Environment Still Matters: Examining Person-Place-Relationships in the Old and the New Normal Across Settings

Abstract In environmental gerontology, the home and the neighborhood have always been of particular interest for empirical research. Issues such as orientation and safety, place attachment and biographical bonding, have proven to be important for community dwellings older adults and for those living in care homes. However, with Covid-19, the seemingly stable person-place-relationships have been challenged. This symposium provides a set of applied research contributions that demonstrate the persistent salience of the environment by examining person-place-relationships in the old and the new normal in private homes and care homes. Contributions draw from ideas of “precarious ageing” (Grenier & Phillipson) and “pandemic precarity”, for instance to understand housing insecurity, while concepts from environmental gerontology are used to explain processes of environmental agency and belonging. The first contribution by Mahmood and colleagues introduces an environmental audit tool for people at risk of homelessness to assess built environmental features of housing and neighborhood that support housing stability in the face of insecurity. Second, Wanka provides data from people framed as ‘risk-groups’ through the Covid-19 pandemic and how they dealt with contact restrictions, showing the role of intergenerational neighborhood relations to mediate risks of pandemic precariousness. Third, Elkes examined mobility and wayfinding challenges for residents in a long-term care home and subsequent environmental interventions to improve orientation. Forth, Leontowitsch and colleagues present findings from long-term care home residents during the pandemic to gain understanding of their experiences of social isolation and a biographical sense of resilience. Finally, Amanda Grenier will serve as the session’s discussant.

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Impact of a public policy restricting staff mobility between long-term care homes in Ontario, Canada during the COVID-19 pandemic

10.1101/2020.11.17.20231498 ◽

2020 ◽

Cited By ~ 1

Author(s):

Aaron Jones ◽

Alexander G. Watts ◽

Salah Uddin Khan ◽

Jack Forsyth ◽

Kevin A. Brown ◽

...

Keyword(s):

Public Policy ◽

Long Term Care ◽

Care Home ◽

Relative Difference ◽

Care Staff ◽

Care Homes ◽

Term Care ◽

Undirected Network ◽

Before And After

AbstractObjectivesTo assess changes in the mobility of staff between long-term care homes in Ontario, Canada before and after enactment of public policy restricting staff from working at multiple homes.DesignPre-post observational study.Setting and Participants623 long-term cares homes in Ontario, Canada between March 2020 and June 2020.MethodsWe used anonymized mobile device location data to approximate connectivity between all 623 long-term care homes in Ontario during the 7 weeks before (March 1 – April 21) and after (April 22 – June 13) the policy restricting staff movement was implemented. We visualized connectivity between long-term care homes in Ontario using an undirected network and calculated the number of homes that had a connection with another long-term care home and the average number of connections per home in each period. We calculated the relative difference in these mobility metrics between the two time periods and compared within-home changes using McNemar’s test and the Wilcoxon rank-sum test.ResultsIn the period preceding restrictions, 266 (42.7%) long-term care homes had a connection with at least one other home, compared to 79 (12.7%) homes during the period after restrictions, a drop of 70.3% (p <0.001). The average number of connections in the before period was 3.90 compared to 0.77 in after period, a drop of 80.3% (p < 0.001). In both periods, mobility between long-term care homes was higher in homes located in larger communities, those with higher bed counts, and those part of a large chain.Conclusions and ImplicationsMobility between long-term care homes in Ontario fell sharply after an emergency order by the Ontario government limiting long-term care staff to a single home, though some mobility persisted. Reducing this residual mobility should be a focus of efforts to reduce risk within the long-term care sector during the COVID-19 pandemic.

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Implementation of eHealth to support assessment and decision-making for residents with dementia in long-term care: systematic review (Preprint)

10.2196/preprints.29837 ◽

2021 ◽

Author(s):

Juliet Gillam ◽

Nathan Davies ◽

Jesutofunmi Aworinde ◽

Emel Yorganci ◽

Janet E Anderson ◽

...

Keyword(s):

Decision Making ◽

Long Term Care ◽

Care Home ◽

End Users ◽

Care Homes ◽

Successful Implementation ◽

Key Factors ◽

Term Care ◽

Care Assessment

BACKGROUND As dementia progresses, symptoms and concerns increase causing considerable distress for the person and caregivers. Integration of care between care homes and healthcare services is vital to meet increasing care needs and maintain quality of life. However, access to high-quality healthcare is inequitable. eHealth offers a potential solution, by supporting remote specialist input on care processes like clinical assessment and decision-making, and streamlining care on site. How best to implement eHealth in the care home setting is unclear. OBJECTIVE This review aimed to identify key factors that influence implementation of eHealth for people living with dementia in long-term care. METHODS A systematic search of EMBASE, PsychInfo, MEDLINE and CINHAL was conducted to identify studies published between 2000-2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analysed and deductively mapped onto the six constructs of the adapted Consolidated Framework for Implementation Research (CFIR). Results are presented as a narrative synthesis. RESULTS 29 studies were included, focusing on a variety of eHealth interventions including remote video-consultations and clinical decision support tools. Key factors which influenced eHealth implementation were identified across all six constructs of the CFIR. Most concerned the Inner Setting construct about requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership and sufficient training and resources. Four novel subconstructs were identified to inform implementation requirements to meet resident needs and engage end-users. CONCLUSIONS Implementing eHealth in care homes for people with dementia is multi-factorial and complex, involving interaction between the resident, staff and organisation. Application of the CFIR for care homes requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed, and translated into 18 practical recommendations on implementation of eHealth in long-term care to guide implementers or innovators in care homes. The policy imperative for integrated health and social care demands successful implementation of eHealth, to maximise uptake and drive improvements.

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Derivation and validation of a decision support algorithm for urgent admissions to long-term care homes in Ontario

10.31219/osf.io/34tvb ◽

2019 ◽

Author(s):

Aaron Jones ◽

Chi-Ling Joanna Sinn

Keyword(s):

Decision Support ◽

Long Term Care ◽

Care Home ◽

Decision Support Tool ◽

Fundamental Principle ◽

Care Homes ◽

Risk Level ◽

Term Care ◽

Support Tool

Equitable access to care is a fundamental principle of Canada’s healthcare system. In Ontario, the absence of a provincial standard to support consistent decision making around urgent admissions to long-term care homes has led to variation in practice across the province. A working group was established in 2014 to develop an evidence-informed decision support tool to promote consistency in care planning regarding urgent admissions to long-term care homes. The resulting CRISIS algorithm demonstrates good prognostic ability, with the proportion of patients urgently admitted to a long-term care home within 90 days ranging from 2.4% in the lowest risk level to 39.9% in the highest risk level. The implementation of the algorithm will improve equity in access to long-term care homes in Ontario.

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Evaluation of factors associated with urinary incontinence in elderly people in long-term care homes

Acta Scientiarum Health Sciences ◽

10.4025/actascihealthsci.v38i2.29237 ◽

2016 ◽

Vol 38 (2) ◽

pp. 137

Author(s):

Tábada Samantha Marques Rosa ◽

Melissa Medeiros Braz ◽

Valdete Alves Valentins dos Santos Filha ◽

Anaelena Bragança de Moraes

Keyword(s):

Urinary Incontinence ◽

Elderly People ◽

Long Term Care ◽

Demographic Data ◽

Care Home ◽

Care Homes ◽

Term Care ◽

Significance Level ◽

Factors Associated

The aim of this study was to assesses the factors associated with the occurrence of urinary incontinence (UI) in elderly people living in long-term care homes. Reports on Urinary Incontinence coupled to clinical-functional and socio-demographic data were retrieved from the medical records of elderly people. In addition, the application of the protocols: Mini-Mental State Examination, Katz Index, Short Physical Performance Battery. It was considered a significance level of 5%. It was noted that the UI occurred in 80.6% of elderly people, with average age 76.5 years (± 8.3) and average time at the care home reaching 5.2 years (± 6.4). Significant UI association was reported with gender, education and disease. A discrete increase in scores occurred in protocols for elderly people without UI occurrence. It is concluded that sample was characterized by elderly females with less than five years living in homes. The elderly with UI were similar to elderly people in general with regard to protocols.

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It takes time: Building relationships and understanding through an intergenerational ballet programme

Dementia ◽

10.1177/1471301218772895 ◽

2018 ◽

Vol 19 (2) ◽

pp. 270-284

Author(s):

Shelley E Canning ◽

Michael Gaetz ◽

Darren Blakeborough

Keyword(s):

Older Adults ◽

Residential Care ◽

Long Term Care ◽

Care Home ◽

Care Homes ◽

Term Care ◽

Negative Stereotypes ◽

Building Relationships ◽

Meaningful Relationships

Individuals living in long-term residential care homes are often viewed through a negative lens. These residents have increasingly complex care needs, and their functional, communication and cognitive challenges can support conceptualizations of difference and disability perpetuating negative stereotypes of age and dementia. However, engaging in meaningful activities and relationships with older adults, including those with dementia, has been shown to promote positive attitudes. Specifically, intergenerational programming that provides opportunities for meaningful engagement between children and older adults has been shown to support positive emotional experiences through socializing and building relationships. This qualitative study explored the development of relationships between school-aged children and older adults with dementia living in a long-term residential care home. Residents in long-term care homes and children typically have limited opportunities to interact with each other; in this study, participating in an intergenerational dance programme provided an opportunity for meaningful relationships to develop. This paper focuses on the development of the children’s attitudes and understandings of their much older dance partners. Seven girls between the ages of seven and nine participated in ballet classes with residents in a long-term care home for one hour each week over a six-month period. All of the residents had a diagnosis of moderate to advanced dementia. Further, all of the residents also had other chronic health issues such as cardiac, respiratory and/or neurological diseases. The children were interviewed at the baseline, three- and six-month intervals. Prior to beginning the dance programme, the children anticipated their dance partners to be unwell and unable. However, by the end of six months, the children described the residents much more positively highlighting their abilities and strengths. Over time, through participating in a structured intergenerational programme, the children’s views of disability and difference disappeared as they formed dance partnerships and developed meaningful relationships.

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Evaluating and Motivating Activation in Long Term Care: Lessons From a Pilot Study

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101016 ◽

2021 ◽

Vol 10 (1) ◽

pp. 42-46

Author(s):

J. Jbilou ◽

A. El Bouazaoui ◽

B. Zhang ◽

J.L. Henry ◽

L McDonald ◽

...

Keyword(s):

Long Term Care ◽

Driving Simulator ◽

Care Home ◽

Lessons Learned ◽

Term Care ◽

Care Facilities ◽

Technological Intervention ◽

The Impact ◽

Research Recommendations

Older adults living in long-term care facilities typically receive insufficient exercise and have long periods of the day when they are not doing anything other than sitting or lying down, watching television, or ruminating (Wilkinson et al., 2017). We developed an intervention called the Experiential Centivizer, which provides residents with opportunities to use a driving simulator, watch world travel videos, and engage in exercise. We assessed the impact of the intervention on residents of a long-term care home in Fredericton, NB, Canada. In this paper, we report on the results observed and highlight the lessons learned from implementing a technological intervention within a long-term care setting. Practical and research recommendations are also discussed to facilitate future intervention implementation in long-term care.

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