Search Results (494)

Background: Several strategies have been proposed to promote hydration among institutionalized older adults, including systematic hydration rounds and, more recently, the use of Socially Assistive Robots (SAR). However, their implementation in nursing homes remains limited. Objective: To compare changes in fluid intake over a one-month period among residents exposed to two hydration-promotion strategies and to identify baseline characteristics associated with fluid intake. Methods: A quasi-experimental study was conducted in a nursing home. Residents were assigned to either a systematic hydration rounds intervention with manual recording or a SAR-supported multicomponent educational intervention including reminders, positive reinforcement, and digital intake monitoring. Fluid intake was monitored for one month and analyzed using adjusted mixed-effects linear regression models. Results: Residents in the systematic hydration rounds group showed higher fluid intake throughout follow-up. In the longitudinal analysis, assignment to the SAR-supported group was independently associated with lower fluid intake during follow-up (β = −354.24 mL/day; p < 0.001), after adjustment for baseline fluid intake and functional dependence. No significant differences were observed in intake trajectories between strategies. Dysphagia was independently associated with lower fluid intake, whereas diabetes was associated with higher fluid intake. Conclusions: Residents assigned to the systematic hydration rounds group showed higher fluid intake during follow-up. Dysphagia was associated with lower fluid intake, highlighting the need to adapt hydration-promotion strategies to residents’ swallowing-related needs. Although the SAR-supported intervention was not associated with higher fluid intake, the findings suggest that technological tools for hydration promotion and monitoring require adequate integration into routine clinical practice. Full article

Background: This single-site qualitative interview study sought the opinions of 15 stakeholders from a nursing home based in the United Kingdom (UK) about identification and management of comorbidities in residents with dementia. Methods: Stakeholders were recruited through one of the nursing home owners, who acted as the gatekeeper. No residents with dementia were interviewed. Semi structured interviews were conducted online via Microsoft Teams in 2024. Data was analyzed using thematic analysis. Results: Stakeholders comprised four care assistants; three well-being companions; two nurses; a general practitioner (GP); two informal caregivers; a chaplain; the manager; and the owner of the nursing home. Stakeholders perceived that the identification and management of comorbidities in residents with dementia were shaped by interacting factors across four domains: the wider healthcare context, nursing home organization, staff capability and care practices, and resident-related challenges. Perceived healthcare under-resourcing increased complexity, while coordinated teamwork, continuous improvement, staff well-being, geriatric expertise, and person-centred, inclusive care were viewed as key facilitators. Conclusions: Overall, the perspectives of stakeholders interviewed in this single-site case study suggest that improving the identification and management of comorbidities in residents with dementia requires multilevel interventions that strengthen staff capability, organizational practices, and integration between nursing homes and the wider healthcare system. Full article

Urogenital toileting practices for residents in nursing homes (NHs) and their implications for the occurrence of bacteriuria remain largely unknown. Our purpose was to assess urogenital toileting practices in NHs in our region and their association with bacteriuria and urinary culture contamination rates. NHs reported on the direction of urogenital cleaning with respect to the urinary meatus and related practices during resident care over 7 years (2017 to 2023). Linear mixed models were used to relate two urogenital cleaning techniques, with bacteriuria rates (positive urinary cultures per resident over a year) and urinary culture contamination proportions. Of the 111 participating NHs, 33% used a technique involving outward cleaning with respect to the urinary meatus. Of these, 50 institutions had 7-year urinary microbiological data available (10,602 cultures, 13,059 isolates). Escherichia coli (45%) was the most frequently isolated microorganism while 12.4% of all cultures were contaminated (>3 microorganisms). We did not observe any significant association between the cleaning technique and the bacteriuria rates. The technique involving outward cleaning away from the urinary meatus was associated with lower odds of urinary culture contamination (odds ratio = 0.15, 95% CI: 0.05–0.48, p < 0.01). Urogenital cleaning techniques varied across participating institutions. We observed an association with urinary culture contamination, but not with bacteriuria rates. These findings warrant further investigation. Full article

Background/Objectives: Nursing home residents were among the most vulnerable populations during the COVID-19 pandemic, facing strict restrictive measures, limited access to medical services, and significant psychological consequences derived from institutional confinement. Despite the magnitude of these impacts, the perspective of residents themselves remain underrepresented in the qualitative literature, particularly in the Spanish context. The aim of this study was to analyze and describe the perspectives of residents in a nursing home regarding the restrictive measures adopted by the facility and their access to medical services during the COVID-19. Methods: An exploratory qualitative study was conducted with 24 residents of a nursing home in Cáceres, Spain. Data were collected through in-depth interviews and field notes, and analyze using inductive thematic analysis following Braun and Clarke’s framework. Results: Two main themes were identified: Necessary to feel safe, but unpleasant: accepting the restrictive measures (Accepting the measures; and Better safe, even if unpleasant) and Barriers to healthcare: abandonment, fear, and age-based exclusion (Neglect and abandonment by healthcare system; The residence as a “bubble” and fear of hospital transfer; and Not treated because of our age). Conclusions: The findings highlight the complexity of the experiences of older adults in residential care during the COVID-19 pandemic and underscore the urgent need to balance health protection with psychological well-being, dignity, and the rights of older people in future emergency responses. Full article

Background/Objectives: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent among nursing home residents and represent a major clinical and care-related challenge. These symptoms are frequently associated with increased psychotropic drug use despite limited efficacy and important safety concerns. This study aimed to evaluate longitudinal changes in BPSD and psychotropic drug use following implementation of the “Los Filabres” protocol, a structured person-centered non-pharmacological intervention, in nursing home residents with dementia. Methods: A single-arm longitudinal pre–post observational study was conducted in five nursing homes in Andalusia, Spain, including 204 residents with dementia or cognitive impairment. After staff training, the intervention was implemented over 12 months. Outcomes were assessed at baseline (T0), 6 months (T1) and 12 months (T2) using the Neuropsychiatric Inventory (NPI), including symptom frequency, severity, clinical relevance, and caregiver-related distress. Psychotropic drug use was analyzed according to the Anatomical Therapeutic Chemical classification system. Statistical analyses included Friedman and Cochran’s Q tests, with effect sizes estimated using Cohen’s d and h. The observational nature of the study implies that observed changes may be subject to limitations such as Hawthorne effects. Results: Significant reductions were observed across all global NPI dimensions over time (p < 0.001), including symptom frequency, severity, clinical relevance, and caregiver-related distress. The proportion of participants with at least one clinically relevant symptom decreased from 93.1% at baseline to 35.8% at 12 months (p < 0.001). Significant longitudinal reductions were also observed in psychotropic drug use, with the mean number of psychotropic drugs per participant decreasing from 2.38 to 1.57 (p < 0.001). Reductions were observed in anxiolytic and antipsychotic use, as well as in as-needed prescriptions. Conclusions: The “Los Filabres” protocol was associated with significant longitudinal reductions in BPSD and psychotropic drug use in nursing home residents with dementia. These findings suggest that structured person-centered non-pharmacological interventions based on the identification of unmet needs may help support dementia care and more individualized pharmacological management in long-term care settings. These findings should be interpreted cautiously due to the observational pre–post design and absence of a control group. Full article

Background/Objectives: Polypharmacy is common in elderly nursing home residents (NHR), due to the high prevalence of chronic diseases. This practice increases the risk of clinically significant drug–drug interactions (DDIs) with serious consequences for patient health and safety. The objective of this study was to evaluate the prevalence of DDIs using the UpToDate Drug–Drug Interaction Checker, potentially inappropriate medication (PIM, as defined by the STOPP-START criteria), and their association with major clinical outcomes. Methods: Demographic data, clinical history and detailed medication records of 275 patients from Romania were collected. Potentially inappropriate medications were identified using 16 selected criteria from the 2023 STOPP/START guidelines. Statistical analysis was performed using GraphPad, R, and Python, involving Chi-squared and Fisher’s exact tests with Benjamini–Hochberg correction, linear regression, and drug-interaction network analysis to characterise interaction frequency and severity. Results: Detailed medical histories over the past year were available for 76 patients. The mean number of drugs prescribed was 9.61 ± 4.47 drugs, with an average of 10.68 ± 10.54 potential interactions per patient. The primary clinical outcome was associated with not respecting certain STOPP-START recommendations (p < 0.01). Overall, 33.1% of NHRs utilised herbal supplements, resulting in a total of 76 potential herb–drug interactions. Conclusions: The results suggest a potential impact of DDIs on clinical outcomes, underscoring the need for further studies to clarify causality. The use of STOPP/START recommendations and deprescribing could lead to better tolerability and smaller drug-related burden in the institutionalised, elderly population. Full article

Background/Objectives: Loneliness is a major public health concern in later life and may be especially prevalent among older adults living in nursing homes. Evidence from Spain remains limited regarding modifiable correlates of different loneliness dimensions. This study aimed to describe social and existential loneliness among nursing home residents and examine their associations with sociodemographic, institutional, functional, and psychosocial factors. Methods: We conducted a cross-sectional study in Spanish nursing homes using face-to-face structured interviews with residents aged ≥65 years (n = 139). Social loneliness was assessed with the ESTE-II scale and existential loneliness with the existential loneliness subscale of the ESTE-R. Functional dependence was measured with the Barthel Index. Health literacy, locus of control, institutional variables, and suicidality-related items were also collected. Spearman correlations and multiple linear regression models with BCa bootstrapped 95% confidence intervals (5000 resamples) were used. Results: Social and existential loneliness were moderately correlated (ρ = 0.481, p < 0.001). Greater activity engagement was independently associated with lower social (B = −1.105, p < 0.001) and existential loneliness (B = −0.732, p = 0.029). Receiving visits regularly was associated with lower social loneliness (B = −4.083, p = 0.002), but not existential loneliness. Greater functional independence was associated with lower existential loneliness (B = −0.044, p = 0.023). Conclusions: Activity engagement was a consistent correlate across loneliness dimensions, whereas regular visits were mainly related to social loneliness and functional independence to existential loneliness. These findings support feasible long-term care strategies focused on meaningful activities, relational contact, and functional support. Full article

Background: Long-term care facility (LTCF) residents are highly susceptible to healthcare-associated infections, and prevention is challenging given frailty, dementia, communal living, and resource constraints. Environmental surface and air contamination contribute to transmission. Novel no-touch automated disinfection technologies have been studied in hospitals, but evidence specific to LTCFs is scarce. This scoping review summarizes recent LTCF-focused interventions, their effectiveness, and implementation considerations. Methods: This scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched PubMed, Medline, Embase, CINAHL, and Scopus for observational or experimental studies evaluating environmental disinfection in LTCFs/nursing homes, excluding body decolonization, non-LTCF settings, and reviews/protocols. Two reviewers independently screened and extracted data via Covidence. This review has been registered on OSF (Open Science Framework). Results: Of 1491 records, 7 studies met the inclusion criteria (6 from the USA, 1 from Australia): one cluster randomized trial, one interrupted time series studies, three prospective observational studies, and two pre–post designs. Interventions included physical methods (HVAC-integrated UV/UVGI, continuous UVGI) and chemical approaches (dry hydrogen peroxide, room fogging plus chlorine dioxide wipes, hydrogen peroxide wipes). Outcomes were heterogeneous (surface SARS-CoV-2 RNA, COVID-19 attack/case rates, airborne/surface microbial loads, and one clinical endpoint—acute respiratory illness). Several studies reported reductions in environmental or airborne bioburden; however, UV-based studies did not demonstrate statistically significant reductions in clinical infections. Certainty was limited by small numbers, non-randomized designs, and diverse outcome measures. Conclusions: No-touch automated disinfection methods appear promising as supplements to standard infection prevention control bundles for reducing environmental contamination in LTCFs. Nevertheless, consistent clinical benefits are unproven. Rigorous, LTCF-tailored, adequately powered trials with standardized clinical and environmental outcomes, plus implementation and cost-effectiveness evaluations, are needed. Full article

Background/Objectives: Nursing home (NH) residents who become acutely unwell may frequently be conveyed to emergency departments (EDs). However, at least half of such low-acuity visits could be avoided. Telehealth-supported acute care programmes may potentially reduce unnecessary ED attendances and subsequent hospital utilization. This study aimed to describe a telehealth-based acute care programme for NH residents and to explore a pragmatic method for estimating potential inpatient bed-day savings using publicly available diagnosis-related group (DRG)-based average-length-of-stay (ALOS) data. Methods: A telehealth-based programme was implemented at Sengkang General Hospital (SKH) to support NH staff in the management of acutely unwell residents. NH residents were prospectively tracked for ED non-attendance within 14 days following teleconsultation. Potential inpatient bed-day savings were estimated by mapping teleconsultation diagnoses to relevant DRGs and referencing Singapore Ministry of Health Hospital Bill Size and Fee Benchmarks. Institution-specific and nationally derived ALOS estimates were compared using exploratory Bland–Altman agreement analysis. Results: Over two financial year periods, seven NHs participated in the programme. A total of 726 teleconsultations were conducted, of which 424 encounters were successfully managed within NHs without ED attendance within 14 days (ED non-attendance rate being 58.4%). Using DRG-based estimation, the projected inpatient bed-day savings for FY2023 were 694.31 days using institution-specific ALOS and 805.42 days using nationally derived ALOS estimates. Exploratory Bland–Altman analysis across 34 mapped diagnostic categories demonstrated a mean bias of 0.098 days (approximately 2.4 h), with 95% limits of agreement ranging from −1.31 to +1.51 days. Conclusions: The acute care programme may reduce ED attendances and hospitalizations among NH residents. Publicly available national DRG-based ALOS data may provide a pragmatic approach for estimating the potential inpatient hospital bed-day savings when institution-specific data are unavailable. Full article

Background/Objectives: The health status of institutionalized older adults is determined by the interaction of functional, cognitive, nutritional, anthropometric, and biochemical factors, which may not be adequately captured through single-domain assessments. Within the framework of the VIVA Project (Vulnerability Index: Valencia institutionalized Adults), this study aimed to characterize institutionalized older adults during the COVID-19 pandemic using an integrated multidimensional approach and to explore clinically interpretable vulnerability profiles. Methods: This cross-sectional study included 124 residents from 10 nursing homes of Valencia, Spain. Data were obtained from institutional records and included age, sex, body mass index (BMI), Barthel Index, Mini-Examination of Cognition (MEC), Tinetti scale, Mini Nutritional Assessment-Short Form (MNA-SF), and biochemical markers related to protein status, lipid metabolism, micronutrient availability, and renal function. An exploratory VIVA multidimensional index was constructed from nine standardized variables, and k-means clustering was applied to these variables rather than to a single summed score to identify residents’ phenotypes. An exploratory logistic regression model was used to assess the internal discrimination of the high-vulnerability phenotype. Results: The cohort showed marked heterogeneity across functional, cognitive, nutritional, anthropometric, and biochemical domains. Cluster analysis identified three clinically interpretable phenotypes ranging from lower to higher vulnerability. Functional impairment, particularly the Barthel Index and Tinetti score, was the main driver of separation between phenotypes, while biochemical markers contributed to refining profile discrimination. The exploratory logistic regression model showed high internal discrimination for the high-vulnerability phenotype, supporting the internal coherence of the integrated framework. Conclusions: An integrated multidimensional framework may be useful for characterizing vulnerability among institutionalized older adults and supporting risk stratification in long-term care settings. The logistic regression findings, including the high AUC, should be interpreted only as evidence of internal discrimination and internal coherence of the exploratory construct, not as evidence of external validity, reproducibility, diagnostic accuracy, or future predictive utility. Full article

Background/Objectives: Declining masticatory function affects dietary variety, nutritional status, cognitive function, and health. Although factors related to chewing ability have been reported, the causes of temporal changes in masticatory kinematics in older adults remain unclear because prospective longitudinal data remain limited. Objectives: This follow-up study investigated factors associated with changes in masticatory movement in older adults requiring long-term care. Methods: Participants were 42 older adults residing in long-term care facilities. Survey items included mandibular kinematic data during rice cracker chewing and variables related to chewing, and the same assessment was performed two years after baseline. Relationships between changes in masticatory movement and other variables were examined, and factors associated with masticatory movement were identified using a linear mixed model (LMM). Results: A change in the number of cycles was significantly associated with the rate of change in the appendicular skeletal muscle mass index (ASMI). The rates of change in the number of linear motions and circular motion frequency were significantly associated with changes in the ABC Dementia Scale (ABC-DS). In the LMM results, cycle frequency remained associated with ASMI after adjustment for confounding factors, and both the number of circular motions and circular motion frequency were associated with ABC-DS. Conclusions: The findings suggest that masticatory movement in older adults requiring long-term care is influenced by skeletal muscle mass and cognitive function. In care facilities, interventions to maintain these factors are essential to help prevent dietary texture modifications among residents, while supporting nutrition, oral function, and health in this population. Full article

Background/Objectives: Malnutrition and diabetes mellitus (DM) have been linked to gut microbial perturbations, yet data are scarce for the aging population, especially in a nursing-home setting. As this group is generally at risk for malnutrition, we aimed to investigate the link between DM and gut microbial patterns in interaction with nutritional risk status in nursing-home residents. Methods: Stool samples were collected from 173 nursing-home residents (77.5% female, mean age 86 years) and were analyzed via 16S rRNA sequencing. Furthermore, the Geriatric Nutritional Risk Index (GNRI) was assessed and data on comorbidity status, anthropometric measurements, and medication were acquired. Results: Fifty-one residents had DM (mean HbA1c 6%). There were no DM-related differences in alpha diversity (observed richness: p = 0.733; Shannon index: p = 0.747). PERMANOVA revealed slight differences in beta diversity according to GNRI (R² = 0.009, p = 0.032), but no significant differences when adding DM status. Differential abundance analysis showed Clostridium_Clostridiaceae, Haemophilus, Actinomycetaceae and Micrococcaceae as significantly decreased with DM, independent of age, sex, and BMI. No interaction between DM and the GNRI in microbial diversity or composition was found. Conclusions: We report malnutrition-related differences in beta diversity and diabetes-related microbial taxa differences in nursing-home residents. DM status did not influence the relationship between the GNRI and gut microbiota in this population. Full article

Background/Objectives: Community hospitals can be a valuable and cost-effective resource for elderly people, especially in rural areas. Their aim is to promote self-reliance, prevent unnecessary hospital admissions, and facilitate rapid recovery after acute illness. The widespread adoption of intermediate care facilities helps alleviate hospital overcrowding by preventing clinical deterioration through advanced and continuous nursing care. An intermediate care unit was established in a rural area of central Italy. This study aims to describe the impact of a community hospital on patients’ functional status from admission to discharge, describing a real-life model. Methods: This single-center descriptive study examines trends in the quality of care provided. Data were retrieved from anonymized electronic clinical records. Statistical analyses were performed using descriptive statistics, paired t-tests, and Pearson correlation coefficients. Results: A total of 532 residents (mean age 80.7 ± 13.2 years; 61% female) were admitted to the community hospital between January 2022 and September 2025. The mean length of stay was 15.2 ± 7.6 days, with a mean improvement in Modified Barthel Index score of 5.24 ± 7.95 (p < 0.05). Most patients (81.8%) were discharged home, while 6.0% required hospitalization. No readmissions were recorded in 2025. Clinical risk events occurred only in 1.2% of the total. Nursing specialization increased during the study period, correlating with improved patient outcomes (R = 0.88). Conclusions: This descriptive cross-sectional study in a rural nurse-led intermediate care unit found relatively short lengths of stay, high rates of home discharges and modest, but statistically significant, improvements in functional autonomy. Full article

To identify the determinants, prevalence, and proposed solutions for potentially avoidable hospital transfers (PAHT) of residential aged care facility (RACF) residents in Australia, a scoping review was conducted using PubMed, CINAHL, Cochrane Library and Google Scholar, covering the period from 2015 to 2025. The database search identified 1350 articles, of which 43 studies met inclusion criteria. Prevalence of PAHT ranged from of 8.5% to 95.2% when defined as specific conditions manageable by an outreach service; from 2.2% to 55.6% when defined as potentially manageable with primary care; and from 11.6% to 53% when defined as an Emergency Department (ED) presentation not requiring a hospital admission. The most frequently reported determinant of PAHT pertained to the overarching theme of RACF clinical decision-making and systemic RACF practice-based factors. Establishment of, and access to, outreach services was the main proposed solution, alongside onsite General Practitioners (GP), Advance Care Planning (ACP), and capacity building for RACF nurses. Despite Australia’s diversity, our findings demonstrate patterns and similarities in prevalence, determinants and solutions. Consensus or standardisation of denominators would enhance comparability of outcomes across studies. These findings offer opportunities to reconsider solutions in response to the chronic challenge of avoidable nursing home patient transfers. Full article

Background/Objectives: The rapid growth of the global aging population, projected to reach 2.1 billion older adults by 2050, presents major challenges for pharmacotherapy and drug delivery. Age-related physiological changes affecting pharmacokinetics and pharmacodynamics, widespread polypharmacy, and functional impairments such as dysphagia, cognitive decline, and sensory or motor limitations reduce the effectiveness and safety of conventional “one-size-fits-all” medication approaches. This review aimed to evaluate the major barriers to effective drug delivery in older adults and to assess emerging patient-centered and technology-driven drug delivery systems designed to improve medication adherence, safety, and therapeutic outcomes in geriatric populations. Methods: A comprehensive narrative review of current literature was conducted focusing on geriatric pharmacotherapy, age-related barriers to medication administration, and advanced drug delivery technologies. The review analyzed evidence regarding modified oral formulations, transdermal systems, long-acting injectables, implantable devices, nanotechnology-based platforms, digital health integrations, pharmacogenomics, biomarker-guided therapy, and deprescribing strategies including STOPP/START criteria and Beers Criteria. Studies addressing polypharmacy, medication adherence, and personalized medicine in older adults were also evaluated. Results: Evidence indicates that older adults experience significant medication-related challenges due to multimorbidity, polypharmacy, and functional decline. Dysphagia affects more than half of nursing home residents, while polypharmacy prevalence reaches up to 86.6% in some populations. Emerging drug delivery technologies demonstrated potential to improve adherence, dosing precision, and patient convenience. Personalized approaches incorporating pharmacogenomics, biomarker-guided treatment, and AI-assisted dosing showed promise for optimizing therapy. However, major limitations remain, including underrepresentation of older adults in clinical trials, limited high-quality evidence supporting many polypharmacy interventions, and insufficient implementation of advanced drug delivery systems in routine clinical practice. Conclusions: Current evidence supports a transition from standardized medication approaches toward flexible, individualized, and patient-centered drug delivery strategies for older adults. Advanced delivery technologies and personalized pharmacotherapy may improve medication safety, adherence, and quality of life in aging populations, although stronger clinical evidence and broader implementation are still needed. Future progress will require interdisciplinary care models, improved geriatric representation in clinical research, and regulatory reforms supporting the integration of innovative drug delivery systems into routine healthcare practice. Full article