Collection of articles on Aging is available here.

Implementation of an integrative movement program for residents with dementia in a VA nursing home.
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Akram A, Nicosia F, Lee J, Lee M, Martin L, Martinez S, et al.
BMC geriatrics 2021 oct;21(1):607.
BACKGROUND: Preventing Loss of Independence through Exercise (PLIÉ) is an integrative group movement program developed for adults with mild-to-moderate dementia attending day programs. However, many older adults with dementia ultimately require assistance with their activities of daily living and become residents in nursing homes or other long-term care facilities with their complex comorbidities and unique needs. We conducted a post-implementation evaluation of PLIÉ at a San Francisco Veterans Affairs (VA) nursing home to assess reach and effectiveness among residents, staff, and family members who participated in ≥ 1 PLIÉ class from 9/2018 to 6/2019. METHODS: Post-implementation number of classes offered and mean attendance; anonymous satisfaction surveys (5-point Likert scales); qualitative content analysis of open-ended survey responses and clinical progress notes. RESULTS: Forty-five PLIÉ classes were offered over 9 months. Residents attended an average of 13 ± 12 classes with an average class size of 14 residents, 4 staff members, and 2 family members. Most survey respondents rated the program overall as “very good” or “excellent” (100 % residents, n = 15; 87 % staff, n = 14; 100 % family members, n = 8). Respondents reported improvements in themselves and/or others in four domains: (1) physical, (2) psychological, (3) social, and (4) cognitive. Physical improvements among veterans included mobility, strength, and energy. Psychological improvements included feelings of happiness/well-being, enjoyment, and self-empowerment. Social improvements included connection, social skills, and social support. Cognitive improvements included engagement, communication ability, and focus/attention. Responses were similar among resident, staff, and family member surveys and clinical progress notes. Participants frequently reported improvements in multiple domains (e.g., “The veterans are more alert and engaged, many are smiling and laughing.”). Negative comments were primarily related to logistics, suggesting that the class occur more frequently. CONCLUSIONS: PLIÉ was successfully implemented in a VA nursing home with high attendance and satisfaction among residents, staff, and family members. Participants reported clinically meaningful physical, psychological, social, and cognitive benefits. Other long-term care facilities could potentially benefit from implementing PLIÉ to increase quality of life in residents with dementia.

Research on Acoustic Environment in the Building of Nursing Homes Based on Sound Preference of the Elderly People: A Case Study in Harbin, China.
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Cui P, Zhang J, Li TT.
Frontiers in psychology 2021;12:707457.
Nursing homes are the facilities where the elderly conduct their daily activities. This may lead to a complicated acoustic environment which would potentially affect the ability of the elderly to function. In this study, the main indoor public space of a nursing home in Harbin was taken as the research object, and the methods of field observation, sound measurement, and questionnaire survey were used to explore the sound perception and preference of the elderly. The results revealed that in terms of the temporal and spatial distribution of sound pressure level (SPL), the unit living space had the highest SPL, which was above 60 dB (A). The reverberation time (RT) of the unit living space, medical and health care center corridor, was 2.15 and 2.13 s, respectively, at a frequency of 1,000 Hz, which was within the discomfort range. The results also revealed that an acoustic environment had a strong correlation with humidity and a weak correlation with temperature. However, no significant correlation could be assessed with a luminous environment. The elderly people were generally willing to accept the natural sound sources. The factors of gender and offspring numbers had no significant impact on the evaluation of acoustic environment comfort, whereas marriage and income status affected the comfort. This study may help improve the quality of life of the elderly in the nursing home and provide a reference for the construction and design of pension facilities.

Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study.
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Inacio MC, Jorissen RN, Wesselingh S, Sluggett JK, Whitehead C, Maddison J, et al.
BMJ open 2021 nov;11(11):e057247.
OBJECTIVES: To: (1) examine the 90-day incidence of unplanned hospitalisation and emergency department (ED) presentations after residential aged care facility (RACF) entry, (2) examine individual-related, facility-related, medication-related, system-related and healthcare-related predictors of these outcomes and (3) create individual risk profiles. DESIGN: Retrospective cohort study using the Registry of Senior Australians. Fine-Gray models estimated subdistribution HRs and 95% CIs. Harrell’s C-index assessed risk models’ predictive ability. SETTING AND PARTICIPANTS: Individuals aged ≥65 years old entering a RACF as permanent residents in three Australian states between 1 January 2013 and 31 December 2016 (N=116 192 individuals in 1967 RACFs). PREDICTORS EXAMINED: Individual-related, facility-related, medication-related, system and healthcare-related predictors ascertained at assessments or within 90 days, 6 months or 1 year prior to RACF entry. OUTCOME MEASURES: 90-day unplanned hospitalisation and ED presentation post-RACF entry. RESULTS: The cohort median age was 85 years old (IQR 80-89), 62% (N=71 861) were women, and 50.5% (N=58 714) had dementia. The 90-day incidence of unplanned hospitalisations was 18.0% (N=20 919) and 22.6% (N=26 242) had ED presentations. There were 34 predictors of unplanned hospitalisations and 34 predictors of ED presentations identified, 27 common to both outcomes and 7 were unique to each. The hospitalisation and ED presentation models out-of-sample Harrell’s C-index was 0.664 (95% CI 0.657 to 0.672) and 0.655 (95% CI 0.648 to 0.662), respectively. Some common predictors of high risk of unplanned hospitalisation and ED presentations included: being a man, age, delirium history, higher activity of daily living, behavioural and complex care needs, as well as history, number and recency of healthcare use (including hospital, general practitioners attendances), experience of a high sedative load and several medications. CONCLUSIONS: Within 90 days of RACF entry, 18.0% of individuals had unplanned hospitalisations and 22.6% had ED presentations. Several predictors, including modifiable factors, were identified at the time of care entry. This is an actionable period for targeting individuals at risk of hospitalisations.

Dog-assisted interventions in care homes: A qualitative exploration of the nature, meaning and impact of interactions for older people.
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Jain B, Hafford-Letchfield T, Ellmers T, Chandra C, Billings B, Teacher R, et al.
Health & social care in the community 2021 sep;29(5):1450-1460.
Dog-assisted interventions (DAI) have been shown to have a wide-range of potential benefits for older adults living in care homes. Yet, there is a lack of published qualitative research which explores the experiences of care home residents, staff and dog-owner volunteers involved in DAI to fully understand its meaning, impact and value. This study aimed to explore the impact of a DAI on the social and emotional wellbeing of older residents living in care homes. The research employed a qualitative study design comprising overt, naturalistic researcher observation of weekly DAI sessions with 54 older adult residents across four participating care homes in the South East region of England over 3 months in 2018. Data were also collected through focus groups with 12 care home staff and 7 dog-owner volunteers. The data from the observations and focus groups was individually coded followed by thematic analysis across the three data sources. Findings demonstrated there were clear benefits for older people who engaged with DAI, as well as for dog-owners and to some extent for care home staff members. Benefits included sensory, emotional stimulation and opportunities for social interaction, reminiscence on early life experiences and these were supported by the development of some new social relationships. While there were some environmental challenges to implementing DAI, the findings confirm its value for care home residents, with minimal drawbacks from an organizational standpoint. As a low cost intervention, adoption of DAI in care home settings appeared to strengthen relationships between residents and staff and enable wider relationships with an external community resource.

Evaluating the Implementation of the Conversation Starter
Kit in Long Term Care.

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Kaasalainen S, Sussman T, Nicula M, Lawrence J, Thompson G, McCleary L, et al.
SAGE open nursing 2021;7:23779608211051824.
INTRODUCTION: Advance care planning can improve the quality of life for residents in long-term care homes and reduce stress for families. However, care home staff and families often lack knowledge about advance care planning, making it especially difficult for residents with dementia to communicate their care plan wishes. A Conversation Starter Kit may increase advance care planning awareness among staff and families. OBJECTIVES: This study evaluated an advance care planning intervention, the Conversation Starter Kit booklet, for use in long term care homes. METHODS: Data were collected at three long-term care homes in southern Ontario. We collected data from 55 residents who were able to make decisions on their own paired with 11 family members of these residents. We also collected data from 24 family members of residents who were unable to make decisions on their own. This study used a quasi-experimental, one group pre/post design. Quantitative surveys were administered before and after a three-month advance care planning intervention. An additional structured interview was completed at the end of the intervention period, which included both closed and open-ended questions to assess perceptions about the booklet’s use or non-use. RESULTS: Residents reported more engagement in advance care planning after completing the Conversation Starter Kit booklet, particularly related to asking questions to health care providers about health care decisions. Family members reported feeling very certain that they would be able to make decisions on behalf of the resident but felt less certain after completing the booklet, implying the booklet raised their awareness of the types of decisions they might need to make, hopefully prompting them to be more prepared for decisions in the future. CONCLUSIONS: An advance care planning intervention – The Conversation Starter Kit booklet – appears acceptable and easy to use for residents and family members/friends in long-term care and can improve resident engagement in advance care planning. Although using the booklet may decrease efficacy for decision making among family members of long-term care residents, it may highlight the importance of more actionable engagement in advance care planning among residents, their families/friends, and staff.

The mediating role of self-acceptance in the relationship between loneliness and subjective well-being among the elderly in nursing home: A cross-sectional study.
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Li S, Zhang X, Luo C, Chen M, Xie X, Gong F, et al.
Medicine 2021 oct;100(40):e27364.
The purpose of this study was to investigate the mediating effects of self-acceptance on loneliness and subjective well-being (SWB) among elderly subjects living in Chinese nursing homes.This cross-sectional study was conducted between October 2019 and March 2020. A total of 415 elderly participants aged 60 to 97 years (mean 81.12 ± 8.90 years) from 3 medical and nursing homes in Fuyang city, Anhui province, were selected using a convenience sampling method. Data were collected using a general information questionnaire, the Memorial University of Newfoundland Scale of Happiness, the self-acceptance scale, and the UCLA Loneliness scale. Correlations, regressions, and structural equation models were used for the analyses. Multiple linear regression analysis was performed to confirm the factors influencing the SWB. Bootstrapping was performed to confirm the mediation effect.The loneliness of elderly subjects in nursing homes was significantly correlated with self-acceptance and SWB (r = -0.338, P < .01; r = -0.383, P < .01), and self-acceptance was significantly correlated with SWB (r = 0.401, P < .01). Multiple linear regression revealed that the relationship with children, loneliness, residence time in nursing homes, income, marital status, self-acceptance, original residence, and frequency of children’s visits were the main factors affecting SWB. Bootstrapping showed that the mediating role of self-acceptance was statistically significant.The SWB of elderly individuals living in Chinese nursing homes was moderate. Low-income people, subjects from rural areas, and those newly admitted to nursing homes should be emphasized in interventions, and appropriate measures should be taken to harmonize the relationships between elderly residents and their children. Self-acceptance partially mediated the relationship between loneliness and SWB. Consequently, self-acceptance should be the focus of improving the SWB of elderly nursing home residents.

What Constitutes Preferred Long-Term Care Provided in Residential Aged Care Facilities? An Empirical Comparison of the Preferences of the General Population, Residents, and Family Members
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Milte RK, Mpundu-Kaambwa C, Chen G, Crotty M, Ratcliffe J.
Value in Health 2021.
Objectives Relatively few studies to date have examined the preferences of members of the general population as potential future consumers of long-term aged care services. This study aimed to use discrete choice experiment methodology to compare the preferences of 3 groups: the general population, residents, and family members of people living in long-term aged care. Methods A total of 6 salient attributes describing the physical and psychosocial care in long-term residential aged care were drawn from qualitative research with people with a lived experience of aged care and were used to develop the discrete choice experiment questionnaire. The 6 attributes included: the level of time care staff spent with residents, homeliness of shared spaces, the homeliness of their own rooms, access to outside and gardens, frequency of meaningful activities, and flexibility with care routines. The questionnaire was administered to 1243 respondents including consumers (residents [n = 126], family member carers [n = 416]), and members of the general population (n = 701). Results For both the general population and resident samples, having their own room feeling “home-like” exhibited the largest impact upon overall preferences. For the family member sample, care staff being able to spend enough time exhibited the largest impact. Tests of poolability indicated that the resident and general population samples estimates could be pooled. The null hypothesis of equal parameters between the groups was rejected for the family members, indicating significant differences in preferences relative to the resident and the general population samples. Conclusions This study illustrates that preferences for residential aged care delivery may vary depending upon perspective and experience.

Racial Disparities in Care Interactions and Clinical Outcomes in Black Versus White Nursing Home Residents With Dementia.
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Resnick B, Van Haitsma Kimberly, Kolanowski A, Galik E, Boltz M, Ellis J, et al.
J Nurs Care Qual 2021 nov.
BACKGROUND: With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised. PURPOSE: The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months. METHODS: This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia study. A total of 553 residents, 24% Black residents and 76% White residents, from 55 nursing homes were included. RESULTS: Differences favoring Black resident were noted in agitation, quality of life, inclusion of person-centered care approaches in care plans, and fewer falls and hospitalizations. Differences in quality-of-care interactions favored White residents. There were no differences in depression, resistiveness to care, function, pain, or transfers to the emergency department. CONCLUSIONS: Disparities in clinical outcomes were small and generally favored Black versus White residents except for quality-of-care interactions.

Delirium During Acute Events in Nursing Home Patients.
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Skretteberg WH, Holmefoss I, Krogseth M.
Journal of the American Medical Directors Association 2021 nov.
OBJECTIVES: Assess the frequency of delirium during any acute event, its risk factors, and the duration of delirium in nursing home patients. DESIGN: Prospective 2-month follow-up study. SETTING AND PARTICIPANTS: 145 nursing home patients living in 3 Norwegian nursing homes. METHODS: At baseline, known risk factors for delirium were obtained from medical records. During any acute events where the nurses decided that a physician had to be alerted, the Confusion Assessment Method was used to identify delirium on days 1, 2, 4, and 6 and thereafter weekly if delirium was present on day 6. The precipitating cause of delirium was registered based on diagnostics performed and treatment given. RESULTS: One or more acute events occurred in 57 patients, and 34 (60%) of these patients developed delirium. In 91% of the patients with delirium, the delirium was present when the physician was alerted about the acute change. Delirium lasted for more than 1 week in 15 of the 34 patients. In 18 of the 34 patients with delirium, an infection was its precipitating factor. Regular use of benzodiazepines and a diagnosis of vascular dementia were significantly associated with delirium in the logistic regression model adjusted for age, number of drugs, and comorbidity [adjusted odds ratio (95% confidence interval) 3.75 (1.44-9.74) and 5.59 (1.53-20.43), respectively]. CONCLUSIONS AND IMPLICATIONS: Acute events and illness were common in nursing home patients, and in our study, 60% had delirium associated with the event. In 9 of 10 patients, the delirium was present when the physician was alerted about the acute change, and infection was the most frequent cause of the delirium. Regular use of benzodiazepines and a diagnosis of vascular dementia were independent predisposing factors for delirium.

Effectiveness of reminiscence therapy in reducing agitation and depression and improving quality of life and cognition in long-term care residents with dementia: A systematic review and meta-analysis.
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Thomas JM, Sezgin D.
Geriatr Nurs 2021 oct;42(6):1497-1506.
This paper assesses the effectiveness of reminiscence therapy (RT) in people with mild to moderate dementia in long-term care facilities. A literature search was conducted in CINAHL, MEDLINE, PsychINFO, and Embase from inception to December 2020. Five RCTs with 267 participants were included; two were meta-analysed. Cochrane collaboration’s risk of bias tool was used to evaluate the methodological quality of the included RCTs, and the risk of bias across studies was assessed using the GRADE method. The overall quality of evidence was moderate to low. Among the five trials, none measured the efficacy of RT on agitation. Reminiscence therapy was effective in reducing depression and improving autobiographical memory, but its effects were inconsistent. There was a significant improvement in quality of life (QoL) following RT. The meta-analysis showed no statistical significance on the pre-post intervention differences in depression (SMD -0.28, 95%CI -0.91-0.35, p > 0.05) and autobiographical memory scores (SMD 0.57, 95%CI -0.07-1.21, p > 0.05). Reminiscence therapy may have some benefits in reducing depression and improving the QoL and cognition in this population; however, its effectiveness should be tested further.