Person-centered care in Chinese residential care facilities: a preliminary measure

Objectives: Person-centered care (PCC) is one of the most desirable approaches for elderly with dementia. However, it has not been initiated and systematically studied in China, on which lacking of reliable and valid measurement tools is one of the key barriers. This paper aims to validate person-centered care assessment tools (P-CAT) in a Chinese context.

Method: The original 13-item was translated and back translated. And 11 items were added based on literature review and expert consultation. The resulting 24-item P-CAT-C was validated among a sample of formal caregivers (n = 330) in all 34 residential care facilities in urban Xi’an, a representative city in north-western China. Chinese versions of staff-based measures of individualized care for institutionalized persons with dementia (IC) and caregiver psychological elder abuse behavior (CPEAB) scale were used to test the criterion validity.

Results: Confirmatory factor analysis (CFA) showed that a three-factor 15-item solution provided adequate fit indices to the data (χ² = 145.691, df = 81, p < 0.001, comparative fit index (CFI) = 0.926, Tucker-Lewis index (TLI) = 0.905, root mean square error of approximation (RMSEA) = 0.050). Four new items were identified and two original items were excluded. The three factors are named as (1) individualized care (6-item); (2) organizational support (6-item); and (3) environmental accessibility (3-item). The internal consistency coefficient (Cronbach's α = 0.684) is satisfactory. The interscale correlation among P-CAT-C, IC, and CPEAB showed good criterion validity.

Conclusion: P-CAT-C is a culturally adapted version of the original P-CAT, which showed satisfactory reliability and validity for evaluating PCC in Chinese residential care facilities. It also provides insight to other developing countries.     

End-of-life care policies in Flemish residential care facilities accommodating persons with intellectual disabilities

Objective This article aims to describe the presence, content and implementation strategies of written policies on end‐of‐life decisions in Flemish residential care facilities (RCFs) accommodating persons with intellectual disabilities (ID), and to describe training, education and quality assessments of end‐of‐life care. Methods A cross‐sectional mail survey was conducted among general directors of all RCFs accommodating persons with ID (n = 140) in Flanders, Belgium. Institutions were asked to provide us with a copy of their end‐of‐life care policy documents for content analysis. Results Of the 140 institutions, 84 (60%) completed the questionnaire and 25 institutions provided 45 policy documents. Presence of policies on specific end‐of‐life decisions with a possible life‐shortening effect lay between 18% (palliative sedation) and 26% (withdrawing or withholding of life‐prolonging treatment). The content analysis showed that the focus in the majority of these policy documents is on palliative care, while end‐of‐life decisions with a possible life‐shortening effect are mentioned but rarely elaborated on. Furthermore, few documents incorporate the distinctive features and needs of persons with ID regarding end‐of‐life care. On the other hand, half of the institutions trained and educated their professional care providers in some aspects of end‐of‐life care while one‐third assessed the satisfaction of residents and families on several of these aspects. However, more than half reported explicitly that they have no plans for such assessments. Conclusions The presence of end‐of‐life care policies is low in Flemish RCFs and their content is not very specific for persons with ID.     

A survey of people with intellectual disabilities living in residential aged care facilities in Victoria

Background Australia's national ageing policy recognises that people ageing with intellectual disability (ID) require particular attention, yet there is no policy framework concerning this population. This study describes the distribution and characteristics of people with ID in residential aged care in Victoria, provides insights into the pathways they take into aged care, and gives some indications of how facilities adapt to their needs. Method A postal survey was sent to 826 residential aged care facilities in Victoria, seeking information from directors about their residents with ID. Facilities that responded were fairly representative of all facilities in Victoria. Findings Residents with ID were younger, had entered at an earlier age and remained longer than other residents. Their reported dependency profile was similar to the general aged care population, although the incidence of dementia was lower. Primary areas of concern identified by providers were: inability to fit into the resident community, lack of participation in activities and lack of meaningful relationships. Conclusion This study provides a first glimpse into how older people with ID find their way into aged care and how others view their experiences once there. It suggests that further investigation is required into the accuracy of assessment undertaken prior to entry to more clearly understand whether residents with ID are inappropriately placed in residential aged as a result of a shortage of disability accommodation and inadequate resources to support aging in place for those in such accommodation.     

The use of psychotropic drugs for behavioral and psychological symptoms of dementia among residents in long-term care facilities in Japan

Objective: To examine whether the use of psychotropic drugs (PDs) was related to behavioral and psychological symptoms of dementia (BPSD) focusing on the prevalence, numbers of symptoms, severity, and care burden among the elderly with BPSD living in long-term care facilities in Japan.

Method: We conducted a cross-sectional survey among older people with dementia or similar symptoms (n = 312) using a questionnaire for care staff in 10 selected long-term care facilities. A brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD.

Results: PDs were used in 45% among all participants and 47.5% among those exhibiting at least one BPSD. We found that use of PDs was associated with greater numbers, severity, and care burden of BPSD. Also, there was significantly more use of PDs among people who had specific BPSD symptoms, such as delusions, anxiety, and disinhibition, compared with those who did not.

Conclusion: The use of PDs among residents in long-term care facilities with dementia or similar symptoms was relatively low compared with previous reports from other countries. Nonetheless, the greater numbers, severity, and care burden of BPSD were associated with the use of PDs.     

Direct health and residential care costs of people living with dementia in Australian residential aged care

Objectives

This analysis estimates the whole‐of‐system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.

Methods

Data were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals.

Results

The average annual whole‐of‐system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out‐of‐hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia.

Conclusion

This study provides the first estimate of the whole‐of‐system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom‐up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top‐down, population costing approaches are taken.     

The needs of older people with dementia in residential care

BACKGROUND: People with dementia often move into care homes as their needs become too complex or expensive for them to remain in their own homes. Little is known about how well their needs are met within care homes. METHOD: The aim of this study was to identify the unmet needs of people with dementia in care and the characteristics associated with high levels of needs. Two hundred and thirty-eight people with dementia were recruited from residential care homes nationally. Needs were identified using the Camberwell Assessment of Needs for the Elderly (CANE). RESULTS: Residents with dementia had a mean of 4.4 (SD 2.6) unmet and 12.1 (SD 2.6) met needs. Environmental and physical health needs were usually met. However, sensory or physical disability (including mobility problems and incontinence) needs, mental health needs, and social needs, such as company and daytime activities, were often unmet. Unmet needs were associated with psychological problems, such as anxiety and depression, but not with severity of dementia or level of dependency. CONCLUSION: Mental health services and residential home staff need to be aware that many needs remain unmet and much can be done to improve the quality of life of the residents with dementia.     

Functional status and depressive symptoms among older adults from residential care facilities in the Czech Republic

BACKGROUND: Depressive symptoms are common among older adults, particularly those living in long-term care facilities. However, little is known about factors associated with depressive symptoms among long-term care residents in the Czech Republic and in other Eastern European countries. Moreover, the role of mobility and pain in depressive symptoms among long-term care residents is relatively understudied. OBJECTIVE: We examined the relationship between functional status and depressive symptoms in 308 older adults from residential care facilities (RCFs) in the Czech Republic. METHOD: We used baseline data from two randomized controlled trials testing the effects of dance and reminiscence therapies on quality of life in older RCF residents. Functional status was measured as cognitive function, general ability to perform basic Activities of Daily Living (ADLs), mobility, and functional limitation by pain. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. RESULTS: In multiple regression analyses adjusted for sociodemographic factors and taking antidepressants, we found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms. The ability to perform basic ADLs and mobility were also related to depressive symptoms. CONCLUSION: Our findings suggest factors that may be important in efforts to improve psychological well-being in this population.     

The prediction of mental health service use in residential care

The purpose of this study was to characterize the clinical and psychosocial factors of residents living in psychiatric nursing homes, assess residents' levels of mental health service utilization, and examine the factors that predict the utilization of mental health services. Data were collected from 200 randomly selected residents with schizophrenia living in four intermediate care facilities. Fewer than 60% of residents received mental health services beyond medication and nearly one-half of the residents were readmitted to the hospital in the course of a year. Family contact and involvement in activities were associated with mental health service utilization. Hospital readmission was predicted, not by substance use, but rather by not using substances. There is a growing need among service providers to better identify relevant factors that are important in treatment planning and service delivery. Attention to these issues may impact treatment provision and outcomes for persons with schizophrenia and their families.     

A narrative exploration of older people's transitions into residential care

Objectives: Moving into residential care has been argued to be a significant life transition for older people, often resulting in stress and anxiety. This research aimed to explore qualitatively older people's experiences of this transition, including how relocation is reflected upon and incorporated into their personal narratives.

Method: Eight older adults (65–97 years) living in a residential facility for between three and 12 months participated in interviews focussed on their experiences of relocating to a residential care home.

Results: Narrative analysis revealed that rather than depicting time bound stages of transition, participants’ experiences reflected key plots of ‘control’, ‘power’, ‘identity’ and ‘uncertainty’ interwoven throughout their narratives. Participants experienced some difficulties in incorporating this transition into their life stories. Furthermore, participants discussed not feeling confident in their decision to move, living in constant fear of losing their memory, and limited expectations for their future.

Conclusion: Professionals should move away from considering transition as a stage-based process ending in acceptance, instead focussing on how residents perceive relocation in relation to previous life experiences, unspoken fears evoked by moving and how the environment and relationships with staff may be altered to assist residents in maintaining their identity and sense of control.     

Protection from clinical depression in medical long-term care facilities: Evidence for psychologic adaptation in cognitively intact patients

A recent study in a medical long-term care facility (LTCF) population demonstrated evidence of psychologic adaptation in a predominantly demented population. We have also reported evidence of such adaptation which lowered the risk of depression in an LTCF sample. The present study extends the adaptational variables for depression compares areas of agreement between the dementia and depression studies, reviews the adaptational construct, and suggests clinical applications targeted to primary prevention of depression in this setting.     

An evaluation of two models of long-term residential care for elderly people with dementia

This article reports the findings of a prospective study of two residential units for elderly people with dementia: a community hospital ward (unit 1) providing an enhanced version of traditional hospital care and a scheme developed in partnership with a charity (unit 2) operating an explicit policy emphasizing resident choice, opportunity, support and independence. Residents, staff and unit policy were assessed at baseline in long-stay mental hospital wards, and at 6 months and 12 months after relocation. The Quality of Interactions Schedule (QUIS) was carried out on one occasion on a comparison long-stay mental hospital ward, at 12 and 24 months in unit 1 and at 6 and 12 months in unit 2. At 12 months, there was an increase in the quality but not the number of staff– resident interactions observed in unit 1, compared to the long-stay ward: both number and quality had improved on this unit at 24 months. Much larger increases in number and quality of interactions were observed in unit 2 at both 6 and 12 months. These changes were associated in unit 2 but not unit 1 with a decrease in observed depression, no decline in self-care (ADL) and improvement in communication skills over the follow-up period. There was a significant excess mortality in the unit 2 cohort at 6 months, but there was no difference at 12 months. At 12 months, staff on both units reported good levels of job satisfaction and morale.     

Agism and burnout among nurses in long-term care facilities in Israel

Objectives: The extent to which agism and professional qualifications are associated with nurses' burnout in long-term care facilities for older adults has been barely examined. This study is aimed to examine the extent to which agism, professional education, and geriatric training explain work burnout.

Method: The study included a convenience sample of 154 nurses working in 17 long-term care facilities in the Tel Aviv area in Israel. To examine agism, Kogan's Attitudes toward Old People Scale was used, and to probe burnout, the Maslach Burnout Inventory was used.

Results: Overall burnout was significantly explained by agism, nurses' professional education, length of working as a nurse, and type of facility ownership. When examining each dimension of burnout, agism was a significant predictor of depersonalization and personal achievement.

Conclusion: Agism plays a role in overall burnout. Therefore, training programs that can combat agism can reduce burnout of nurses in long-term care facilities.     

Prevalence of Helicobacter pylori in people with intellectual disability in a residential care centre in Israel

Background In 1982, Helicobacter pylori (formerly Campylobacter pylori) was identified as a pathogenic factor in peptic ulcer disease by researchers from Australia. Because only a small number of studies of H. pylori infection have been conducted in people with intellectual disability (ID), and none of these were done in Israel, the present authors decided to conduct a pilot study on its prevalence in this population. Methods The Israeli Division for Mental Retardation provides services to over 6000 people in 54 residential care centres (or institutions), and one centre in the south of the country with kibbutz‐style living arrangements was selected for this pilot study. The study was performed as part of the yearly routine medical examination of all residents, and blood specimens were drawn for IgG antibodies to H. pylori (ELISA). Results Out of the 47 individuals screened, 75% (n = 36) were seropositive. Conclusion In addition to the reported high rates of H. pylori infection in residents with ID living in large facilities, the present pilot study suggests that people with ID living in smaller, kibbutz‐style arrangements are also at high risk.     

Factors associated with antidepressant treatment in residential care: changes between 1990 and 1997.

BACKGROUND: Depression is common among older people living in residential and nursing homes. Detection and treatment of late life depression may be sub-optimal in these settings. AIM: To report the changes in, and factors associated with, antidepressant use among residents in care homes in 1990 and 1997. METHOD: Censuses of those aged 65 years and over in any type of residential care in the county of Leicestershire, UK, on 27 November 1990 and 30 November 1997. Care staff were asked to complete an assessment form for each resident which included a rating of depression and use of antidepressants. RESULTS: The use of antidepressants increased from 11% (484/4415) in 1990 to 18.9% (777/4111) in 1997. Severity of depression as assessed by care staff, gender, younger age, better cognitive functioning, and use of other medications were consistently associated with antidepressant treatment. Antidepressant use was associated with better physical functioning (p = 0.001) in 1990 and frequency of falls in 1997 (p = 0.044). CONCLUSIONS: Increased use of antidepressants appears to be due to the wider range of antidepressant drugs available since 1990. However there is a need for better methods for care staff to detect depression in residents, and for appropriate action to be taken by those responsible for their medical management.