Search Results (90)

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

Background: Falls in residential aged care facilities (RACFs) have a significant impact, often leading to costly and unnecessary emergency department (ED) transfers. This scoping review examined the ED discharge proportions and patient characteristics of RACF residents presenting to the ED following a fall, to identify factors that could reduce unnecessary ED transfers. Methods: The databases MEDLINE, CINAHL, Scopus, and Web of Science were searched, resulting in an initial 1385 articles. Nine of these articles met the inclusion criteria and were included in this review. Results: The median age of patients reported in the nine papers ranged from 80.8 to 88 years. Discharge proportions from ED back to RACF ranged from 36% to 91%, with an average of 63%. The studies that reported on computed tomography of the brain (CTB) showed that CTB findings did not significantly influence discharge decisions. Conclusions: Many RACF residents transferred to EDs following falls are discharged without hospital admission. The heterogeneity of study methods makes it challenging to draw definitive conclusions about factors that may help identify patient groups that do not require transfer to the ED following a fall. However, this scoping review highlights potential opportunities to reduce ED transfers from RCAFs. These findings highlight a need for geriatric-specific, person-centred protocols that reduce unnecessary ED transfers while safeguarding quality of care and respecting residents’ advance care preferences. Full article

Background: Older adults living in aged care are at risk of poor health outcomes due to influenza, pneumococcal disease, and herpes zoster infections. Despite these conditions being vaccine-preventable, little is known about vaccine uptake rates in the residential elderly care setting in Australia. Methods: This was a retrospective cohort study examining the medical records of residents of 31 aged care homes in Australia (n = 1108). Data were extracted from medical records for the period March 2023 to September 2023. The proportion of residents vaccinated against influenza, pneumococcal disease, and herpes zoster was calculated. Univariate and multivariate logistic regressions were used to identify possible demographic and other characteristics associated with the vaccination uptake. Results: This study included 1108 residents. Two-thirds (68%) were female, and the median age was 87 years. All residents had one or more comorbidities. Most (92.6%) had received an influenza vaccine within the prior two years, but only 38.3% had received a pneumococcal vaccine, and 16.8% had received herpes zoster vaccination. In all models, receipt of the other vaccines was a significant predictor for vaccine administration. The other factor associated with influenza vaccination was non-consumption of alcohol and younger age for herpes zoster vaccination. Conclusions: While there is a high uptake of influenza vaccines, there is a low uptake of both pneumococcal and herpes zoster vaccines in residents of aged care facilities. Further research into the barriers and enablers of vaccine uptake should be undertaken, with the goal of increasing the vaccination uptake in this vulnerable population. Full article

Background/Objectives: The role of environmental modifications and design in mitigating behavioural symptoms is increasingly being recognised as a way to address the psychosocial needs of individuals with dementia. This study aims to investigate various nature-based interventions for reducing agitation in people with dementia in long-term residential care environments. Methods: Database searches were conducted on MEDLINE, PsycINFO, Scopus, and Web of Science. A literature search was conducted with the following inclusion criteria: (i) peer-reviewed journal publication written in English; (ii) random controlled trials (RCTs) and quasi-experimental design with results for pre- and post-testing reported; (iii) interventions using natural elements, where the effectiveness of the reduction in agitation was measured using a validated instrument; and (iv) participants aged 65 and older with dementia residing in long-term care facilities. Results: This meta-analysis included 29 studies with 733 participants. The results showed that such interventions had a significant negative mean effect on lowering agitation in this population. Additionally, intervention settings (indoor vs. outdoor) and the presence of social interaction were significant predictors of the effect size for agitation reduction. At the same time, no significant differences in effect size were observed between the types of experiences with nature (indirect vs. direct) or the duration of the interventions. Conclusions: This study demonstrates that, when thoughtfully applied, nature-based interventions can significantly alleviate agitation in patients with dementia residing in long-term residential care facilities. This review lays the groundwork for future research aimed at developing design guidelines and planning strategies to integrate natural elements into dementia-friendly environments effectively. Full article

Cognitive–motor integration is the coordination of cognitive and motor processes; it is commonly impaired among people living with dementia (PWD) and may be improved through exercise. This pilot randomized controlled trial (1:1) aimed to determine the effect of 6 months of exercise on cognitive–motor integration compared to usual care in n = 42 PWD at two residential care facilities. Participants completed single- and dual-task standing (30 s of standing while counting backward by 1 s), walking (4 m walk while naming words), and timed-up-and-go (TUG) tests (TUG with a category task), measured using APDM inertial sensors at baseline and 6 months (age = 82 years, 35% female, Montreal Cognitive Assessment = 10.2 ± 5.9, NCT05488951). The adapted Otago Exercise Program involved 60 min of lower-body strength and balance exercises and walking 3x/week for 6 months. Usual care involved regular social activities and healthcare appointments. Exercise provoked increased single-task stride length and increased dual-task TUG turn velocity compared to usual care (p < 0.05). Usual care may reduce the ability to appropriately select cautious gait, as the usual care group exhibited faster dual-task gait speed at 6 months compared to the OEP plus usual care (p < 0.05), which was faster than their single-task gait speed. Our results support implementing the OEP to improve cognitive–motor integration in PWD. Full article

Background: Falls are the leading cause of emergency department (ED) presentations among residential aged care facility (RACF) residents. This study identified the factors influencing the decision to discharge RACF residents from the ED following fall-related presentations. Methods: A single-centred, cross-sectional observational study was conducted in rural Shepparton, Victoria, Australia. The study included residents aged ≥65 in RACFs with fall-related ED presentations between 1 January and 19 November 2024. The main outcome was to determine factors that may prevent unwarranted ED transfers among RACF residents following falls. Statistical methods, including multivariate logistic regression, were used to examine factors associated with ED dispositions. Results: A total of 181 presentations (69.4%) were discharged, and 80 (30.6%) were admitted. The presence of an Advance Care Directive (ACD) (adjusted odds ratio [aOR] = 2.89; 95% confidence interval [CI]: 1.37–6.05) and lower triage levels (aOR = 2.69; 95% CI: 1.06–6.80) increased the odds of discharge. Major injuries (aOR = 0.20; 95% CI: 0.09–0.42) and obvious injuries (aOR = 0.24; 95% CI: 0.10–0.56) reduce discharge chances. Whether computed tomography brain scans were performed or anticoagulation therapy was used did not significantly influence ED discharge chances. Conclusion: In addition to traditional factors associated with ED discharge in post-fall patients from RACFs, an ACD was associated with increased discharge from the ED. Strengthening fall-specific advance care planning, improving ACD accessibility, and enhancing the clinical capacity of RACFs may reduce unnecessary ED transfers and better align care with residents’ goals, particularly in rural settings. Full article

Objective: This study aimed to explore self-care understanding and behaviours among aged-care workers in Australia. It was conducted as part of a project to co-produce a self-care resource for the Australian aged-care workforce. Methods: Semi-structured interviews with eleven aged-care staff and a focus group with four staff at an aged-care facility were undertaken to understand how staff understand and practice self-care and how death and dying affect workers. Thematic analysis was performed using software to generate a data coding tree. Results: Aged-care workers view self-care as taking care of oneself and as being a way to manage and maintain wellbeing so that they can continue to care. As practiced in daily life, self-care is highly individualised, with actions at work and at home having significant impact on a person’s wellbeing. Supportive organisational cultures and collegial teams were found to be particularly relevant in helping staff to deal with death and dying. Conclusions: Aged-care workers may benefit from an online self-care resource tailored to their specific needs and based on their first-hand experiences of working in aged-care. Organisations can support aged-care workers by creating space and time for self-care. Full article

Background/Objectives: Unmet oral health needs of residents in residential aged care facilities (RACFs) arise due to the unique challenges of assessing oral health statuses and maintaining oral healthcare in RACFs. This pilot study assessed the feasibility of using real-time teledentistry under the guidance of a dentist to train RACF staff to undertake an oral health assessment. Methods: An oral health assessment of residents was first conducted by RACF staff at two Queensland, Australia RACFs using the Oral Health Assessment Tool, with an intra-oral camera connected to a laptop, through videoconferencing, under the guidance of a dentist. A survey recorded the views of RACF staff on the acceptability of the teledentistry method. The quality of the images obtained through the camera was assessed by the dentist. Finally, cost-effectiveness was calculated between teledentistry and traditional face-to-face assessments. Results: Sixteen residents (mean age 79.3 ± 8.68 years) and eight staff (mean age 33.3 ± 6.16 years) participated in this study. Both RACF staff and residents found that the real-time teledentistry set-up was user-friendly, while the dentist rated the quality of the images as acceptable for diagnostic purposes. Real-time teledentistry was more cost-effective than bringing a dentist on-site, while taking the RACF residents to an off-site dental office for examination was the most expensive approach. Conclusions: Real-time teledentistry is feasible and cost-effective, and it is an acceptable alternative to a face-to-face clinical exam for oral health assessment in RACFs. This approach could be used in RACFs where wireless internet connectivity is available. Full article

The demographic trends of an aging global population present significant challenges and opportunities for healthcare, particularly in providing optimal care environments for older adults living in long-term care facilities, with it being imperative to ensure these environments provide basic care and promote overall well-being through enhanced environmental comfort. This scoping review intends to show evidence-based practices enhancing the environmental comfort of institutionalized older people. Following the Joanna Briggs Institute’s methodology, this scoping review’s inclusion criteria included studies in English, Portuguese, or Spanish between 2013 and 2023, focused on institutionalized people over the age of 65 years residing in long-term care settings where nurses implemented strategies or interventions designed to enhance environmental comfort in which older residents themselves directly evaluated, indexed in Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Psychology and Behavioral Sciences Collection, DART-Europe, or Repositório Científico de Acesso Aberto de Portugal (RCAAP). Out of 497 initially retrieved studies, none of them met the established criteria, leading this study to be an empty review. The absence of studies meeting the inclusion criteria indicates a significant gap in the existing literature, highlighting the need for specialized training programs that equip nurses with the skills and knowledge to implement effective comfort-enhancing interventions, ensuring that the unique and challenging needs of older people are covered. Full article

Background: The increasing number of institutionalized older individuals worldwide stresses the need to evaluate the association between the functional profile of institutionalized older adults and their quality of life (QoL), depressive symptoms and feelings of loneliness. Methods: A cross-sectional study was conducted in 19 residential facilities in Alentejo, Portugal. Between March and September 2023, all individuals aged ≥65 years were invited to complete a structured questionnaire (n = 1303). Sociodemographic and clinical data were collected, and validated scales for the Portuguese older population were used. Linear regression and unconditional binary logistic models were computed. Results: The highest level of dependence was observed in the self-care dimension (mean (SD) = 2.93 (1.21)), with 40% of participants exhibiting levels of dependence requiring daily care or total replacement. QoL was inversely associated with functionality in all dimensions, as well as with severe or complete dependence, even after adjusting for sex, age and education. Participants with depressive symptoms and feelings of loneliness were, respectively, three and two times more likely to be dependent on care (adjusted OR = 3.69, 95% CI: 1.80–7.52; adjusted OR = 2.04, 95% CI: 1.07–3.87). Conclusions: Public policies and interventions should include social and emotional support strategies alongside traditional medical interventions. Full article

Agitation is one of the most common and persistent behavioral and psychological symptoms among persons with dementia (PWD) in residential aged care facilities (RACFs). While most studies have explored the general impact of COVID-19 on the mental health and well-being of aged care residents, there has been limited research on the pandemic’s impact on agitation in dementia within RACFs. This knowledge is crucial to ensuring that RACFs are better equipped to handle future public health emergencies. Therefore, this retrospective cohort study investigates the impact of the pandemic on agitation incidents within 40 Australian RACFs. Using Python, we extracted agitation symptoms from nursing notes and compared the frequency and percentage of symptom occurrence pre-pandemic versus during-pandemic. Chi-square tests examined any significant change in the prevalence of dementia and agitation in dementia between the comparative groups and periods. Dementia prevalence dropped significantly during the second year of the pandemic, with a concurrent increase in early-onset dementia cases. Overall, agitation symptoms decreased by 20.1%, but six symptoms significantly increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%). Conversely, pacing decreased by 15.88% and speaking loudly decreased by 10.9%. Over half of the care recipients with dementia experienced agitation symptoms 2–5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021. Despite the co-occurrence of symptoms such as falls, confusion, and weakness, there was no evidence to suggest that these comorbidities were specific to COVID-19; rather, they appeared to be prevalent even before the pandemic. Persons with agitation in dementia had a significantly higher death rate during the COVID-19 pandemic than otherwise. Full article

Background: Older adults in residential aged care facilities (RACFs) experience disproportionate levels of poor oral health relative to other groups in the general population, affecting their physical and mental wellbeing. The Oral Health Assessment Tool (OHAT) is a validated and widely used dental assessment tool; however, recent systematic reviews have identified shortcomings with respect to its measurement properties. Objective: The objective of this protocol is to provide a detailed overview of a multidisciplinary qualitative study that aims to (a) co-design and develop a modified OHAT for RACFs and (b) inform the development of an OHAT training package and implementation strategies. Methods: This study will utilize a co-design methodology with aged care residents, caregivers, staff members, and health professionals. The co-design workshops will: (1) investigate the barriers to and enablers of optimal oral healthcare in RACFs; and (2) co-design a modified version of the Oral Health Assessment Tool and a referral to treatment pathway that is appropriate for use in RACFs. The co-design workshops will facilitate group discussion and involve interactive activities using, for example, mind mapping and Sticky Notes. Qualitative data (transcripts and artefacts from co-design activities) will be analyzed in NVivo using an inductive codebook thematic analysis, specifically a template analysis. Conclusion: The findings of this study will inform a modified OHAT (M-OHAT), as well as future study phases regarding training and implementation strategies. It is expected that the M-OHAT will have enhanced usability and relevance to RACFs, facilitating the identification of poor oral health and timely referral to dental treatment. Full article

Female-friendly public spaces are crucial for the sustainable development of old residential communities. To advance the development of female-friendly public spaces in Beijing’s old residential communities, this study employs a method that integrates the Kano model with an importance–performance analysis. The research focuses on the public spaces of Baiwanzhuang in Beijing, specifically targeting female users. Field research, including interviews and surveys, is conducted to understand women’s needs in these spaces. Based on this, an evaluation index system is developed, and data from questionnaires distributed to women are analyzed using the Kano model and importance–performance metrics. The study classifies female users into four age groups to address their specific needs and proposes targeted strategies for enhancing female-friendly features in public spaces. This paper proposes a quantitative evaluation method for public spaces in old residential communities of Beijing, which combines the Kano model with IPA and is grounded in the perspective of female-friendliness. This research offers valuable insights for the revitalization of old residential communities and support for the diversification of public areas. The results indicate that increasing the types of public spaces, enriching public space facilities, enhancing the aesthetic appeal of public spaces, and promoting social care can improve the female-friendly level of public spaces in old residential communities. Full article

As the aging population in China increases, home-based elderly care is set to become the main mode of elderly care in the future. The construction of community elderly care service facilities is receiving more and more attention from society. Currently, residential area design standards in China lack clear guidance on the spatial planning of facilities, which will lead to unreasonable facility layout planning and insufficient convenience in the utilization of facilities by the elderly. Fully considering the distribution characteristics of community elderly care service facilities and the needs of the community life circle when planning residential areas can effectively solve this problem. This study takes Xi’an City as the research object, based on the theory of life circle, through questionnaire surveys and cluster analysis, analyzes the current situation of the construction of elderly care service facilities and the characteristics of the use by the elderly. Combined with the community life circle model, the study scope is divided into community life circle levels, and put forward the planning strategies of coverage rate, number, richness, and spatial layout of the facilities, respectively. These strategies are designed to enhance the quality of life for seniors, ensuring that they have access to essential support and resources within their communities. It demonstrated that middle-aged elderly prefer community canteens and activity centers, while those with limited mobility and multiple chronic diseases have a higher demand for health service centers and community canteens. The utilization weight analysis shows that vegetable markets and supermarkets are most frequently used, whereas health service centers are the least utilized. The research proposes strategic planning enhancements, including full coverage of basic facilities, targeted increases in high-demand facilities, and tailored facilities for elderly characteristics. It recommends cross-community layouts to ensure service radius coverage, development reservations for future needs, and quality improvements to address the low satisfaction rates of existing facilities. The study concludes that a targeted approach to facility planning, considering the elderly’s diverse needs, can enhance the community elderly care service system’s sustainability and effectiveness. Full article

As the population ages, the living environment for the elderly is receiving more attention. “Multi-Purpose Residential Architecture” is transforming the traditional ways of building horizontally to meet a person’s daily activity and living needs. We surveyed 140 seniors over the age of 55 years to find their perspectives on building and expanding space vertically. Differences between the needs and expectations for living spaces between different ages of seniors were found. There are not enough facilities and space in Taiwan to meet the seniors’ needs for their daily lives, social activities, care, and other support. Full article