Exploring Australian pharmacists' views toward reducing the risk of medicines-related harm in aged care residents.

Medicines-related harm is common in older people living in residential aged care facilities (RACFs). Pharmacists offering services in the aged care sector may play a key role in reducing medicines-related injury. This study aimed to explore Australian pharmacists' views toward reducing the risk of medicines-related harm in older residents. Qualitative, semi-structured interviews were conducted with 15 Pharmacists across Australia providing services (e.g., through the provision of medication reviews, supplying medications, or being an embedded pharmacist) to RACFs identified via convenience sampling. Data were analyzed by thematic analysis using an inductive approach. Medicines-related harm was thought to occur due to polypharmacy, inappropriate medicines, anticholinergic activity, sedative load, and lack of reconciliation of medicines. Pharmacists reported that strong relationships, education of all stakeholders, and funding for pharmacists were facilitators in reducing medicines-related harm. Pharmacists stated that renal impairment, frailty, staff non-engagement, staff burnout, family pressure, and underfunding were barriers to reducing medicines-related harm. Additionally, the participants suggested pharmacist education, experience, and mentoring improve aged care interactions. Pharmacists believed that the irrational use of medicines increases harm in aged care residents, and medicines-specific (e.g., sedative load) and patient-specific risk factors (e.g., renal impairment) are associated with injuries in residents. To reduce medicines-related harm, the participants highlighted the need for increased funding for pharmacists, improving all stakeholders' awareness about medicines-associated harms through education, and ensuring collaboration between healthcare professionals caring for older residents.

Outcome measures from international older adult care home intervention research: a scoping review.

BACKGROUND: Care homes are increasingly important settings for intervention research to enhance evidence-informed care. For such research to demonstrate effectiveness, it is essential that measures are appropriate for the population, setting and practice contexts. OBJECTIVE: To identify care home intervention studies and describe the resident outcome measures used. DESIGN: Scoping review. METHODS: We reviewed international care home research published from 2015 to August 2022. We searched MEDLINE, EMBASE, CINAHL and ASSIA. We included any intervention study conducted in a care home, reporting resident outcomes. We extracted resident outcome measures, organised these using the domains of an adapted framework and described their use. RESULTS: From 7,330 records screened, we included 396 datasets reported in 436 publications. These included 12,167 care homes and 836,842 residents, with an average of 80 residents per study. The studies evaluated 859 unique resident outcomes 2,030 times using 732 outcome measures. Outcomes were evaluated between 1 and 112 times, with 75.1% of outcomes evaluated only once. Outcome measures were used 1-120 times, with 68.4% of measures used only once. Only 14 measures were used ≥20 times. Functional status, mood & behaviour and medications were the commonest outcome domains assessed. More than half of outcomes were assessed using scales, with a fifth using existing records or administrative data. CONCLUSIONS: There is significant heterogeneity in the choice and assessment of outcomes for intervention research in care homes. There is an urgent need to develop a consensus on useful and sensitive tools for care homes, working with residents, families and friends and staff.

The Impact of the COVID-19 Pandemic on People With Cognitive Impairment Residing in Aged Care Facilities: An Integrative Review.

This review explored the impact of the COVID-19 pandemic on people with cognitive impairment living in aged care facilities. It also considered policy and organizational responses to COVID-19, and makes recommendations to ameliorate the impact of the pandemic on residents with cognitive impairment in aged care facilities. ProQuest, PubMed, CINAHL, Google Scholar, and Cochrane Central were searched April-May 2022 for peer reviewed articles, and an integrative review of reviews was conducted. Nineteen reviews were identified which referred to people with cognitive impairment living in residential aged care facilities (RACFs) during COVID-19. Negative impacts were highlighted, including COVID-19 related morbidity and mortality, social isolation, and cognitive, mental health and physical decline. Few research articles and policy responses consider people with cognitive impairment in residential aged care. Reviews highlighted that social engagement of residents should be better enabled to reduce the impact of COVID-19. However, residents with cognitive impairment may have inequitable access to communications technology for the purposes of assessment, health care and social engagement, and require more support (along with their families) to access this technology. Greater investment in the residential aged care sector (eg, for workforce and training) is required to address the significant impacts of the COVID-19 pandemic on people with cognitive impairment.

In Australian hospitals and residential aged care facilities, how do we train nursing and direct care staff to assist patients and residents to move? A national survey.

Objective Nursing workplace injuries related to staff-assisted patient/resident movement occur frequently, however, little is known about the programs that aim to prevent these injuries. The objectives of this study were to: (i) describe how Australian hospitals and residential aged care services provide manual handling training to staff and the impact of the coronavirus disease 2019 (COVID-19) pandemic on training; (ii) report issues relating to manual handling; (iii) explore the inclusion of dynamic risk assessment; and (iv) describe the barriers and potential improvements. Method Using a cross-sectional design, an online 20-min survey was distributed by email, social media, and snowballing to Australian hospitals and residential aged care services. Results Respondents were from 75 services across Australia, with a combined 73 000 staff who assist patients/residents to mobilise. Most services provide staff manual handling training on commencement (85%; n = 63/74), then annually (88% n = 65/74). Since the COVID-19 pandemic, training was less frequent, shorter in duration, and with greater online content. Respondents reported issues with staff injuries (63% n = 41), patient/resident falls (52% n = 34), and patient/resident inactivity (69% n = 45). Dynamic risk assessment was missing in part or in whole from most programs (92% n = 67/73), despite a belief that this may reduce staff injuries (93% n = 68/73), patient/resident falls (81% n = 59/73) and inactivity (92% n = 67/73). Barriers included insufficient staff and time, and improvements included giving residents a say in how they move and greater access to allied health. Conclusion Most Australian health and aged care services provide clinical staff with regular manual handling training for staff-assisted patient/resident movement, however, issues with staff injuries, as well as patient/resident falls and inactivity, remain. While there was a belief that dynamic in-the-moment risk assessment during staff-assisted patient/resident movement may improve staff and resident/patient safety, it was missing from most manual handling programs.

Older Black Americans During COVID-19: Race and Age Double Jeopardy.

The concept of "double jeopardy"-being both older and Black-describes how racism and ageism together shape higher risks for coronavirus exposure, COVID-19 disease, and poor health outcomes for older Black adults. Black people and older adults are the two groups most affected by COVID-19 morbidity and mortality. Double jeopardy, as a race- and age-informed analysis, demonstrates how Black race and older age are associated with practices and policies that shape key life circumstances (e.g., racial residential segregation, family and household composition) and resources in ways that embody elevated risk for COVID-19. The concept of double jeopardy underscores long-standing race- and age-based inequities and social vulnerabilities that produce devastating COVID-19 related deaths and injuries for older Black adults. Developing policies and actions that address race- and age-based inequities and social vulnerabilities can lower risks and enhance protective factors to ensure the health of older Black Americans during the COVID-19 pandemic.

"Now I Understand You": Changes in the Communication of Professionals in Nursing Homes After Receiving Training in the Validation Method.

Caring for older persons is a challenge for professionals who work in nursing homes. Problems in maintaining effective communication with a person with dementia in an effort to understand their needs is a major barrier to good care. Therefore, the main goals of this study were to explore communication barriers between professionals and people with dementia and to observe changes in communication patterns between them after completing Naomi Feil's introductory training in the bases of the validation method (BVM). The 11 professionals who worked in nursing homes attended a 16-hour introductory course on BVM. Participants were interviewed individually three times. The goal was to observe qualitatively the changes in relationships and communication patterns with people with dementia. The results were analyzed thematically. The professionals highlighted how, after the training, they had a different understanding of the person with dementia and a more humane perspective. These changes also reflected how the professionals experienced improvements in job satisfaction, security, and confidence. This study concluded that training nursing home staff in BVM for person-centered and human care has positive implications on how the professionals view their daily work and their way of interacting with older residents. [J Contin Educ Nurs. 2023;54(4):157-168.].

Residential Aged Care Facilities During the COVID-19 Pandemic: A Staff Survey on Impact and Resources.

The current study explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on staff in residential aged care facilities (RACFs). A hardcopy, voluntary, anonymous survey was circulated to local RACFs (June-July 2020), exploring challenges, staffing effects, mood within RACFs, and staff perceptions of supports. Overall, 105 staff members responded, which were mainly nursing personnel (67.6%) and owners/managers (10.5%). Seventy percent believed they were equipped to handle patients with COVID-19. One quarter reported personal protective equipment shortages. Respondents reported pressures to accept patients with COVID-19 from hospitals and/or keep residents in the RACF. One third reported staff "calling in sick" related to COVID-19/quarantine. Common compensatory strategies included increasing part-time workers' hours. Reported mood was largely positive. Most (86.4%) respondents felt supported by general practitioner and local geriatric outreach services. Opportunities to best support RACF staff require further research and dialogue. [Journal of Gerontological Nursing, 49(3), 13-17.].

IMpleMenting Effective infection prevention and control in ReSidential aged carE (IMMERSE): protocol for a multi-level mixed methods implementation study.

BACKGROUND: Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice. METHODS: Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities' readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to best practice IPC, and (4) determine and evaluate feasible and locally tailored solutions to overcome the identified barriers. IPC leads will be upskilled and supported to operationalise the selected solutions. Staff working in residential aged care facilities, residents and their families will be recruited for participation in surveys and semi-structured interviews. Data will be analysed and triangulated at each phase, with findings informing the subsequent phases. Stakeholder groups at each facility and the IMMERSE project's Reference Group will contribute to the interpretation of findings at each phase of the project. DISCUSSION: This multi-site study will comprehensively explore infection prevention and control practices in residential aged care. It will inform and support locally appropriate evidence-based strategies for enhancing infection prevention and control practice.

Evolution of the incidence of COVID-19 during the first five waves in residents and professionals of nursing homes in Normandy, France.

BACKGROUND: Older adults living in nursing homes (NH) paid a heavy price to the COVID-19 pandemic, despite early and often drastic prevention measures. AIMS: To study the characteristics and the impact of the pandemic on NH residents and professionals over 2 years. METHODS: Cross-sectional study of COVID-19 clusters among residents and/or professionals in NH, from March 2020 to February 2022, in Normandy, France. We used data from the French mandatory reporting system, and cross-correlation analysis. RESULTS: The weekly proportion of NH with clusters was strongly correlated with population incidence (r > 0.70). Attack rates among residents and professionals were significantly lower in period 2 (vaccination rate in residents ≥ 50%) compared with periods 1 (waves 1 and 2) and 3 (Omicron variant ≥ 50%). Among residents, mortality and case fatality rates decreased drastically during periods 2 and 3. CONCLUSION: Our study provides figures on the evolution of the pandemic in NH.

Exploring what matters to residents of Australian aged care facilities with the Happy Life Index: comparison of qualitative responses between pre- and mid-Covid-19 pandemic time points.

PURPOSE: This study analysed data from a national survey of people living in Australian Residential Aged Care Facilities (RACFs) reporting on what is the best thing about where they live and suggestions for improvement. Data from prior to the Covid-19 pandemic were compared with data during the Covid-19 pandemic. METHODS: Qualitative data from the Happy Life Index Survey were analysed using summative content analysis to code the responses in the data sets and then organise them into categories. Once categorised, the pre-Covid-19 and mid-Covid-19 data sets were compared using descriptive statistics. RESULTS: A total of 4745 residents, from over 100 RACFs, provided 8512 open-text responses to at least one of the two survey questions. Pre-Covid-19 responses were compared with mid-Covid-19 responses and those trending towards relevance (5-10% change) were identified. There were both positive and negative relevant percent changes for staff number, food (general comments), and friendliness. A trending positive percentage change was observed for staff quality and the internal environment. There was a trending negative relevant percentage change for lifestyle activities, staff generally, level of contentedness, the general environment, general choice, and general views about the service. CONCLUSION: People living in RACFs notice the changes in staffing levels and visitors during restrictions imposed during infectious outbreaks. During these times, they appreciate the quality of the staff attending to their needs and the quality of their food. Further exploration is needed of the value of lifestyle activities and strategies to promote feelings of contentedness and general wellbeing during times of restriction.

All-cause mortality among Danish nursing home residents before and during the COVID-19 pandemic: a nationwide cohort study.

A substantial part of mortality during the COVID-19-pandemic occurred among nursing home residents which caused alarm in many countries. We investigate nursing home mortality in relation to the expected mortality prior to the pandemic. This nationwide register-based study included all 135,501 Danish nursing home residents between 2015 until October 6, 2021. All-cause mortality rates were calculated using a standardization method on sex and age distribution of 2020. Survival probability and lifetime lost for 180 days was calculated using Kaplan Meier estimates. Of 3,587 COVID-19 related deaths, 1137 (32%) occurred among nursing home residents. The yearly all-cause mortality rates per 100,000 person-years in 2015, 2016, and 2017 were 35,301 (95% CI: 34,671-35,943), 34,801 (95% CI: 34,180-35,432), and 35,708 (95% CI: 35,085-36,343), respectively. Slightly elevated mortality rates per 100,000 person-years were seen in 2018, 2019, 2020, and 2021 of 38,268 (95% CI: 37,620-38,929), 36,956 (95% CI: 36,323-37,600), 37,475 (95% CI: 36,838-38,122), and 38,536 (95% CI: 37,798-39,287), respectively. For SARS-CoV-2-infected nursing home residents, lifetime lost difference was 42 days (95% CI: 38-46) in 2020 versus non-infected in 2018. Among vaccinated in 2021, lifetime lost difference was 25 days (95% CI: 18-32) for SARS-CoV-2-infected versus non-infected. Even though a high proportion of COVID-19 fatalities took place in nursing homes and SARS-CoV-2-infection increased the risk of individual death, the annual mortality was only slightly elevated. For future epidemics or pandemics reporting numbers of fatal cases in relation to expected mortality is critical.

Cognitive stimulation and socialization of institutionalized older adults during the Covid-19 pandemic / Estímulo cognitivo e socialização de idosos institucionalizados na pandemia por Covid-19 / Estímulo Cognitivo y Socialización de Ancianos Institucionalizados en la Pandemia por Covid-19

Objetivo: Relatar a experiência de discentes e docentes de enfermagem no desenvolvimento de atividades lúdico-pedagógicas em uma Instituição de Longa Permanência para Idosos (ILPI) durante a pandemia por COVID-19. Síntese dos dados: Trata-se de um relato de experiência, a partir da vivência de acadêmicas e docentes de um projeto de extensão do curso de Enfermagem em uma Instituição de Longa Permanência para Idosos, no interior de Minas Gerais, nos meses de junho e julho de 2020. A equipe do projeto elaborou o planejamento de um bingo, sendo todos os idosos premiados com livros de colorir e gizes de cera. As ações se desdobraram em quatro etapas: planejamento das atividades; elaboração do material; entrega do material impresso; e operacionalização da ação. Com a entrega do material na instituição no dia 23 de julho, realizou-se a dinâmica no dia 20 de agosto de 2020. Conclusão: O planejamento e a elaboração de materiais, como o jogo do bingo e o livro de colorir, permitiram que o projeto de extensão desse seguimento ao trabalho mesmo no período da pandemia, propondo duas atividades que despertaram o interesse e a participação de todos os envolvidos.

Objective: To report the experience of nursing students and professors in the development of recreational and pedagogical activities in a Long-Term Care (LTC) Institution for older adults during the COVID-19 pandemic. Data synthesis: This is an experience report based on the experience of students and professors of an extension project of the Nursing program in a Long-Term Care Institution for older adults in the countryside of Minas Gerais in the months of June and July 2020. The project team prepared a bingo plan, with all the older adults being awarded with coloring books and crayons. The actions unfolded in four stages: planning of activities; preparation of the material; delivery of printed material; and operationalization of the action. With the delivery of the material to the institution on July 23, the action took place on August 20, 2020. Conclusion: The planning and construction of materials, such as the bingo game and the coloring book, allowed the project to extend this follow-up to work even during the pandemic period by proposing two activities that aroused the interest and participation of all those involved.

Objetivo: Informar la experiencia de dicentes y docentes de enfermería en el desarrollo de actividades lúdico-pedagógicas en una Institución para Ancianos de Larga Estancia (IALE) en la pandemia por Covid-19. Síntesis de datos: Se trata de un informe de experiencia, a partir de la vivencia de académicas y docentes de un proyecto de extensión del curso de Enfermería en una Institución para Ancianos de Larga Estancia, en el interior de Minas Gerais, en los meses de junio y julio de 2020. El equipo del proyecto elaboró la planificación de un bingo, premiando todos los ancianos con libros de colorear y crayón. Las acciones se desplegaron en cuatro etapas: planificación de las actividades; elaboración del material; entrega del material impreso; y operacionalización de la acción. Con la entrega del material en la institución en el día 23 de julio, se realizó la dinámica en el día 20 de agosto de 2020. Conclusión: La planificación y la elaboración de materiales, como el juego de bingo y el libro de colorear, permitieron que el proyecto de extensión diera continuidad al trabajo aunque en período de la pandemia, proponiendo dos actividades que despertaron el interés y la participación de todas las partes.

Osteosarcopenic Adiposity and Nutritional Status in Older Nursing Home Residents during the COVID-19 Pandemic.

The aim was to evaluate body composition and prevalence of osteosarcopenic adiposity (OSA) in nursing home residents (NHR) and to assess their nutritional status. This research builds on our pilot study (conducted prior COVID-19 pandemic) that revealed high OSA prevalence and poor nutritional status in NHR. The current study included newly recruited n = 365 NHR; 296 women, 69 men, aged 84.3 ± 5.6 and 83.1 ± 7.3 years, respectively. Body composition was measured by bioelectrical impedance BIA-ACC®, yielding total bone mass along with all components of lean and adipose tissues. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess nutritional status. Participants reported about their present/past diseases, including COVID-19. Mean duration of stay in nursing homes was 46.3 ± 47.0 months. Approximately 30% of participants had COVID-19 prior (median 6.7 months) to entering the study. OSA was diagnosed in 70.8% women and 47.8% men (p < 0.001). Malnourishment was detected in 5.8% women and 6.2% men while the risk of malnourishment was found in 30.8% women and 30.0% men. No significant differences in age, body composition parameters, prevalence of OSA, malnutrition/risk for malnutrition were found in participants who had COVID-19 compared to those who did not. Regression analysis showed that intramuscular adipose tissue (%) was significantly positively, while bone mass was significantly negatively associated with OSA. In this population, the high prevalence of OSA coincided with the high prevalence of malnutrition/risk of malnutrition. Such unfavorable body composition status is more likely a consequence of potentially poor diet quality in nursing homes, rather than of health hazards caused by COVID-19.

The Impact of COVID-19 on Nursing Homes: Study Design and Population Description.

Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.