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.

The Effect of Food Odor Exposure on Appetite and Nutritional Intake of Older Adults with Dementia

Objectives Dementia can lead to decreased appetite and nutritional intake. Food odor exposure has been shown to increase appetite and nutritional intake in young healthy adults. This study investigates the effect of food odor exposure on appetite, nutritional intake and body weight of Dutch nursing home residents with dementia. Design This was a one-armed, non-randomized, non-blinded intervention study consisting of a four-week control period followed by a twelve-week intervention period. Setting Four nursing homes in the Netherlands. Participants Forty-five nursing home residents with dementia. Intervention During the intervention period, odors were dispersed prior to the main meals. Measurements General and specific appetite for sweet and savory foods was measured weekly. Nutritional intake was measured once during the control period and three times during the intervention period through a 3-day food record. Body weight was assessed at the start and end of the control period and at the start, end and halfway the intervention period. Data were analyzed with linear mixed models. Results Small changes in general and specific appetite were observed after odor exposure. Overall energy intake did not change during the first four intervention weeks, but increased during the second and third (+118kcal/d, p=0.003 and +122kcal/d, p=0.004). Protein intake and body weight did not significantly change during the study. Conclusion In this study, no clinically relevant changes in appetite, nutritional intake and body weight were observed after food odor exposure. Future studies should assess the effect of natural food odors and/or meal-tailored odors on nutritional intake of older adults with dementia.

"That's Something for Children"

Robotic systems are increasingly seen as possible technical aids against the background of demographic change and the associated pressures on care systems, with increasing numbers of care recipients and a decreasing number of trained caregivers. In human-computer interaction and computer-supported cooperative work, different design paradigms are currently being pursued to explore which features and appearances are favorable for meaningful interactions of humans with robotic systems. One such approach, labeled as "otherware", proposes to conceptualize robots beyond a naive anthropomorphism or zoomorphism, rather developing the idea of a figure that goes beyond the dichotomy between "being alive" and "being a technical artefact". We present an ethnographic study on the perceptions, attitudes, and practices of care attendants and nursing-home residents in their experimenting with off-the-shelf robotic cats and dogs. The three-week study shows specific appropriation practices of the robotic pets, and how the care attendants - partly together with the residents - define their experiences of the robotic pets, i.e., in which situations the robotic pets are considered either as living beings or as technology toys. The study provides practice-based insights into how possible uses of robotic pets could be meaningfully integrated into care practices, but also which ethical reflections were discussed during their use. Finally, this ethnographic study functioned as a collaborative learning process between researchers, care attendants, and residents, and thus also points out possible aspects that arose with regard to future learning spaces of professional and organizational development for dealing with innovative technologies in residential care contexts.

Population homogeneity for the antibody response to COVID-19 BNT162b2/Comirnaty vaccine is only reached after the second dose across all adult age ranges

While mRNA vaccines are administrated worldwide in an effort to contain the COVID-19 pandemic, the heterogeneity of the humoral immune response they induce at the population scale remains unclear. Here, in a prospective, longitudinal, cohort-study, including 1245 hospital care workers and 146 nursing home residents scheduled for BNT162b2 vaccination, together covering adult ages from 19 to 99 years, we analyse seroconversion to SARS-CoV-2 spike protein and amount of spike-specific IgG, IgM and IgA before vaccination, and 3-5 weeks after each dose. We show that immunogenicity after a single vaccine dose is biased to IgG, heterogeneous and reduced with increasing age. The second vaccine dose normalizes IgG seroconversion in all age strata. These findings indicate two dose mRNA vaccines is required to reach population scale humoral immunity. The results advocate for the interval between the two doses not to be extended, and for serological monitoring of elderly and immunosuppressed vaccinees.

The use of analgesics and associated factors among nursing home residents

Aim: This study examined the use of analgesics and associated factors among nursing home residents (NHRs). Materials & methods: A descriptive correlational design and a convenience sample of 209 NHRs receiving analgesics was used in this study. Results: Higher use of analgesics was noted among NHRs without cognitive impairment (p < 0.001), those with higher anticholinergic burden scores (p = 0.002) and those with a higher average number of oral pills taken daily (p = 0.045). Conclusion: These findings contribute to a better understanding of the prevalence and associated factors of analgesic use, which will inform the development and application of evidence-based pain practice and guidelines in nursing homes in Jordan and beyond.

Known in the nursing home: development and evaluation of a digital person-centered artistic photo-activity intervention to promote social interaction between residents with dementia, and their formal and informal carers

Background To address the lack of social interaction and meaningful activities for persons with dementia (PWD) in nursing homes an artistic Photo-Activity was designed. The present study aims to develop a digital version of the Photo-Activity and to investigate its implementation and impact on nursing home residents with advanced dementia, and their (in)formal carers. Methods First, within a user-participatory design, a digital-app version of the Photo-Activity will be developed and pilot-tested, in co-creation with (in)formal carers and PWD. Next, the feasibility and effectiveness of the Photo-Activity versus a control activity will be explored in a randomized controlled trial with nursing home residents (N=90), and their (in)formal carers. Residents will be offered the Photo-Activity or the control activity by (in)formal carers during one month. Measurements will be conducted by independent assessors at baseline (T0), after one month (T1) and at follow up, two weeks after T1 (T2). Qualitative and quantitative methods will be used to investigate the effects of the intervention on mood, social interaction and quality of life of the PWD, sense of competence of informal carers, empathy and personal attitude of the formal carers, and quality of the relationship between the PWD, and their (in)formal carers. In addition, a process evaluation will be carried out by means of semi-structured interviews with the participating residents and (in)formal carers. Finally, an implementation package based on the process evaluation will be developed, allowing the scaling up of the intervention to other care institutions. Discussion Results of the trial will be available for dissemination by Spring 2023. The digital Photo-Activity is expected to promote meaningful connections between the resident with dementia, and their (in)formal carers through the facilitation of person-centered conversations. Trial registration Netherlands Trial Register: NL9219; registered (21 January 2021); NTR (trialregister.nl)