Collection of articles on Aging is available here.

How do family carers and care-home staff manage refusals when assisting a person with advanced dementia with their personal care?
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Backhouse T, Jeon YH, Killett A, Mioshi E.
Dementia (London). 2022 Sep 2;14713012221123578.
BACKGROUND AND OBJECTIVES: Caregivers may encounter, or inadvertently cause, refusals of care by a care recipient. Managing refusals of care can be challenging and have potential negative consequences. We aimed to examine caregivers’ (care-home staff and family carers) experiences of managing refusals of personal care in advanced dementia. RESEARCH DESIGN AND METHODS: One-to-one semi-structured interviews with 12 care assistants from six care homes and 20 family carers who were physically assisting a person with advanced dementia with their personal care in the UK. Interviews were audio recorded and transcribed verbatim, with data analysed using qualitative content analysis. FINDINGS: Core to the caregiver experience of refusals of care was knowing the person. This underpinned five key themes identified as caregivers’ strategies used in preventing or managing refusals of care: (1) finding the right moment to care; (2) using specific communication strategies; (3) being tactful: simplifying, leaving, or adapting care; (4) having confidence in care; and (5) seeking support from others when safety is at risk. DISCUSSION AND IMPLICATIONS: Different caregiver relationships with the person with dementia influenced how they managed refusals of care. Refusals of care can place caregivers in tough situations with tensions between providing care when it is seemingly not wanted and leaving care incomplete. Both caregiver groups require support such as coaching, mentoring and/or advice from other health and social care practitioners to manage difficult personal care interactions before crisis points occur.

Well-being right before and after a permanent nursing home admission.
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Bom J, Bakx P, Rellstab S.
Health Econ. 2022 Sep 4.
Permanent nursing home (NH) admissions are a frequent and major life event aimed at maintaining quality of life in old age. Yet, insights into the impact of a NH admission on well-being are scarce and inconclusive. We evaluate the effect of a NH admission on domains of well-being among those who are admitted using event study methodology for cross-sections combined with inverse probability weighting. We apply this doubly robust approach to Dutch survey data on well-being linked to extensive administrative data on NH admissions, health, and socio-economic status. We find that a NH admission leads to a temporary increase in loneliness, the risk of anxiety and depression, and a loss of control over one’s life. However, these scores revert to pre-admission levels after 6 months. These findings may contribute to better-informed individual-level and policy decisions about potential NH entry and aging in place policies.

VR Exergame Interventions among Older Adults Living in Longterm Care Facilities: A Systematic Review with Meta-analysis.
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Chen PJ, Hsu HF, Chen KM, Belcastro F. VR
Ann Phys Rehabil Med. 2022 Aug 23;101702.
BACKGROUND: To improve the motivation toward exercise in older adults, exergames have shifted from entertainment to rehabilitation. OBJECTIVES: To review the training focus of exergames and analyze the effectiveness of exergame training on physical, psychological, or cognitive outcomes among older adults in long-term care facilities (LTCFs). METHODS: This review followed the PRISMA guidelines. By searching 7 electronic databases up to April 30, 2022, studies were included if they 1) involved adults ≥65 years old residing in LTCFs, 2) were randomized controlled trials (RCTs) with virtual reality-based exergames as the intervention, 3) compared the effects of exergames to usual care or conventional exercises, and 4) reported physical, psychological, or cognitive outcomes. The Cochrane Risk-of-Bias tool for randomized trials version 2 (RoB 2) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to evaluate the methodological quality of studies and levels of evidence for outcomes. The meta-analysis was conducted with Review Manager 5.4. Results are presented as standardized mean differences (SMDs) and 95% confidence intervals (CIs). RESULTS: A total of 12 RCTs were included in the systematic review and meta-analysis. For overall methodological quality, 10 studies showed some concerns and 2 studies showed high risk. Levels of evidence for outcomes were assessed as low (n = 8) and very low (n = 4). The studies involved a total of 482 older adults. Most studies implemented balance exercise as the exergame intervention. Older adults who completed exergame interventions showed improvements in cognitive outcomes (SMD 0.90, 95%CI 0.61; 1.19, p<0.001) and in balance self-efficacy (SMD 1.04, 95%CI 0.47-1.61, p<0.001) as compared with those in usual care. They also showed improvements in balance (SMD 0.49, 95%CI 0.20-0.78, p<0.001) as compared with those in conventional exercise programs. Overall, exergames had a positive effect on balance (SMD 0.62, 95%CI 0.29-0.95, p<0.001). CONCLUSION: This review revealed that exergames can improve the balance ability of older adults in LTCFs.

Use of the Xiaomi Mi Band for sleep monitoring and its influence on the daily life of older people living in a nursing home.
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Concheiro-Moscoso P, Groba B, Martínez-Martínez FJ, Miranda-Duro MDC, Nieto-Riveiro L, Pousada T, et al.
Digit Health. 2022 Dec;8:20552076221121160.
Background: Lower quantity and poorer sleep quality are common in most older adults, especially for those who live in a nursing home. The use of wearable devices, which measure some parameters such as the sleep stages, could help to determine the influence of sleep quality in daily activity among nursing home residents. Therefore, this study aims to analyse the influence of sleep and its changes concerning the health status and daily activity of older people who lived in a nursing home, by monitoring the participants for a year with Xiaomi Mi Band 2. Methods: This is a longitudinal study set in a nursing home in [Details omitted for double-anonymized peer reviewed]. The Xiaomi Mi Band 2 will be used to measure biomedical parameters and different assessment tools will be administered to participants for evaluating their quality of life, sleep quality, cognitive state, and daily functioning. Results: A total of 21 nursing home residents participated in the study, with a mean age of 86.38 ± 9.26. The main outcomes were that sleep may influence daily activity, cognitive state, quality of life, and level of dependence in activities of daily life. Moreover, environmental factors and the passage of time could also impact sleep. Conclusions: Xiaomi Mi Band 2 could be an objective tool to assess the sleep of older adults and know its impact on some factors related to health status and quality of life of older nursing homes residents. Trial Registration: NCT04592796 (Registered 16 October 2020) Available on:

Feasibility of EMDR in Older Adults with PTSD to Reduce Frailty and Improve Quality of Life.
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Gielkens EMJ, Turksma K, Kranenburg LW, Stas L, Sobczak S, van Alphen SPJ, et al.
Clin Gerontol. 2022 Sep 4;1–11.
OBJECTIVES: Posttraumatic stress disorder (PTSD) after exposure to multiple (childhood) trauma’s is strongly associated with accelerated aging and high psychiatric and somatic comorbidity, influencing frailty and Quality of Life (QoL) in older adults. Eye Movement Desensitization therapy (EMDR) addresses psychological and physiologic symptoms stemming from adverse life events and therefore could influence frailty and QoL in older adults. METHODS: We conducted a multi-center feasibility study (two psychiatric hospitals) in Dutch older outpatients (N = 24; ≥60 years) with PTSD. Participants received weekly EMDR-treatment during the course of the trial (3 months to a maximum of 9 months). Frailty (Groninger Frailty Indicator) and QoL (EuroQol 5D-3L), were assessed pre- and posttreatment. RESULTS: A linear mixed-model approach showed significant reduction of frailty (F(1,23) = 9.019, p = .006) and improvement of QoL (F(1,23) = 13.787, p = .001). For both frailty and QoL, there was no significant influence of Clinician-Administered PTSD Scale (CAPS-5) pre-treatment score, therapy duration, and neither an interaction effect of therapy duration x CAPS-5 pre-treatment score. CONCLUSIONS: EMDR with older adults with PTSD showed a significant reduction of frailty and improvement of QoL. Randomized controlled studies are needed to more precisely study the impact of trauma-focused treatment in older adults on frailty and QoL and the implications this might have for lessening disease burden. CLINICAL IMPLICATIONS: Screening for PTSD in older frail adults is important to treat PTSD as a possible way to reduce frailty and improve QoL.

Frailty in Nursing Homes: A Prospective Study Comparing the FRAIL-NH and the Clinical Frailty Scale
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Grosshauser FJ, Schoene D, Kiesswetter E, Sieber CC, Volkert D. F
Journal of the American Medical Directors Association. 2022 Sep.
ObjectivesFrailty is common in nursing home (NH) residents, but its prevalence in German institutions is unknown. Valid and easy-to-use screening tools are needed to identify frail residents. We used the FRAIL-NH scale and the Clinical Frailty Scale (CFS) to (1) obtain the prevalence of frailty, (2) investigate the agreement between both instruments, and (3) evaluate their predictive validity for adverse health events in German NH residents.

Antibiotic postprescribing modification opportunities among nursing home residents treated for urinary tract infection.
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Langenstroer MC, Jolles S, Hossin T, Nora A, Bahrainian M, Crnich C, et al.
Infect Control Hosp Epidemiol. 2022 Aug 30;1–6.
OBJECTIVE: To characterize opportunities to postprescriptively modify antibiotic prescriptions initiated for treatment of suspected urinary tract infection (UTI) in nursing homes. DESIGN: Cross-sectional cohort study. METHODS: Data from the health records of residents treated for UTI between 2013 and 2014 in 5 Wisconsin nursing homes were abstracted using a structured approach. Explicit definitions were used to identify whether the prescribed antibiotic could have been stopped, shortened, or changed to a nonfluoroquinolone alternative. Antibiotic treatments appropriately modified by study nursing home providers in real time were not considered modifiable. Identification of >1 potential modification opportunity (eg, stop and shorten) per antibiotic treatment event was permitted. RESULTS: In total, 356 eligible antibiotic treatment courses among 249 unique residents were identified. Only 59 antibiotic courses prescribed for treatment of suspected UTI (16.6%) were not amenable to any modification. Discontinuation of treatment due to lack of signs or symptoms of infection was the most frequently identified potential modification opportunity (66.2%). Although less common, substantial numbers of antibiotic treatment courses were potentially amenable to shortening (34%) or agent change (19%) modifications. If applied in concert at 72 hours after antibiotic initiation, stop and shorten modifications could eradicate up to 1,326 avoidable antibiotic days, and change modifications could remove a 32 remaining avoidable fluoroquinolone days. CONCLUSIONS: Substantial opportunity exists to enhance the quality of antibiotic prescribing for treatment of suspected UTI in nursing homes through postprescriptive review interventions. Additional studies examining how to best design and implement postprescriptive review interventions in nursing homes are needed.

Improving nutrition and hydration in older people with dementia in care homes.
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Murphy JL.
Nurs Older People. 2022 Sep 7.
Dementia can have significant adverse effects on people’s ability to eat and drink sufficiently. People with dementia can experience malnutrition and unintentional weight loss at any stage of the condition, but these occur more often in the middle and late stages. It is important that nurses and care staff working in care homes have the appropriate knowledge and skills to provide optimal nutritional care to residents, thereby improving their health, well-being and quality of life. This article provides an overview of nutrition and hydration issues commonly experienced by people with dementia. It explores common causes of suboptimal nutrition and hydration, outlines tools for nutritional screening and assessment and discusses interventions to improve the nutritional care of care home residents with dementia.

Quality of dying among elderly people diagnosed with dementia in nursing homes: a mixed methods study.
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Puente-Fernández D, Olivencia Peña P, Soto-Felipe C, Montoya-Juárez R, Roldán C, García-Caro MP.
J Psychiatr Ment Health Nurs. 2022 Sep 6.
INTRODUCTION: The complex nature of end-of-life assessment of individuals diagnosed with dementia would benefit from a mixed methods approach that simultaneously assess the perception and response of nurses to standardised tools. AIM: To examine nursing professionals’ perceptions of the quality of dying among residents diagnosed with dementia using the Quality of Dying in Long-Term Care settings (QoD-LTC) questionnaire, and to identify consistencies and inconsistencies in their narratives. METHOD: Mixed methods study using concurrent triangulation with data integration for results and interpretation. Nurses from eight nursing homes assessed 117 residents diagnosed with dementia who died in the previous three months using the QoD-LTC scale. After informed consent was obtained (nurses/caregivers), 17 semi-structured scale-based interviews were conducted. RESULTS: Symptom management, quality of care, and end-of-life appearance were found to be adequate, while end-of-life communication was deemed insufficient. The qualitative and quantitative data were consistent for most of the items on the QoD-LTC, but concepts such as dignity, holistic care, good relationships, and a peaceful death are complex and not fully incorporated into professional practice. The results highlight the need for greater involvement of mental health nurses as well as improved communication, training and specific tools tailored to residents diagnosed with dementia.

Social interactions and quality of life of residents in aged care facilities: A multi-methods study.
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Siette J, Dodds L, Surian D, Prgomet M, Dunn A, Westbrook J.
PLoS One. 2022;17(8):e0273412.
BACKGROUND: The relationship between social contact and quality of life is well-established within the general population. However, limited data exist about the extent of social interactions in residential aged care facilities (RACFs) providing long-term accommodation and care. We aimed to record the frequency and duration of interpersonal interactions among residents in RACFs and identify the association between residents’ interpersonal interactions and quality of life (QoL). MATERIALS AND METHODS: A multi-methods study, including time and motion observations and a QoL survey, was conducted between September 2019 to January 2020. Thirty-nine residents from six Australian RACFs were observed between 09:30-17:30 on weekdays. Observations included residents’ actions, location of the action, and who the resident was with during the action. At the end of the observation period, residents completed a QoL survey. The proportion of time residents spent on different actions, in which location, and with whom were calculated, and correlations between these factors and QoL were analysed. RESULTS: A total of 312 hours of observations were conducted. Residents spent the greatest proportion of time in their own room (45.2%, 95%CI 40.7-49.8), alone (47.9%, 95%CI 43.0-52.7) and being inactive (25.6%, 95%CI 22.5-28.7). Residents were also largely engaged in interpersonal communication (20.2%, 95%CI 17.9-22.5) and self-initiated or scheduled events (20.5%, 95%CI 18.0-23.0). Residents’ interpersonal communication was most likely to occur in the common area (29.3%, 95%CI 22.9-35.7), residents’ own room (26.7%, 95%CI 21.0-32.4) or the dining room (24.6%, 95%CI 18.9-30.2), and was most likely with another resident (54.8%, 95%CI 45.7-64.2). Quality of life scores were low (median = 0.68, IQR = 0.54-0.76). Amount of time spent with other residents was positively correlated with QoL (r = 0.39, p = 0.02), whilst amount of time spent with facility staff was negatively correlated with QoL (r = -0.45, p = 0.008). DISCUSSION AND CONCLUSIONS: Our findings confirm an established association between social interactions and improved QoL. Opportunities and activities which encourage residents to engage throughout the day in common facility areas can support resident wellbeing.

Health, well-being and quality of life in aged care: Validation of theoretical domains to inform a person-centred outcomes measurement framework.
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Taylor S, Walton R, Martini A.
Australas J Ageing. 2022 Aug 30.
OBJECTIVES: The constructs of health, well-being and quality of life are not routinely understood or measured for people accessing aged care services. This study aimed to identify and validate theoretical domains of health, well-being and quality of life for recipients of care, their informal carers and staff, and inform the development of a person-centred outcomes measurement framework. METHODS: First, a rapid review to identify recurrent domains of health, well-being and quality-of-life in aged care, using systematic searches of electronic databases, and review of grey literature, following the PRISMA guidelines. Second, establish content validity of identified domains using (a) Delphi technique with n = 134 aged care staff, care recipients and caregivers, and (b) comparability with categories within the International Classification of Functioning, Disability and Health (ICF) and ICF Geriatric Core Set. RESULTS: From 972 records detected in the rapid review, 19 peer-reviewed research articles and 27 grey literature sources were included in the content analysis. Twenty-four domains and 109 concepts were identified, and health, quality of life, security and food and nutrition were ranked as the most important. One domain, cognition, linked to both the Geriatric Core Set and ICF, and 37% of domains and 39% of concepts were evident within the ICF. CONCLUSIONS: This study identified and validated 24 important domains of health, well-being and quality of life for the older person receiving care, their informal carers and staff. These domains can be used to guide the selection of outcome measures and facilitate person-centred care and care planning.

Promoting empowerment for people living with dementia in nursing homes: Development and feasibility evaluation of an empowerment program.
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van Corven C, Bielderman A, Wijnen M, Leontjevas R, Lucassen PL, Graff MJ, et al.
Dementia (London). 2022 Sep 5;14713012221124984.
OBJECTIVES: This article describes the development and feasibility evaluation of an empowerment program for people living with dementia in nursing homes. METHODS: Development and feasibility evaluation of the empowerment program was guided by the British Medical Research Council’s (MRC) framework. In the developmental phase, we used intervention mapping to develop the theory- and evidence-based intervention. During the feasibility phase, two care teams utilised the program from September to December 2020. We evaluated the feasibility in terms of demand, acceptability, implementation, practicality, integration and limited efficacy. FINDINGS: This study showed that, according to healthcare professionals, the program was feasible for promoting empowerment for people living with dementia in a nursing home. Healthcare professionals mentioned an increased awareness regarding the four themes of empowerment (sense of identity, usefulness, control and self-worth), and greater focus on the small things that matter to residents. Healthcare professionals experienced challenges in involving family caregivers. CONCLUSION: An important step is to take into account the implementation prerequisites that follow from our findings, and to further investigate feasibility, as the use of the program and data collection was hindered by the COVID-19 pandemic. Subsequent research could investigate the effects of the empowerment program.