Younger Nursing Home Residents: A Scoping Review of Their Lived Experiences,Needs, and Quality of Life

ObjectivesThe percentage of younger nursing home (NH) residents (ages 18–64 years) in some countries such as the United States and Canada has been increasing over the years. In fact, it is generally held that younger NH residents are considerably different from the older residents (age ≥65 years). There is a need to understand who they are, why they resided in NHs, and their quality of life (QoL). The aims of the study were to describe the experiences, needs, and QoL among younger residents living in NHs.DesignScoping review.Settings and Participants(Younger) Residents of NHs.MethodsFive databases (PubMed, CINAHL, PsycINFO, Web of Science, and Scopus) and Google Scholar were used to search for relevant studies. PRISMA diagram was used to guide this scoping review.ResultsThe key findings of the study cover 5 themes: (1) Confinement, (2) Lack of socialization, (3) Lack of privacy, (4) Lack of appropriate settings, and (5) Loss of identity, as well as results of QoL were generated.Conclusions and ImplicationsThis scoping review provides a deeper understanding of the lived experiences, needs, and QoL among younger NH residents. The results provide suggestions for future studies regarding new interventions to optimize the QoL of NH residents.     

Factors Associated With the Quality of Life of Nursing Home Residents During the COVID-19 Pandemic: A Cross-Sectional Study

ObjectivesQuality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL.DesignCross-sectional study (July to December 2021).Setting and ParticipantsWe purposefully selected 9 NHs in Alberta, Canada, based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). We included data for 689 residents from 18 care units.MethodsWe used the DEMQOL-CH to assess resident QoL through video-based care aide interviews. Independent variables included a COVID-19 outbreak in the NH in the past 2 weeks (health authority records), care unit-levels of care aide burnout (9-item short-form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit (validated surveys), and resident covariates (Resident Assessment Instrument–Minimum Data Set 2.0).ResultsRecent COVID-19 outbreaks (β = 0.189; 95% CI: 0.058–0.320), higher proportions of emotionally exhausted care aides on a care unit (β = 0.681; 95% CI: 0.246–1.115), and lack of access to geriatric professionals (β = 0.216; 95% CI: 0.003–0.428) were significantly associated with poorer resident QoL.Conclusions and ImplicationsPolicies aimed at reducing infection outbreaks, better supporting staff, and increasing access to specialist providers may help to mitigate how COVID-19 has negatively affected NH resident QoL.     

The Course of Quality of Life and Its Predictors in Nursing Home Residents With Young-Onset Dementia

ObjectiveTo explore the course of quality of life (QoL) and possible resident-related predictors associated with this course in institutionalized people with young-onset dementia (YOD).DesignAn observational longitudinal study.Setting and ParticipantsA total of 278 residents with YOD were recruited from 13 YOD special care units in the Netherlands.MethodsSecondary analyses were conducted with longitudinal data from the Behavior and Evolution in Young-ONset Dementia (BEYOND)-II study. QoL was assessed with proxy ratings, using the Quality of Life in Dementia (QUALIDEM) questionnaire at 4 assessment points over 18 months. Predictors included age, gender, dementia subtype, length of stay, dementia severity, neuropsychiatric symptoms, and psychotropic drug use at baseline. Multilevel modeling was used to adjust for the correlation of measurements within residents and clustering of residents within nursing homes.ResultsThe total QUALIDEM score (range: 0-111) decreased over 18 months with a small change of 0.65 (95% confidence interval −1.27, −0.04) points per 6 months. An increase in several domains of QoL regarding care relationship, positive self-image, and feeling at home was seen over time, whereas a decline was observed in the subscales positive affect, social relations, and having something to do. Residents with higher levels of QoL and more advanced dementia at baseline showed a more progressive decline in QoL over time. Sensitivity analyses indicated a more progressive decline in QoL for residents who died during the follow-up.Conclusion and ImplicationsThis study shows that although overall QoL in nursing home residents with YOD was relatively stable over 18 months, there were multidirectional changes in the QoL subscales that could be clinically relevant. Higher levels of QoL and more advanced stages of dementia at baseline predicted a more progressive decline in QoL over time. More longitudinal studies are needed to verify factors influencing QoL in YOD.     

The Association Between Quality of Care and Quality of Life in Long-Stay Nursing Home Residents With Preserved Cognition

ObjectivesTo assess the overall quality of life of long-stay nursing home residents with preserved cognition, to examine whether the Centers for Medicare and Medicaid Service's Nursing Home Compare 5-star quality rating system reflects the overall quality of life of such residents, and to examine whether residents' demographics and clinical characteristics affect their quality of life.Design/measurementsQuality of life was measured using the Participant Outcomes and Status Measures—Nursing Facility survey, which has 10 sections and 63 items. Total scores range from 20 (lowest possible quality of life) to 100 (highest).Setting/participantsLong-stay nursing home residents with preserved cognition (n = 316) were interviewed.ResultsThe average quality- of-life score was 71.4 (SD: 7.6; range: 45.1–93.0). Multilevel regression models revealed that quality of life was associated with physical impairment (parameter estimate = −0.728; P = .04) and depression (parameter estimate = −3.015; P = .01) but not Nursing Home Compare's overall star rating (parameter estimate = 0.683; P = .12) and not pain (parameter estimate = −0.705; P = .47).ConclusionThe 5-star quality rating system did not reflect the quality of life of long-stay nursing home residents with preserved cognition. Notably, pain was not associated with quality of life, but physical impairment and depression were.     

Factors Associated With Low and High Social Engagement Among Older Nursing Home Residents in Korea

ObjectivesWith the increase in older adults receiving long-term care in facilities, the level of social engagement within nursing homes is a growing concern for improving the quality of life of residents. This study seeks to assess the level of social engagement and identify the factors associated with high and low engagement among older adults in Korean nursing homes.DesignCross-sectional study.Setting and ParticipantsData were obtained from a nationally representative sample of 1453 older residents in 92 long-term care facilities across Korea.MethodsMultilevel-multivariate analyses were carried out to identify individual- and institution-level risk factors of social engagement, as measured by the Revised Index of Social Engagement (RISE).ResultsThree-fourths of older residents had a low level of social engagement, whereas only about one tenth showed a high level of social engagement. Being male, having severe functional impairments, having depression, and having no supportive family relationships were risk factors for low social engagement. Conversely, a high level of social engagement was significantly associated with being female, having no impairments, and a longer length of stay. Meeting staffing requirements for personal care assistants, an institution-level factor, was negatively associated with low social engagement and positively associated with high social engagement.Conclusions and ImplicationsLow social engagement is very common in Korean nursing homes and is concentrated among those with poor functional and social outcomes. Future efforts to improve long-term care will need to address the various factors associated with social engagement in designing social care for nursing home residents.     

Nursing Home Star Ratings and New Onset of Depression in Long-Stay Nursing Home Residents

ObjectivesTo examine the association between nursing home (NH) quality and new onset of depression and severity of depressive symptoms in a national cohort of long-stay NH residents in the United States.DesignCohort study.Setting and participants129,837 long-stay residents without indicators of depression admitted to 13,921 NHs.MethodsNH quality was measured by Nursing Home Compare star ratings (overall, health inspection, staffing, quality measures) closest to admission. Study outcomes at 90 days from the Minimum Data Set 3.0 included depression diagnosis and severity of depressive symptoms (minimal; mild; moderate; moderately severe/severe). Symptoms were measured by resident self-report Patient Health Questionnaire (PHQ-9) or a staff-report observational version (PHQ-9-OV). Logistic and multinomial logistic models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).ResultsAt 90 days postadmission, 14.1% of residents had a new diagnosis of depression, and odds did not differ across star ratings. Nearly 90% of these residents had minimal depressive symptoms, with only 8.5% reporting mild symptoms and 2.6% with moderate to severe symptoms. Using minimal depressive symptoms as the reference, residents in NHs with 5-star overall ratings were 12% less likely than those in 3-star NHs to experience mild (95% CI: 0.81-0.96) and 31% less likely to experience moderate symptoms (95% CI: 0.58-0.82). In NHs with 1-star staffing compared to 3-star, residents had 37% higher odds of moderate symptoms (95% CI: 1.14-1.64) and 57% higher odds of moderately severe to severe depressive symptoms (95% CI: 1.17-2.12). The odds of any above-minimal depressive symptoms decreased as quality measure ratings increased.Conclusions/ImplicationsLower NH quality ratings were associated with more severe depressive symptoms. Further investigation is warranted to identify potential mechanisms for a targeted intervention to improve quality and provide more equitable care.     

Diapers as Promising Alternative Collection Method for Urine Specimens in Nursing Home Residents: A Noninferiority Study

ObjectiveThere is unmet need for an easy, noninvasive urine collection method to diagnose urinary tract infections (UTIs) in nursing home residents suffering from urinary incontinence or cognitive impairments. UTIs are highly prevalent in nursing home residents, and urine specimen collection can be difficult. The objective of this study was to assess if urine specimens collected from super-absorbing incontinence pads (adult diapers) are a reliable collection method for UTI diagnosis.DesignThis was a paired noninferiority laboratory study, in which pairing refers to UTI diagnostics performed directly using clinical urine specimens (reference specimen) and indirectly using urine extracted from diapers (diaper specimen).Setting and participantsIn this study, remnants of 250 clinical urine specimens were used to assess noninferiority in diagnosing UTIs, based on a 1-sided type I error of 2.5%, a power of 90%, and a noninferiority margin of 15%.MethodsUrine specimens were poured on super-absorbing disposable adult diapers and extracted after 3 hours, to use for dipstick urinalysis and bacterial culture. UTIs were defined as presence of leukocytes and a positive bacterial culture. Noninferiority was assessed by calculating a Wald-type test statistic.ResultsNoninferiority was established for diagnosing UTIs in diaper specimens, and for each of its components (dipstick leukocyte detection and bacterial culture positivity). Positive bacterial cultures were found in 72 (29.0%) diaper specimens compared with 65 (26.2%) reference specimens (difference ?2.8%, 97.5% CI ?7.1% to 1.5%). Leukocytes were present in 162 (64.8%) diaper specimens, compared with 175 (70.0%) reference specimens (difference ?5.7%, 97.5% CI: ?10.6% to ?0.7%).Conclusion and implicationsOur results on diagnosing UTIs, by dipstick analysis and bacterial cultures, using super-absorbing adult diapers are promising. Before translation into clinical practice, further studies are needed to evaluate the risk of bacterial contamination by wearing adult diapers, possibly resulting in overdiagnosis of UTI.     

A Novel Collaborative Care Program to Augment Nursing Home Care During and After the COVID-19 Pandemic

The 2019 novel coronavirus (COVID-19) pandemic created an immediate need to enhance current efforts to reduce transfers of nursing home (NH) residents to acute care. Long-Term Care Plus (LTC+), a collaborative care program developed and implemented during the COVID-19 pandemic, aimed to enhance care in the NH setting while also decreasing unnecessary acute care transfers. Using a hub-and-spoke model, LTC+ was implemented in 6 hospitals serving as central hubs to 54 geographically associated NHs with 9574 beds in Toronto, Canada. LTC+ provided NHs with the following: (1) virtual general internal medicine (GIM) consultations; (2) nursing navigator support; (3) rapid access to laboratory and diagnostic imaging services; and (4) educational resources. From April 2020 to June 2021, LTC+ provided 381 GIM consultations that addressed abnormal bloodwork (15%), cardiac problems (13%), and unexplained fever (11%) as the most common reasons for consultation. Sixty-five nurse navigator calls addressed requests for non-GIM specialist consultations (34%), wound care assessments (14%), and system navigation (12%). One hundred seventy-seven (46%, 95% CI 41%-52%) consults addressed care concerns sufficiently to avoid the need for acute care transfer. All 36 primary care physicians who consulted the LTC+ program reported strong satisfaction with the advice provided. Early results demonstrate the feasibility and acceptability of an integrated care model that enhances care delivery for NH residents where they reside and has the potential to positively impact the long-term care sector by ensuring equitable and timely access to care for people living in NHs. It represents an important step toward health system integration that values the expertise within the long-term care sector.     

Effects of Acupressure on Sleep Quality and Psychological Distress in Nursing Home Residents: A Randomized Controlled Trial

ObjectiveTo compare the efficacy of acupressure with sham acupressure in older-adult nursing home residents presenting with poor sleep quality and psychological distress.DesignProspective, randomized, double-blind, sham-controlled trial.Setting and participantsSixty-two nursing home residents with poor sleep quality and psychological distress participated in this study. Participants were randomly assigned to an experimental group (n = 31) receiving acupressure at true acupoints (Baihui, Juque, Neiguan, Tianzhu, and Yongchung) or control group (n = 31) receiving acupressure at sham points. All participants received 20 minutes of acupressure before sleeping 3 times a week for 8 weeks. All participants were blinded to group allocation.MeasuresSleep quality and psychological distress were measured using the Pittsburgh Sleep Quality Index and the Kessler Psychological Distress scale, respectively. Both groups' outcomes were assessed by assessors blinded to group allocation at the baseline, the end of the intervention, and 1 month after the intervention.ResultsThe experimental group demonstrated significantly more improvement in sleep quality than did the control group at the end of the intervention (10.5 vs 13.3) and 1 month after the intervention (8.3 vs 14.2; both P ≤ .001). Moreover, the experimental group had lower psychological distress levels than did the control group at 1 month after the intervention (14.6 vs 17.9, P = .05). Furthermore, significant differences in mean sleep quality (F = 60.8, P < .001) and psychological distress (F = 24.6, P < .001) were observed in the experimental group between the measurements at baseline and after the intervention.ConclusionsAcupressure at true acupoints improves sleep quality, reduces psychological distress, and provides more clinically beneficial effects compared with that at sham points. Future studies should examine whether these effects are maintained in the long term.     

Quality of Life and Pneumonia in Nursing Home Residents: A 1-Year Observational Study

ObjectivesTo compare the evolution of quality of life (QoL) in nursing home residents (NHRs) with and without (hospitalization for) pneumonia.DesignTwelve-month prospective, observational study.Setting and ParticipantsParticipants of the Incidence of pNeumonia and related ConseqUences in nursing home Resident (INCUR) study were included. The INCUR study included 800 NHRs in France for which comprehensive assessments were performed at baseline, 6 months, and 12 months in 2012-2013.MethodsParticipants’ health related QoL was assessed at 3 time points: baseline, 6 months, and 12 months. NHRs with or without pneumonia and hospitalizations for this condition at any time during follow-up were compared using adjusted mixed effects linear regressions on the QoL outcome. Pre- and postpneumonia QoL were compared using a Wilcoxon signed-rank test.ResultsA total of 622 NHRs (mean age 86.2 years; 73.3% women) were included; 13.8% (n = 86) died, 19.9% (n = 124) developed at least 1 episode of pneumonia and 6.4% (n = 40) were hospitalized for pneumonia. Median QoL was 70 at baseline [n = 436, interquartile range (IQR) = 50-90], 80 at 6 months (n = 546, IQR = 50-90), and 76 at 12 months (n = 468, IQR = 50-80). QoL in NHRs with pneumonia showed a 2-point decrease during the 12-month follow-up, whereas QoL in NHRs without pneumonia showed an 8-point increase during follow-up. QoL in NHR hospitalized for pneumonia showed a 16-point decrease during the 12-month follow-up, whereas QoL in NHRs in the control group showed a 6-point increase. In linear regressions, neither pneumonia nor hospitalization for pneumonia were significantly associated with the evolution of QoL during follow-up. No significant difference was found between pre- and postpneumonia QoL.Conclusions and ImplicationsQoL in NHRs remains stable over 12 months regardless of pneumonia events but seems to decline in NHRs hospitalized for pneumonia. Uncaptured short-term variations of QoL after pneumonia and/or related hospitalizations may occur.     

Effects of Horticulture on Frail and Prefrail Nursing Home Residents: A Randomized Controlled Trial

Objective

Frail nursing home residents face multiple health challenges as a result of their frail status. The aim of this study was to examine the effects of HT on the psychosocial well-being of frail and prefrail nursing home residents.

Prediction of the Incidence of Falls and Deaths Among Elderly Nursing Home Residents: The SENIOR Study

Objective

The objective of this study was to evaluate, among nursing home residents, the extent to which the various operational definitions of frailty predict mortality and falls at 1 year.

Nursing Home Research: The First International Association of Gerontology and Geriatrics (IAGG) Research Conference

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations.     

农村留守居民抑郁和生存质量现状及关系

目的了解农村留守居民抑郁症状,并探讨其与生存质量的关系,为提高农村留守居民的整体健康水平提供参考依据。方法采用多阶段分层随机抽样的方法,使用中文版流调用抑郁量表(CES-D)和与健康相关的生存质量(SF-36)量表,对514名沈阳市农村留守居民的抑郁症状和生存质量进行调查,采用多元线性回归分析评价抑郁及其它变量和生存质量间的关系。结果沈阳市农村留守居民抑郁症状总发生率为21.8%,其中男性发生率为19.3%,女性发生率为22.8%;生存质量中的8个维度分值均与抑郁评分呈负相关,且在除了总体健康外的7个维度中拥有最高的标准化回归系数(范围是-0.28~-0.49)。结论沈阳市农村留守居民抑郁症状发生率较高,抑郁是农村留守居民生命质量下降的一个重要影响因素。提高生存质量要优先考虑对抑郁症状的评估和解决。