A two-echelon responsive health analytic model for triggering care plan revision in geriatric care management

Due to the increasing ageing population, how can caregivers effectively provide long-term care services to meet the older adults’ needs with finite resources is emerging. In addressing this issue, nursing homes are striving to adopt smart health with the internet of things and artificial intelligence to improve the efficiency and sustainability of healthcare. This study proposed a two-echelon responsive health analytic model (EHAM) to deliver appropriate healthcare services in nursing homes under the Internet of Medical Things environment. A novel care plan revision index is developed using a dual fuzzy logic approach for multidimensional health assessments, followed by care plan modification using case-based reasoning. The findings reveal that EHAM can generate patient-centred long-term care solutions of high quality to maximise the satisfaction of nursing home residents and their families. Ultimately, sustainable healthcare services can be within the communities.

The Role of Nursing Homes Architectural Design in Mitigating the Risk of COVID-19 Pandemics: The Case of Slovenia

Currently, many older people live in institutions for various social and health reasons. In Slovenia, this proportion is almost 5% of the population aged 65 and over. In the COVID-19 pandemic, the elderly proved to be the most vulnerable social group, as they are exposed to a number of comorbidities that increase the risk of mortality. At that time, nursing homes represented one of the most critical types of housing, as seen from a disproportionate number of infections and deaths among nursing home residents worldwide, including Slovenia. During the emergency, a number of safety protocols had to be followed to prevent the spread of infection. Unfortunately, it turned out that while the safety measures protected the nursing home residents, they also had a negative effect on their mental health, mainly due to isolation and social distancing. It follows that especially in times of epidemics of infectious respiratory diseases, the quality of life in nursing homes requires special attention. In this context, it is also necessary to consider whether and how an appropriate architectural design can help mitigating the spread of infections, while at the same time enable older people to live in dignity and with a minimum of social exclusion. To this end, the present study examined 97 nursing homes in Slovenia, analysing the number of infections in nursing homes and their correlation with the degree of infection in the corresponding region in Slovenia. Additionally, 2 nursing homes were studied in more detail with the use of newly developed “Safe and Connected” evaluation tool, analysing the architectural features of each building. The advantages identified so far include living in smaller units, single rooms with balconies, the possibility of using green open spaces and the use of an adequate ventilation. Conclusions of this study are useful for further consideration of design of new nursing homes and the refurbishment of existing ones.

Meal-Monitoring Systems Using Weight and Temperature Sensors for Elder Residents in Long-Term Care Facilities

This paper presents a few meal-monitoring systems for elder residents (especially patients) in LTCFs by using electronic weight and temperature sensors. These monitoring systems enable to convey the information of the amount of meal taken by the patients in real-time via wireless communication networks onto the mobile phones of their nurses in charge or families. Thereby, the nurses can easily spot the most patients who need immediate assistance, while the families can have relief in seeing the crucial information for the well-being of their parents at least three times a day. Meanwhile, the patients tend to suffer burns of their tongues because they can hardly recognize the temperature of hot meals served. This situation can be avoided by utilizing the meal temperature-monitoring system, which displays an alarm to the patients when the meal temperature is above the reference. These meal-monitoring systems can be easily implemented by utilizing low-cost sensor chips and Arduino NANO boards so that elder-care hospitals and nursing homes can afford to exploit them with no additional cost. Hence, we believe that the proposed monitoring systems would be a potential solution to provide a great help and relief for the professional nurses working in elder-care hospitals and nursing homes.

Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes

Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in 5 Spanish NHs. UI (measured with Minimum Data Set 3.0.), sociodemographic and health-related variables were collected. Chi- square (or Fisher’s) or Student’s t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6–77.2) and was significantly associated with frailty (PR 1.84; 95%CI 0.96–3.53), faecal incontinence (FI) (PR 1.65; 95%CI 1.02–2.65), anxiety (PR 1.64; 95%CI 1.01–2.66), physical performance (PR 1.77; 95%CI 1.00–3.11) and cognitive state (PR 1.95; 95%CI 1.05–3.60). Statistically significant differences between incontinent-continent groups were found for activities of daily living (ADL) limitations, mobility, quality of life, sedentary behaviour (SB) and handgrip strength. It can be concluded that 2/3 of the residents experienced UI, and its significant associated factors were mainly physical (SB, frailty, physical performance, ADL limitations, mobility, FI and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety and quality of life).

COVID-19 outbreaks in nursing homes: A strong link with the coronavirus spread in the surrounding population, France, March to July 2020

Background Worldwide, COVID-19 outbreaks in nursing homes have often been sudden and massive. The study investigated the role SARS-CoV-2 virus spread in nearby population plays in introducing the disease in nursing homes. Material and methods This was carried out through modelling the occurrences of first cases in each of 943 nursing homes of Auvergne-Rhône-Alpes French Region over the first epidemic wave (March-July, 2020). The cumulative probabilities of COVID-19 outbreak in the nursing homes and those of hospitalization for the disease in the population were modelled in each of the twelve Départements of the Region over period March-July 2020. This allowed estimating the duration of the active outbreak period, the dates and heights of the peaks of outbreak probabilities in nursing homes, and the dates and heights of the peaks of hospitalization probabilities in the population. Spearman coefficient estimated the correlation between the two peak series. Results The cumulative proportion of nursing homes with COVID-19 outbreaks was 52% (490/943; range: 22–70% acc. Département). The active outbreak period in the nursing homes lasted 11 to 21 days (acc. Département) and ended before lockdown end. Spearman correlation between outbreak probability peaks in nursing homes and hospitalization probability peaks in the population (surrogate of the incidence peaks) was estimated at 0.71 (95% CI: [0.66; 0.78]). Conclusion The modelling highlighted a strong correlation between the outbreak in nursing homes and the external pressure of the disease. It indicated that avoiding disease outbreaks in nursing homes requires a tight control of virus spread in the surrounding populations.

Contacts with general practitioners, dentists, and medical specialists among nursing home residents: a cross-sectional study in 44 German nursing homes

Background Nursing home residents have high medical care needs. Their medical care utilization is, however, lower compared to community-dwelling elderly and varies widely among nursing homes. This study quantified the utilization of general practitioners (GPs), dentists, and medical specialists among nursing homes and residents, and investigated whether dentist utilization is associated with individual and nursing home characteristics. Methods Forty-four nursing homes invited 2124 residents to participate in a cross-sectional study. For 10 medical specialties, data on contacts in nursing homes, practices, and by telephone in the last 12 months were assessed at individual and nursing home level. The proportion of nursing homes and residents with any form of contact, and the median number and interquartile range (IQR) of contacts among individuals with contact were determined. Using multilevel logistic regression, associations between the probability of individual dental care utilization and sex, age, LTC grade, years of residence, sponsorship, number of nursing home beds, and transport and medical escort services for consultations at a practice were investigated. Results The proportion of nursing homes with any form of contact with physicians ranged from 100% for GPs, dentists, and urologists to 76.7% for gynecologists and orthopedists. Among the nursing homes, 442 residents participated (20.8% response). The proportion of residents with any contact varied from 97.8% for GPs, 38.5% for neurologists/psychiatrists, and 32.3% for dentists to 3.0% for gynecologists. Only for GPs, neurologists/psychiatrists, dentists, otorhinolaryngologists, urologists, and dermatologists, the proportion was higher for nursing home contacts than for practice and telephone contacts. Among residents with any contact, the median number of contacts was highest for GPs (11.0 [IQR 7.0-16.0]), urologists (4.0 [IQR 2.0-7.0]), and neurologists/psychiatrists (3.0 [IQR 2.0-5.0]). Dentist utilization varied widely among nursing homes (median odds ratio 2.5) and was associated with higher age. Conclusions Almost all residents had regular contact to GPs, but only one third had contact with dentists. Lower proportions with contact were found for medical specialists, except for neurologists/psychiatrists. Reasons for the large variations in dental care utilization among nursing homes should be identified. Trial registration DRKS00012383 [2017/12/06].

Adherence and barriers to the vitamin D and calcium supplement recommendation at Danish nursing homes: a cross-sectional study

Background Nursing home residents are in high risk of vitamin D deficiency, which negatively affects bone health. Vitamin D and calcium supplements haves shown to increase bone density and reduce fracture risk. Therefore, The Danish Health Authority recommends all nursing home residents a daily supplement of 20 μg vitamin D and 800–1000 mg calcium. However, adherence to the recommendation and knowledge of it is unknown. The aims of this study were to investigate adherence, knowledge, and potential barriers to this recommendation in Denmark. Methods A cross-sectional electronic survey was conducted in May–June 2020 among 50 randomly selected nursing homes widely distributed in Denmark. Questions included degree of adherence to the recommendation at each nursing home as well as respondent’s knowledge and attitudes towards it, and experienced barriers in relation to adherence. Results Respondents from 41 nursing homes answered the questionnaire, and these were mainly nurses (63%) or nursing home leaders (20%). Low adherence (≤ 40% of residents receiving both supplements) was reported at 35% of nursing homes, and only 8% of the nursing homes had a high adherence (> 80% of residents receiving both supplements). Most respondents (88%) had knowledge of the recommendation and 62% rated importance of increased implementation as high. Common explanations of low implementation were a lack of prescription by the general practitioner in the central electronic database (60%), resident-refusal to eat tablets (43%), chewing-swallowing difficulties (40%), and a high number of tablets given to the residents daily (34%). Conclusions The recommendation of daily vitamin D and calcium supplements to Danish nursing home residents is poorly implemented even though knowledge of the recommendation is relatively high. Barriers relate to an ambiguity of responsibility between the general practitioners and the nursing home staff, as well as the high number of tablets to be consumed in total by the residents. These barriers must be targeted to improve adherence in this vulnerable group of institutionalized older adults.