Longitudinal changes in frailty prevalence and related factors in older adults living in long-term care facilities.

AIMS: To investigate longitudinal changes in the prevalence of frailty and related factors in older adults residing in long-term care facilities (LTCFs) in Korea. DESIGN: A longitudinal cohort study design. METHODS: Three hundred and fifty adults (aged 65 and older) residing in 10 LTCFs between January 2014 and January 2016 in Korea were initially investigated. Among these, 182 participants were included in the final analysis. Fried's Cardiovascular Health Study index was used to assess frailty based on Freiheit and colleagues. Data analysed included descriptive statistics and repeated-measures multivariate analysis of variance. RESULTS: The prevalence of frailty was 25.8%, 33.5% and 35.2% in 2014, 2015 and 2016, respectively. Differences in dependence of activities of daily living, number of chronic diseases, nutritional status and depression were statistically significant among the normal, pre-frail and frail groups at each year. Overall, from 2014-2016, the percentage of older adults decreased from 9.4-6.0% in the normal group and from 64.8%-58.8% in the pre-frail group, while increasing in the frail group from 25.8%-35.2%. CONCLUSION: The prevalence rate of frailty among older adults living in LTCFs was high and the rate of frail older adults gradually increased over time. IMPACT: Frailty is a comprehensive health condition and a dynamic, changeable state. This longitudinal study showed a high rate of frailty and dynamic change in frailty level over time among residents. Because frailty is dynamic in every older adult over time, management should be tailored according to the individual's state of frailty to prevent functional decline. Development of a comprehensive frailty assessment tool that can easily measure not only physical frailty but also the comprehensive aspects of frailty would be useful for older adults in LTCFs.

National study of the nutritional status of Korean older adults with dementia who are living in long-term care settings.

AIM: To evaluate the nutritional status of older adults with dementia who were living in long-term care settings. METHODS: As a secondary analysis, this study used the data from the Nationwide Survey on Dementia Care in Korea that was conducted between December 1, 2010, and August 31, 2011, which surveyed 3472 older adults with dementia, aged ≥60 years (mean age: 81.24 years), who were residing in 248 randomly selected long-term care settings in South Korea. Twenty-three different variables that related to the participants' demographics, diseases, and functional and nutritional characteristics were selected. The nutritional status was assessed by using the Mini Nutritional Assessment (MNA). Descriptive statistics, an ANOVA, and a chi-squared test were used to analyze the data. RESULTS: The mean MNA score of the participants was 17.90. The malnutrition rate was 38.4% (n = 1333), with 54.7% (n = 1900) of the participants at risk for malnutrition. The largest population with malnutrition resided in long-term care hospitals (47.9%), followed by nursing homes (34.1%), and group homes (25.9%). Being older and female, while exhibiting higher cognitive impairment, more neuropsychiatric symptoms, higher functional dependency, and a higher number of disabilities, were associated with poor nutritional status. CONCLUSION: The nutritional status of older adults with dementia who were living in long-term care settings in South Korea was poor and associated with multiple factors. Paying special attention to recognizing, assessing, preventing, and treating malnutrition in this population is necessary.

Initial psychometrics of the ambiance scale: a tool to study person-environment interaction in dementia.

Our purpose was to evaluate the psychometric properties of the Ambiance Scale (AS), a new instrument that assesses the capacity of long-term care environments for generating affective and behavioural responses in people with dementia. Within the context of three parent studies of dementia-related behaviour in long-term care settings, we conducted a cross-sectional correlational study by creating two separate samples of ratings from among all those available. Factor analysis revealed a two-factor structure (engaging, soothing) for the AS. Internal consistency and evaluation of inter- and intra-rater reliability were favourable. A consistent pattern of ratings on the AS and its subscales, moderate subscale correlations, and significant differences between facility types: nursing homes (NH) vs assisted living facilities (ALF) and among selected locations (residents' rooms, dining rooms, halls) within facility types support construct validity of the scale.