How Long Do Older Adults Remain Homebound in the Community? Implications for Long-Term Services and Support Systems

Abstract A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community but are homebound (never/rarely leave home). While homebound status is associated with decreased access to medical services and poor health outcomes, it is unclear how long individuals remain homebound. We used the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries age 65 and over, with survey weighting to assess duration of homebound status in the community. Among the incident homebound in 2016 (n=253) , only 28% remained homebound after 1 year. 21% died, 18% were recovered, and one-third left the home but still reported difficulty. As the locus of long-term care shifts from nursing homes to the community and models of care expand to serve the needs of the homebound, it is critical that we better understand the heterogeneity and transitions of the homebound population.

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Converting threats from COVID-19 in long term care into opportunities for improvement

Clinical Nursing Studies ◽

10.5430/cns.v9n2p36 ◽

2022 ◽

Vol 9 (2) ◽

pp. 36

Author(s):

Leona Konieczny

Keyword(s):

Older Adults ◽

Policy Implementation ◽

Nursing Staff ◽

Policy Development ◽

Shared Governance ◽

Long Term Care ◽

Models Of Care ◽

Term Care ◽

Nursing Advocacy

The effects of the COVID-19 pandemic on long term care (LTC) have been published in the literature and experienced by residents, their support persons and nursing staff. The morbidity and mortality, as well as the threats of isolation and psychosocial distress continue. Both LTC residents and staff experience physiological and psychological impacts. Nurses can use the current threats produced by the pandemic to advocate for alternate models of care and reduced isolation for residents. The pandemic is an opportunity for nursing advocacy in LTC for shared governance and empowerment, involvement in policy development, and oversight in policy implementation. Nurses are presented with the opportunities for advocacy related to resources and reshaping the paradigm of residential care for older adults.

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Assessment of Anxiety in Long-Term Care Residents: Issues and Strategies

The International Journal of Aging and Human Development ◽

10.1177/0091415020943321 ◽

2020 ◽

pp. 009141502094332

Author(s):

Marissa A. Pifer ◽

Daniel L. Segal ◽

Dylan J. Jester ◽

Victor Molinari

Keyword(s):

Older Adults ◽

Anxiety Disorders ◽

Long Term Care ◽

Self Report ◽

Term Care ◽

Measurement Tools ◽

Assessment And Treatment ◽

Clinically Significant ◽

Growing Population

The experience of clinically significant anxiety and anxiety disorders represent significant and often debilitating problems for many residents in long-term care (LTC) settings. However, anxiety problems often go undetected and untreated in this growing population. The purposes of this paper are to examine the prevalence and impact of anxiety problems among residents in LTC facilities, describe the efficacy of the current instruments that are used to detect anxiety in these settings, and provide clinical guidance for the thorough assessment of anxiety. Regarding measurement tools, the GAI, GAI-SF, GAS-LTC, and the BADS are the only self-report measures designed for older adults that have been successfully validated for use with older adults living in LTC settings. Clinicians should focus on ways to educate LTC directors and staff to emphasize the importance of screening and assessing for anxiety, using validated measures, to improve the assessment and treatment of anxiety in their residents.

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Author response for "The Effect Of Fall Biomechanics On Risk For Hip Fracture In Older Adults: A Cohort Study Of Video‐Captured Falls In Long‐Term Care"

10.1002/jbmr.4048/v2/response1 ◽

2020 ◽

Author(s):

Yijian Yang ◽

Vicki Komisar ◽

Nataliya Shishov ◽

Bryan Lo ◽

Alexandra MB Korall ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Hip Fracture ◽

Long Term Care ◽

Author Response ◽

Term Care

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Decision Making and Implementation of Aging-in-Place/Long Term Care Plans Among Older Adults

Case Medical Research ◽

10.31525/ct1-nct03960476 ◽

2019 ◽

Author(s):

Keyword(s):

Older Adults ◽

Decision Making ◽

Long Term Care ◽

Aging In Place ◽

Term Care ◽

Care Plans

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Uitbraak COVID-19 in de verpleeghuiszorg

Tijdschrift voor Gerontologie en Geriatrie ◽

10.36613/tgg.1875-6832/2020.03.01 ◽

2020 ◽

Keyword(s):

Older Adults ◽

Nursing Home ◽

Nursing Homes ◽

Long Term Care ◽

Informal Caregivers ◽

Rapid Review ◽

Daily Routine ◽

Term Care ◽

Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

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Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

BMC Public Health ◽

10.1186/s12889-021-10463-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zijing Wang ◽

Wenjia Peng ◽

Mengying Li ◽

Xinghui Li ◽

Tingting Yang ◽

...

Keyword(s):

Older People ◽

Functional Disability ◽

Long Term Care ◽

Strong Association ◽

Binary Logistic Regression ◽

Term Care ◽

Logistic Regression Models ◽

Disease Pattern ◽

Long Term Care Insurance

Abstract Background Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. Methods We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. Results Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16–1.41) and IADL (OR 1.41, 95%CI 1.19–1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40–1.72). Conclusions Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

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Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02049-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chan Mi Park ◽

Wonsock Kim ◽

Hye Chang Rhim ◽

Eun Sik Lee ◽

Jong Hun Kim ◽

...

Keyword(s):

Older Adults ◽

Primary Outcome ◽

Long Term Care ◽

Functional Decline ◽

Tube Feeding ◽

Term Care ◽

Pneumonia Severity ◽

Frailty Assessment ◽

Nasogastric Tube Feeding

Abstract Background Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty. Methods A prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0–1; robust < 0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0–5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution. Results The population had a median age 79 (interquartile range, 75–84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0–2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3–5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar. Conclusions Older adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.

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Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice

Journal of Holistic Nursing ◽

10.1177/08980101211025372 ◽

2021 ◽

pp. 089801012110253

Author(s):

Verónica G. Walker ◽

Elizabeth K. Walker

Keyword(s):

Older Adults ◽

Life Course ◽

Health Beliefs ◽

Long Term Care ◽

Life Course Theory ◽

Nursing Research ◽

Term Care ◽

Holistic Nursing ◽

Care Facilities

Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.

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