas y psicoemocionales. Existen escasas intervenciones desarrolladas en centros geriátricos que integren a la familia en el cuidado de los pacientes. Conclusión: La ejecución de las intervenciones de enfermería seleccionadas podrá favorecer una mejoría tanto en el manejo como en la prevención de los cambios conductuales. La realización de dichas actividades por parte de la unidad familiar incrementa los efectos positivos en la familia, la residente y en el equipo de enfermería. Sin embargo, se precisa un número mayor de estudios que integren a la familia para poder generalizar los resultados (AU)

Case presentation: 76-year-old patient living in a geriatric centre with moderate-phase Alzheimer, who shows agitation and stress in an uncomfortable situation. Faced with the appearance of these behavioural changes, both the nurse in charge and the family do not know how to act. Objectives: To identify the most effective nursing interventions to manage and prevent behavioural changes in a person with Alzheimer’s in a moderate phase, and assess family integration into these care strategies. Literature review: A bibliographic search was carried out on the CINAHL and PubMed databases, selecting 7 articles. Results: Four types of nursing interventions have been identified for the management and prevention of behavioural changes: sensory, environmental, physical and psycho-emotional. There are few interventions developed in geriatric centres that integrate the family in the care of patients. Conclusion: The implementation of the selected nursing interventions creates an improvement in both the management and prevention of behavioural changes. The implementation of such activities by the family unit increases the positive effects on the family, the resident and the nursing team. However, more studies that integrate the family are needed to generalize the results (AU)

Fragility syndrome: determinant factors ininstitutionalized elderly / Síndrome de fragilidade: fatores determinantes em idosos institucionalizados / Síndrome de fragilidad: factores determinantes em personas institucionalizadas

The aim of the study was to evaluate the frailty syndrome in residents of a Long-Term Care Facility for the Elderly. A cross-sectional study was carried out on 24 subjects over the age of 60 years. For the screening of frailty syndrome, the criteria of the Cardiovascular Study were used, which classifies the subjects into fragile, pre-fragile and non-fragile according to five criteria: decreased handgrip strength; self-reported fatigue; decrease in walking speed; unintentional weight loss; and low level of physical activity. The average age of the population studied was 81.13 years, with 54.20% being female. Among the elderly, 83.33% were frail, 12.50% were pre-frail and 4.17% were not frail. Elderly people over 80 years old had a higher incidence of frailty when compared to those aged 60 -79 years, with 85.7% and 80%, respectively. Since 66.67% of the elderly had decreasedhandgrip muscle strength, 37.50% reported fatigue, 41.67% demonstrated decreased gait speed, 12.50% unintentional weight loss and 87.50% were physically inactive. We identified a high prevalence of DES among the elderly residing in the institution studied, thus reinforcing the importance of early screening for frailty in institutionalized elderly(AU)

O objetivo do estudo foi avaliar a síndrome de fragilidade em residentes de uma Instituição de Longa Permanência para Idosos. Foi realizado um estudo transversal em 24 sujeitos com idade superior a 60 anos. Para rastreamento da síndrome de fragilidade foram utilizados os critérios do Estudo Cardiovascular que classifica os sujeitos em frágil, pré-frágil e não frágil de acordo com cinco critérios: diminuição da força de preensão manual; auto-relato de fadiga; diminuição da velocidade de marcha; perda de peso não intencional; e baixo nível de atividade física. A idade média da população estudada foi de 81,13 anos, sendo 54,20% do sexo feminino. Entre os idosos houve 83,33% com fragilidade, 12,50% eram pré-frágeis e 4,17% não frágeis. Os idosos acima de 80 anos apresentaram incidência maior de fragilidade quando comparados aos de 60 ­79 anos, com 85,7% e 80%, respectivamente. Sendo que 66,67% dos idosos apresentaram diminuição da força muscular de preensão manual, 37,50% relataram fadiga, 41,67% demonstraram diminuição da velocidade da marcha, 12,50% perda de peso não intencional e 87,50 % eram inativos fisicamente. Identificamos alta prevalência de SF entre os idosos residentes na Instituição estudada, reforçando assim a importância do rastreamento precoce da fragilidade em idosos institucionalizados(AU)

El objetivo del estudio fue evaluar el síndrome de fragilidad en los residentes de un centro de atención a largo plazo para ancianos. Se realizó un estudio transversal en 24 sujetos mayores de 60 años. Para el cribado de síndrome de fragilidad, se utilizaron los criterios del Estudio Cardiovascular, que clasifica a los sujetos en frágiles, pre-frágiles y no frágiles de acuerdo con cinco criterios: disminución de la fuerza del mango; fatiga autoinformada; disminución de la velocidad al caminar; pérdida depeso involuntaria; y bajo nivel de actividad física. La edad promedio de la población estudiada fue de 81.13 años, con un 54.20% de mujeres. Entre los ancianos, 83.33% eran frágiles, 12.50% eran pre-frágiles y 4.17% no eran frágiles. Las personas mayores de más de 80 años tuvieron una mayor incidencia de fragilidad en comparación con las personas de 60 a 79 años, con 85.7% y 80%,respectivamente. Dado que el 66.67% de los adultos mayores había disminuido la fuerza muscular de la empuñadura, el 37.50% informó fatiga, el 41.67% demostró una disminución de la velocidad de la marcha, 12.50% de pérdida de peso no intencional y 87.50% físicamente inactivo Identificamos una alta prevalencia de DES entre los ancianos que viven en la institución estudiada, lo que refuerza la importancia de la detección temprana de la fragilidad en ancianos institucionalizados(AU)

Home fall of elderly people: implications of stressors and representations in the COVID-19 context.

OBJECTIVES: To describe personal conditions and home structure that predisposes the elderly to the risk of falling, in the perspective of Neuman's stressors; to describe the content, structure and origin of social representations about falling at home by elderly people; and conjecture the implications of this empirical evidence on the daily lives of the elderly in the context of the pandemic caused by COVID-19. METHOD: Mixed method with concomitant triangulation (January-July/2017), qualitative design (structural and procedural approaches to the Social Representations Theory) and quantitative (sectional) approaching elderly people ≥65 years. RESULTS: Environmental factors were identified for falling at home, fear of activities of daily living and loss of visual acuity. Feelings and behaviors mentioned in the possible central nucleus justified the modulation of behaviors. Analysis categories: 1) Representation of the (in)adaptability of the home environment; 2) Representation and overcoming limitations arising from weaknesses. CONCLUSION: It was possible to produce conjectures based on empirical evidence in the current situation in the pandemic's dynamics.

Socio-economic and health determinants of preference for separate living among older adults: A cross-sectional study in India.

INTRODUCTION: The living arrangements among the older population form a basic pointer to the care and support of older adults in India, and living with extended kin is clearly differentiated from living separately. This paper attempts to understand the associations between socio-economic and health-related variables with preference for the separate living among older adults in India. MATERIALS AND METHODS: Using data from Building Knowledge Base on Population Ageing in India (BKPAI), we employed bivariate and probit regressions on a sample of 9540 older adults to fulfil the study objective. RESULTS: Nearly 21% of older adults were living alone/with a spouse. Additionally, those older adults who lived alone/with spouse had specific reasons, i.e. about 14.6% reported that they had no children, 47.3% of older adults had their children away and 15.9% of older adults reported a family conflict. Availability of children is consistently found to be negatively associated with the preference of separate living. Besides, better self-rated health, independence in daily activities, and facing any type of violence were the strongest predictors of preference for separate living. In addition, the background characteristics, including age, sex, education, religion, and ethnicity, were found as significant predictors of living arrangement preference. Preference for co-residential arrangements emerges among older persons who have a feeling of importance within their family. CONCLUSION: Physical proximity to kin and health conditions, in addition to economic conditions, substantially determine the swing towards separate living among older adults in India. This suggests that attention has to be paid to the demand for specialized care and health services among older adults living separately.

The impact of health-related supports in senior housing on ambulance transfers and visits to emergency departments: The Right Care, Right Place, Right Time Project.

OBJECTIVE: To test the impact of placing a wellness team (nurse and social worker) in senior housing on ambulance transfers and visits to emergency departments over 18 months. DATA SOURCES/STUDY SETTING: Intervention sites included seven Boston-area buildings, with five buildings at comparable settings acting as controls. Data derive from building-level ambulance data from emergency responders; building-level Medicare claims data on emergency department utilization; and individual-level baseline assessment data from participants in the intervention (n = 353) and control (n = 208) sites. STUDY DESIGN: We used a pre/postdifference in difference quasi-experimental design applying several analytic methods. The preintervention period was January 2016-March 2017, while the intervention period was July 2017-December 2018. DATA COLLECTION/EXTRACTION METHODS: Emergency responders provided aggregate transfer data on a daily basis for intervention and control buildings; the Quality Improvement Organization provided quarterly aggregate data on emergency department visit rates; and assessment data came from a modified Vitalize 360 assessment and coaching tool. PRINCIPAL FINDINGS: The study found an 18.2% statistically significant decline in ambulance transfers in intervention buildings, with greater declines in buildings that had fewer services available at baseline, compared to other intervention sites. Analysis of Medicare claims data, adjusted for the proportion of residents over 75 per building, found fewer visits to emergency departments in intervention buildings. CONCLUSIONS: Health-related supports in senior housing sites can be effective in reducing emergency transfers and visits to emergency departments.

Understanding the Wicked Problem of Providing Accessible Housing for the Ageing Population in Sweden.

While accessible housing is known as important to promote healthy ageing, the societal issue of providing accessible housing for the ageing population bears the characteristics of a "wicked problem". The aim of this study was to gain a better understanding of crucial variables for decision-making about the provision of accessible housing for the ageing population in Sweden. Materials used for a deductive content analysis were elicited through a research circle involving three researchers and twelve non-academic representatives. Brown and colleagues' conceptual five-dimension framework to address wicked problems was used for the understanding of crucial variables in decision-making about housing provision. The findings show that such reasoning is dominated by the socioeconomic dimension. Findings in the biophysical dimension reveal well-known challenges pertaining to the definition and interpretation of the concept of accessibility and its operationalization. The dimensions are intertwined in a complex manner, which is essential for effective and efficient decision-making. The findings could make decision-makers aware of the diversity of individual thinking involved when addressing this wicked problem. Acting upon the crucial variables identified in this study could contribute to progressive decision-making and more efficient ways to develop and provide accessible housing to promote health ageing.

Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study.

BACKGROUND: Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. OBJECTIVE: This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. METHODS: Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. RESULTS: During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. CONCLUSIONS: Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.

Older adults living in social housing in Canada: the next COVID-19 hotspot?

Older adults in social housing have high rates of chronic diseases and live in clustered housing, creating the ideal situation for a tragic outbreak in this vulnerable population, which has been largely unrecognized in the public health discourse. It is estimated that two thirds of this population have cardiometabolic conditions that put them at higher risk of poor outcomes from COVID-19. In addition, their social isolation, low mobility, low health literacy, and limited internet access are barriers to accessing basic needs, health information, and health care in a Canadian context where many services have moved to virtual platforms. Since older adults in social housing tend to be clustered in apartment buildings with shared facilities, there is an increased risk of exposure through common spaces (e.g., elevator, laundry room) and high-touch surfaces. Compared to long-term care homes, there is substantial movement in and out of social housing buildings as residents are required to go out to meet their basic needs and individuals providing support enter the buildings without screening (e.g., personal support workers, volunteers delivering groceries). Without a targeted public health strategy to support this vulnerable population, we surmise that social housing will be the next COVID-19 hotspot.

RéSUMé: Les adultes âgés en logement social présentent des taux élevés de maladies chroniques et vivent dans des logements regroupés, une situation propice à une éclosion tragique dans cette population vulnérable largement laissée pour compte dans le discours de la santé publique. Il est estimé que les deux tiers de ces adultes ont des troubles cardiométaboliques qui les exposent davantage aux résultats défavorables de la COVID-19. En outre, leur isolement social, leur faible mobilité, leur faible littératie en santé et leur accès limité à l'Internet font obstacle à la satisfaction de leurs besoins fondamentaux et à leur accès aux renseignements médicaux et aux soins de santé dans un contexte canadien où de nombreux services ne sont maintenant offerts que sur des plateformes virtuelles. Comme les adultes âgés en logement social tendent à être regroupés dans des immeubles d'appartements avec des installations communes, les espaces communs (ascenseur, salle de lavage) et les surfaces souvent touchées leur font courir un risque d'exposition accru. Comparativement aux maisons de soins de longue durée, il y a de nombreux va-et-vient dans les immeubles de logements sociaux, car les résidents doivent sortir pour satisfaire leurs besoins fondamentaux, et les personnes qui les aident (préposés aux services de soutien à la personne, bénévoles qui livrent des produits d'épicerie) entrent dans l'immeuble sans être assujetties à un contrôle. En l'absence d'une stratégie de santé publique pour appuyer cette population vulnérable, nous présumons que les logements sociaux seront le prochain « point chaud ¼ de la COVID-19.

Lonely in a crowd: loneliness in New Zealand retirement village residents.

OBJECTIVES: The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population. DESIGN: A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the "Older People in Retirement Villages Study." SETTING: RVs, Auckland, New Zealand. PARTICIPANTS: Participants included RV residents living in 33 RVs (n = 578). MEASUREMENTS: Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs). RESULTS: Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15-16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15-10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43-7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99-2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53-4.35; high risk: OR 4.20, 95% CI 1.47-11.95). CONCLUSION: A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being.

Homes Too Large for Household Needs? Under-Occupancy as Policy Problem and Lived Experience among Older Social Housing Tenants.

Rising demand for social housing has induced housing authorities to find ways to increase the utilisation of existing housing stock, including targeting households thought to be living in homes that are larger than they need. This "under-occupation" of social housing is common among older tenants who, as with other under-occupiers, have been subject to unpopular measures designed to encourage downsizing. Yet little attention has been given to the housing needs of under-occupying older tenants and the ability of the social housing sector to meet those needs. In reviewing a new housing initiative for older under-occupying social housing tenants in Brisbane, Australia, this paper explores the housing needs and experience of this cohort. It shows that under-occupancy is a lived experience for some tenants and that downsizing to a smaller property is an attractive, albeit limited option. This suggests that policy prescriptions about the problem of older under-occupiers in the social housing sector should be reframed around the issue of tenants housing needs as they age.

Atividades socioculturais como interface de bem-estar emocional e de prevenção da transmissão da Covid-19 em estruturas residenciais para pessoas idosas / Sociocultural activities as an interface between emotional well-being and the prevention of Covid-19 transmission in nursing homes / Actividades socioculturales como interfaz de bienestar emocional y de prevención de la transmisión de la Covid-19 en estructuras residenciales para ancianos

Em Portugal, cerca de 40% das mortes por Covid-19 aconteceram em instituições para idosos, passando a exigir delas práticas institucionais de isolamento social, com graves repercussões na Saúde Mental dos residentes. Com esta pesquisa, qualitativa e exploratória, pretendeu-se perceber se, em período de pandemia, a realização de atividades socioculturais, por meio da animação de idosos, pode funcionar como interface do bem-estar emocional dos residentes e da prevenção da transmissão da Covid-19, segundo os técnicos que desempenham o papel de animadores. São, assim, apresentados os resultados obtidos com base na análise de conteúdo da entrevista semiestruturada aplicada a 16 profissionais que trabalham em estruturas residenciais para idosos, de norte a sul de Portugal Continental, tendo os dados evidenciado que a realização de atividades socioculturais surge como elemento determinante de bem-estar e de qualidade de vida daqueles que vivem nas instituições. (AU)

Around 40% of Covid-19 deaths in Portugal have occurred in nursing homes, resulting in the implementation of social isolation measures, with grave consequences for the mental health of residents. This exploratory study aimed to explore whether performing sociocultural activities designed to cheer up the elderly during the pandemic works as an interface between emotional well-being and the prevention of Covid-19 transmission, from the viewpoint of the professionals performing the activities. We present the findings of a content analysis of semi-structured interviews conducted with 16 professionals working in nursing homes in continental Portugal. The findings show that performing sociocultural activities is a determining factor in the well-being and quality of life of nursing home residents. (AU)

En Portugal, casi el 40% de las muertes por Covid-19 tuvieron lugar en instituciones para ancianos, pasando a que se les exigieran prácticas institucionales de aislamiento social, con graves repercusiones en la salud mental de los residentes. Con esta investigación, cualitativa y exploratoria, se pretendió percibir si, en el período de pandemia, la realización de actividades socioculturales, por medio de la entretención de ancianos, puede funcionar como interfaz del bienestar emocional de los residentes y de la prevención de la transmisión de la Covid 19, según los técnicos que desempeñan el papel de entretenedores. De tal forma, se presentan los resultados obtenidos a partir del análisis de contenido de la entrevista semiestructurada realizada con 16 profesionales que trabajan en estructuras residenciales para ancianos de norte a sur de Portugal Continental, habiendo los datos dejado claro que la realización de actividades socioculturales surge como elemento determinante del bienestar y de la calidad de vida de las personas que viven en esas instituciones. (AU)

Meaning of care for resident older adults, family members and professionals working in long-term care institutions / Significado de la atención a adultos mayores residentes, familiares y profesionales de instituciones de larga estadía / Significado do cuidado para idosos residentes, familiares e profissionais de instituições de longa permanência

ABSTRACT Objective to understand the meaning of care from the perspective of resident older adults, family members and professionals from Long-Term Care Institutions for Older Adults. Method a descriptive and exploratory study with a qualitative approach, developed with 14 resident older adults, 35 family members and 41 professionals from Long Term Care Institutions for Older Adults, located in the city of Florianópolis, Brazil. The data were collected between May 2017 and January 2018, being organized through the Atlas.ti software for the analysis of qualitative data and analyzed according to the content analysis method proposed by Bardin, in the light of the Theory of Social Representations. Results for the older adults, care was linked to three main dimensions: technical care related to the institution, family care, and self-care. The meaning of care from the perspective of family members was related to the moment experienced with the institutionalization of the aged family member, mainly characterized by the dimensions of affective care, when providing comfort and technical care. For the professionals, technical care was related to the affective character. Conclusion care could be understood in different ways, from different perspectives, but it also made it possible to identify points of synchrony among the participants.

RESUMEN Objetivo comprender el significado del cuidado desde la perspectiva de los adultos mayores residentes, familiares y profesionales de las Instituciones de Atención de Larga Estadía para el Adulto Mayor. Método estudio descriptivo y exploratorio, con abordaje cualitativo, desarrollado con 14 adultos mayores residentes, 35 familiares y 41 profesionales de Instituciones de Atención de Larga Estadía para Adultos Mayores, ubicadas en la ciudad de Florianópolis, Brasil. Los datos fueron recolectados entre mayo de 2017 y enero de 2018, la organización de los mismos se llevó a cabo a través del software de análisis de datos cualitativos Atlas.ti y el análisis mediante el método de análisis de contenido propuesto por Bardin, a la luz de la Teoría de las Representaciones Sociales. Resultados para el adulto mayor, la atención se vinculó a tres dimensiones principales: atención técnica relacionada con la institución, atención familiar y autocuidado. El significado del cuidado desde la perspectiva de los familiares se relacionó con el momento vivido a partir de la institucionalización del familiar anciano, caracterizado principalmente por las dimensiones del cuidado afectivo, al brindar confort y cuidado técnico. Para los profesionales, el cuidado técnico estaba vinculado con el carácter afectivo. Conclusión el cuidado pudo entenderse de diferentes formas, desde diferentes perspectivas, sin embargo, fue posible identificar puntos de sincronía entre los participantes.

RESUMO Objetivo compreender o significado do cuidado na perspectiva de idosos residentes, familiares e profissionais de Instituições de Longa Permanência para Idosos. Método estudo do tipo descritivo e exploratório, com abordagem qualitativa, desenvolvido com 14 idosos residentes, 35 familiares e 41 profissionais de Instituições de Longa Permanência para Idosos, localizadas na cidade de Florianópolis, Brasil. Os dados foram coletados entre maio de 2017 e janeiro de 2018, sendo organizados através do software para análise de dados qualitativos Atlas.ti e analisados segundo o método de análise de conteúdo proposto por Bardin, à luz da Teoria das Representações Sociais. Resultados para os idosos, o cuidado esteve vinculado a três dimensões principais: o cuidado técnico relacionado à instituição, o cuidado familiar e o cuidado de si. O significado de cuidado na perspectiva de familiares esteve relacionado ao momento vivido com a institucionalização do familiar idoso, caracterizado principalmente pelas dimensões do cuidado afetivo, ao prover conforto e cuidado técnico. Para os profissionais, o cuidado técnico esteve relacionado ao caráter afetivo. Conclusão o cuidado pôde ser compreendido de formas distintas, sob ópticas diferentes, mas que também possibilitou a identificação de pontos de sincronia entre os participantes.

Older Adult Segmentation According to Residentially-Based Lifestyles and Analysis of Their Needs for Smart Home Functions.

Globally, the percentage of older people in the general population is growing. Smart homes have the potential to help older adults to live independently and healthy, improving their quality of life, and relieving the pressure on the healthcare and social care systems. For that, we need to understand how older adults live and their needs. Thus, this study aims to analyze the residentially-based lifestyles (RBL) of older adults and segment them to compare and analyze the real needs of smart home functions for each group. To identify a person's RBL, a questionnaire was designed to include questions about activities at home, social events, quality of life, etc. This study surveyed 271 older Koreans. As a result of the survey on RBL, five groups with different characteristics were clustered. Finally, each groups' features and the differences in their needs for smart home functions were compared and analyzed. The priority of needed functions for each group was found to be significantly different. In a total of 26 smart home functions, there were meaningful differences in the needs for 16 functions among the groups. This study presents the results in South Korea, according to older adults' RBL and their smart home needs.

Thermal Personalities of Older People in South Australia: A Personas-Based Approach to Develop Thermal Comfort Guidelines.

An important consideration for future age-friendly cities is that older people are able to live in housing appropriate for their needs. While thermal comfort in the home is vital for the health and well-being of older people, there are currently few guidelines about how to achieve this. This study is part of a research project that aims to improve the thermal environment of housing for older Australians by investigating the thermal comfort of older people living independently in South Australia and developing thermal comfort guidelines for people ageing-in-place. This paper describes the approach fundamental for developing the guidelines, using data from the study participants' and the concept of personas to develop a number of discrete "thermal personalities". Hierarchical Cluster Analysis (HCA) was implemented to analyse the features of research participants, resulting in six distinct clusters. Quantitative and qualitative data from earlier stages of the project were then used to develop the thermal personalities of each cluster. The thermal personalities represent different approaches to achieving thermal comfort, taking into account a wide range of factors including personal characteristics, ideas, beliefs and knowledge, house type, and location. Basing the guidelines on thermal personalities highlights the heterogeneity of older people and the context-dependent nature of thermal comfort in the home and will make the guidelines more user-friendly and useful.

Single Time-Point Study of the Home Environment and Functionality of Older Adults in Spain.

Background: The literature favors discussion on socio-spatial conditions at the macro- (city) and micro- (housing) level that promote healthy aging in place. Objectives: (a) Identify the association between physical and social characteristics of the family home and the functional level and quality of life of older people and (b) provide normative data on adequate/inadequate households based on the Home Observation for Measurement of the Environment (HOME) inventory and the Spanish Informant Questionnaire on Cognitive Decline in the Elderly (S-IQCODE) test. Methods: In total, 79 healthy older adults completed the HOME inventory and the Montreal Cognitive Assessment (MoCA), S-IQCODE, Kessler Psychological Distress Scale (K-10) and ICEpop CAPability measure for Older people (ICECAP-O) tests. A regression model, the effect size and the means of the scores of HOME (adequate/inadequate) test and the cognitive level (optimal/normal) were calculated. Results: The regression model discloses that adequate home scores are associated with cognitive level (odds ratio (OR): 0.955, confidence interval (CI)95%: 0.918-0.955); quality of life (OR: 6.542, CI95%: 1.750-24.457), living with other people (OR: 5.753, CI95%: 1.456-22.733) and level of education (OR: 0.252, CI95%: 0.064-0.991). The normative data between HOME and S-IQCODE scores showed a good adjustment (d = 0.70). Conclusion: There is a significant relationship between the physical environment of the home and personal variables (sociodemographic information, quality of life and cognitive functionality). In addition, from this last variable, the normative data of an adequate/inadequate household for an older person have been established.

Towards Responsible Rebellion: How Founders Deal with Challenges in Establishing and Governing Innovative Living Arrangements for Older People.

In the Netherlands, there is an increasing need for collective forms of housing for older people. Such housing bridges the gap between the extremes of living in an institutionalised setting and remaining in their own house. The demand is related to the closure of many residential care homes and the need for social engagement with other residents. This study focuses on housing initiatives that offer innovative and alternative forms of independent living, which deviate from mainstream housing arrangements. It draws on recent literature on healthcare 'rebels' and further develops the concept of 'rebellion' in the context of housing. The main research question is how founders dealt with challenges of establishing and governing 'rebellious' innovative living arrangements for older people in the highly regulated context of housing and care in the Netherlands. Qualitative in-depth interviews with 17 founders (social entrepreneurs, directors and supervisory board members) were conducted. Founders encountered various obstacles that are often related to governmental and sectoral rules and regulations. Their stories demonstrate the opportunities and constraints of innovative entrepreneurship at the intersection of housing and care. The study concludes with the notion of 'responsible rebellion' and practical lessons about dealing with rules and regulations and creating supportive contexts.