Objectives To investigate the suspected acute respiratory infection (ARI) risk and the clinical impact of a range of respiratory viruses in Dutch nursing home (NH) residents. Design Prospective cohort study (March 2023-May 2025). Setting and Participants Residents from 15 Dutch NHs were enrolled when suspected of an ARI. Methods Clinical data were collected on days 0, 14, and 28. Residual nasopharyngeal and oropharyngeal swabs were tested for a broad respiratory virus panel. A Bayesian multilevel logistic model including seasonal and NH-level random effects estimated suspected ARI risk. Relative clinical outcomes were compared by virus. Results Among 3195 residents, 526 suspected ARI episodes occurred. The estimated suspected ARI risk was 10.2% (95% credible interval, 1.7-43.8). Viruses were identified in 291 episodes: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; 29.0%), influenza A virus (23.6%), rhinovirus/enterovirus (18.8%), respiratory syncytial virus (11.8%), human metapneumovirus (hMPV; 6.4%), parainfluenza viruses (5.1%), and human coronaviruses (5.4%). hMPV and respiratory syncytial virus tended to be associated with higher odds of moderate or severe disease, and hMPV was linked to a 4-fold increase in bed hours. Influenza A was associated with delayed recovery, oxygen requirement, and a 3-fold risk of secondary bacterial pneumonia. SARS-CoV-2 cases had higher estimated odds of recovery by day 14 and spent fewer additional hours in bed during ARI episodes. Conclusions and Implications Influenza remains a major contributor to ARI burden in NH residents, whereas SARS-CoV-2 has relatively limited impact. The pronounced clinical impact of hMPV suggests its relevance for ARI management in this population.
OBJECTIVES:To examine treatment duration of oral and transdermal cholinesterase inhibitor formulations in older adults with severe Alzheimer's disease (AD) in routine clinical practice. DESIGN:Retrospective population-based cohort study. SETTING AND PARTICIPANTS:Linked medical and long-term care insurance claims databases from Tochigi Prefecture, Japan, between April 2019 and October 2023. We included patients aged ≥65 years with AD who were certified at care needs level 4 or 5 (indicating complete dependence in activities of daily living) or were institutionalized under the Japanese Long-Term Care Insurance system. METHODS:Patients were classified according to the initial cholinesterase inhibitor formulation: oral formulations (donepezil or galantamine) or transdermal patches (rivastigmine or donepezil). The primary outcome was duration of treatment with the initial formulation. Continuous treatment was defined using a 30-day grace period. Kaplan-Meier analysis and Cox proportional hazards models were used to compare treatment discontinuation between groups. Hospitalization and mortality were evaluated as exploratory outcomes. RESULTS:Among 8117 eligible patients, 6467 initiated oral formulations and 1650 initiated transdermal patches. Mean treatment duration was longer in the oral group than in the patch group (1.5 vs 0.6 years; log-rank P < .001). In adjusted Cox regression analysis, the patch group showed a higher risk of discontinuation than the oral group (hazard ratio, 11.3; 95% CI, 10.2-12.4). Hospitalization and mortality rates were lower in the oral group than in the patch group (236 vs 272 and 210 vs 272 per 1000 person-years, respectively). CONCLUSIONS AND IMPLICATIONS:In older adults with severe AD, oral cholinesterase inhibitor formulations were continued substantially longer than transdermal patches. Given the limited evidence supporting prolonged cholinesterase inhibitor use in severe AD, these findings raise concerns regarding long-term prescribing practices in advanced dementia care.
OBJECTIVES:To characterize assisted living (AL) direct care worker (DCW) training requirements across the United States and how these regulations have changed over time. Specifically, we examine state-level profiles of training regulations, including duration, frequency, content, source of materials, evaluation, and changes in regulatory coverage. DESIGN:Cross-sectional and longitudinal descriptive study using state policy data and AL directories from 2019, 2021, and 2023. SETTING AND PARTICIPANTS:All US states' AL training-related regulations; all ALs and AL beds governed by those regulations. METHODS:We used a mixed-methods approach with an explanatory sequential design (QUAN → qual), first conducting health services regulatory analysis followed by qualitative content analysis. RESULTS:In 2023, 43 states (90% of ALs, nationally) required DCW training, 29 states required annual training frequency, 28 states specified training hours (median 10 hours), 28 required dementia-specific content, and 29 required training to cover at least 5 topics when onboarding. Common training topics included resident rights, emergency response, infection control, and personal care; dementia-specific training topics included Alzheimer's disease, behavior, communication, and dignity of residents, with only 2 states requiring training that addressed DCWs' well-being. Ten states mandated use of professionally designed courses, and 5 states required DCWs to complete an exam. From 2019 to 2023, 6 states made changes to the scope of dementia-specific training. CONCLUSIONS AND IMPLICATIONS:While most states mandate DCW training and over half require annual frequency, duration, and cover 5 topic areas, few states specify sources of training materials or require competency checks. Lack of specificity in training requirements requires AL operators to determine what constitutes adequate training for DCWs to be successful. To better prepare the AL workforce for growing resident complexity, policymakers should consider promoting specific training requirements that ensure both onboarding and continuous education for DCWs, particularly around dementia care and workforce well-being.
OBJECTIVES:To estimate the effect of initial Elderly Health Check-up (EHC) attendance on the 5-year risk of functional disability or death in community-dwelling older adults in a setting where preventing entry into long-term care (LTC) is a primary health-policy goal. DESIGN:Sequential target trial emulation using a population-based cohort. SETTING AND PARTICIPANTS:Community-dwelling adults aged 75 to 84 years without functional disability and without recent EHC participation, drawn from the Sukagawa Study, a population-based cohort in Sukagawa City, a rural municipality with an aging population in Fukushima Prefecture, Japan, between April 2018 and March 2021. METHODS:We compared initial EHC attendance within a 3-month grace period with nonattendance. The primary outcome was a composite of incident functional disability (LTC certification at care-need level ≥3) or death over 5 years; secondary outcomes were each component, with death treated as dependent censoring for disability. Five-year risks were estimated by inverse probability-weighted pooled logistic regression with 95% CIs. RESULTS:The cohort included 21,484 person-trials from 3096 unique individuals (1001 EHCs, 20,483 non-EHCs). The 5-year composite risk was 20.6% (EHC) vs 26.7% (non-EHC): risk difference, -6.1 percentage points (pp; 95% CI, -11.6 to 0.9); risk ratio, 0.77 (95% CI, 0.57-1.03). Corresponding risk differences were -3.7 pps (95% CI, -10.4 to 3.9) for all-cause mortality and -5.4 pps (95% CI, -12.9 to 0.1) for functional disability alone. CONCLUSIONS AND IMPLICATIONS:The evidence is uncertain about the effect of initial EHC participation on the 5-year risk of functional disability or death; the point estimate is compatible with a modest benefit, but the 95% CI included the null. These findings neither support expansion nor justify discontinuation of the EHC program for preventing entry into LTC, and call for replication in additional cohorts before policy changes are considered.
OBJECTIVES:As more older adults use home- and community-based services (HCBS) to support aging in place, it is critical to understand the benefits and possibilities of these services. One that has not been previously considered is whether use of HCBS assists in elder abuse prevention. DESIGN:Cross-sectional secondary analysis of a national sample of adults aged 60 and older. SETTING AND PARTICIPANTS:Participants in the 2008 National Elder Mistreatment Study (N = 5513 for the primary model). METHODS:Multivariable models were used to examine differences in elder abuse likelihood among HCBS consumers and nonconsumers. The exposure was HCBS use, and the outcome was elder abuse occurrence, defined as physical, emotional, or sexual abuse in the last year or financial abuse or neglect as an older adult, given the survey design. All models controlled for demographic and health characteristics. The primary model (N = 5513) was an inverse propensity-weighted logistic regression model with multiple imputation to recover missing household income (n = 1298, 23.5%) given means-tested programs in HCBS. Three sensitivity and inverse propensity-weighted logistic regression models were performed: adding a missing indicator, limiting the outcome to abuse in the last year, and using complete case analysis (N = 4233). RESULTS:The primary sample was 67.9% female and 83.7% non-Hispanic White, with an average age of 71.9 years (SD, 8.4). HCBS consumers made up 19.1% of participants, and 12.4% of participants reported elder abuse. Primary (odds ratio, 1.07; CI, 0.86-1.32) and sensitivity models found no association between HCBS use and elder abuse occurrence. CONCLUSIONS AND IMPLICATIONS:These findings suggest that HCBS as an aggregate service category is not associated with reduced elder abuse. Future research is needed to examine the role of individual services in elder abuse prevention.
Many older adults prefer aging in place, but complex medical and social care needs and fragmented care systems are barriers to maintaining independence at home. Choose Home was implemented at the Veteran Affairs Boston Health Care System in September 2023 to address a critical care gap for patients who seek to remain independent at home but are at high risk for acute care hospitalizations and institutionalization in long-term care facilities. This report describes a subpopulation (n = 16) of patients enrolled after subacute rehabilitation discharge who were at very high risk of readmission and long-term care entry. Among 16 patients (mean age, 76.8 years; 81% with severe frailty), the program provided an average of 14.8 (SD, 11.2; range, 3-50) care encounters over 96.3 days (range, 19-224). Qualitative analysis of veterans' medical records revealed key program interventions categorized into 4 themes: (1) Clinical care, (2) Case management, (3) Psychosocial safety, and (4) Home safety. At program discharge, 81.3% (n = 13) of patients remained independent in the community and transitioned to longitudinal care teams: primary care (n = 7; 43.8%), home-based primary care (n = 3; 18.8%), and hospice (n = 3; 18.8%). This innovation demonstrates the early feasibility of episodic, home-based care for medically and socially complex patients transitioning home after subacute rehabilitation.
Despite more than a decade of value-based reimbursement under the Hospital Readmissions Reduction Program and the Skilled Nursing Facility Value-Based Purchasing program, 30-day readmission rates from US post-acute care (PAC) settings remain at 20% to 25% among skilled nursing facility residents and contribute more than $15 billion annually to Medicare expenditure. Elevated rates have persisted despite sustained policy attention. This suggests that the dominant clinical quality frame captures only part of the problem. The operational substrate of PAC transitions, therefore, warrants systematic examination. The objective is to synthesize peer-reviewed and gray literature published between 2021 and January 2026 on the operational determinants of preventable readmissions from US PAC settings and to map evidence-based interventions to each determinant domain. A structured narrative review was conducted following the Scale for the Assessment of Narrative Review Articles guidance. PubMed, CINAHL, and Google Scholar were searched alongside targeted gray literature retrieval from the Centers for Medicare & Medicaid Services, Medicare Payment Advisory Commission, Agency for Healthcare Research and Quality, Office of the National Coordinator for Health Information Technology, American Heart Association, and the Leonard Davis Institute. Of 312 records identified, 41 were retained after screening for US PAC relevance, operational focus, and currency. This review pursues a single aim: to identify these operational determinants and organize them within a 6-domain framework, pairing each determinant with the interventions that target it. The literature converges on 6 operational determinants: discharge protocol heterogeneity and role ambiguity, referral to capacity mismatch, gaps in bidirectional information exchange (only about 1 in 6 hospitals routinely transmits structured summary of care records to PAC providers), workforce attrition, role conflation, and limited operational authority, inconsistent screening and integration of social determinants of health, and asymmetric financial incentives. Targeted operational interventions across all 6 domains have demonstrated meaningful effects in controlled and single-site evaluations, though scalability evidence is uneven. Many preventable readmissions from PAC follow from how care is organized across hospitals, post-acute providers, payers, and community services, rather than from isolated clinical failures. Practical reduction requires coordinated intervention across all 6 determinants; single-domain interventions consistently underperform when deployed in isolation.
OBJECTIVES:This scoping review aimed to map the available evidence on digital predictive technologies for fall risk assessment, prediction, and prevention support among older adults in long-term care settings. DESIGN:Scoping review. SETTING AND PARTICIPANTS:Included studies focused on older adults or residents in long-term care settings, including nursing homes, residential aged care facilities, assisted living facilities, skilled nursing facilities, and other institutional or residential long-term care environments. METHODS:A comprehensive search was conducted in PubMed, Scopus, Web of Science, and CINAHL for English-language original studies published from 2016 to 2026. Additional records were identified through manual reference searching and citation tracking. Eligible studies examined digital predictive technologies, including artificial intelligence, machine learning, deep learning, wearable sensors, inertial measurement units, passive sensors, Internet of Things-based systems, electronic health record-based prediction models, Minimum Data Set-based analytics, predictive dashboards, and clinical decision-support systems. Data were synthesized descriptively and narratively following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance. RESULTS:A total of 2030 records were identified from electronic databases, and 15 additional records were identified through manual reference searching and citation tracking. After 845 duplicates were removed, 1185 database records were screened, and 60 reports were assessed for eligibility. Eleven studies met the eligibility criteria. The included studies used diverse technologies and data sources, including electronic health records, Minimum Data Set records, medication data, functional assessments, fall history, vital signs, wearable sensors, inertial sensors, passive sensors, and dashboard-linked data streams. Prediction windows varied from daily fall probability to 90-day, 3-month, and 6-month fall risk prediction. Reported outcomes included fall risk probability, future falls, recurrent falls, major falls, and fall rates. Model performance varied across studies, with evidence ranging from proof-of-concept findings to moderate or good discrimination. However, most studies focused on model development, validation, feasibility, or early implementation, and only limited evidence directly evaluated fall reduction or sustained clinical outcomes. CONCLUSIONS AND IMPLICATIONS:Digital predictive technologies show emerging potential to support fall risk assessment and prevention planning in long-term care. However, the evidence base remains small, heterogeneous, and largely developmental. These technologies should be viewed as decision-support tools that complement, rather than replace, clinical judgment and nursing assessment. Future research should prioritize prospective validation, workflow integration, ethical governance, cost effectiveness, staff response, resident-centered outcomes, and real-world effects on fall reduction in diverse long-term care settings.
OBJECTIVES:To develop and evaluate the usability, feasibility, and preliminary effectiveness of the Stroke Care Companion. DESIGN:A mobile health application was designed to support anticoagulation management, medication adherence, vital sign monitoring, and follow-up care among stroke survivors. SETTING AND PARTICIPANTS:A total of 114 clinically stable adult stroke survivors receiving anticoagulation therapy (warfarin or direct oral anticoagulants) were recruited from neurology outpatient clinics and stroke follow-up services. Participants used the application for 8 weeks. METHODS:The Stroke Care Companion provides medication reminders, appointment scheduling, blood pressure and symptom logging, adherence tracking, and caregiver support. Usability was assessed using the System Usability Scale, whereas medication adherence, follow-up compliance, and vital sign monitoring were evaluated using descriptive statistics. Qualitative feedback was collected through user interviews. RESULTS:The mean age of participants was 64.7 ± 9.8 years, and 58.8% were men. The application demonstrated excellent usability, with a mean System Usability Scale score of 82.4 ± 8.7 and a task completion rate of 94.7%. Medication adherence improved from 63.2% at baseline to 90.1% after 8 weeks, whereas follow-up compliance increased from 61% to 89%. Regular blood pressure monitoring was reported by 89% of participants, and 92% found the application easy to use. Caregivers reported that the application improved patient monitoring and communication. CONCLUSIONS:The Stroke Care Companion demonstrated high usability and feasibility as a stroke-specific mobile health application for supporting anticoagulation management and poststroke care. The application shows promise for improving medication adherence, vital sign monitoring, and continuity of care. Larger randomized controlled studies are needed to confirm its effectiveness and evaluate long-term clinical outcomes.
OBJECTIVES:Feasible assessments of hospitalized patients' mobility are essential to support the promotion of mobility. We investigated the construct validity of the Life-Space Assessment in Institutionalized Settings (LSA-IS) and direct observation toward the goal of including patients who are often excluded from device-based assessments. DESIGN:Cross-sectional study. SETTING AND PARTICIPANTS:Patients admitted to a convalescent rehabilitation hospital (n = 119; median age, 83.0 years; 63.9% female). METHODS:The LSA-IS was measured by an assigned physiotherapist. Direct observation was performed on a single day at 10-min intervals between 8:00 and 17:00. Physical activity and location observations were recorded. Locations (own room, within the ward, and outside the ward) and physical activity (lying, sitting, and moving) were categorized into 3 groups for analysis. Construct validity between the LSA-IS results and the direct observations was assessed using Spearman's rank correlation. Hypotheses regarding the expected direction and magnitude of correlations were specified a priori to evaluate construct validity. RESULTS:The median LSA-IS score was 14.0 points (interquartile range, 9.5). The LSA-IS was significantly positively correlated with the time spent moving (ρ = 0.676), significantly negatively correlated with the time spent lying down (ρ = -0.609), significantly positively correlated with the time spent sitting (ρ = 0.416) and the time spent within and outside the ward (ρ = 0.348 and ρ = 0.427, respectively), and significantly negatively correlated with time spent in the patient's own room (ρ = -0.487). The LSA-IS was more strongly correlated with moving vs lying down or sitting. These results supported our hypotheses and indicate sufficient construct validity. The correlation between the LSA-IS and the time spent moving remained strong after stratifications by age, diagnostic category, and cognitive status. CONCLUSIONS AND IMPLICATIONS:The LSA-IS demonstrated moderate-to-high correlations with hospitalized patients' physical activity and location, and it may provide a clinically applicable method for evaluating mobility in hospitalized patients.
OBJECTIVES:To examine and quantify geographic variation in gabapentinoids, opioids, and their concurrent use among long-stay nursing home residents in the United States. DESIGN:Cross-sectional study. SETTING AND PARTICIPANTS:A total of 232,484 long-stay residents aged ≥65 years in 9741 US nursing homes across 300 hospital referral regions (HRRs) in 2021. METHODS:We used Minimum Data Set 3.0 linked to Medicare Parts A and D claims, facility characteristics, and HRR data. Outcomes were gabapentinoid-only use, opioid-only use, and concurrent use. Residents were classified by nursing home state and HRR. Cross-classified multilevel logistic regression models quantified between-HRR and between-state variation. Sequential models estimated the proportional change in variance after adjustment for resident, facility, and HRR characteristics. RESULTS:The prevalence of gabapentinoid-only use was 13.4%, opioid-only use was 9.1%, and concurrent use was 5.4%. Geographic variation was substantial, particularly for opioid-only and concurrent use. For opioid-only use, resident characteristics explained 39.1% of HRR-level and 35.3% of state-level variation, with 61.2% and 60.8% explained in fully adjusted models. For concurrent use, resident characteristics explained most variation, accounting for 64.3% of HRR-level and 52.1% of state-level variation, with 65.4% and 62.2% explained after full adjustment. In contrast, gabapentinoid-only use showed smaller geographic variation, with facility characteristics explaining more HRR-level variance than resident factors. CONCLUSIONS AND IMPLICATIONS:Geographic variation exists in gabapentinoids, opioids, and their concurrent use in US nursing homes. Variation in opioid-only and concurrent use largely reflects resident characteristics, whereas gabapentinoid use appears more influenced by facility and regional factors, suggesting differences in prescribing practices beyond clinical need.
OBJECTIVES:Loneliness/isolation is known to result in negative health outcomes among older adults in US nursing homes. Understanding the variation in loneliness/isolation among long-stay nursing residents and the individual and facility-level characteristics associated with loneliness/isolation can help guide care planning and ultimately lead to the development of effective interventions. DESIGN:Cross-sectional. SETTING AND PARTICIPANTS:Long-stay residents aged ≥50 years (n = 732,808) living in US nursing homes (n = 13,491) between October 1, 2023 and December 31, 2023. METHODS:Data from the Minimum Data Set 3.0 provided resident-level characteristics. Residents able to self-report were asked: "How often do you feel lonely or isolated from those around you?" Responses were dichotomized as sometimes, often, always vs never or rarely. Facility-level variables came from the long-term care focus and Nursing Home Compare datasets. Multilevel logistic regression estimated proportional change in cluster variance and variance partitioning coefficients (VPCs) to assess contributions of resident-, facility-, and county-level factors, and the fully adjusted model identified characteristics associated with loneliness/isolation. RESULTS:The overall prevalence of loneliness/isolation was 20.7%, with most variation driven by differences between facilities rather than counties (VPCcounty = ∼2%; VPCfacility = ∼35%). Resident- and facility-level characteristics explained only a small portion, and county-level factors contributed minimally (proportional change in cluster variance = 1%-2%). Higher prevalence of loneliness/isolation was observed among women, those with mental health diagnoses or sensory impairments, and a lower prevalence was observed in older, Non-Hispanic Black residents; facility factors like for-profit status, rural location, racial/ethnic diversity, and more certified nursing assistant care were associated with reduced loneliness/isolation. CONCLUSIONS AND IMPLICATIONS:Interventions to reduce loneliness/isolation should focus on helping facilities address contextual factors. Staffing levels may be associated with loneliness/isolation and warrant further investigation. Future research should focus on the development, implementation, and evaluation of evidence-based practices to reduce resident loneliness/isolation.
OBJECTIVES:More longitudinal studies of the implications of sarcopenia are needed in patients with hip fractures. This study compared 2 sarcopenia-related measurements and 1 questionnaire-based screening tool and examined their association with rehabilitation outcomes after hip fracture. DESIGN:A prospective cohort study with 1-year follow-up was performed between 2021 and 2023. SETTING AND PARTICIPANTS:Four hundred thirty older adults (≥70 years) with hip fractures participated in a single university hospital. METHODS:The associations of handgrip strength, calf circumference, and the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls) questionnaire were examined with early postoperative mobilization (the Cumulated Ambulation Score), walking mobility (the New Mobility Score, up to 4 months), and functional outcome [the Barthel Index (BI) up to 12 months]. The analyses were adjusted for age and sex, American Society of Anesthesiologists score, and cognitive and nutritional status. RESULTS:Only SARC-F was consistently associated with impaired early mobilization (odds ratio [OR], 1.99; 95% CI, 1.14-3.45 for day 1; OR, 4.90; 95% CI, 2.84-8.44 for day 2; OR, 7.56; 95% CI, 3.61-15.81 for day 3). Similarly, only the SARC-F-based sarcopenia group was associated with inferior walking ability from 1 month to 4 months after fracture and a greater functional decline in BI at 4 months compared with those without sarcopenia [mean New Mobility Score change (CI) 2.0 (1.7-2.4) vs 0.6 (0.3-0.9); mean BI change -17.5 (-20.9 to -14.2) vs -11.2 (-13.9 to -8.6)]. No significant improvement in BI was observed in either group between 4 and 12 months. Handgrip strength or calf circumference was not consistently associated with the studied outcomes. CONCLUSIONS AND IMPLICATIONS:SARC-F was consistent in predicting short- and long-term functional outcomes. It may be a practical screening tool to identify patients at risk of poor recovery after hip fracture.
Background Paratonia is a form of involuntary muscle resistance affecting virtually all individuals with late-stage dementia, causing significant morbidity, including pain, skin breakdown, and caregiver burden. Despite its near-universal prevalence, paratonia remains under-recognized, and no standardized screening tools exist within routine care assessments. Identifying care-interfering paratonia supports nonpharmacologic care, helps avoid misdirected treatments, and enables research into investigational therapies such as botulinum toxin A. Objectives To develop a preliminary Collaborative Action Plan using items from the Minimum Data Set 2.0 (MDS 2.0) to identify residents with advanced dementia whose paratonia may have progressed to care-interfering severity. Design Pilot study using nominal group technique consensus methodology combined with retrospective chart review. Setting and Participants Single-site study at a 472-bed long-term care facility in Toronto, Canada. Thirty residents with advanced dementia and confirmed care-interfering paratonia who were candidates for botulinum toxin A treatment were included. Methods An expert panel of 6 clinicians used nominal group technique to identify candidate MDS 2.0 items. Items were extracted from charts using double data entry, and frequency analysis informed final consensus on preliminary screening items. Results From 51 initially identified items across 22 MDS 2.0 sections, the panel achieved consensus on 10 preliminary items spanning activities of daily living dependency, range-of-motion limitations, medication use, pressure injuries, and resistance to care behaviors. Conclusions and Implications This pilot study represents a first step toward systematic paratonia identification in long-term care and community home care settings. The preliminary screening items require validation in larger, multisite studies before clinical implementation.
Objectives The number of older people in Australia living with disability has grown disproportionately compared with growth in aged care services. We aimed to determine secular trends of emergency department (ED) use of older people in Western Australia (WA) who are living in the community and in residential aged care facilities (RCFs). Design Retrospective cohort study. Setting and Participants We studied all individuals aged 65 years or over living in WA between January 1, 2002 and December 31, 2019, who presented to WA's EDs. Methods Linked data sets were used to track trends in ED use by RCF and non-RCF residents over time. Results Two million, one hundred thirty-seven thousand, five hundred ninety-one presentations from 383,324 individuals were included. During the period 2002 to 2019, the age- and sex-standardized rate ratio of RCF:non-RCF residents decreased, with most diagnoses decreasing to less than 2-fold, although mental disorders and urinary tract infections remained high at 4.7 and 3.4 in 2019. Similarly, patients in RCFs were more likely to be diagnosed with mental disorders [odds ratio (OR), 1.92; 95% CI, 1.89-2.07], hip fracture (OR, 1.60; 95% CI, 1.55-1.66), urinary tract infections (OR, 1.49; 95% CI, 1.43-1.54), and lower respiratory tract infections (OR, 1.22; 95% CI, 1.18-1.25). RCF residents were less likely to be diagnosed with circulatory disorders (OR, 0.87; 95% CI, 0.85-0.90) and neoplasms (OR, 0.38; 95% CI, 0.35-0.42). Conclusions and Implications Although the overall relative use of ED by RCF residents decreased over time, RCF residents continued to have an increased risk of presenting with specific health needs. ED health services should be tailored to the specific needs of RCF residents.
Objectives This scoping review examined the question: What community-integrated activities are undertaken in long-term care (LTC) residential homes for older adults? Design Scoping review following the Joanna Briggs Institute method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Setting and Participants LTC settings for older adults, aged 65 years and above. Methods Peer-reviewed English studies on community-integrated activities in LTC were included. Studies involving clinical or therapeutic interventions, mixed-care settings, populations under 65, broad commentary without specific activities, or reviews were excluded. A health sciences librarian assisted with a comprehensive search of MEDLINE, Embase, Scopus, PsycINFO, and SocINDEX. Screening and data extraction were conducted using Covidence. Data extracted included study title, authors (year), country, study design (methods), purpose, participants (sample size), community-integrated activity, duration, outcomes, and author recommendations. Data were analyzed using descriptive statistics and narrative summaries. Results After duplicate removal, 5604 studies were screened, and 46 were included. The number of publications notably increased within the past 5 years. There was a wide diversity in the types of community-integrated activities, including intergenerational activities (n = 25), volunteering (n = 10), on-site services and shared spaces (n = 4), and those involving animals (n = 3). Activity duration varied from permanent, cyclical, or transient. Overarching themes across outcomes included (1) psychosocial and emotional well-being, (2) social connection and belonging, (3) reciprocal intergenerational and community benefits, and (4) structural and implementation factors. Conclusions and Implications Overall, community-integrated activities represent a promising approach to supporting ongoing social connection for older adults in LTC homes. Planning for participant diversity and developing sustainable community partnerships may improve their impact. Policy support for stable funding and clear standards, together with future research examining the feasibility and outcomes of long-term programs, is needed to improve quality of life for older adults in LTC.
