OBJECTIVES: To evaluate the psychometric properties of the translated Indonesian version of the Nursing Home Survey on Patient Safety Culture (NHSOPSC-INA).
METHODS: This study was a cross-sectional survey conducted using NHSOPSC-INA. A total of 258 participants from 20 NH in Indonesia were engaged. Participants included NH managers, caregivers, administrative staff, nurses and support staff with at least junior high school education. The SPSS 23.0 was used for descriptive data analysis and internal consistency (Cronbach's alpha) estimation. The AMOS (version 22) was used to perform confirmatory factor analysis (CFA) on the questionnaire's dimensional structure.
RESULTS: The NHSOPSC CFA test originally had 12 dimensions with 42 items and was modified to eight dimensions with 26 items in the Indonesian version. The deleted dimensions were 'Staffing' (4 items), 'Compliance with procedure' (3 items), 'Training and skills' (3 items), 'non-punitive response to mistakes' (4 items) and 'Organisational learning' (2 items). The subsequent analysis revealed an accepted model with 26 NHSOPSC-INA items (root mean square error of approximation = 0.091, comparative fit index = 0.815, Tucker-Lewis index = 0.793, CMIN = 798.488, df = 291, CMIN/Df = 2.74, GFI = 0.782, AGFI = 0.737, p
OBJECTIVES: To review the literature on trials conducted among older adults residing in care homes within the UK and collate evidence on their methodological characteristics and outcomes.
METHODS: A systematic rapid review methodology was employed. MEDLINE, EMBASE and CENTRAL were searched in two incremental stages: stage 1 searched for oral health-related trials conducted within the UK care homes up to July 2021, whereas stage 2 sought for general health-related trials in the same setting from 2011 to 2021. The quality of included studies was assessed using Cochrane's RoB 2 and ROBINS-I tools. Findings were summarised descriptively.
RESULTS: Five oral health and 33 general health-related trials involving care home residents were included for analysis. The most common trial design was parallel group with two arms (n = 25) involving individual randomisation (n = 21). Consent was mainly obtained from residents and/or their proxies (n = 24), followed by residents only (n = 13) and care homes only (n = 1). Based on available data, the number needed to screen to recruit one participant ranged from 2 to 40 (median: 3; Q1-Q3: 2-9). Attrition rates ranged from 0% to 73% (median: 21%; Q1-Q3: 13%-32%) for follow-up periods between 1 and 52 weeks. The studies were of mixed methodological quality.
CONCLUSION: This rapid review outlines the methodological characteristics and outcomes of trials conducted among older adults in UK care homes. The findings of this review provide valuable information to assist in navigating and designing future research in this complex setting.
METHODS AND ANALYSIS: This scoping review will be guided by the smart technology adoption behaviours of elder consumers theoretical model (Elderadopt) by Golant and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. First, we will conduct an internet search for nursing homes and websites and databases related to the stakeholders to retrieve the definitions, concepts and criteria of a smart nursing home (phase 1). Second, we will conduct an additional systematic electronic database search for published articles on any measures of technological feasibility and integration of medical services in nursing home settings and their acceptability by nursing home residents and caregivers (phase 2). The electronic database search will be carried out from 1999 to 30 September 2020 and limited to works published in English and Chinese languages. For phase 2, the selection of literature is further limited to residents of nursing homes aged ≥60 years old with or without medical needs but are not terminally ill or bed-bound. Qualitative data analysis will follow the Framework Methods and thematic analysis using combined inductive and deductive approaches, conducted by at least two reviewers.
ETHICS AND DISSEMINATION: This protocol is registered on osf.io (URL: https://osf.io/qtwz2/). Ethical approval is not necessary as the scoping review is not a primary study, and the information is collected from selected articles that are publicly available sources. All findings will be disseminated at conferences and published in peer-reviewed journals.
BACKGROUND: Caregivers play an important role in the oral health care of elders in nursing homes.
METHODS: This study employed a qualitative approach using the nominal group technique (NGT) to obtain caregivers' feedback in nursing homes in Malaysia. Data were manually transcribed, summarised into keywords/key phrases, and ranked using weighted scores.
RESULTS: In total, 36 caregivers (21 from government and 15 from private nursing homes) participated in the NGT sessions. Overall, caregivers were satisfied with the low treatment cost, the quality of treatment, and the availability of dental visits to nursing homes. Caregivers were dissatisfied with the frequency of dental visits, long waiting times at government dental clinics, and inadequate denture hygiene education for elders in nursing homes. The challenges faced by caregivers were elders' poor oral health knowledge and attitude and lack of elders' trust of caregivers to look after their oral health. Suggestions for improvement were to increase the frequency of dental visits to nursing homes, provide oral health education to elders and caregivers, and give treatment priority to elders at dental clinics.
CONCLUSION: Despite being satisfied with the basic oral healthcare services received by elders in Malaysian nursing homes, caregivers raised some issues that required further attention. Suggestions for improvement include policy changes in nursing home dental visits and treatment priority for elders at government dental clinics.
METHODS: We source daily death registry data for 4100 municipalities in Italy's north and match them to Census data. We augment the dataset with municipality-level data on a host of co-factors of COVID-19 mortality, which we exploit in a differences-in-differences regression model to analyze COVID-19-induced mortality.
RESULTS: We find that COVID-19 killed more than 0.15% of the local population during the first wave of the epidemic. We also show that official statistics vastly underreport this death toll, by about 60%. Next, we uncover the dramatic effects of the epidemic on nursing home residents in the outbreak epicenter: in municipalities with a high share of the elderly living in nursing homes, COVID-19 mortality was about twice as high as in those with no nursing home intown.
CONCLUSIONS: A pro-active approach in managing the epidemic is key to reduce COVID-19 mortality. Authorities should ramp-up testing capacity and increase contact-tracing abilities. Adequate protective equipment should be provided to nursing home residents and staff.
Methods: This is a controlled semi-experimental study with a pre-test, post-test design. Ninety eligible ones of the elderly living in the Abadeh nursing homes and from July to September 2017, entered the study. Some of the criteria for entering the study include being over 60 years old, orientation, not having blindness and deafness, lack of physical and mental problems. After determining the intervention and control groups, the scale of depression and QOL was administered to the subjects and their scores were collected in the pre-test.
Results: Most of the study samples were in the intervention (35.55%) and control (37.77%) group in the age range of 60-69 years. In both intervention and control groups, respectively, 31.11% and 68.88% elderly were males and females. The mean scores of depression in the intervention group after LT (M = 2.57) were lower than those before the intervention (M = 6.87) [CI = -5.58-(-3.02)] and also the results of independent t-test showed a statistically significant difference before and after the intervention between the two groups (P < 0.001). The mean score of dimensions of QOL after LT was higher than that before in the intervention and there was a statistically significant difference in all dimensions with paired t-test (P < 0.001).
Conclusion: Since the implementation of this programme could improve the mental status and QOL of the elderly, this method of therapy can be used as an alternative or complementary model to enhance the health of the elderly.
METHODS: Six electronic databases were searched from inception until November 2018 for articles published in English examining the services offered by pharmacists in nursing homes. Studies were included if it examined the impact of interventions by pharmacists to improve the quality use of medicine in nursing homes.
RESULTS: Fifty-two studies (30 376 residents) were included in the current review. Thirteen studies were randomised controlled studies, while the remainder were either pre-post, retrospective or case-control studies where pharmacists provided services such as clinical medication review in collaboration with other healthcare professionals as well as staff education. Pooled analysis found that pharmacist-led services reduced the mean number of falls (-0.50; 95% confidence interval: -0.79 to -0.21) among residents in nursing homes. Mixed results were noted on the impact of pharmacists' services on mortality, hospitalisation and admission rates among residents. The potential financial savings of such services have not been formally evaluated by any studies thus far. The strength of evidence was moderate for the outcomes of mortality and number of fallers.
CONCLUSION: Pharmacists contribute substantially to patient care in nursing homes, ensuring quality use of medication, resulting in reduced fall rates. Further studies with rigorous design are needed to measure the impact of pharmacist services on the economic benefits and other patient health outcomes.
METHODS: This study included 302 ambulating Malaysian institutionalised older adults. Frailty was identified using Fried's frailty criteria. Cognitive status was assessed using the Mini Mental State Examination and Addenbrooke's Cognitive Examination. Functional fitness was assessed using the Senior Fitness test. The association between frailty groups, cognitive status and functional fitness was analysed using binary logistic regression.
RESULTS: Prevalence of frailty, prefrailty and robustness in the older adults was 56.6%, 40.7% and 2.9%, respectively. Frailty was found to be associated with hypertension (OR 2.15, 95% CI: 1.11-4.16, p = 0.024), lower cognitive status (Addenbrooke's Cognitive Examination) (OR 0.98, 95% C.I: 0.96-0.99, p = 0.038), and lower dynamic balance and mobility (Timed Up and Go test) (OR 1.09, 95% CI: 1.01-1.16, p = 0.024).
CONCLUSION: Frailty is highly prevalent among Malaysian institutionalised older adults. Hypertension, cognitive impairment and lower dynamic balance and mobility were found to be risk factors of frailty. Screening of frailty and its associated factors should be prioritized among institutionalised older adults in view of early prevention and rehabilitation.
DESIGN: This was a qualitative study comprising semi-structured face-to-face interviews guided by 10 open-ended questions. Interviews were conducted until data saturation was achieved and no new ideas were formed. The interviews were audio-recorded, transcribed verbatim and analysed for themes. To derive themes, we employed directed content analysis of transcript data. Coding was completed using a combination of open, axial and selective coding.
SETTING: Four nursing homes in Singapore.
PARTICIPANTS: The study involved 17 participants (comprising 4 doctors, 4 pharmacists and 9 nurses).
RESULTS: Two key themes were identified, enablers and challenges. These were enablers and challenges faced by doctors, pharmacists and nurses towards deprescribing. The identified subthemes for enablers of deprescribing were: (1) awareness of medications that are unnecessary or could be targeted for deprescribing; (2) improving quality of life for patients with limited life expectancy; (3) improving communication between doctors, pharmacists and nurses; (4) systematic deprescribing practice and educational tools and (5) acknowledgement of possible benefits of deprescribing. The identified subthemes for challenges of deprescribing were: (1) symptoms not acknowledged as possibly drug-related; (2) lack of knowledge in patient's and family members' preferences; (3) lack of coordination between health professionals in hospitals and nursing homes and (4) limited tools for deprescribing. The development of a local guideline, mentoring nurses, case discussions, better shared decision-making and improving multidisciplinary communication, may help to support the process of deprescribing.
CONCLUSION: In conclusion, this study highlighted that deprescribing in the nursing homes is perceived by health professionals to be challenging and future research could assess how routine case studies, mentoring and better multidisciplinary communication could improve deprescribing knowledge and process in the nursing homes.
DESIGN: Systematic review and meta-analysis of randomized controlled trials. CINAHL, International Pharmaceutical Abstracts, MEDLINE, EMBASE, and Cochrane Library were searched from inception until September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials. (PROSPERO CRD42016050028).
SETTING AND PARTICIPANTS: Randomized controlled trials in a nursing home setting that included participants of at least 60 years of age.
MEASURES: Falls, all-cause mortality, hospitalization, and potentially inappropriate medication were assessed in the meta-analysis.
RESULTS: A total of 41 randomized clinical studies (18,408 residents) that examined deprescribing (defined as either medication discontinuation, substitution, or reduction) in nursing were identified. Deprescribing interventions significantly reduced the number of residents with potentially inappropriate medications by 59% (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.19-0.89). In subgroup analysis, medication review-directed deprescribing interventions reduced all-cause mortality by 26% (OR 0.74, 95% CI 0.65-0.84), as well as the number of fallers by 24% (OR 0.76, 95% CI 0.62-0.93).
CONCLUSIONS: Compared to other deprescribing interventions, medication review-directed deprescribing had significant benefits on older residents in nursing homes. Further research is required to elicit other clinical benefits of medication review-directed deprescribing practice.
METHODS: Unstructured observations and a focus-group discussion were carried out with 18 participants involved in a six-week SRT program in a residential care facility in Kuala Lumpur.
RESULTS: Analysis revealed four themes: (i) Enthusiastic participation; (ii) Connections across boundaries; (iii) Expressing and reflecting; and (iv) Successful use of triggers.
CONCLUSIONS: The findings suggest that the process of reminiscence, on which the program was based, was enjoyable for the participants and created opportunities to form connections with other members of the group. The use of relevant triggers in the SRT program that related to Malaysian cultures, ethnicities and religions was helpful to engage the participants and was acceptable across the different religions and ethnicities.