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BACKGROUND: Skin carotenoids are a valid biomarker for approximating fruit and vegetable consumption (FVC). Veggie Meter® (VM®, Longevity Link Corp.) is a pressure-mediated reflection spectroscopy (RS)-based device that allows for noninvasive and rapid assessment of skin-carotenoid score (SCS) in adults and children. Although VM® is established as a valid tool to measure FVC in adults, there is limited research supporting the validity evidence of the VM® to approximate FVC among preschool children. OBJECTIVE: The current study aims to assess evidence supporting the criterion-related validity of RS-based SCS for approximating FVC among preschool children (3-5-y old). METHODS: We collected cross-sectional data from typically developing preschool children (n = 136) attending the Child and Adult Care Food Program-participating family child care home settings (FCCHs) (n = 46) in Nebraska. Research team members collected children's height and weight to calculate body mass index; and measured children's SCS using the VM®. Children's FVC in FCCHs were collected using dietary observation. In addition, parents (n = 89) completed a shortened food frequency questionnaire to report children's FVC at home. Kendall's Tau (τ) correlation tests were conducted to measure the association between children's SCS with FVC in FCCHs and with parent-reported total fruit and vegetable (FV) frequency scores. RESULTS: Children's SCS were significantly correlated with their mean FVC in FCCHs, τ = 0.14 (P = 0.02), total provitamin A carotenoids intake in FCCHs, τ = 0.19 (P < 0.001), and with parent-reported total FV frequency score, τ = 0.16 (P = 0.04). CONCLUSION: The correlation coefficients in this study are comparable with results from a meta-analysis examining associations between FVC and SCS in 7-10-y-old children (r = 0.20). Thus, evidence suggests that RS offers a potentially valid, objective, and feasible method to assess preschool children's total FVC in multiple settings, especially in conjunction with other dietary assessment tools.
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Frutas , Verduras , Adulto , Pré-Escolar , Humanos , Carotenoides/análise , Estudos Transversais , Dieta , Comportamento Alimentar , Frutas/química , Análise EspectralRESUMO
Generating and translating high-quality evidence is integral to providing safe and effective medication management for residents of aged care homes. Residents are often under-represented in trials of medication effectiveness and safety. This paper reviews opportunities and challenges for generating and translating evidence for safe and effective medication management in aged care homes. There are an increasing number of randomized controlled trials (RCTs) being conducted in aged care homes. Observational studies can also help address the evidence-practice gap arising from underrepresentation of residents in RCTs. Stepped-wedge and helix counterbalanced designs may help overcome limitations of traditional RCTs for evaluating medication management interventions in the aged care setting. Strategies for generating evidence include building effective partnerships with aged care homes and organizations, using novel trial designs, leveraging existing data and knowledge sharing through international platforms. Strategies for translating evidence include using quality indicators for audit and feedback, provision of education and training, engaging internal and external stakeholders, and development of local action plans and guideline implementation tools. There is an emerging interest in the role of knowledge brokers to facilitate knowledge translation. Future directions for generating and translating evidence include strengthening international research collaboration, industry partnerships, standardizing aged care home data to support national and international comparisons, and optimizing the use of technology. Initiatives may include improving access to routinely collected administrative health and medication data for conducting high-quality observational studies. Future studies should assess outcomes prioritized by residents to ensure that medication management strategies are tailored to their needs.
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PURPOSE: With epilepsy increasingly affecting older adults, seizure-related care needs arise in new settings. Persons in these settings must receive optimal support and challenges identified for remediation. This may entail the epilepsy community researching in unfamiliar environments. One setting is care homes. Seizure-related ambulance incidents in them are common. We conducted the first qualitative study with care home staff to explore their experiences and challenges in managing suspected seizures. METHODS: Three online focus groups were organised for January 2024 to explore ambulance calls, post-incident procedures, and challenges faced by care home staff when managing seizures. Persons were eligible to participate if they worked as a care assistant, nurse or manager in a care home in North-West England. Different recruitment pathways were employed including direct approach, a managers' network, social media and a register of research interested homes. Focus group audio recordings were transcribed and analysed using Hamilton's Rapid Analysis. RESULTS: Recruitment was difficult; 13 care home staff from 12 different homes were ultimately recruited. Despite data saturation not being achieved, insights were gained regarding ambulance call decisions, paperwork navigation, and follow-up care challenges. Patients not having meaningful seizure action plans in place and regulatory restrictions were identified as factors that contributed to potentially avoidable calls for ambulance help being made. CONCLUSION: This study highlights systemic issues in care homes' seizure care, emphasizing the need for further research. The epilepsy community may need to innovate to better research within this increasingly important setting. This study offers insights into the effectiveness of different recruitment strategies.
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Epilepsia , Grupos Focais , Convulsões , Humanos , Inglaterra , Epilepsia/terapia , Convulsões/terapia , Masculino , Feminino , Adulto , Pesquisa Qualitativa , Pessoal de Saúde/psicologia , Pessoa de Meia-Idade , AmbulânciasRESUMO
OBJECTIVES: To validate and examine the psychometric properties of the Chinese version of QUALIDEM (QUALIDEM-C). METHODS: The psychometric properties of the Chinese QUALIDEM were tested in a sample of 150 residents in long-term care homes. Concurrent validity, internal consistency, inter-rater reliability, test-retest reliability and factor structure were determined. RESULTS: QUALIDEM-C demonstrated good semantic equivalence with original version and good content validity. QUALIDEM-C showed satisfactory internal consistency (Cronbachs' alpha = 0.895), inter-rater reliability (ICC = 0.970) and test-retest reliability (ICC = 0.942). Acceptable concurrent validity was showed by consistently moderate correlations of QUALIDEM-C with generic and disease specific quality of life measures. CONCLUSIONS: QUALIDEM-C is reliable and valid scales to measure quality of life of residents in long-term care home. Its applicability across residents with different levels of cognitive function favors its use over other measures in this context. It is potentially an effective tool, rather by multiple measures, to evaluate quality of life in future long-term care home research.
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Demência , Instituição de Longa Permanência para Idosos , Assistência de Longa Duração , Casas de Saúde , Psicometria , Qualidade de Vida , Humanos , Masculino , Feminino , Idoso , Reprodutibilidade dos Testes , Psicometria/instrumentação , Assistência de Longa Duração/normas , Idoso de 80 Anos ou mais , Demência/psicologia , Casas de Saúde/normas , Inquéritos e Questionários , Instituição de Longa Permanência para Idosos/normas , China , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: As populations age globally, there is an increasing prevalence of dementia, with an estimated 153 million living with dementia by 2050. Up to 70% of people with dementia experience dementia-related psychosis (D-RP). Antipsychotic medications are associated with many adverse effects in older people. This review aims to evaluate the evidence of non-pharmacological interventions in managing D-RP. METHOD: The search of Medline, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane included randomised controlled trials that evaluated non-pharmacological interventions. Data extraction and assessment of quality were assessed independently by two researchers. Heterogenous interventions were pooled using meta-analysis. RESULTS: A total of 18 articles (n = 2040 participants) were included and categorised into: sensory-, activity-, cognitive- and multi-component-orientated. Meta-analyses showed no significant impact in reducing hallucinations or delusions but person-centred care, cognitive rehabilitation, music therapy, and robot pets showed promise in single studies. CONCLUSIONS AND IMPLICATIONS: Future interventions should be developed and evaluated with a specific focus on D-RP as this was not the aim for many of the included articles.
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Demência , Transtornos Psicóticos , Humanos , Demência/terapia , Transtornos Psicóticos/terapia , Musicoterapia/métodosRESUMO
BACKGROUND: Exercise interventions are highly effective at preventing falls in older people living in the community. In residential aged care facilities (RACFs), however, the evidence for effectiveness is highly variable, warranting exploration of drivers of successful trials. This study aims to identify the conditions of randomised controlled trials (RCTs) that are associated with reducing falls in RACFs and test whether it can explain the variability. METHODS: RCTs testing exercise interventions in RACFs compared to usual care, reporting rate or risk of falls from the 2018 Cochrane Collaboration review and a search update to December 2022 were included. Two authors independently extracted and coded trial conditions and outcomes according to a theory developed from prior Intervention Component Analysis. Trial outcomes were coded as successful or unsuccessful based on point estimates for the rate or risk ratio for falls, or p value. Qualitative Comparative Analysis (QCA), utilising Boolean minimisation theory, was conducted to determine the key conditions driving trial success. A subgroup meta-analysis and the GRADE approach was applied to the final theory. RESULTS: Eighteen trials undertaken in 11 countries with 2,287 residents were included. Participants were predominately ambulant females aged 70 to 80 with cognitive impairment. Most interventions were fully supervised or supervised at the start of the intervention. QCA identified two configurations as drivers of successful exercise falls prevention programs: (i) group exercise that is moderate or low intensity, or (ii) for independent ambulatory residents, exercise for more than 1 h per week. The combination of configuration (i) and (ii) had consistency and total coverage scores of 1, indicating all trials were explained. This combination was associated with a reduction in falls (rate ratio 0.45, 95%CI 0.34 to 0.59; risk ratio 0.66, 95%CI 0.53 to 0.82; low certainty evidence). CONCLUSION: To successfully reduce falls in RACFs, exercise programs should provide continuous supervised moderate-intensity group exercise. For programs that mostly include independent ambulatory residents, exercise for at least 80 min per week should be provided. As many current residents are frail, tailored exercise is likely necessary and an individualised dose may be required. Future trials should test exercise interventions for less mobile residents.
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Acidentes por Quedas , Terapia por Exercício , Instituição de Longa Permanência para Idosos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodosRESUMO
BACKGROUND: Social connection is a basic human need and is essential to quality of life. It is associated with better mental and physical health outcomes for long-term care (LTC) home residents and is a key aspect of quality of care and person-centred care. There are considerations for LTC homes that may present obstacles to and opportunities for social connection. It is therefore important to understand what restricts or enables good social connection in LTC homes, to guide better quality care and future interventions in this population. This qualitative study aims to identify barriers and facilitators to social connection for LTC residents. METHODS: We used thematic analysis to describe themes derived from individual and group qualitative interviews from 67 participants (18 residents, 17 staff members and clinicians, 32 family members and friends) recruited from LTC homes in the United Kingdom and Canada. RESULTS: Themes were grouped into four categories: (1) becoming familiar with life in the LTC home to support social connection; (2) physical and virtual access beyond the LTC home as strategies to maintain contact; (3) getting to know residents to deepen relationships; (4) person-centred approaches to build social connection. 'Becoming familiar with life in the LTC home to support social connection' described the benefits of counteracting the institutionalized feel of LTC homes, enabling LTC residents to spend time in meaningful ways, and increasing freedom of mobility around the home. 'Physical and virtual access beyond the LTC home as strategies to maintain contact' related to the benefits of outings, providing support with technology, and involving family and friends in LTC home life. 'Getting to know residents to deepen relationships' related to the benefits of using routine care and interactions as opportunities for social contact, using family and friend knowledge as a resource, and fostering resident relationships. 'Person-centred approaches to build social connection' included considering physical, mental, cognitive, and sensory impairments, accounting for adjustment and sociability, using communal spaces well, and prioritizing psychosocial needs. CONCLUSIONS: This study identifies barriers and facilitators to social connection for LTC residents which can be addressed in care policies, staff selection and training, and can inform policies and interventions to build and maintain social connection in LTC homes. CLINICAL TRIAL NUMBER: clinicaltrials.gov ID NCT05315960.
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Assistência de Longa Duração , Casas de Saúde , Pesquisa Qualitativa , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/psicologia , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Instituição de Longa Permanência para Idosos , Apoio Social , Interação Social , Pessoa de Meia-Idade , Qualidade de Vida/psicologiaRESUMO
BACKGROUND: Dementia has a major impact on individuals, their families and caregivers, and wider society. Some individuals experience a faster decline of their function and health compared to others. The objective of this systematic review was to determine prognostic factors, measurable in primary care, for poor outcome in people living with dementia. METHODS: Cohort studies set in the community or primary care, and examining prognostic factors for care home admission, cognitive decline, or palliative care were included. Databases were searched from inception to 17th June 2022. Identified papers were screened, the risk of bias assessed using Quality in Prognostic Studies (QUIPS) tool, and data extracted by 2 reviewers, with disagreements resolved by consensus or a 3rd reviewer. A narrative synthesis was undertaken, informed by GRADE, taking into consideration strength of association, risk of bias and precision of evidence. Patient and Public Involvement and Engagement (PPIE) and stakeholder input was obtained to prioritise factors for further investigation. RESULTS: Searches identified 24,283 potentially relevant titles. After screening, 46 papers were included, 21 examined care home admission investigating 94 factors, 26 investigated cognitive decline as an outcome examining 60 factors, and 1 researched palliative care assessing 13 factors. 11 prognostic factors (older age, less deprived, living alone, white race, urban residence, worse baseline cognition, taking dementia medication, depression, psychosis, wandering, and caregiver's desire for admission) were associated with an increased risk of care home admission and 4 prognostic factors (longer duration of dementia, agitation/aggression, psychosis, and hypercholesterolaemia) were associated with an increased risk of cognitive decline. PPIE and other stakeholders recommended further investigation of 22 additional potential prognostic factors. CONCLUSIONS: Identifying evidence for prognostic factors in dementia is challenging. Whilst several factors highlighted as of relevance by our stakeholder groups need further investigation, inequalities may exist in care home admission and there is evidence that several prognostic factors measurable in primary care could alert clinicians to risk of a faster progression. REGISTRATION: PROSPERO CRD42019111775.
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Demência , Atenção Primária à Saúde , Humanos , Demência/terapia , Demência/diagnóstico , Demência/psicologia , Demência/epidemiologia , Prognóstico , Cuidados Paliativos/métodos , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/terapiaRESUMO
BACKGROUND: The anticipatory prescribing of injectable controlled drugs (ICDs) by general practitioners (GPs) to care home residents is common practice and is believed to reduce emergency hospital transfers at the end-of-life. However, evidence about the process of ICD prescribing and how it affects residents' hospital transfer is limited. The study examined how care home nurses and senior carers (senior staff) describe their role in ICDs prescribing and identify that role to affect residents' hospital transfers at the end-of-life. METHODS: 1,440 h of participant observation in five care homes in England between May 2019 and March 2020. Semi-structured interviews with a range of staff. Interviews (n = 25) and fieldnotes (2,761 handwritten A5 pages) were analysed thematically. RESULTS: Senior staff request GPs to prescribe ICDs ahead of residents' expected death and review prescribed ICDs for as long as residents survive. Senior staff use this mechanism to ascertain the clinical appropriateness of withholding potentially life-extending emergency care (which usually led to hospital transfer) and demonstrate safe care provision to GPs certifying the medical cause of death. This enables senior staff to facilitate a care home death for residents experiencing uncertain dying trajectories. CONCLUSION: Senior staff use GPs' prescriptions and reviews of ICDs to pre-empt hospital transfers at the end-of-life. Policy should indicate a clear timeframe for ICD review to make hospital transfer avoidance less reliant on trust between senior staff and GPs. The timeframe should match the period before death allowing GPs to certify death without triggering a Coroner's referral.
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Casas de Saúde , Assistência Terminal , Humanos , Cuidados Paliativos , Pesquisa Qualitativa , Hospitais , MorteRESUMO
BACKGROUND: Care home residents aged 65 + years frequently experience acute health issues, leading to emergency department visits. Falls and associated injuries are a common cause of these visits and falls in a geriatric population can be a symptom of an incipient acute illness such as infection. Conversely, the traumatic event can cause illnesses to arise due to consequences of the fall, e.g. delirium or constipation due to opioid use. We hypothesised that a traumatic event treat-and-release emergency department visit serves as an indicator for an upcoming acute hospital admission due to non-trauma-related conditions. METHODS: We studied emergency department visits for traumatic events among all care home residents aged 65+ (n = 2601) living in Southern Jutland, Denmark, from 2018 to 2019. Data from highly valid national registers were used to evaluate diagnoses, mortality, and admissions. Cox Regression was used to analyse the hazard of acute hospital admission following an emergency department treat-and-release visit. RESULTS: Most visits occurred on weekdays and during day shifts, and 72.0% were treated and released within 6 h. Contusions, open wounds, and femur fractures were the most common discharge diagnoses, accounting for 53.3% of all cases (n = 703). In-hospital mortality was 2.3%, and 30-day mortality was 10.4%. Among treat-and-release visits (n = 506), 25% resulted in a new hospital referral within 30 days, hereof 13% treat-and-release revisits (duration ≤ 6 h), and 12% hospital admissions (duration > 6 h). Over half (56%) of new hospital referrals were initiated within the first seven days of discharge. Almost three-fourths of subsequent admissions were caused by various diseases. The hazard ratio of acute hospital admissions was 2.20 (95% CI: 1.52-3.17) among residents with a recent traumatic event treat-and-release visit compared to residents with no recent traumatic event treat-and-release visit. CONCLUSION: Traumatic event treat-and-release visits among care home residents serve as an indicator for subsequent hospitalisations, highlighting the need for a more comprehensive evaluation, even for minor injuries. These findings have implications for improving care, continuity, and resource utilisation. TRIAL REGISTRATION: Not relevant.
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Serviço Hospitalar de Emergência , Hospitalização , Sistema de Registros , Humanos , Dinamarca/epidemiologia , Masculino , Feminino , Idoso , Serviço Hospitalar de Emergência/tendências , Idoso de 80 Anos ou mais , Hospitalização/tendências , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia , Estudos de Coortes , Acidentes por Quedas , Casas de Saúde/tendências , Instituição de Longa Permanência para Idosos/tendências , Visitas ao Pronto SocorroRESUMO
BACKGROUND: Pathways into care-homes have been under-researched. Individuals who move-in to a care-home from hospital are clinically distinct from those moving-in from the community. However, it remains unclear whether the source of care-home admission has any implications in term of costs. Our aim was to quantify hospital and care-home costs for individuals newly moving-in to care homes to compare those moving-in from hospital to those moving-in from the community. METHODS: Using routinely-collected national social care and health data we constructed a cohort including people moving into care-homes from hospital and community settings between 01/04/2013-31/03/2015 based on records from the Scottish Care-Home Census (SCHC). Individual-level data were obtained from Scottish Morbidity Records (SMR01/04/50) and death records from National Records of Scotland (NRS). Unit costs were identified from NHS Scotland costs data and care-home costs from the SCHC. We used a two-part model to estimate costs conditional on having incurred positive costs. Additional analyses estimated differences in costs for the one-year period preceding and following care-home admission. RESULTS: We included 14,877 individuals moving-in to a care-home, 8,472 (57%) from hospital, and 6,405 (43%) from the community. Individuals moving-in to care-homes from the community incurred higher costs at £27,117 (95% CI £ 26,641 to £ 27,594) than those moving-in from hospital with £24,426 (95% CI £ 24,037 to £ 24,814). Hospital costs incurred during the year preceding care-home admission were substantially higher (£8,323 (95% CI£8,168 to £8,477) compared to those incurred after moving-in to care-home (£1,670 (95% CI£1,591 to £1,750). CONCLUSION: Individuals moving-in from hospital and community have different needs, and this is reflected in the difference in costs incurred. The reduction in hospital costs in the year after moving-in to a care-home indicates the positive contribution of care-home residency in supporting those with complex needs. These data provide an important contribution to inform capacity planning on care provision for adults with complex needs and the costs of care provision.
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Hospitalização , Pacientes Internados , Adulto , Humanos , Hospitais , Custos Hospitalares , Apoio SocialRESUMO
OBJECTIVE: To examine the effectiveness of one dose of the COVID-19 vaccine on care-home residents. STUDY DESIGN: Natural experiment. METHODS: We compared the effectiveness of single doses of Pfizer/BioNTech BNT162b2 (effective at 10 days) and AstraZeneca ChAdOx1 (effective at 14 days) vaccines in vaccinated and control (unvaccinated) homes. Using routine data, all care-homes reporting COVID-19 outbreaks between 11/12/2020 and 12/3/2021 in a sub-region of North West England were included. RESULTS: Of 126 care-homes (4042 residents), with outbreaks, 55 (44%, 1686 residents) reported onset dates before vaccination commenced; 38 (30%, 1304 residents) reported onset < 10 (BNT162b2) and < 14 days (ChAdOx1) after vaccine administration; and 33 (26%, 1052 residents) reported onset > 10 (BNT162b2) and > 14 (ChAdOx1) days after vaccination. Eighty-nine (71%) homes used ChAdOx1 vaccine. A single dose of vaccine before the outbreak onset significantly lowered the risk of symptoms (reduced by 48%), positivity (by 65%), hospitalisation (by 68%), and death (by 81%). Some vaccine effectiveness was also noted in care-homes that received one dose of vaccine within 10-14 days of outbreak onset. The number needed to vaccinate to prevent one resident from COVID-19-related hospitalisation was 34, and death was 17. CONCLUSIONS: This real-world, natural experiment adds to the evidence of COVID-19 vaccine effectiveness from different studies using varying designs. In the context of lockdown's impact on infection rates and on-going care-home outbreaks, a single dose of either ChAdOx1 or BNT162b2 vaccine had a significant impact on reducing COVID-19 related hospitalisation and death in care-home residents. Natural experiments should be used more in public health.
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Vacina BNT162 , Vacinas contra COVID-19 , COVID-19 , ChAdOx1 nCoV-19 , Hospitalização , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , COVID-19/mortalidade , Inglaterra/epidemiologia , Hospitalização/estatística & dados numéricos , Vacinas contra COVID-19/administração & dosagem , Idoso , Masculino , SARS-CoV-2 , Feminino , Surtos de Doenças/prevenção & controle , Casas de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou maisRESUMO
INTRODUCTION: Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. METHODS: Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations. RESULTS: Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. CONCLUSION: Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience. WHAT THIS PAPER ADDS: What is already known on this subject? Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents. There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia. Care for nursing home residents at mealtimes is often task-centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds? Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification. Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas. Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work? Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission. Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia. The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines. Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely. Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety.
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Transtornos de Deglutição , Terapia da Linguagem , Fonoterapia , Patologia da Fala e Linguagem , Humanos , Masculino , Deglutição , Transtornos de Deglutição/terapia , Instituição de Longa Permanência para Idosos/normas , Casas de Saúde/normas , Fidelidade a Diretrizes , Planejamento de Assistência ao Paciente , Idoso , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Poor oral health is common among older adults residing in care homes impacting their diet, quality of life, self-esteem, general health and well-being. The care home setting is complex and many factors may affect the successful implementation of oral care interventions. Exploring these factors and their embedded context is key to understanding how and why interventions may or may not be successfully implemented within their intended setting. OBJECTIVES: This methodology paper describes the approach to a theoretically informed process evaluation alongside a pragmatic randomised controlled trial, so as to understand contextual factors, how the intervention was implemented and important elements that may influence the pathways to impact. MATERIALS AND METHODS: SENIOR is a pragmatic randomised controlled trial designed to improve the oral health of care home residents in the United Kingdom. The trial uses a complex intervention to promote and provide oral care for residents, including education and training for staff. RESULTS: An embedded, theoretically informed process evaluation, drawing on the PAHRIS framework and utilising a qualitative approach, will help to understand the important contextual factors within the care home that influence both the trial processes and the implementation of the intervention. CONCLUSION: Utilising an implementation framework as the basis for a theoretically informed process evaluation provides an approach that specifically focuses on the contextual factors that may influence and shape the pathways to impact a given complex intervention a priori, while also providing an understanding of how and why an intervention may be effective. This contrasts with the more common post hoc approach that only focuses on implementation after the empirical results have emerged.
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Casas de Saúde , Saúde Bucal , Humanos , Idoso , Qualidade de Vida , Reino Unido , EscolaridadeRESUMO
OBJECTIVES: SENIOR (uSing rolE-substitutioN In care homes to improve oRal health) is a randomised controlled trial designed to determine whether role substitution could improve oral health for this population. A parallel process evaluation was undertaken to understand context. This paper reports on the first phase of the process evaluation. BACKGROUND: The oral health and quality-of-life of older adults residing in care homes is poorer than those in the community. Oral health care provision is often unavailable and a concern and challenge for managers. The use of Dental Therapists and Dental Nurses rather than dentists could potentially meet these needs. MATERIALS AND METHODS: Semi-structured interviews were conducted with 21 key stakeholders who either worked or had experience of dependent care settings. Questions were theoretically informed by the: Promoting Action on Research Implementation in Health Services (PAHRIS) framework. The focus was on contextual factors that could influence adoption in practice and the pathway-to-impact. Interviews were fully transcribed and analysed thematically. RESULTS: Three themes (receptive context, culture, and leadership) and 11 codes were generated. Data show the complexity of the setting and contextual factors that may work as barriers and facilitators to intervention delivery. Managers are aware of the issues regarding oral health and seek to provide best care, but face many challenges including staff turnover, time pressures, competing needs, access to services, and financial constraints. Dental professionals recognise the need for improvement and view role substitution as a viable alternative to current practice. CONCLUSION: Although role substitution could potentially meet the needs of this population, an in-depth understanding of contextual factors appeared important in understanding intervention delivery and implementation.
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Interprofessional collaboration (IPC) is essential for high-quality palliative care (PC) for persons with dementia. The aim of this scoping review was to identify IPC approaches in palliative dementia care and explore the elements constituting these approaches. We performed a search in PubMed, CINAHL, and PsychINFO using the Joanna Briggs Institute Reviewers' manual and PRISMA guidelines, and conducted content analysis of the included articles. In total, 28 articles were included, which described 16 IPC approaches in palliative dementia care. The content analysis revealed three overall elements of these approaches: 1) collaborative themes, 2) collaborative processes, and 3) resources facilitating collaboration. Frequently reported collaborative themes embraced pain management and providing care in the dying phase. These themes were addressed through intertwined collaborative processes including communication, coordination, assessing and monitoring, and reflecting and evaluating. To ensure optimal IPC in palliative dementia care, various resources were required, such as PC knowledge, skills to manage symptoms, skills to communicate with collaborators, and a facilitating environment. In conclusion, the identified IPC approaches in palliative dementia care involve diverse collaborating professionals who mainly manage symptoms, prepare for the dying phase and require material and immaterial resources to enable optimal IPC in palliative dementia care.
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Comportamento Cooperativo , Demência , Relações Interprofissionais , Cuidados Paliativos , Humanos , Demência/terapia , Cuidados Paliativos/organização & administração , Comunicação , Equipe de Assistência ao Paciente/organização & administração , Manejo da DorRESUMO
This study looked at the effect of group music therapy on dementia patients' levels of feelings of depression and anxiety. Quasi-experiment was carried out (N = 121) in which patients were randomly divided into a control (N = 61) and an experimental group (N = 60). Following a six-weeks, twelve-sessions trial involving both passive and active music therapy, it was discovered that the music group therapy intervention decreased the anxiety and depression levels of dementia patients in the experimental group as compared to the control group, which did not receive any music therapy. It was also noted that after three months of follow-up, participants in the experimental group still maintained a low level of anxiety and depression, but the control group's level remained high, therefore, substantiating the effect of music in lowering anxiety and depression among older ones. We urge the nursing descipline, medical professionals, carers, and care homes to include music therapy in the care they provide for patients with dementia.
Assuntos
Ansiedade , Demência , Depressão , Musicoterapia , Psicoterapia de Grupo , Humanos , Demência/psicologia , Demência/terapia , Feminino , Masculino , Ansiedade/terapia , Ansiedade/psicologia , Idoso , Depressão/terapia , Depressão/psicologia , Psicoterapia de Grupo/métodos , Idoso de 80 Anos ou mais , Resultado do TratamentoRESUMO
Despite the increasing use of music therapy to treat patients with dementia, studies focused on developing nations are still in their embryonic stages. In this view, this study examined the impact of group music therapy intervention in ameliorating depression levels among older people in two care homes. A randomized control trial (RCT) was carried out in which a total of 121 patients were randomly divided into control 61 and experimental group 60. After 6 weeks, 12-session experiment which involved passive and active music therapy, it was found that music group therapy intervention reduced the depression level of older persons in the experimental group, compared to those who were not exposed to the music therapy; control group. The music therapy session also influenced the salivary cortisol of the patients as it was shown to reduce their salivary cortisol levels. It was also observed that after three months of follow-up, participants in the experimental group still maintained a low level of depression and salivary cortisol level, but the control group's level was still high, thus, substantiating the effect of music in reducing depression among older people. We encouraged clinicians, nursing practitioners and care homes in Nigeria to incorporate music therapy as part of the treatment offered to patients with dementia.
Assuntos
Demência , Musicoterapia , Música , Psicoterapia de Grupo , Humanos , Idoso , Idoso de 80 Anos ou mais , Depressão/terapia , Casas de Saúde , Demência/complicações , Demência/terapia , HidrocortisonaRESUMO
OBJECTIVES: We aimed to increase the understanding of emotion regulation (ER) and depression in older residents. METHODS: A sample of depressed and non-depressed nursing home residents (N = 164, Mage = 82.63) were compared to younger patients with depression (N = 163, Mage = 37.4) and a non-clinical student sample (N = 635, Mage = 23.82). The Affective Style Questionnaire (ASQ), and in the older adults, cognitive capacity, access to people, and a facet of mindfulness were assessed. With two MANCOVAs ER was compared between the depressed and non-depressed participants. RESULTS: Depressed and non-depressed individuals differed significantly regrading Adjusting and Tolerating after controlling for age, with an interaction significant for Tolerating (p = .034). Access to people and monitoring of experience were significant predictors of ER in residents. CONCLUSIONS: Interventions that include ER for older patients in nursing homes as a possibility to reduce age related stereotypes are discussed.
Assuntos
Depressão , Regulação Emocional , Casas de Saúde , Humanos , Masculino , Feminino , Depressão/psicologia , Idoso de 80 Anos ou mais , Inquéritos e Questionários , Idoso , AdultoRESUMO
Residents of long-term care facilities (LTCFs) were disproportionately affected by the COVID-19 pandemic. We assessed the extent to which hospital-associated infections contributed to COVID-19 LTCF outbreaks in England. We matched addresses of cases between March 2020 and June 2021 to reference databases to identify LTCF residents. Linkage to health service records identified hospital-associated infections, with the number of days spent in hospital before positive specimen date used to classify these as definite or probable. Of 149,129 cases in LTCF residents during the study period, 3,748 (2.5%) were definite or probable hospital-associated and discharged to an LTCF. Overall, 431 (0.3%) were identified as index cases of potentially nosocomial-seeded outbreaks (2.7% (431/15,797) of all identified LTCF outbreaks). These outbreaks involved 4,521 resident cases and 1,335 deaths, representing 3.0% and 3.6% of all cases and deaths in LTCF residents, respectively. The proportion of outbreaks that were potentially nosocomial-seeded peaked in late June 2020, early December 2020, mid-January 2021, and mid-April 2021. Nosocomial seeding contributed to COVID-19 LTCF outbreaks but is unlikely to have accounted for a substantial proportion. The continued identification of such outbreaks after the implementation of preventative policies highlights the challenges of preventing their occurrence.