Attitudes to long-term care in India: A secondary, mixed methods analysis.

OBJECTIVES: In India, globalisation is purported to have contributed to shifting family structures and changing attitudes to long-term care (LTC) facility use. We investigated the attitudes to and usage frequency of LTC in India. METHODS: We conducted secondary analyses of: (a) The Moving Pictures India Project qualitative interviews with 19 carers for people with dementia and 25 professionals, collected in 2022, exploring attitudes to LTC; and (b) The Longitudinal Ageing Study in India (LASI) 2017-2018, cross-sectional survey of a randomised probability sample of Indian adults aged 45+ living in private households. RESULTS: We identified three themes from qualitative data: (1) LTC as a last resort, describes how LTC could be acceptable if care at home was "impossible" due to the person's medical condition or unavailability of the family carer, for example, if family members lived overseas or interstate. (2) Social expectations of care at home from family members and paid carers and; (3) Limited availability of LTC facilities in India, especially in rural localities, and the financial barriers to their use. Of 73,396 LASI participants, 40 were considering moving to LTC; 18,281 had a parent alive, of whom 9 reported that their father, and 16 that their mother, lived in LTC. LTC use was rare. While a third of participants with a living parent lived in urban areas, 14/24 of those with a parent in LTC lived in an urban area, supporting our qualitative findings that LTC is mainly accessed in urban areas. CONCLUSIONS: Preference for intergenerational community care combined with limited availability and societal stigma contribute to low rates of LTC use among Indian families. Future social policies should consider how to plan for greater equity in strengthening care at home and in the community, and bolstering respite and LTC services as a last resort.

Professional dental care and survival rates in long-term care recipients: A cohort study of 1 459 163 individuals in South Korea.

OBJECTIVES: To determine the dental care pattern and survival rates of participants who received long-term care (LTC) and a matched control cohort in South Korea. BACKGROUND: Global ageing trends and the development of superaged societies pose healthcare challenges. South Korea's LTC system aids those with chronic illnesses and disabilities. Despite the link between oral health and systemic diseases, providing dental care in LTC facilities often reflects social neglect. METHODS: We identified 1 459 163 individuals eligible for LTC insurance in the Korean National Health Insurance Service database from July 2008 to 2015 (LTC cohort) and 1 459 544 individuals matched through propensity-score matching (matched cohort). The LTC recipients were further categorised into subgroups based on their care type (institutional, home or mixed care). Population of utilising dental services and the average number of dental visits were counted in each cohort, and the survival rate of the LTC cohort was determined according to dental utilisation. RESULTS: Population of utilising dental services increased steadily in all cohorts except for institutional care, with the highest utilisation (around 30%) observed in the matched cohort. Lower independence in LTC cohorts was associated with lower dental utilisation: 18-27% for home care, 12-18% for mixed care, and 10% for institutional care. The survival rates in the LTC cohort were significantly lower than in the matched cohort (P < .0001), with 28.1% survival in LTC vs 59.3% in the matched cohort. CONCLUSION: Long-term care recipients experience social neglect for oral care, while higher survival rates were observed in those utilised dental services.

Policy Narratives on Palliative Care in Sweden 1974-2018.

In Sweden, efforts to govern end-of-life care through policies have been ongoing since the 1970s. The aim of this study is to analyse how policy narratives on palliative care in Sweden have been formulated and have changed over time since the 1970s up to 2018. We have analysed 65 different policy-documents. After having analysed the empirical material, three policy episodes were identified. In Episode 1, focus was on the need for norms, standards and a psychological end-of-life care with the main goal of solving the alleged deficiencies within end-of-life care in hospital settings. Episode 2 was characterised by an emphasis on prioritising end-of-life care and dying at home, and on the fact that the hospice care philosophy should serve as inspiration. In Episode 3, the need for a palliative care philosophy that transcended all palliative care and the importance of systematic follow-ups and indicators was endorsed. Furthermore, human value and freedom of choice were emphasised. In conclusion, the increase of policy-documents produced by the welfare-state illustrate that death and dying have become matters of public concern and responsibility. Furthermore, significant shifts in policy narratives display how notions of good palliative care change, which in turn may affect both the practice and the content of care at the end of life.

Intestinal Helminthiasis: Risk factors and relationship with Nutritional status and Anaemia among Institutionalised Children in three States of South-East Nigeria.

BACKGROUND: Intestinal helminthiasis occurs in sub-optimal living conditions with poor hygiene practices and is more prevalent in rural, suburban and institutionalized centres. Heavy helminthic burden negatively affects the nutritional status and the severity of anaemia among children living in orphanages. AIM: To determine the risk factors and relationship of intestinal helminthiasis with nutritional status and anaemia among institutionalized children in three states of South-East Nigeria. METHODS: A cross-sectional study was conducted over seven months involving 198 children recruited from orphanages in Anambra, Ebonyi and Enugu states. Their stool samples were analyzed using the Kato-Katz and Ether concentration techniques, and packed cell volume and anthropometric indices were documented. Data were analyzed. RESULTS: Of the 198 children, 109 (55.1%) were females with a median age of 2.5 years and interquartile range (3 months - 17 years). The prevalence of intestinal helminthiasis was 2.5%. Among the children that had intestinal helminthiasis, 4 (80%) had mono-parasitism with Ascaris lumbricoides, while 1 (20%) had mixed infestation of Ascaris lumbricoides and Trichuris trichiura. There was a significant association (p=0.01) between being infested with intestinal helminthiasis and caregiver handwashing practices. The anthropometric indices demonstrated that 5.6%, 6.6% and 13.1% of the children were underweight, wasted and stunted respectively. No helminth-infested child had malnutrition and only 1 (20%) infested child had moderate anaemia. CONCLUSION: Caregivers' good handwashing practice was associated with reduced prevalence of intestinal infestations and should be encouraged. There was no relationship found between the presence of helminthic infestations and nutritional status or anaemia among the institutionalised children.

CONTEXTE: Les helmintiases intestinales surviennent dans des conditions de vie sous-optimales avec des pratiques d'hygiène médiocres et sont plus fréquentes dans les centres ruraux, périurbains et institutionnalisés. Une charge helminthique importante affecte négativement l'état nutritionnel et la gravité de l'anémie chez les enfants vivant dans des orphelinats. OBJECTIF: Déterminer les facteurs de risque et la relation entre les helmintiases intestinales, l'état nutritionnel et l'anémie chez les enfants institutionnalisés dans trois États du sud-est du Nigéria. MÉTHODES: Une étude transversale a été menée sur sept mois, impliquant 198 enfants recrutés dans des orphelinats des États d'Anambra, d'Ebonyi et d'Enugu. Leurs échantillons de selles ont été analysés à l'aide des techniques de Kato-Katz et de concentration à l'éther, et le volume globulaire et les indices anthropométriques ont été documentés. Les données ont été analysées. RÉSULTATS: Sur les 198 enfants, 109 (55,1 %) étaient des filles avec un âge médian de 2,5 ans et une plage interquartile (3 mois - 17 ans). La prévalence des helmintiases intestinales était de 2,5 %. Parmi les enfants atteints d'helmintiases intestinales, 4 (80 %) présentaient une mono-parasitose à Ascaris lumbricoides, tandis que 1 (20 %) présentait une infestation mixte à Ascaris lumbricoides et Trichuris trichiura. Il y avait une association significative (p=0,01) entre l'infestation par les helmintiases intestinales et les pratiques de lavage des mains par les aidants. Les indices anthropométriques ont montré que 5,6 %, 6,6 % et 13,1 % des enfants étaient respectivement sous-pondérés, émaciés et retardés en taille. Aucun enfant infesté par les helminthes n'était malnutri et seul 1 (20 %) enfant infesté avait une anémie modérée. CONCLUSION: La bonne pratique du lavage des mains par les aidants était associée à une prévalence réduite des infestations intestinales et devrait être encouragée. Aucune relation n'a été trouvée entre la présence d'infestations helminthiques et l'état nutritionnel ou l'anémie chez les enfants institutionnalisés. Mots-clés: Anémie, Enfants, Helminthes, Institutionnalisés, État nutritionnel.

Providing culturally appropriate residential dementia care for older adults with an Indian heritage: Perspectives from Sydney-based stakeholders.

BACKGROUND AND OBJECTIVES: Global migration and an increased life expectancy led to a growing number of people with dementia from Culturally and Linguistically Diverse (CaLD) backgrounds living in long-term residential care settings. These minority groups' wellbeing may be negatively impacted due to poor culturally appropriate care that fails to honour valued cultural traditions. This study considered culturally appropriate dementia care for older adults with an Indian heritage living in Sydney-based residential aged care facilities. RESEARCH DESIGN AND METHODS: The Nominal Group Technique was employed to collect data from three groups of stakeholders of Indian heritage over a period of 6 months: care staff (n = 8), family of residential care recipients (n = 8), and community-dwelling older adults (n = 7). RESULTS: Perspectives highlighted six concepts for consideration: (1) embracing a person-centred approach to promote culturally appropriate dementia care; (2) training staff in culturally appropriate forms of respect; (3) the impact of staff ratios on care; (4) the importance of familiarity to meaningful engagement; (5) the importance of food; and (6) the necessity of engaging family and the wider Indian community in residential care activities. CONCLUSIONS: Culturally appropriate dementia care for older adults with an Indian heritage is an area in need of further development. To ensure that residents with an Indian heritage are respected as an ethnic minority, it remains crucial that research is generated to inform policy development on each CaLD group as a separate entity.

A randomised clinical trial on the effect of oral antimicrobial sprays in institutionalised elders.

OBJECTIVE: To compare the effectiveness of chlorine dioxide, chlorhexidine and placebo sprays in improving oral hygiene among institutionalised elders. BACKGROUND: Available evidence suggests that oral sprays may be an effective alternative delivery method for plaque control; however, few studies have evaluated antimicrobial agents other than chlorhexidine. MATERIALS AND METHODS: A total of 228 elders across 11 nursing homes in Hong Kong were recruited into the clinical trial. Participants were randomly allocated into one of the following groups: 0.1% pH-balanced chlorine dioxide spray, 0.2% chlorhexidine spray or sterile water spray (placebo control), once daily. Dental plaque, gingival bleeding and other clinical oral health outcomes were assessed at baseline, 3 and 6 months. Participant acceptability of the interventions was assessed at the end of the clinical trial. RESULTS: Review assessments were conducted for 135 elders at 6 months. Significantly greater reductions in plaque index scores were observed with the chlorhexidine spray (0.4) and chlorine dioxide spray (0.3) than the placebo spray (0.1). While significant reductions in gingival bleeding scores were observed within the chlorhexidine (7.4), chlorine dioxide (7.5) and placebo (5.3) sprays after 6 months, change scores were not significantly different between groups. Significantly greater increases in the levels of staining were observed in the chlorhexidine spray group (-0.1) than the chlorine dioxide (0.0) and placebo spray (0.0) groups. CONCLUSION: Antimicrobial sprays were shown to be effective among institutionalised elders. Chlorine dioxide spray showed equivalent effects on dental plaque and gingival bleeding relative to the chlorhexidine spray over a 6-month period.

Understanding China's dam-induced resettlement under the institutionalised governance process of policy coevolution.

Development-induced involuntary resettlement has been intensively studied, demonstrating its essential role in the discussion of development studies, water governance and hydropower research. As the world's largest hydropower developer, however, China's dam-induced resettlement policy process remains largely unknown, so as its interactions with the larger governance system and policies of other sectors. The aim here, in this present study, was to identify the policy coevolution processes from three perspectives - national policy dynamics, local-central interactions, and across-sector coevolution between resettlement policy and land reform policy. Two cases studies of large dam-induced resettlement in Manwan project and Longkaikou project were presented to assess the performance of such a policy coevolution process. The findings revealed the dynamics of policy coevolution processes under China's unique institutionalised governance system, and their validity and shortcomings were tested by empirical evidence and observations. Overall, this study filled in a gap between 'fragmented authoritarianism' and 'institutional bricolage' for understanding China's dam-induced resettlement policy framework and process, and it encouraged dynamic study of policy processes in different institutional contexts.

Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care-dependent older people: An e-Delphi study.

OBJECTIVES: This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels. BACKGROUND: Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet. METHODS: The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1. RESULTS: A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative. CONCLUSIONS: Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people.

Caregivers' perceptions towards oral healthcare services for elders living in Malaysian nursing homes-A qualitative study.

OBJECTIVE: To assess the perceptions of caregivers towards oral healthcare services received by elders in Malaysian nursing homes and to identify challenges and suggestions for improvement. BACKGROUND: Caregivers play an important role in the oral health care of elders in nursing homes. METHODS: This study employed a qualitative approach using the nominal group technique (NGT) to obtain caregivers' feedback in nursing homes in Malaysia. Data were manually transcribed, summarised into keywords/key phrases, and ranked using weighted scores. RESULTS: In total, 36 caregivers (21 from government and 15 from private nursing homes) participated in the NGT sessions. Overall, caregivers were satisfied with the low treatment cost, the quality of treatment, and the availability of dental visits to nursing homes. Caregivers were dissatisfied with the frequency of dental visits, long waiting times at government dental clinics, and inadequate denture hygiene education for elders in nursing homes. The challenges faced by caregivers were elders' poor oral health knowledge and attitude and lack of elders' trust of caregivers to look after their oral health. Suggestions for improvement were to increase the frequency of dental visits to nursing homes, provide oral health education to elders and caregivers, and give treatment priority to elders at dental clinics. CONCLUSION: Despite being satisfied with the basic oral healthcare services received by elders in Malaysian nursing homes, caregivers raised some issues that required further attention. Suggestions for improvement include policy changes in nursing home dental visits and treatment priority for elders at government dental clinics.

Beyond measurement: the drivers of disrespect and abuse in obstetric care.

Concerns about disrespect and abuse (D&A) experienced by women during institutional birth have become critical to the discourse on maternal health. The rapid growth of the field from diverse points of origin has given rise to multiple and, at times, confusing interpretations of D&A, pointing to the need for greater clarity in the concepts themselves. Furthermore, attention to measurement of the problem has been excessive when viewed in relation to the small amount of work on critical drivers of disrespect and abuse. This paper raises some key issues of conceptualisation and measurement for the field, puts forward a working definition, and explores two critical drivers of D&A - intersecting social and economic inequality, and the institutional structures and processes that frame the practice of obstetric care. By identifying gaps and raising questions about the deeper causes of D&A, we point to potentially fruitful directions for research and action.

Positive and negative outcomes of informal caregiving at home and in institutionalised long-term care: a cross-sectional study.

BACKGROUND: Our ageing society is putting tremendous strain on public health and welfare programs to meet the needs of ageing individuals. Promoting informal caregiving is one way for policymakers to reduce this burden. However, caregiving may be experienced as stressful and is associated with adverse health consequences. While quite a lot of research focuses on caregiving for community-dwelling older adults, little is known about informal care in institutionalised long-term care (ILTC). Therefore, the objectives of this study were: 1) to compare characteristics of informal caregivers and care receivers and caregiver outcomes - at home and in ILTC; 2) to study the association between these characteristics and positive and negative caregiver outcomes; 3) to investigate the moderating effect of the setting (at home vs. ILTC) on these associations. METHODS: A cross-sectional study was conducted using the TOPICS-MDS DataSet. A total of 5197 Dutch dyads were included. The average age of the care receivers and caregivers was respectively 80.7 years and 63.2 years. Several sociodemographic, health-related and caregiving-related characteristics of care receiver and caregiver and two caregiver outcomes (i.e., subjective burden and care-related quality of life) were included in the analyses. RESULTS: Caregivers in both settings experienced comparable levels of subjective burden. Caregivers at home had slightly lower care-related quality of life than caregivers in ILTC. Several care receiver characteristics (i.e., male sex, married/cohabiting, more morbidities/disability, and less self-perceived health/psychological wellbeing) and several caregiver characteristics (i.e., female sex, being younger, living together with the care receiver, more objective burden, less self-perceived health, and more support) were associated with an increase in burden and/or a decrease in care-related quality of life. Some of these associations were stronger for dyads at home compared to dyads in ILTC. CONCLUSIONS: Informal caregiving does not stop with admission to an ILTC facility. Both settings need an informal caregiving policy, which is (1) tailored to the individual characteristics of care receivers and caregivers; (2) pays attention to the identified risk groups; and (3) reduces the negative caregiver outcomes and emphasizes the positive outcomes at the same time.

A Dedicated Nutritional Care Program (NUTRICARE) to reduce malnutrition in institutionalised dysphagic older people: A quasi-experimental study.

AIMS AND OBJECTIVES: To assess the effects of a texture-modified food program for dysphagia on the nutritional, biochemical and functional profile in a cohort of institutionalised older people in Italy. BACKGROUND: Dysphagic institutionalised older people, often also affected by dementia, are frequently exposed to malnutrition. Malnutrition in older people has negative effects on mortality, days of hospitalisation, infection, wound healing and risk of pressure injuries. Therefore, it is very important to prevent malnutrition in this frail population. DESIGN: A pre-post study without a control group. METHODS: The study included 479 dysphagic institutionalised older people from 20 nursing homes. Anthropometrical, biochemical, nutritional and functional parameters were collected retrospectively, 6 months before the study intervention, at time zero and, prospectively for 6 months after implementing the NUTRICARE food programme, for a total of nine evaluations. The NUTRICARE programme includes meals without nutritional supplementation, and personalised levels of density, viscosity, texture and particle size. RESULTS: The total mean body mass index of our sample passed from 17.88-19.00; body weight averagely improved by 7.19%, as well as their nutritional and biochemical profiles. There was a progressive improvement of total protein and serum albumin values. Nutritional parameters (serum transferrin and lymphocytes) displayed similar changes. Plasma lymphocytes reached normal levels in 98.23% of the sample. Plasma creatinine levels remained steady throughout the study and within the normal range. No side effects were reported. CONCLUSION: The NUTRICARE food programme with a adequate proteins, calories, balanced nutritional and bromatological properties, and appropriate texture and palatability significantly improved the nutritional, biochemical and functional profile in a cohort of institutionalised dysphagic older people. RELEVANCE TO CLINICAL PRACTICE: The introduction of a balanced nutritional programme, using high-quality natural ingredients, appropriate texture and palatability can significantly improve health and quality of life in dysphagic older people.

Effectiveness of an alcohol-free essential oil-containing mouthwash in institutionalised elders receiving long-term care: a feasibility study.

OBJECTIVES: To conduct a feasibility study on investigating the effectiveness of an alcohol-free essential oil mouthwash (AF-EOMW) to reduce plaque accumulation and oral pathogen levels in institutionalised elders receiving long-term care and to obtain preliminary results. BACKGROUND: Although simple, cost-effective strategies to improve oral hygiene in seniors such as the use of mouthwashes have been shown to reduce the risks of respiratory diseases, little information is available on the feasibility of implementing these measures. METHODS: Twenty-five elderly participants with significant loss of autonomy were initially recruited and divided into two groups. A test group rinsed with an AF-EOMW twice a day, and a control group rinsed with tap water. Data on demographic characteristics, dental history and tobacco use were collected from a questionnaire. Problems encountered during recruitment and data collection were documented. Plaque index, denture cleanliness and salivary levels of several pathogens were measured at three time points: baseline (T0 ), day 22 (T1 ) and day 45 (T2 ). RESULTS: Eighteen participants completed the study. Several problems were encountered during recruitment and execution of the study protocol. No significant differences in clinical or microbiological measures were found between the test group and controls at three time points (p > 0.05). CONCLUSION: This pilot study shows that, if sufficient logistical and financial resources are available, it is feasible to conduct randomised clinical trials in a seniors' facility. The use of an AF-EOMW to improve oral hygiene in seniors was not found to be superior to tap water. However, larger controlled clinical studies are needed to confirm these results.

High prevalence of undernutrition and low dietary diversity in institutionalised elderly living in Sri Lanka.

OBJECTIVE: The present study aimed to assess nutritional status, dietary diversity and lifestyle risk factors associated with undernutrition in an institutionalised Sri Lankan elderly population. DESIGN: The study was of cross-sectional design followed by a stratified sampling method. SETTING: Twelve homes for the elderly recruited from six provinces in Sri Lanka. SUBJECTS: A total of 311 institutionalised elderly aged ≥60 years. RESULTS: The mean age of the study population was 75 (sd 8) years. Prevalence of undernutrition was 30 %. Mean food variety score, dietary diversity score and dietary serving score of the study population were 8·7 (sd 1·5), 7·3 (sd 1·2) and 10·9 (sd 2·0), respectively. Mean daily intakes of fruit, vegetables, meat, fish, eggs and pulses and dairy portions were below the national recommendations, whereas the mean consumption of sugar exceeded the national recommendation. Only the mean intake of starch was within the recommendation. Food allergies (OR=8·0; 95 % CI 3·9, 16·2), skipping meals (OR=3·8; 95 % CI 2·0, 7·5) and lack of leisure activities (OR=3·1; 95 % CI 1·5, 6·7) significantly increased the risk of undernutrition, whereas the use of dentures decreased the risk (OR=0·20; 95 % CI 0·06, 0·69). CONCLUSIONS: High prevalence of undernutrition and low dietary diversity were observed in an institutionalised elderly Sri Lankan population. Therefore, there is an urgent need to implement nutrition interventions as part of geriatric care to reduce undernutrition and improve the diets of the institutionalised elderly population in Sri Lanka.

Beta-blockers increase the risk of being born small for gestational age or of being institutionalised during infancy.

OBJECTIVE: To compare infant outcomes between mothers with hypertension treated by beta-blockers alone and by methyldopa alone during pregnancy. DESIGN: Historical cohort study. SETTING: Saskatchewan, Canada. POPULATION: Women who delivered a singleton birth in Saskatchewan during the periods from 1 January 1980 to 30 June 1987 or from 1 January 1990 to 31 December 2005 (women who delivered between 1 July 1987 and 31 December 1989 were excluded because the information recorded on maternal drug use during pregnancy is incomplete) with a diagnosis of a hypertensive disorder during pregnancy, and who were dispensed only beta-blockers (n = 416) or only methyldopa (n = 1000). METHODS: Occurrences of adverse infant outcomes were compared between women who received beta-blockers only and women who received methyldopa only during pregnancy, first in all eligible women, and then in women with chronic hypertension and in women with gestational hypertension or pre-eclampsia/eclampsia, separately. Multiple logistic regression analyses were performed to adjust for potential confounding. MAIN OUTCOME MEASURES: Small for gestational age (SGA) < 10th percentile, SGA < 3rd percentile, preterm birth, stillbirth, institutionalisation for respiratory distress syndrome (RDS), sepsis, seizure during infancy, and infant death. RESULTS: Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for infants born to mothers with chronic hypertension who were dispensed beta-blockers only, as compared with infants born to mothers who were dispensed methyldopa only, during pregnancy were: 1.95 (1.21-3.15), 2.17 (1.06-4.44), and 2.17 (1.09-4.34), respectively, for SGA < 10th percentile, SGA < 3rd percentile, and being institutionalised during infancy. CONCLUSIONS: For infants born to mothers with chronic hypertension, compared with those treated by methyldopa alone, those treated by beta-blockers appear to be at increased rates of SGA and hospitalisation during infancy.

Helping Institutionalised Children through a Trusting Relationship-Findings from a One-Year Psychosocial Intervention Programme.

Children growing up in institutions lack a stable relationship-essential for development. A significant proportion of them have disorganised attachment, which is associated with negative outcomes. Therefore, interventions aimed at improving attachment security are needed. We conducted a case series study (involving five participants aged 8-11 years) in a newly established psychosocial rehabilitation daycare centre to describe the changes in attachment security and mental health of institutionalised children after one year of attendance. The intervention consisted of individualised care focusing on staff building a trusting relationship with participants using the principles of Trust-Based Relational Intervention® (TBRI). Measures such as the Child Attachment Interview, SDQ, CBCL6/18, TRF6/18, and clinical interviews were used to follow change. The descriptive data of five participants are presented. All five children improved in mental health, and for two participants, organisation of attachment changed. Three children experienced relational ruptures. The findings suggest that psychosocial interventions that focus on building trusting relationships may be beneficial in institutionalised children. For these children, given their life history, it can be damaging to experience repeated breakdowns. Thus, the practical implication is that any new relationship for them with an adult should be established after an assessment of whether the relationship can be sustained.

Development and psychometric testing of a Chinese-language instrument for assessing institutionalised older males' motivations for living.

AIMS AND OBJECTIVES: To develop and psychometrically test a Chinese-language instrument, the Motivations for Living Inventory, for use with older adult institutionalised males. BACKGROUND: While tools exist for testing reasons for living among English-speaking individuals, none are available to assess Chinese-speaking older adults' motivation for living. DESIGN: This study had three steps: cross-sectional survey to collect data on instrument items, instrument development and psychometric testing. METHODS: Participants were 247 older male residents of five veterans' homes, including 22 who had attempted suicide in the previous three months and 225 nonsuicide attempters. The Chinese-language instrument, Motivations for Living Inventory, was developed based on individual interviews with older male residents of nursing homes and veterans' homes, focus groups with workers at nursing and veterans' homes, the literature and the authors' clinical experiences. The resulting Inventory was examined by content validity, construct validity, criterion-related validity, internal consistency reliability and test-retest reliability. RESULTS: The inventory had good content validity index (1·00). Factor analysis yielded a five-factor solution, accounting for 82·02% of the variance. Veterans' home male residents who had not attempted suicide tended to have higher scores than residents who had attempted suicide in the previous three months across the global inventory and all its subscales, indicating good criterion validity. Inventory reliability (Cronbach's α for the total scale was 0·86 and for subscales ranged from 0·80-0·94) and intraclass correlation coefficient (0·81) was satisfactory. CONCLUSIONS: The Chinese-language Motivations for Living Inventory can be completed in five to seven minutes and is perceived as easy to complete. Moreover, the inventory yielded highly acceptable parameters of validity and reliability. RELEVANCE TO CLINICAL PRACTICE: The Chinese-language Motivations for Living Inventory can be used to assess reasons for living in Chinese-speaking, institutionalised older male adults.

Oral healthcare provision at long-term care facilities in eThekwini: Perspectives of coordinators.

BACKGROUND: The prevalence and impact of oral disease among long-term institutionalised residents highlight the need for a scale-up of preventive and promotional oral health services that include oral health education and training for caregiving staff. However, opportunities to improve oral healthcare services are met with challenges. AIM: This study was undertaken to establish coordinator perspectives on oral health provision. SETTING: Seven long-term care facilities in the eThekwini district, South Africa. METHODS: An in-depth exploratory study was conducted with 14 purposively selected coordinators (managers and nurses). Semi-structured interviews were conducted and focused on coordinators' experience and perspectives on oral healthcare. Data were analysed using thematic analysis. RESULTS: The following themes emerged from the study: A lack of comprehensive oral health care practices, inadequate support from the dental sector, insufficient oral health prioritisation, limited funding for oral health, and challenges associated with coronavirus disease (COVID-19). All respondents reported that no oral health initiatives existed. Plans for oral health training workshops presented with coordination and funding challenges. Oral health screening initiatives have ceased since COVID-19. CONCLUSION: The study findings indicated that prioritisation of oral health services was inadequate. There is a need for continual oral health in-service training for caregivers and support from coordinators in guiding the implementation of oral health training programmes.Contribution: It is envisaged that the findings of this study will bring about greater coordinator involvement and collaboration with the public and private dental sectors to improve oral healthcare at long-term care facilities.

Does Aging Have an Impact on Vitamin C Status and Requirements? A Scoping Review of Comparative Studies of Aging and Institutionalisation.

The global healthcare burden of an aging population continues to increase, with nearly a quarter of the total global burden of disease attributable to people aged ≥60 years. Older people are at greater risk of micronutrient deficiencies, including immune-supportive vitamin C, which is both a contributor to and a consequence of acute and chronic illnesses. However, whether healthy aging, per se, is associated with depleted vitamin C status and increased requirements for the vitamin is less certain. A systematic scoping review was carried out to assess comparative studies that reported the vitamin C status and prevalence of deficiency in older versus younger people and in older people relative to residential status. Furthermore, vitamin C requirements were assessed through comparative studies reporting vitamin C status and pharmacokinetics in older people relative to younger people. Overall, there was limited evidence to suggest that healthy aging, per se, is related to lower vitamin C status or higher requirements for the vitamin. However, institutionalised elderly had lower vitamin C status and enhanced vitamin C requirements, primarily as a result of low intakes and/or chronic illnesses, which were not being met by hospital or residential diets. Because institutionalised elderly are vulnerable to malnutrition and micronutrient deficiencies, it is imperative that appropriate nutritional interventions are instigated to provide optimal micronutrient intake to support healthy aging.

Caregivers' knowledge, attitudes, and oral health practices at long-term care facilities in KwaZulu-Natal.

Background: Vulnerable individuals residing at long-term care facilities require special oral health consideration. Examining concepts of oral health and hygiene practices of caregivers becomes essential for understanding the quality of oral health services provided to residents. Aim: This study explored the oral health-related knowledge, attitudes and practices (KAP) of caregivers. Setting: Long-term care facilities in the eThekwini District, KwaZulu-Natal. Methods: A cross-sectional study was conducted at seven long-term care facilities among 188 caregivers who completed a self-administered questionnaire. Data were collated and analysed using the Statistical Package for the Social Sciences (SPSS) version 24. Inferential techniques included an analysis of variance (ANOVA) test. A p-value ≤ 0.05 was considered to be statistically significant. Results: Participants reported that dentures do not to be cleaned (n = 139; 73.9%). Participants (n = 70; 37.2%) reported that some medications have oral side effects. Most participants (n = 173; 92%) were optimistic about improving their oral health knowledge and skills. Participants (n = 108; 57.4%) only reported flossing when they had food trapped between their teeth. Few participants (n = 30; 16%) reported visiting the dentist every 6 months. Conclusion: Participants had a positive attitude to improve their oral health-related knowledge and practices. However, the study showed that there is a need to scale-up oral health education and training activities for caregivers. Contribution: It is envisaged that findings of this study will demonstrate the importance of oral health-related knowledge among caregivers in providing better oral health care through improved attitudes and practices.