Search Results (1,397)

Background/Objectives: Accurately assessing the independence level of older adults using useful assessment tools is an important step toward providing them with the necessary care while preserving their dignity. These tools allow older adults to receive effective, personalized home care, which improves their quality of life. This study aimed to clarify the current prevalence of severe and complete functional dependence and associated factors among Kazakhstan’s older adults aged >60 years. Methods: This cross-sectional study was conducted in several polyclinics and geriatric service care centers in two cities of Kazakhstan from March to May 2024. Functional status was assessed by the Barthel Index. We combined the selection into two categories: total dependency and severe dependency in the category “dependent”, and moderate dependency, slight dependency, and total independence in the category “active patients”. Results: Among the 642 older people in this study, 43.3% were dependent patients, and 56.7% were active patients. The odds of severe and total functional dependence are significantly higher for frail participants (adjusted odds ratio (AOR) = 2.96, 95% confidence interval (CI) [1.70, 5.16], p < 0.001) compared to those that are not frail; eleven times higher for those at home (AOR =11.90, 95% CI [5.77, 24.55], p < 0.001) than those in nursing homes; two times higher for participants with sarcopenia (AOR =2.61, 95% CI [1.49, 4.55], p < 0.001) compared to those with no sarcopenia; and three times higher for participants with high risk of fracture (AOR =3.30, 95% CI [1.94, 5.61], p < 0.001) compared to those with low risk. The odds of having severe and total functional dependence are significantly higher for participants with low dynamometry (AOR =1.05, 95% CI [1.03, 1.07], p < 0.001) compared to those with normal dynamometry. Conclusions: Old age, low dynamometry (for men ≤ 29 kg, for women ≤ 17 kg), frailty, being at home, high risk of fracture and osteoporosis, and sarcopenia were associated with increased risk of severe and total functional dependence. Full article

Introduction: Falls are the leading cause of Emergency Department (ED) presentations among residents from residential aged care facilities (RACFs). While most current studies focus on post-fall evaluations and fall prevention, limited research has been conducted on decision-making in post-fall management. Objective: To develop and internally validate a model that can predict the likelihood of RACF residents being discharged from the ED after being presented for a fall. Methods: The study sample was obtained from a previous study conducted in Shepparton, Victoria, Australia. Consecutive samples were selected from January 2023 to November 2023. Participants aged 65 and over were included in this study. Results: A total of 261 fall presentations were initially identified. One patient with Australasian Triage Scale category 1 was excluded to avoid overfitting, leaving 260 presentations for analysis. Two logistic regression models were developed using prehospital and ED variables. The ED predictor model variables included duration of ED stay, injury severity, and the presence of an advance care directive (ACD). It demonstrated excellent discrimination (AUROC = 0.83; 95% CI: 0.79–0.89) compared to the prehospital model (AUROC = 0.77, 95% CI: 0.72–0.83). A simplified four-variable Discharge Eligibility after Fall in Elderly Residents (DEFER) score was derived from the prehospital model. The score achieved an AUROC of 0.76 (95% CI: 0.71–0.82). At a cut-off score of ≥5, the DEFER score exhibited a sensitivity of 79.7%, a specificity of 60.3%, a diagnostic odds ratio of 5.96, and a positive predictive value of 85.0%. Conclusions: The DEFER score is the first validated discharge prediction model for residents of RACFs who present to the ED after a fall. Importantly, the DEFER score advances personalised medicine in emergency care by integrating patient-specific factors, such as ACDs, to guide individualised discharge decisions for post-fall residents from RACFs. Full article

Aim: To explore the experiences, beliefs, and values of patients who participated in a two-arm randomized clinical trial assessing a nurse-led intervention program for chronic pain self-management, which demonstrated positive effects on pain reduction, depression, and anxiety, and on health-related quality of life 24 months after completion of the program. Design: Descriptive phenomenological qualitative study. Methods: Patients were recruited via telephone, informed about the study, and invited to participate in an individual interview at a place of their choice (hospital or home). All interviews were audiotaped, and an inductive thematic analysis was performed. Results: Seven interviews were carried out between both groups. Six emerging categories were found: effective relationship with the healthcare system, learning to live with pain, family and social support, behaviors regarding pain, resources for self-management, and concomitant determinants. Conclusions: Patients report key aspects that help us to understand the impact of this type of nurse-led group intervention: the intrinsic therapeutic effect of participating in the program itself, the ability to learn to live with pain, the importance of family and social support, the modification of pain-related behaviors, and the identification of resources for self-care. The findings highlight the need for gender-sensitive, individualized care approaches to chronic pain, addressing stigma and social context. Expanding community-based programs and supporting caregivers is essential, as is further research into gender roles, family dynamics, and work-related factors. Full article

To enhance social interaction of residents living with dementia and their (in)formal carers in nursing homes, we examined the effects of a digital, person-centred, Photo-Activity (PA) versus a conversation activity (control). An explorative randomized controlled trial was conducted in 81 resident-informal carer (IC) dyads and 51 formal carers (FC) with three measurements (pre/post-test, 2-week follow-up). Intervention effects were tested using Mann–Whitney U’s, and ANCOVA’s with pre-test scores as covariates. Interaction effects were examined between dementia severity (DS; less/more) and condition (PA/control). A post-test effect was observed in social interaction (INTERACT-subscale: Mood [p = 0.037, ηp² = 0.07]), with PA residents showing better mood than controls. Residents with less DS showed more positive effects of PA than residents with more DS (interaction effects: INTERACT-subscales Mood [p = 0.017, ηp² = 0.092], Stimulation Level [p = 0.011, ηp² = 0.106], and Need for Prompting [p = 0.013, ηp² = 0.099]). Higher QUALIDEM Positive Affect scores were observed in the PA group, post-test (p = 0.025, ηp² = 0.082), and follow-up (p = 0.042, d = 0.39). PA FC showed less empathy (IRI; p = 0.006, ηp² = 0.185;) than controls, but reported getting to know the residents better (p = 0.035, r = 0.299). PA improved mood and positive affect of residents with dementia and led to FC knowing the residents better. Less empathy was observed in FC providing PA, requiring further investigation. Full article

Background: Sexuality is a central aspect of being human, even if people experience it in different ways in various stages of life. Sexuality in older people may be expressed, as well as affection, companionship, touch, and physical contact. However, older peoples’ sexual needs are not properly considered by themselves, caregivers, or healthcare professionals. Reviews on barriers related to identification and satisfaction of sexual needs of people living in nursing home are scarce. In this scenario we intended to summarize the state of evidence regarding sexual need identification and satisfaction among older people living in nursing homes and possible barriers that could limit sexual need identification and satisfaction. Methods: We carried out a narrative review. The included studies responded to the research question, using the following key words: nursing homes, sexuality or sexual need, or sexual behavior, older people. Searched databases included PubMed, Embase, CINAHL, PsycInfo, and Scopus. Results: After searching and screening we included 22 studies, finding three main topics: 1. identification of sexual needs by residents and healthcare personnel attitude and practice; 2. barriers and reasons hindering the identification of sexual needs; and 3. manifestation and satisfaction of sexual needs. Conclusions: The findings showed that nursing homes’ residents have different sexual needs, but there are many organizational, educational, and cultural barriers and negative attitudes of healthcare personnel. Supporting nursing home residents to express their sexual needs is a challenge for the healthcare professionals and managers of nursing homes. Full article

Background: While Asia contributes 44.3% of traumatic brain injuries (TBI) worldwide, data regarding Asian TBI inpatient rehabilitation length of stay (RLOS) is scarce. A retrospective cohort study was conducted to determine correlates of inpatient RLOS (days) and prolonged RLOS >30 days (PRLOS > 30). (2) Methods: Data extraction of discharged inpatient records was performed from 2018 to 2024. Dependent variables included RLOS (days) and PRLOS > 30. Independent variables included demographic characteristics, TBI severity (emergency-room Glasgow Coma Scale-GCS), admission/discharge Functional Independence Measure (FIM), intra-rehabilitation complications, post-traumatic amnesia (PTA) duration, and discharge placement. (3) Results: Altogether, 289 data sets were analysed, median (IQR) age, 64 (28) years, 78.9% (228/289) males, and 79.6% (230/289) Chinese. Median (IQR) RLOS was 28 (21) days, with PRLOS >30 at 39.8% (115/289); RLOS of 44 (19.5) days. PRLOS > 30 was significantly associated with PTA duration >28 days (OR 4.01, 95% CI 1.90–8.45, p < 0.001), admission FIM ≤ 40/126 (OR 4.71, 95% CI 2.32–9.59, p < 0.001), delayed neurosurgical complications (OR 4.74, 95% CI 1.28–17.6, p = 0.02) and discharge to non-home destination (OR 2.75. 95% CI 1.12–6.76, p = 0.03). (4) Conclusion: PRLOS >30 was significantly associated with longer PTA > 4 weeks, lower admission FIM score, delayed neurosurgical complications, and discharge to a nursing home. Full article

The quality of living environments for older adults represents a critical component of social sustainability in an ageing society. Among various housing options, nursing homes are the most institutionalised form of elderly care and demand special attention regarding architectural design. This paper explores the impact of architectural and open space features on social sustainability in living environments for older adults. A comparative analysis of three Slovenian nursing homes is presented. The first two, built in the post-war period, were based on elevated architectural criteria inspired by Swedish human-centred housing design. The third was completed in 2021 in the post-COVID-19 era, which revealed the vulnerability of such housing typologies. An integrated methodological framework was developed by applying two complementary assessment tools: the Safe and Connected, developed by the authors to evaluate the spatial, health, and social resilience of nursing home environments, and the Well-being and Integration, addressing the role of open space with a particular emphasis on the identification of older adults with their environment and the facilitation of social resilience. Both tools evaluate indicators linked to the social dimension of quality of life for older adults. The results show a gradual improvement in architectural quality from the 1960s to the 1980s, followed by a partial decline in the contemporary case. The Swedish example scored highest across both tools. In contrast, the newest Slovenian facility scored surprisingly low in social integration, highlighting critical gaps in current nursing home design. This study demonstrates the value of applying interdisciplinary, tool-based evaluations in identifying design strategies that foster resilient and inclusive LTC environments, and the proposed framework may serve as a decision-making aid for architects, planners, and policymakers. This research highlights the importance of reintroducing human-oriented design principles to support socially sustainable nursing home environments. Full article

Background and aims: The Last Aid Course (LAC) has been established to enhance the discussion about dying, death and grief and to raise the public’s awareness of palliative care. The aim of this study was to explore the views and experiences of German Last Aid Course instructors with the LAC as means for Public Palliative Care Education (PPCE), including their opinion about the course content and format and practical aspects of teaching in different settings. Methods: A longitudinal mixed-methods approach was used to explore the views and experiences of the Last Aid Course instructors over a period of five years. Social space orientation was used as the framework for the data analysis. Results: The LAC participants felt empowered after the LACs. Continuing development was a characteristic of the LAC project. The positive effects of the LACs included empowerment and positive interactions between the instructors and participants. In addition, the LACs had a positive impact on all five principles of social space orientation. Conclusions: LACs can contribute to raising public awareness about dying, death, grief and palliative care and empower people to participate in caring for those who are serious ill, dying and grieving. Full article

Background: After an older person moves into a nursing home, the next of kin often continues to participate in the care provided there. This participation in care may contribute valuable knowledge of the preferences and wishes of the older person, thereby helping nursing staff deliver personalised care. Objectives: The aim of this study was to explore how next of kin experience their participation in the care of older persons residing in nursing homes after educating nursing staff about participation in palliative care. Methods: This follow-up study used a qualitative design based on semi-structured interviews with 37 next of kin. A thematic analysis was applied. Results: Participation of the next of kin involved active communication and collaboration with nursing staff, expressed in three themes: striving to achieve co-created care, navigating involvement through presence, and building commitment through communication and information. The dual role of being an emotionally close next of kin and a participant in the relative’s care was challenging and became increasingly burdensome and often overwhelming when the older person’s health deteriorated. Conclusions: This study reveals the need to develop and implement a policy for the participation of next of kin in the care of older people living in nursing homes. In addition, support groups can increase well-being through dialogue with other next of kin, thereby alleviating emotional strain. Increased implementation of life stories and the use of digital communication would keep the next of kin informed about the older person’s condition, especially when they cannot be present in person. Life story is a valuable tool for person-centred care and strengthens the relationships between the next of kin, the older person, and the nursing staff. Full article

Background/Objectives: Proper management of food services aimed at preventing malnutrition and weight loss among residents of long-term care facilities is a critical priority. Accordingly, accurate prediction of energy intake requirements is necessary. This study aimed to estimate the energy intake required to prevent weight loss in residents of Japanese long-term care facilities. Methods: Body weight and 12-day dietary intake were measured from residents aged ≥75 years with a body mass index (BMI) < 25.0 kg/m² who were consuming a regular or chopped diet. In the survey, individuals with oral intake were included, while those with swallowing problems, serious illnesses, dietary restrictions, or medications causing appetite loss were excluded. The rate of body-weight loss and the energy intake per kilogram of body weight (kcal/kg BW) during each 6-month period were calculated. The energy intake per kilogram of body weight corresponding to the rate of body-weight loss of 0% was estimated from the regression line between the rate of body-weight loss and energy intake per kilogram of body weight. Results: The data was analyzed for 99 residents (15 men and 84 women, age 89.3 ± 5.0 years, BMI 20.3 ± 2.6 kg/m²). From the regression results in all participants, the energy intake per kilogram of body weight corresponding to the rate of body-weight loss of 0% was 31.4 kcal/kg BW overall and 33.4 kcal/kg BW for those with a BMI < 18.5 kg/m². Conclusions: The calculation of energy intake using a regression line may be able to predict the energy intake required for weight maintenance without using instrumental measurements or estimation equations, especially in the case of underweight individuals. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with rural populations experiencing higher prevalence and worse outcomes. This paper explores the transformative potential of nurse-led palliative care models in addressing the unique challenges faced by rural patients with COPD and their informal caregivers and synthesizes current evidence on nurse-led palliative care interventions, highlighting their impact on symptom management, advance care planning, and psychosocial support. Methods: This is a comprehensive synthesis of nurse-led palliative care programs, focusing on home-based care, telehealth, community outreach, and primary care integration. Results: Nurse-led interventions significantly improve patient satisfaction, reduce symptom burden, and enhance the likelihood of advance care planning discussions. Home-based care models and telehealth are particularly effective in rural settings, offering accessible and continuous support. Conclusions: Nurses have a critical role in bridging the palliative care gap for rural patients with COPD and their informal caregivers. Expanding nurse-led palliative care services can improve quality of life, reduce healthcare utilization, and promote health equity. Future research should focus on long-term outcomes, cost-effectiveness, and strategies for scaling nurse-led palliative care programs in rural contexts. Full article

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and intraoral clinical examinations and educational activities such as lectures and the distribution of printed materials on oral and denture hygiene. According to caregiving staff, oral hygiene, including denture cleaning, was generally performed once daily during morning showers. A total of 118 older adults (68 males and 50 females; mean age 76.1 ± 8.6 years) were examined. Forty-nine used dentures, of whom only 24 (49%) reported satisfaction with their prostheses. In total, 42 oral lesions were identified, mainly angular cheilitis (8), inflammatory fibrous hyperplasia (7), irritation fibroma (7), frictional hyperkeratosis (7), prosthetic stomatitis (5), actinic cheilitis (3), traumatic ulcers (3), and leukoplakia (2). Educational sessions also targeted caregivers, offering practical guidance for improving hygiene practices. The results underscore the need for better oral care and improved access to dental services for institutionalized elderly populations. Academic extension activities play a valuable role in health promotion and in training future professionals in elderly care. Full article

The location-allocation of nursing homes was examined by combining the entropy weight evaluation model and robust allocation model. The data of the elderly in Xuhui District in 2024 after the pandemic were used in this study. We constructed an evaluation index system by establishing the evaluation index principle of nursing homes’ location. Secondly, the polyhedral uncertainty set was used to predict the number of critical patients, and a model of robust configuration with capacity limitation and time constraints was constructed to minimize costs. The entropy weight method provided empirical results for the selection of nursing homes, and the robust configuration model ensured timely medical treatment. The feasibility and robustness of the mathematical model and solution method were verified, and the performance and advantages of the uncertain model over the deterministic model were proved. Full article

Japan has the world’s fastest-aging population. The number of older adults living alone has increased rapidly; however, the number of people waiting for nursing care facilities is high, especially in urban areas, and home care is unavoidable. Few studies have focused on older adults living alone who require nursing care, and almost no reports have examined the factors influencing the continuation or discontinuation of living alone. Furthermore, no reports were found that classified nursing care levels for the survey. This study’s purpose was to clarify what kind of long-term care for older adults living alone in urban areas is most effective in enabling them to continue living at home. A total of 122 older adults in need of long-term care in Osaka City were divided into two groups; one group was those who continued to live alone in December 2022, the other was those who had to discontinue doing so after January 2020. A questionnaire was distributed to the care managers responsible for older adults living alone who required nursing care. The participants’ basic attributes, long-term care services usage, and the characteristics of instrumental activities of daily living (IADL) support were compared according to care level using Fisher’s exact test. The relevant effective factors for continuing to live alone were extracted using a multivariate logistic regression analysis. The results showed differences in the characteristics of both groups at both care level categories used in the study, Support Care Level 1–Nursing Care Level 2 and Nursing Care Level 3–5. Among the support items, indoor temperature control was suggested as a factor that influences continued living alone. Full article

This article describes a case study of the partnership between Healthy Birth Initiatives, a community-based organization (CBO) and Black-led public health nurse home visiting program, and the maternal health division of the Providence Health System located in the Pacific Northwest. This study’s purpose was to explore the formation, significance, and impact of this partnership from the perspectives of staff and leadership members from both organizations. We conducted a case study through qualitative interviews with staff, participant observation, and debrief of leadership meetings. We completed a hybrid deductive–inductive thematic analysis of the data, followed by member checking with study participants and other key interest holders. Key facilitators of the CBO–health system partnership included the vital role of leaders in prioritizing the partnership; health system willingness to incorporate new information from the CBO to improve care; and health system utilization of resources to institutionalize changes that emerged from this partnership. Challenges to the CBO–health system partnership included CBO resource limitations; fragmented referral processes and information sharing; and the persistence required to nurture the relationship without formalized roles. This study contributes to the literature by offering staff perspectives on how a CBO–health system partnership formed, successes, early lessons learned, and practical suggestions for how to develop stronger alignment to provide culturally responsive patient-centered care to Black families. Full article