Professional identity formation of medical students in relation to older persons' healthcare: exploring the views of older persons living in the Netherlands - a qualitative study.

OBJECTIVES: Given the growing population of older persons, medical students need to develop an appropriate professional identity to comply with older persons' healthcare needs. In this study, we explored the needs and expectations of older persons regarding their doctor to gain more insight into the characteristics of this professional identity. DESIGN: A qualitative study based on a constructivist research paradigm was conducted, based on individual semistructured, in-depth interviews using a letter as a prompt, and focus groups. Thematic analysis was applied to structure and interpret the data. SETTING AND PARTICIPANTS: Our study population consisted of older persons, aged 65 years and above, living at home in the South-West of the Netherlands, with no apparent cognitive or hearing problems and sufficient understanding of the Dutch language to participate in writing, talking and reflecting. The in-depth interviews took place at the participant's home or the Leiden University Medical Center (LUMC), and the focus groups were held at the LUMC. RESULTS: The older persons shared and reflected on what they need and expect from the doctor who takes care of them. Four major themes were identified: (1) personal attention, (2) equality, (3) clarity and (4) reasons why. CONCLUSION: Increasing complexity, dependency and vulnerability that arise at an older age, make it essential that a doctor is familiar with the older person's social context, interacts respectfully and on the basis of equality, provides continuity of care and gives clarity and perspective. To this end, the doctor has to be caring, involved, patient, honest and self-aware. Participation in a community of practice that provides the context of older persons' healthcare may help medical students develop a professional identity that is appropriate for this care.

Integrating Residents' Rights and Infection Prevention in Nursing Homes: Summary of the Infection Control Advocate and Resident Education (ICARE) Learning Modules Pilot for Long-term Care Ombudsmen, Residents, and Other Nursing Home Advocates.

The Infection Control Advocate and Resident Education (ICARE) educational modules integrate and promote infection prevention and control (IPC) measures and residents' rights in nursing homes, targeting long-term care ombudsmen, residents, families, and other resident advocates. Survey respondents (N=102) reported increased knowledge in understanding IPC and preserving resident rights. Integrating these topics and identifying barriers to promoting IPC is necessary for implementing quality IPC in nursing homes.

Examining the Feasibility and Acceptability of Digital Cognitive Stimulation Therapy for Dementia Care in Jordan: A Qualitative Study.

Introduction: The use of technology to deliver psychosocial interventions such as cognitive stimulation therapy (CST) to individuals with dementia may improve their cognition and quality of life. Objectives: This study aimed to investigate the participants' experiences with digital CST in Jordanian care homes, as well as the acceptability of the digital CST intervention in Jordanian care homes and recommendations for refinement. Methods: A qualitative study design and semistructured interviews were used to obtain data from 20 people with dementia and 12 care home staff who were purposefully selected. Data were analyzed thematically and comparatively to explore the experiences and outcomes of the participants. This study was conducted from February to April 2023. Results: Analysis of care home staff and residents' experiences revealed seven major themes: (a) personalized support and engagement, (b) positive impact on quality of life, (c) engagement and meaningful activities, (d) adaptable format and accessibility, (e) emotional connection and empowerment, (f) caregiver involvement and support, and (g) suggestions for improvement. The study's findings emphasize the necessity of tailored support, individualized difficulty levels, individualized material selection, emotional support, greater social connection, and caregiver participation in digital CST for people with dementia. Conclusion: Using digital touchscreen technology to deliver CST content has shown potential improvements, making interventions simpler for staff and more beneficial for individuals with dementia, thereby enhancing cognition and quality of life.

Exploring research participation in Scottish care homes since the COVID-19 pandemic.

Knowledge about research participation in care homes is sparse. To explore research participation in Scottish care homes, including the potential barriers and facilitators, a short survey was distributed to all care homes in Scotland in 2014. The survey was repeated in 2022 as care homes emerged from the effects of the coronavirus disease 2019 (COVID-19) pandemic. This article provides a comparison of the results of the 2022 survey (45 responses) with those of the 2014 survey (130 responses); the surveys were completed by care home staff. The results indicate that there has been a slight increase in the proportion of care homes involved in research in the intervening period but overall, research participation has remained low in this sector. In the 2022 survey, the main factors identified as influencing a resident's decision to participate in research were 'to help others', 'to benefit the resident' and the 'resident's desire to participate'. The main obstacles to research participation by staff and/or residents were workload pressure and lack of time, which had increased significantly since the 2014 survey. The results reinforce the importance of ensuring care home staff feel equipped to participate in research.

SARS-CoV-2 Seropositivity in Nursing Home Staff and Residents during the First SARS-CoV-2 Wave in Flanders, Belgium.

(1) Background: early in the COVID-19 pandemic, reverse transcription polymerase chain reaction (RT-PCR) testing was limited. Assessing seroprevalence helps understand prevalence and reinfection risk. However, such data are lacking for the first epidemic wave in Belgian nursing homes. Therefore, we assessed SARS-CoV-2 seroprevalence and cumulative RT-PCR positivity in Belgian nursing homes and evaluated reinfection risk. (2) Methods: we performed a cross-sectional study in nine nursing homes in April and May 2020. Odds ratios (ORs) were calculated to compare the odds of (re)infection between seropositive and seronegative participants. (3) Results: seroprevalence was 21% (95% CI: 18-23): 22% (95% CI: 18-25) in residents and 20% (95% CI: 17-24) in staff. By 20 May 2020, cumulative RT-PCR positivity was 16% (95% CI: 13-21) in residents and 8% (95% CI: 6-12) in staff. ORs for (re)infection in seropositive (compared to seronegative) residents and staff were 0.22 (95% CI: 0.06-0.72) and 3.15 (95% CI: 1.56-6.63), respectively. (4) Conclusion: during the first wave, RT-PCR test programmes underestimated the number of COVID-19 cases. The reinfection rate in residents was 3%, indicating protection, while it was 21% in staff, potentially due to less cautious health behaviour. Future outbreaks should use both RT-PCR and serological testing for complementary insights into transmission dynamics.

Adaptation of French general practitioners for the management of nursing home patients during COVID-19 in 2020: a multilevel analysis.

BACKGROUND: To describe French general practioners' (GPs) adaptation strategies to ensure follow-up care of nursing home patients during the first wave of COVID-19 (May 2020) and to identify factors associated with each strategy. METHODS: A national cross-sectional study was conducted with online questionnaires in May 2020 among GPs practicing in France (metropolitan and overseas) and usually providing nursing home visits before pandemic. The outcome was defined as the GPs' adaptation strategies for managing nursing home patients and was categorized into four groups: Maintenance of Nursing Home Visits NHV (reference), Stopping NHV, Numeric adaptation (teleconsultations only), Mixed adaptation (NHV and teleconsultations). The probability of adaptation strategies was analyzed by multilevel logistic models in which the GPs represented level 1 and the counties level 2. We applied three random-intercept multilevel logistic models with the county of GP's practice as random effect. RESULTS: This analysis included 2,146 responses by GPs coming from 98 French counties. Overall, 40.4% of GPs maintained NHV, while other strategies were: Stopping visits (24.1%), Numeric adaptation (15.4%), Mixed adaptation (20.1%). Several individual (age, training GP, perceived status of being at high risk of severe COVID, compliance with temporary delegation of the patient's management) and territorial factors (excess mortality rate due to COVID-19, GPs' density, proportion of over-75s, presence of reinforcement measures for nursing home patients) were identified as associated with each strategy. CONCLUSIONS: This study highlights a rapid adaptation of general practice to keep supporting nursing home patients. Heterogeneity of adaptation strategies could reflect both the lack of national guidelines and the heterogeneity among GPs' usual practices. Policymakers should take actions at a territorial level (subnational) to strengthen support to nursing home patients considering adaptations to the local context of the pandemic outbreak and perspective of local actors.

Impact of Quality Improvement Interventions on Hospital Admissions From Nursing Homes: A Systematic Review and Meta-Analysis.

OBJECTIVE: To synthesize evidence assessing the effectiveness of quality improvement (QI) interventions in reducing hospital service use from nursing homes (NHs). DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs), controlled before-after (CBA), uncontrolled before-after (UBA), and interrupted time series studies. Searches were conducted in MEDLINE, CINAHL, The Cochrane Library, Embase, and Web of Science from 2000 to August 2023 (PROSPERO: CRD42022364195). SETTING AND PARTICIPANTS: Long-stay NH residents (>30 days). METHODS: Included QI interventions using a continuous and data-driven approach to assess solutions aimed at reducing hospital service use. Risk of bias was assessed using JBI tools. Delivery arrangements and implementation strategies were categorized through EPOC taxonomy. RESULTS: Screening of 14,076 records led to the inclusion of 22 studies describing 29 QI interventions from 6 countries across 964 NHs. Ten studies, comprising 4 of 5 RCTs, 3 of 4 CBAs, and 1 of 12 UBAs were deemed to have a low risk of bias. All but 3 QI interventions used multiple component delivery arrangements (median 6; IQR 3-8), focusing on the "coordination of care and management of care processes" alone or combined with "changes in how, when, where, and by whom health care is delivered." The most frequently used implementation strategies were educational meetings (n = 25) and materials (n = 20). The meta-analysis of 11 studies showed a significant reduction in "all-cause hospital admissions" for QI interventions compared with standard care (rate ratio, 0.60; 95% CI, 0.41-0.87; I2 = 99.3%), with heterogeneity due to study design, QI intervention duration, type of delivery arrangements, and number of implementation strategies. No significant effects were found for emergency department (ED) visits or potentially avoidable hospitalizations. CONCLUSIONS AND IMPLICATIONS: The study provides preliminary evidence supporting the implementation of QI interventions seeking to reduce hospital admissions from NHs. However, these findings require confirmation through future experimental research.

Quality of life, pain and use of analgesic, anxiolytic and antidepressant medication, in people living in care homes.

BACKGROUND: People living in care homes often have problems with pain, anxiety and depression. Whether being on analgesia, anxiolytics or antidepressants has any bearing on pain severity and quality of life (QoL) in this population, requires further investigation. OBJECTIVES: (i) to examine the relationship between pain, anxiety and depression and medication use in care home residents and (ii) to compare those on medications to treat pain, anxiety and depression, and those who were not, and associations with pain severity and overall QoL. METHODS: This was a secondary analysis of a randomised controlled trial testing a falls prevention intervention in care homes. We recorded pain, anxiety and depression, QoL measurements and prescribed medication use. RESULTS: In 1589 participants, the mean age was 84.7 years (±9.3 SD), 32.2% were male and 67.3% had a diagnosis of dementia. 54.3% and 53.2% of participants had some level of pain and anxiety or depression respectively, regardless of prescribed medication use. There was a direct association between pain severity and being on any analgesia, opioid analgesia, and antidepressants, but no associations between pain severity and use of paracetamol and anxiolytics. QoL was best for residents with no pain and not on any analgesia, anxiolytics or antidepressants and worst for those with moderate-extreme pain and taking at least two of these classes of medications. CONCLUSION: Many care home residents live with pain, anxiety and depression. Addressing residents' pain may also increase their quality of life, but using medication alone to reach this goal may be inadequate.

Attitudes of Nursing Home Managers Regarding Cognitively Stimulating Activities in People With Dementia: A Multicentre Cross-Sectional Study.

INTRODUCTION: Group-based cognitive stimulation has shown short-term benefits for the cognitive outcomes of people with dementia living in nursing homes (NH). However, group participation can be a barrier for people with advanced dementia, bedridden people or isolated people. The CogStim24 project seeks to develop and implement a new psychosocial intervention based on cognitively stimulating (CS) activities integrated into daily nursing care. As part of the intervention development process, this study aimed to survey NH managers' attitudes and describe currently used approaches to CS activities in German NH. METHODS: We performed a multicentre cross-sectional study between September and December 2021 in randomly recruited NH in the German federal state of North Rhine-Westphalia. NH representatives were asked to fill in a self-developed online questionnaire. We analysed data descriptively, presenting means and standard deviations. For case scenario questions, we used a summative content analysis. RESULTS: We contacted 354 NH and 106 agreed to participate. Representatives of 64 facilities completed the survey. Almost all stated to have implemented CS activities. Cognitive exercises (98%), physical and relaxation exercises (98%) and reminiscence therapy (95%) were most often used. The majority (96%) thought that CS activities could support people with dementia in maintaining their cognitive functions and that nurses should have a key role in the implementation of CS activities. More than half believed that regular CS activities were easy to implement alongside routine nursing care. CONCLUSIONS: Results indicate that CS activities are frequently applied in German NH. The positive attitude of NH managers regarding the implementation and effects of CS activities is an important implementation resource. IMPLICATIONS FOR PRACTICE: Nursing staff should be more involved in providing CS activities for people with dementia. Training, information, and implementation material must be made available for nursing staff who wish to have an active role in providing CS activities.

Preparedness of Nursing Homes: A Typology and Analysis of Responses to the COVID-19 Crisis in a French Network.

BACKGROUND: Preparing healthcare systems for emergencies is crucial to maintaining healthcare quality. Nursing homes (NHs) require tailored emergency plans. This article aims to develop a typology of French private NHs and study their early COVID-19 responses and mortality outcomes. METHODS: We conducted a cross-sectional survey among NHs of a French network consisting of 290 facilities during the first wave of the COVID-19 pandemic. A Hierarchical Clustering on Principal Components (HCPC) was conducted to develop the typology of the NHs. Association tests were used to analyze the relationships between the typology, prevention and control measures, COVID-19 mortality, and the satisfaction of hospitalization requests. RESULTS: The 290 NHs vary in size, services, and location characteristics. The HCPC identified three clusters: large urban NHs with low levels of primary care (Cluster 1), small rural NHs (Cluster 2), and medium urban NHs with high levels of primary care (Cluster 3). The COVID-19 outcomes and response measures differed by cluster, with Clusters 1 and 2 experiencing higher mortality rates. Nearly all the NHs implemented preventive measures, but the timing and extent varied. CONCLUSIONS: This typology could help in better preparing NHs for future health emergencies, allowing for targeted resource allocation and tailored adaptations. It underscores the importance of primary care territorial structuring in managing health crises.

Implementing telemedicine with 5G technologies in a nursing home for reducing emergency admissions- study protocol of a mixed-methods study.

BACKGROUND: By transmitting various types of data, telemedical care enables the provision of care where physicians and patients are physically separated. In nursing homes, telemedicine has the potential to reduce hospital admissions in nonemergency situations. In this study, telemedicine devices were implemented with the new 5G mobile communications standard in selected wards of a large nursing home in Northwest Germany. The main aim of this study is to investigate which individual and organizational factors are associated with the use of telemedicine devices and how users perceive the feasibility and implementation of such devices. Moreover, it is investigated whether the telemedical devices help to reduce the number of emergency admissions. METHODS: Telemedicine devices are implemented over an 18-month period using a private 5G network, and all users receive training. This study uses qualitative and quantitative methods: To assess the individual and organizational factors associated with the use of telemedicine devices, survey data from employees before and after the implementation of these devices are compared. To assess the perception of the implementation process as well as the feasibility and usability of the telemedical devices, the nursing staff, physicians, medical assistants and residents are interviewed individually. Moreover, every telemedicine consultation is evaluated with a short survey. To assess whether the number of emergency admissions decreased, data from one year before implementation and one year after implementation are compared. The data are provided by the integrated dispatch centre and emergency medical services (EMS) protocols. The interview data are analysed via structured qualitative content analysis according to Kuckartz. Survey data are analysed using multivariable regression analysis. DISCUSSION: Learnings from the implementation process will be used to inform future projects implementing telemedicine in care organizations, making the final telemedicine implementation and care concept available to more nursing homes and hospitals. Moreover, the study results can be used to provide use cases for appropriate and targeted application of telemedicine in nursing homes and to define the role of 5G technologies in these use cases. If the intervention is proven successful, the results will be used to promote 5G network rollout. TRIAL REGISTRATION: German Clinical Trials Register - trial registration number: DRKS00030598.

National stakeholder consultation on how to measure care home residents' quality of life.

Background: The Developing research resources And minimum data set for Care Homes' Adoption and use or DACHA study aims to create a prototype minimum data set combining residents' information recorded by care homes with their data held in health and social care data sets. The DACHA minimum data set will contain information on quality of life. Internationally and in the UK, there is no consensus on collecting information on quality of life in a standardised format equivalent to the consensus for health measures. Objective: This paper describes an online consultation with stakeholder representatives about how to measure the quality of life of residents in UK older-adult care homes, for inclusion in the DACHA minimum data set. Design: We drew on principles of the Delphi technique, identifying participants knowledgeable about living, working in and visiting care homes, and preference scoring. Setting: We used a bespoke online research engagement platform (Thiscovery, www.thiscovery.org, Cambridge, UK) to engage the participants. Participants: Participants included care home staff and managers, old age specialists (clinical/research), commissioners/providers/regulators, primary care professionals, relatives/family carers of care home residents. The consultation is complementary to DACHA's research and patient and public involvement and engagement activities, which have involved people living in care homes; thus, care home residents were not included in this consultation. Results: The first round asked 30 participants to rank the most important principles and domains to consider when measuring quality of life in care homes. Responses to round 1 informed the selection of quality of life measures that round 2 (September 2022) participants were asked to report their familiarity with and confidence in a range of outcome measures all of which met the criteria identified as important in round 1. Recruitment was extended in round 2, and 72 individuals participated. Conclusion: Based on the rankings and the qualitative feedback in round 2, we included four of the shortlisted quality of life outcome measures in DACHA's prototype minimum data set for care homes. The qualitative feedback suggested a shared understanding across the different representative groups about the strengths and limitations of the selected measures. This work makes an important contribution, understanding the opportunities that quality of life measures pose for different stakeholder groups as regular users of care home resident data. Future work: In future DACHA work, interviews and focus groups will collect further data about the perceptions of care home staff who completed measures during the pilot study and about the usefulness of the data collected via these measures. The quality-of-life section of the DACHA minimum data set can contribute to informing similar care home data sets internationally. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR127234.

The Developing research resources And minimum data set for Care Homes' Adoption and use study aims to explore how we can link together and safely share information about older care home residents so that care settings (such as hospitals, GPs and care homes) can best meet their needs. To work towards this aim, we are identifying what information is most important to capture and share in a 'minimum data set'. Having information about care home residents' quality of life was recognised by residents, their family members, care providers, researchers and health professionals as something that is important to measure. Quality of life describes the general well-being of an individual and is more than whether someone is healthy or not. By measuring a person's quality of life, it is possible to explore how changes in their care or innovations within their care home affect their sense of well-being. We asked care home staff, experts on ageing, healthcare workers, local authority officials and family members of residents what is important to know about residents' quality of life. In the first online survey (June 2022), we learned from 30 individuals that any quality of life measurement tool needs to be simple, reliable and meeting the needs of the residents. In our second survey (September 2022), 72 individuals gave us their thoughts about different quality of life measurement tools. They told us about whether they would use these tools, how much confidence they have in them, and what they see as strengths and weaknesses of the tools. This feedback helped us choose the right tools to measure quality of life in care homes and make sure they are a good fit for care home residents.

Optimizing the implementation of Enhanced Barrier Precautions in community-based nursing homes.

BACKGROUND: Enhanced Barrier Precautions (EBP) recommends using gowns and gloves for certain nursing home residents during specific high-contact care activities associated with multidrug-resistant organism (MDRO) transmission. Though EBP is included in CDC guidance as an MDRO control strategy, optimal implementation approaches remain unclear. METHODS: We implemented a quality improvement initiative using the 4E process model (Engagement, Education, Execution, and Evaluation) to optimize EBP implementation in four Maryland nursing homes. Semi-structured interviews with healthcare personnel (HCP) occurred to understand EBP acceptability. RESULTS: Glove use during high-contact care increased from 85% in the baseline to 97% during the intervention (p<0.01). Gown use increased from 27% to 78% (p<0.01). Accuracy of identifying residents eligible for EBP improved from 63% to 99% (p<0.01). Of 780 residents observed, one-third met EBP indications - MDRO colonization (21%), indwelling medical device (14%), and/or chronic wound (10%). The most noted facilitator to EBP implementation included HCP perception that EBP reduces MDRO transmission to other residents and staff. The most noted barrier was uncomfortable gowns. CONCLUSIONS: Implementation was complex and required comprehensive assessments of barriers and facilitators within each facility. HCP interviews identified common barriers and facilitators of EBP that can inform future EBP implementation projects.

Advance Care Planning in Nursing Homes: Comparing Characteristics and Outcomes of Participants and Non-Participants.

BACKGROUND: There is an increasing need to integrate Advance Care Planning (ACP) in nursing homes (NH) due to rapid aging and burden of multimorbidity. This study examines differences in the characteristics and outcomes of NH residents enrolled in a palliative care programme who have completed ACP and those who did not. METHOD: We conducted a retrospective cohort analysis of 294 deceased residents enrolled into a palliative programme from 8 nursing homes in Singapore. Comparison was made between residents who completed an ACP and those who did not. Treatment preferences and place of death preferences were examined and concordance to these preferences were analyzed. RESULTS: ACP completion rate was 81% in the cohort. Residents opting for comfort measures only had high concordance (92%) for their preferred place of death (PPOD). However, residents opting for limited intervention showed lower PPOD concordance (77%), with many dying in hospitals despite a preference for dying in the NH. Residents with ACP were significantly more likely to die in NH (68.2% vs. 36.4%) and had a longer median programme enrolment duration (131 vs. 53 days) compared to those who did not complete ACP. CONCLUSION: Despite high ACP completion rate in our cohort, challenges remain in aligning treatment preferences with actual care provided, particularly for residents opting for limited intervention. Future efforts should focus on increasing ACP participation and addressing systemic barriers to improve end-of-life care outcomes for NH residents.

Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: Analysis from 106 nursing homes in 12 Asia-Pacific and European countries.

PURPOSE: There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty. METHODS: Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0-2 (non-frail), 3-6 (frail) and 7-14 (most-frail). Data were analyzed using descriptive statistics. RESULTS: Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %). CONCLUSIONS: One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.

Comparison of quality of life of older adults living in foster families versus nursing homes. Results from the KASA studies.

OBJECTIVES: Professional foster families for dependent older adults could be an alternative to nursing homes. Engagement in the family life and close contact with a single reference person could enhance their quality of life (QOL). This study aimed to compare the Health-Related Quality of Life (HrQOL) and subjective QOL among older adults living in foster families versus those in nursing homes. DESIGN: Cross-sectional analysis from twin studies conducted in foster families (the KASAF study) and nursing homes (the KASEHPAD study). SETTING AND PARTICIPANTS: Older adults (aged 60 years or older) in French Caribbean Islands living in foster families or nursing homes. MEASUREMENTS: HrQOL was measured using the EuroQol-five dimensions (EQ5D-3L) and QOL was assessed using a Visual Analog Scale (QOL-VAS). For older adults unable to complete these scales, proxy EQ-5D-3L assessments were conducted by paramedical staff or foster caregivers. RESULTS: A total of 439 older adults, with 107 in foster families and 332 in nursing homes were included. Participants living in foster families were less often male, had less often hypertension, were more dependent or physical impaired and had lower score of cognition. In multivariate analyses, factors associated with low self-reported HRQoL (n = 240) were Mini Mental State Examination (MMSE) score (ß: -0.011; p = 0.003) and Activities of Daily Living (ADL) score (ß: 0.014; p < 0.001). A lower QOL-VAS score (n = 150) was associated with living in a nursing home compared to living in a foster family (ß: -19.48 points; p < 0.001) and with the ADL score (2.94 points; p = 0.019). In older adults with major cognitive disorders, the only factor associated with low proxy EQ-5D proxy index score (n = 136) was dependency (ß: 0.167; p < 0.001). CONCLUSION: HrQOL was similar between older adults living in nursing homes and foster families. Additionally, older adults reported a better subjective quality of life when residing in foster families. These findings suggest that the foster family model may meet the social and environmental needs of dependent older adults for whom nursing homes are not suitable.

Global research trends on psychological well­being of children in foster care homes from 2003 to 2023: a bibliometric analysis using Scopus database.

Purpose: The study focuses on contemporary trends in the psychological well­being of foster children residing in care homes over the past two decades. Moreover, it aims to predict future research directions by analyzing hotspots, offering valuable references for academics engaged in further studies in this field. Methods: A quantitative analysis was conducted on nine hundred and twelve documents, including research papers and reviews, from 2003 to 2023. These publications focused on the psychological well­being of foster children and were incorporated from the Scopus database. For visual analysis, we utilized the bibliometric analytical tool VOSviewer to generate a map of information on the authors, journals, organizations, nations, citations, and keywords. We also employed Microsoft Excel tables to record the essential details. Results: The psychological well­being of children and adolescents residing in foster homes is an emerging area of research. The findings show that there has been an ongoing rise in relevant research publications over time. The United States (416) and Harvard Medical School (56) were the most active countries and organizations in this study. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV (91 articles) and Vulnerable Children and Youth Studies (86 articles) are two prominent journals, while the Journal of Child Psychology and Psychiatry had the most co-citations (630). Nelson (52 publications) and Zeanah (50 publications) are the top two leading authors based on citation counts. Institutional care, orphans, HIV/AIDS orphans, psychological well­being, and mental health, resilience are popular research keywords in this study. Conclusion: This study indicates the prevailing interest in the specified domains over the past two decades. Our findings primarily indicate that addressing mental health concerns, along with understanding the needs of children in foster care homes, can enhance their psychological well­being. Developing effective interventions to enhance the psychological well­being of children in foster care is bound to have a profound effect on them and will serve as a key focus for future research in this field.

Assimilation of 3D printing, Artificial Intelligence (AI) and Internet of Things (IoT) for the construction of eco-friendly intelligent homes: An explorative review.

The construction industry is witnessing a transformative shift towards sustainable and intelligent housing solutions driven by advancements in 3D printing, Artificial Intelligence (AI), and the Internet of Things (IoT). Several architectural and construction firms have adopted innovative technologies to make construction easier, sustainable, efficient, cheap, fast, low generation of waste etc. This explorative review critically examines the integration of these technologies in the construction of eco-friendly intelligent homes. Drawing on a comprehensive analysis of literature spanning from 2010 to 2024, the review explores the synergistic potential and challenges associated with amalgamating 3D printing, AI, and IoT in construction processes. The increase need of smart homes equipped with sensors that can sense and regulate temperature, prevent or control fire, sense gas leakage, motion detectors and alarms for security and other application is in high demand. These types of smart homes can only be achieved by integrating different technologies together which include 3D printing (3DP), AI and Internet of Things (IoT). Despite the growing research in the field of automated construction, there are few articles that attempt to integrate these technologies together for futuristic smart homes and potential of smart cities. This study is aim at providing up-to-date advancement in technological innovation within the construction sector with regards to applications of 3DP, IoT, and AI. Key findings highlight how 3D printing enables rapid prototyping and customization of building components, AI enhances energy efficiency and occupant comfort through predictive analytics and automation, while IoT facilitates real-time monitoring and control of building systems. Furthermore, the review discusses the environmental benefits, cost-effectiveness, and societal implications of adopting such integrated approaches. However, challenges such as regulatory barriers, technological limitations, and the need for skilled labor are identified as critical barriers to widespread implementation. Future research directions are proposed to address these challenges and further optimize the integration of 3D printing, AI, and IoT for the construction of sustainable intelligent homes. In this review article, the need for 3DP in construction, advantage and disadvantage of 3DP, (AI) and IoT and the application of these technologies in addressing challenges regarding 3DP and promoting sustainability in the construction industries were comprehensively explored.

The Wellbeing Index for Persons with Dementia-An Observational Study Based on the Group Observational Measurement of Engagement (GOME).

The Group Observational Measurement of Engagement (GOME) was developed to capture the impact of group recreational activities on the engagement and general wellbeing of persons with dementia. The psychometric properties of the GOME were originally described in a study of group activities conducted at one large Canadian geriatric center. Continuing this work in Israel, this article reports on further psychometric properties of the GOME based on observations of 115 persons with dementia from 10 geriatric units, of which four were senior day center units (in three institutions) and six were nursing units (representing five other institutions). Very good inter-rater reliability between research observers was found. Factor analysis suggests that the GOME's four individual-level outcomes can be combined into one indicator, the Wellbeing Index. Validity, examined via agreement between research observers and group activity leaders who were staff members in the facilities where the group activities were conducted, also showed high levels of positive correlations. The GOME provides a practical tool for assessing wellbeing in the context of group activities. It can be useful in clarifying the relative impact of process variables on participants' general wellbeing.

Improving Antibiotic Use in Nursing Homes by Infection Prevention and Control and Antibiotic Stewardship (IMAGINE): Protocol for a Before-and-After Intervention and Implementation Study.

BACKGROUND: Despite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). OBJECTIVE: This study aims to systematize and enhance efforts to prevent health care-associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. METHODS: A before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. RESULTS: A total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. CONCLUSIONS: This is a European Union-funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60099.