Multidisciplinary residential home intervention to improve outcomes for frail residents

Background Residential homes provide accommodation and assistance with personal care only and are not required to have registered nurses on site. However, their residents often have a combination of comorbidity, polypharmacy, frailty and mental-health conditions with poor access to healthcare to meet these needs. Integrated healthcare for older people is a key NHS priority in the Long-Term Plan and the Five-Year Forward View. We describe development and implementation of multi-disciplinary intervention to integrate healthcare and promote interprofessional education. Methods A multi-disciplinary residential home quality improvement project in two cycles by a team comprising senior and trainee general practitioners, trainees in geriatrics, psychiatry, pharmacist and residential home senior staff. The intervention was underpinned by the framework for enhanced health in care homes including Comprehensive Geriatric Assessment (CGA) and mental-health review. Each intervention session included an educational presentation by a team member consideration of each resident in a pre-evaluation multi-disciplinary discussion followed by a structured clinical assessment and discussion of proposed management. Results Three residential homes participated with a total 34 residents receiving intervention. In one residential home, there was a 75% reduction in admissions for those reviewed and a reduction in overall admission costs. Polypharmacy was reduced by an average of 2 medications per resident across the three sites. There was a 63% increase in cardio-pulmonary resuscitation decisions and 76% increase in advance care planning discussions. Conclusion This was an effective model for multi-disciplinary trainees working with a perceived impact on physical and mental health, and valuable opportunities for sharing learning.

The role of demand response in residential electricity load reduction using appliance shifting techniques

Purpose Some of the major concerns since the implementation of smart meters (prepaid meters) in some parts of Ghana is how electricity consumers have benefited from data obtained from these meters by providing important statistics on electricity-saving advice; this is one of the key demand-side management methods for achieving load reduction in residential homes. Appliance shifting techniques have proved to be an effective demand response strategy in load reduction. The purpose of this paper is therefore to help consumers of electricity understand when and how they can shift some appliances from peak to off-peak and vice versa. Design/methodology/approach The research uses an analysis technique of Richardson et al. (2010). In their survey on time-of-use surveys to determine the usage of electricity in households as far as appliance shifting was concerned, this study allowed for the assessment of how the occupants’ daily activities in households affect residential electricity consumption. Fell et al. (2014) modeled an aggregate of electricity demand using different appliances (n) in the household. The data for the peak time used in this study were identified from 05:00 to 08:00 and 17:00 to 21:00 for testing the load shifting algorithms, and the off-peak times were pecked from 10:00 to 16:00 and 23:00. This study technique used load management considering real-time scheduling for peak levels in the selected homes. The household devices are modeled in terms of controlled parameters. Using this study’s time-triggered loads on refrigerators and air conditioning systems, the findings suggested that peak loads can be reduced to 45% as a means of maintaining the simultaneous quality of service. To minimize peak loads to around 35% or more, Chaiwongsa and Wongwises (2020) have indicated that room air conditioning and refrigerator loads are simpler to move compared to other household appliances such as cooking appliances. Yet in conclusion, this study made a strong case that a decrease in household peak demand for electricity is primarily contingent on improvements in human behavior. Findings This study has shown that appliance load shifting is a very good way of reducing electrical consumption in residential homes. The comparative performance shows a moderate reduction of 1% in load as was found in the work done by Laicaine (2014). The results, however, indicate that load shifting to a large extent can be achieved by consumer behavioral change. The main response to this study is to advise policymakers in Ghana to develop the appropriate demand response and consumer education towards the general reduction in electrical load in domestic households. The difficulty, however, is how to get the attention of consumer’s on how to start using appliances with less load at peak and also shift some appliances from off-peak times. By increasing consumer knowledge and participation in demand response, it is possible to achieve more efficiency and flexibility in load reduction. The findings were benchmarked with existing comparison studies but may benefit from the potential production of structured references. However, the findings show that load shifting can only be done by modifying consumer actions. Research limitations/implications It should be remembered that this study showed that the use of appliances shifting in residential homes results in load reduction benefits for customers, expressed as savings in electricity prices. The next step will be to build on this cost/benefit study to explain and measure how these reductions transform into net consumer gains for all Ghanaian households. Practical/implications Load shifting will include load controllers in the future, which would automatically handle electricity consumption from various appliances in the home. Based on the device and user needs, the controllers can prioritize loads and appliance usage. The algorithms that underpin automatic load controllers will include knowledge about the behaviors of groups of end users. The results on the time dependency of activities may theoretically inform the algorithms of automatic demand controllers. Originality/value This paper addresses an important need for the country in the midst of finding solutions to an unending energy crisis. This paper presents demand response to the Ghanaian electricity consumer as a means to help in the reduction of load in residential homes. This is a novel research as no one has at yet carried out any research in this direction in Ghana. This paper has some new information to offer in the field of demand in household electricity consumption.

Psychological Distress, Burden of Care, and the Role of Coping Strategies Among Childminders in Residential Children’s Homes

This study aimed to identify the prevalence of psychological distress and its association with sociodemographic characteristics, burden of care, and the coping strategies used by childminders in residential homes. A total of 151 childminders (median age = 39; 64.7% female) participated in the study. The prevalence of psychological distress was 59.4%, and 74.0% recorded mild to moderate burden. Multivariate analyses showed that caregiver burden (adjusted beta = 0.464, P = .01), lesser application of problem-focused coping (adjusted beta = −0.292, P = .012), lower salary (adjusted beta = −0.196, P = .040), and lower educational qualification (adjusted beta = −0.212, P = .038) predicted higher psychological distress. Regular screening of psychological distress and burden of care is recommended among this population.

Development of a protein energy malnutrition screening tool for older Thais in public residential homes

Objective: This study aimed to develop and validate protein energy malnutrition (PEM) screening tool for older adults in public residential homes, and test its practicality. Design: This cross-sectional study consisted of two phases: tool development/validation and tool practicality evaluation. In Phase 1, the questionnaire was developed based on literature review and tested for content validity. Older residents were interviewed using this questionnaire to identify potential PEM risk factors. A 24-hour recall was used to collect dietary data, and body composition and serum albumin were measured. In Phase 2, practicality of new PEM screening tool was evaluated by intended users. Data were analyzed by Chi-square test, Fisher’s exact test, t-test, Mann-Whitney U test, and multiple logistic regression. Akaike Information Criterion (AIC) was used to estimate the best fit model. Setting: Four public residential homes in central region, Thailand. Participants: 249 older residents residing in public residential homes and eight intended users. Results: 26∙9% had PEM (serum albumin <3∙5 g/dl). According to multiple logistic regression and AIC values, PEM predictors were having pressure ulcer, experiencing significant weight loss and taking ≥9 types of medicine daily. These predictors were included in PEM screening tool. Regarding tool performance test, area under the ROC curve was 0∙8 (P<0∙001) with sensitivity and specificity of 83∙9 and 45∙5%, respectively. For its practicality, eight intended users reported that it was useful and easy to use. Conclusions: New screening tool may be capable of identifying PEM in older residents, and further testing is required before being recommended for use.

The short-term effect of residential home energy retrofits on indoor air quality and microbial exposure: A case-control study

Weatherization of residential homes is a widespread procedure to retrofit older homes to improve the energy efficiency by reducing building leakage. Several studies have evaluated the effect of weatherization on indoor pollutants, such as formaldehyde, radon, and indoor particulates, but few studies have evaluated the effect of weatherization on indoor microbial exposure. Here, we monitored indoor pollutants and bacterial communities during reductions in building leakage for weatherized single-family residential homes in New York State and compared the data to non-weatherized homes. Nine weatherized and eleven non-weatherized single-family homes in Tompkins County, New York were sampled twice: before and after the weatherization procedures for case homes, and at least 3 months apart for control homes that were not weatherized. We found that weatherization efforts led to a significant increase in radon levels, a shift in indoor microbial community, and a warmer and less humid indoor environment. In addition, we found that changes in indoor airborne bacterial load after weatherization were more sensitive to shifts in season, whereas indoor radon levels were more sensitive to ventilation rates.

Practical Performance and User Experience of Novel DUAL-Flush Vacuum Toilets

Vacuum toilets have gained increasing attention in circular urban development projects, because of their marked water saving qualities compared to conventional flush toilets and the increased resource recovery potential for energy in the form of biogas and phosphorous as, e.g., struvite from the resulting concentrated wastewater. A further reduction of the flushing volume of vacuum toilets would also bring nitrogen recovery options in reach. In the framework of the EU Horizon 2020 project Run4Life, a novel dual-flush vacuum toilet was developed and tested at two sites and combined with an analysis of the flushing patterns and a qualitative user survey. The results show that a 25–50% lower flushing water consumption and accordingly 1.5–2 times higher nutrient concentrations are achievable with this novel type of vacuum toilet. The usage frequency of the dual flush feature was higher in residential homes than in an office building, which also had urinals installed at the men toilets. A notable fraction of toilet visits in which the toilet was flushed twice as well as user feedback on dissatisfactory cleaning effects suggest that the applied reduction in water use is most likely the upper limit of what can be achieved in this type of toilet.

A bright idea—metabarcoding arthropods from light fixtures

Arthropod communities in buildings have not been extensively studied, although humans have always shared their homes with them. In this study we explored if arthropod DNA can be retrieved and metabarcoded from indoor environments through the collection of dead specimens in light fixtures to better understand what shapes arthropod diversity in our homes. Insects were collected from 45 light fixtures at the Centre for Biodiversity Genomics (CBG, Guelph, Canada), and by community scientists at 12 different residential homes in Southern Ontario. The CBG ground floor of the CBG showed the greatest arthropod diversity, especially in light fixtures that were continuously illuminated. The community scientist samples varied strongly by light fixture type, lightbulb used, time passed since lamp was last cleaned, and specimen size. In all cases, the majority of OTUs was not shared between samples even within the same building. This study demonstrates that light fixtures might be a useful resource to determine arthropod diversity in our homes, but individual samples are likely not representative of the full diversity.

Functioning and Cognition of Portuguese Older Adults Attending in Residential Homes and Day Centers: A Comparative Study

The functioning and cognition of older adults can be influenced by different care contexts. We aimed to compare the functioning profiles and cognition of institutionalized and noninstitutionalized older adults and to evaluate the effect of sociodemographic factors on the functioning and cognition. This is a cross-sectional study that included 593 older adults. The data were collected using the Elderly Nursing Core Set and Mini Mental State Examination. Women, older adults who did not attend school and those live in Residential Homes are more likely to have a higher degree of cognitive impairment than men, those who attended school and those frequent Day Centre. The chances of an older adult with moderate or severe cognitive impairment increases with age. Older women, older adults who did not attend school, and older adults who live in Residential Homes had a higher degree of functional problem than men, those who attended school and those who frequent a Day Centre, independently to age. It is necessary to promote the health literacy of older adults throughout life. The implementation of social and health responses should allow older adults to remain in their homes, given the influence of functioning and cognition on self-care and quality of life.