Adequate indoor air quality in nursing homes: An unmet medical need.
Reddy Manasa,Heidarinejad Mohammad,Stephens Brent,Rubinstein Israel
The Science of the total environment
A small but growing body of literature indicates that concentrations of indoor particulate and gaseous pollutants in long-term care facilities (i.e., skilled nursing facilities) for older adults, hereafter referred to nursing homes, often exceed those recorded in nearby, comparable outdoor environments. Unlike the outdoors, indoor air quality (IAQ) in nursing homes is not regulated by legislation and is seldom monitored. To that end, residents of nursing homes commonly spend the vast majority of their time indoors where they are exposed to indoor air pollutants for long periods of time. Given that many nursing home residents, especially those of advanced age, are more susceptible to the effects of air pollutants, even at low concentrations, this prolonged exposure may adversely affect their health, well-being, quality of life and increase medical expenditures due to frequent, unscheduled acute care visits and hospitalizations. We propose an action plan for assessing IAQ in nursing homes, understanding the impacts of IAQ on adverse health outcomes of nursing home residents, and addressing vulnerabilities in these facilities to safeguard health, well-being, and quality of life of nursing home residents and minimizing unscheduled acute care visits and hospitalizations. We propose that IAQ should be regularly monitored in nursing homes to proactively identify and address vulnerabilities in these facilities and that resources should be provided for remedial interventions to improve IAQ in nursing homes, including but not limited to source control, improving ventilation and filtration, and deploying air cleaners where appropriate. This proactive approach may pave the way for establishing enforceable standards for indoor air quality in nursing homes that will promote health, well-being, and quality of life of nursing home residents and reduce medical expenditures.
10.1016/j.scitotenv.2020.144273
Increasing implicit rationing of care in nursing homes: A time-series cross-sectional analysis.
International journal of nursing studies
BACKGROUND:Implicit rationing of nursing care is a socio-ecological problem where care workers, due to lack of resources, have to leave necessary nursing care activities undone. Cross-sectional studies on implicit rationing of nursing home care revealed associations with organizational and work environment characteristics. However, little is known on how implicit rationing of nursing care varies over time in nursing homes. OBJECTIVE:This study's purpose was to describe changes in levels and patterns of implicit rationing of nursing care in Swiss nursing homes over time, while accounting for key explanatory factors related to organizational, work environment, and individual characteristics. DESIGN:Time-series cross-sectional analysis. SETTING:Nursing homes in Switzerland. PARTICIPANTS:A convenience sample of 47 nursing homes and 3269 care workers from all educational levels participating in two multicenter cross-sectional studies (the Swiss Nursing Home Human Resources Project) conducted in 2013 and 2018. METHODS:To quantify implicit rationing of nursing care, care workers' data were collected via the nursing home version of the Basel Extent of Rationing of Nursing Care instrument. To control for leadership ability, staffing and resource adequacy, we used the Nursing Work Index-Practice Environment Scale. Objective measures including turnover, staffing and skill mix levels were aggregated at the nursing home level. Our analyses included multiple linear mixed models, using time as a fixed effect and nursing home as a random effect. RESULTS:We found overall increases of rationing of care activities over the five-year period studied, with documentation and social activities most rationed at both measurement points (overall coefficients varied between 0.11 and 0.23, as well as the 95%-confidence intervals between 0.05 and 0.30). Moreover, a considerable increase in rationing of activities of daily living (coefficient of 0.47 in 2013 and 0.63 in 2018) was observed. CONCLUSIONS:Alongside long-term deterioration of staff resources, increases in rationing of nursing care are a worrying development, particularly given their potential negative impacts both on residents and on care workers. To assess nursing home care quality and to determine adequate staffing levels and skill mixes, policy makers and nursing home managers should consider regular monitoring of rationing of nursing care. TWEETABLE ABSTRACT:Time-series cross-sectional analysis reveals increasing rationing of nursing care activities in Swiss nursing homes from 2013 to 2018.
10.1016/j.ijnurstu.2022.104320
Study on Influencing Factors and Countermeasures of Elderly Nursing Services in the Elderly.
Applied bionics and biomechanics
Methods:500 inpatients with chronic diseases in a famous tertiary hospital in a city were studied, and the corresponding countermeasures were put forward through the analysis of their needs and influencing factors. Results. The study found that the vast majority of elderly patients have higher requirements for elderly care services, which is related to factors such as family income. Compared with the huge medical demand, there is a large gap in the level of domestic medical and health talents. According to relevant research, the current number of beds in China is 1 : 0.27, but in fact it is 1 : 0.4. Therefore, relevant units should strengthen the health examination of the elderly, provide high-quality medical services, make full use of health resources, and strengthen nursing management, so as to improve the quality of nursing services. Conclusion:The survey results show that the vast majority of elderly patients have high requirements for their elderly care services, which is related to family income and other related factors. Therefore, relevant departments should formulate corresponding measures to improve the quality of life of the elderly.
10.1155/2022/4501228
Evaluating the technical efficiency of care among long-term care facilities in Xiamen, China: based on data envelopment analysis and Tobit model.
Zhang Liangwen,Zeng Yanbing,Fang Ya
BMC public health
BACKGROUND:The technical efficiency (TE) of care among the elderly in long-term care facilities (LTCF) have become increasingly crucial policy concerns faced by developing countries and Asia, especially China. The purpose of this study was to evaluate the TE and the quality of care and identify its influencing factors among LTCF. METHODS:A total of 32 registered LTCF in Xiamen of China were surveyed in 2016. The Banker-Charnes-Cooper (BCC) model and Slacks-Based Measure (SBM) model of Data Envelopment Analysis (DEA) were used to evaluate the TE of LTCF. The TE has been decomposed into pure technical efficiency and scale efficiency. Utilization of DEA with human, financial, and material resources as inputs and quantity, quality of nursing care as outputs allowed estimation of the relative TE of care in LTCF. In addition, this study applied SBM to measuring the efficiencies and slacks. Furthermore, Tobit model was performed to explore factors associated with TE. RESULTS:There were 7 public and 25 private LTCF respectively, with a total of 6729 beds and 3154 elderly people. 17 LTCF were technically efficient (53.1%). In the BCC model, the average TE was 0.963. The average pure technical efficiency and scale efficiency of LTCF were 0.979, 0.984, respectively. There were 5 LTCF with increasing returns to scale, 8 LTCF with decreasing returns to scale. In the SBM model, the average TE was 0.813, and it had the same effective decision-making unit with SBM model. Depending on TE score from high to low, the top eight are private LTCF, and the last four were public LTCF. The slack analysis showed that they can be reduced in 8 LTCF with decreasing returns to scale such as 53.31% administrative staffs, 67.73% medical staffs, 33.1% caregivers, 51.66% paramedical staffs and 4.1% beds on average. The TE of private LTCF was higher than that of public LTCF. The LTCF in urban were more effective than rural. The TE of LTCF raised by increasing of working hours, training frequency and institutional occupancy. CONCLUSIONS:The overall TE of LTCF in Xiamen of China was relatively high, especially in private institutions. However, LTCF still needs to further improve the utilization of physical resources and the management and training of human resources. The TE of LTCF was associated to their location, institutional nature, allocation of human resources and occupancy rate. It was needed to focus on promoting the efficiency and quality of LTCF in order to achieve sustainability.
10.1186/s12889-019-7571-x
Prevention of falls and consequent injuries in elderly people.
Kannus Pekka,Sievänen Harri,Palvanen Mika,Järvinen Teppo,Parkkari Jari
Lancet (London, England)
Injuries resulting from falls in elderly people are a major public-health concern, representing one of the main causes of longstanding pain, functional impairment, disability, and death in this population. The problem is going to worsen, since the rates of such injuries seem to be rising in many areas, as is the number of elderly people in both the developed and developing world. Many methods and programmes to prevent such injuries already exist, including regular exercise, vitamin D and calcium supplementation, withdrawal of psychotropic medication, cataract surgery, professional environment hazard assessment and modification, hip protectors, and multifactorial preventive programmes for simultaneous assessment and reduction of many of the predisposing and situational risk factors. To receive broader-scale effectiveness, these programmes will need systematic implementation. Care must be taken, however, to rigorously select the right actions for those people most likely to benefit, such as vitamin D and calcium supplementation and hip protectors for elderly people living in institutions.
10.1016/S0140-6736(05)67604-0
A study on depression of the elderly with different sleep quality in pension institutions in Northeastern China.
Zhang Jun,Zhang Yingying,Luan Zhenggang,Zhang Xiujie,Jiang Haoran,Wang Aiping
BMC geriatrics
BACKGROUND:China owns he largest aged population in the world, and the elderly adults who live in pension institutions are more likely to suffer from mental disorders than other elderly adults. The purpose of this study is to discover the risky factors of depression among nursing home residents with various sleeping quality. METHODS:We conducted a cross-sectional study in Northeastern China from May to September in 2017 using multistage sampling method and 507 elderly people without cognitive impairment in six pension institutions were interviewed. The Pittsburgh Sleep Quality Index (PSQI) and Geriatric Depression Scale (GDS) were adopted to collect the information of sleep quality and depression. We used logistic regression to analyze the factors influencing depression among the elderly adults with poor or good sleep quality. RESULTS:The overall depression rate among elderly adults was 21.7%. The logistic regression analysis revealed that marital status, chronic disease, regular exercise, physical ache, filial piety and chewing ability had significant effects on the depression of the elderly with good sleep quality. Loneliness, self-caring ability, chewing ability and chronic diseases had significant effects on depression of the elderly with poor sleep quality. CONCLUSION:The prevalence of depressive symptoms in the elderly is not high. However, sleeping quality distinguishes root causes on elderly adults depression. Therefore, the risk factors of depression among elderly adults should be analyzed separately.
10.1186/s12877-020-01777-4
Association of artificial intelligence use and the retention of elderly caregivers: A cross-sectional study based on empowerment theory.
Journal of nursing management
AIM:The purpose of this study is to investigate how the use of artificial intelligence is associated with the retention of elderly caregivers. BACKGROUND:The turnover of elderly caregivers is high and increasing. Elderly care institutions are beginning to use artificial intelligence to support caregivers in their work, and the use of technology is critical to staff retention. Empowerment of elderly caregivers has been neglected by managers and researchers. METHODS:This cross-sectional study involved 511 elderly caregivers in 25 elderly institutions. Six validated standardized scales were used for data collection, and the software SPSS and SmartPLS were used for data analysis. RESULTS:The quality of artificial intelligence has a significant positive effect on empowerment. Artificial intelligence psychological empowerment (β = .355, p < .001) and artificial intelligence structural empowerment (β = .375, p < .001) both had positive effects on retention intention, and the jointly explained variance (R ) was 42.6%. CONCLUSIONS:The results show that a significant relationship exists between artificial intelligence empowerment and retention intention. Elderly caregivers with more structural empowerment have higher retention intention. IMPLICATIONS FOR NURSING MANAGEMENT:Artificial intelligence suppliers need to pay attention to the role of product quality in elderly care services, continuously improve artificial intelligence quality, and strengthen the application and routine maintenance of artificial intelligence technologies. Elderly care institution managers should pay special attention to artificial intelligence structural empowerment (such as artificial intelligence-related education and training, learning and development opportunities, and resource support).
10.1111/jonm.13823
Options for Care of Elderly Inpatients With Chronic Diseases: Analysis of Distribution and Factors Influencing Use of Care in Shanghai, China.
Frontiers in public health
China's ability to provide sufficient healthcare for an elderly population with chronic diseases has become a challenge because of poor utilization of different levels of medical institutions. We aimed to explore the characteristics and factors influencing patient choices and the resulting utilization of different levels of public medical institutions among elderly inpatients with chronic diseases. Data were collected from the Information Center of the Health and Family Planning Commission of Pudong New Area in Shanghai from 2013 to 2016. A cross-sectional study using multinomial logistic regression analysis was performed to find the factors influencing use of care. Records of patients were identified from electronic health records from public medical institutions. There were 95,445 elderly inpatients with chronic diseases in public medical institutions, 17.78% in community health centers, 68.44% in secondary hospitals, and 13.78% in tertiary hospitals. Compared with those over 80 years old, the 60-69 age group showed a preference for secondary hospitals (OR = 2.980, < 0.001) and tertiary hospitals (OR = 4.497, < 0.001), a trend also observed in the 70-79 age group (OR = 1.353, < 0.001; OR = 1.673, < 0.001). Compared with those using urban employee basic medical insurance, inpatients using urban resident basic medical insurance were less likely to visit secondary hospitals than community health centers (OR = 0.237, < 0.001) or tertiary hospitals (OR = 0.293, < 0.001). Compared with those inpatients who were married, inpatients who were widowed were less likely to go to secondary hospitals (OR = 0.391, < 0.001) or tertiary hospitals (OR = 0.045, < 0.001) than community health centers. The utilization of different levels of medical institutions by elderly people is not well-suited to the respective functions of these medical institutions. Most care services should be provided by community health centers, but our findings indicate that elderly people are more inclined to seek inpatient care at secondary hospitals and tertiary hospitals with some variation based on the patients' sex, age, medical insurance, expenses, and expected length of stay.
10.3389/fpubh.2021.631189
Investigation and research on elderly people's willingness to combine medical and health care and related factors in coastal cities in eastern China.
PeerJ
Background:The problem of global aging was becoming increasingly prominent. At present, the empty nest and miniaturization of family structure reduce the function of home-based elderly care. Methods:A questionnaire survey was conducted on 347 elderly people in multiple communities and nursing homes in eastern coastal cities of China, and 13 institutional staff members of eight nursing institutions that carried out the medical-nursing integration model were interviewed as the research objects. The survey mainly focuses on the basic characteristics of the elderly, the family support system, and the acceptance of medical care and health care. The influencing factors were screened by t test, univariate analysis and multivariate logistic regression analysis. SPSS software was used to test the reliability and validity of the questionnaire, and the Crobach's was 0.792, which can be considered that the questionnaire had good internal reliability. The classification of the questionnaire was reasonable, the reliability of the questionnaire was high, and the internal consistency of the scale was high. According to KMO and Bartlett test, KMO = 0.826, χ2 = 853.731, the degree of freedom was 36, and the value was 0.000. Results:The proportion of male and female respondents was 48.1% and 51.9% respectively. Multivariate logistic regression analysis results showed that gender had no statistical significances on the degree of support for combine medical and health care in the elderly ( > 0.05). The results showed that gender, age, marital status, medical insurance type and old-age insurance type had little effect on the support of the combination of medical care and health care for the elderly ( > 0.05). Compared with the control group with education below primary school, the elderly with bachelor's degree or above are more willing to support the combination of medical care and health ( < 0.05). The registered residence type is more obvious than that of the urban residents ( < 0.05). Compared with the enterprise employees in the control group, the elderly who were employed as migrant workers before retirement were more willing to support the combination of medical care and health ( < 0.05). From the perspective of family monthly income, the elderly with family income ≥10,000 RMB have more obvious support for the combination of medical care and health than the elderly with family monthly income <3,000 RMB in the control group ( < 0.05). In terms of the degree of understanding, the degree of understanding and support in different degrees are significantly higher than that in the control group ( < 0.05). Conclusion:Through multivariate logistic regression analysis, education level, registered residence, pre-retirement occupation and family income are more obvious for the elderly to support medical care and health. It is necessary to increase investment in elderly activity centers, actively carry out activities.
10.7717/peerj.14004
Comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions in Liaoning Province, China: a cross-sectional study.
BMC geriatrics
BACKGROUND:With the global aging problem is becoming increasingly severe, the elderly care has become an important issue that needs attention. Chinese government attaches great importance to the development of medical and health care institutions, and is committed to improving the comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions. METHODS:From June to September 2019, a cross-sectional study among 193 elderly rehabilitation nursing staff was conducted in Liaoning Province, China. Using a self-designed questionnaire, the comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions was investigated by face to face. The multiple linear regression model was explored to analyze the influencing factors. RESULTS:A total of 193 questionnaires were distributed, and 189 (97.93%) valid questionnaires were recovered. Age was from 19 to 65 years old, with an average age of (38.34 ± 9.76) years old. Bachelor degree or above accounted for 54.00%. 57.10% have engaged in elderly rehabilitation nursing for more than one year. There were 163 nurses with qualification certificates, accounting for 86.20%. The total score of comprehensive quality was 118.52 ± 22.90. The total Cronbach ' s α coefficient of the questionnaire was 0.967, and the content validity index was 0.991. Only 61 (32.30%) elderly rehabilitation nurses received professional training in elderly rehabilitation nursing. The results of multiple linear regression analysis showed that the educational level of elderly rehabilitation nursing staff (P = 0.002) and the number of years engaged in elderly rehabilitation nursing (P = 0.005) were the main influencing factors of comprehensive quality. CONCLUSIONS:The comprehensive quality of elderly rehabilitation nursing staff is at a medium level in Liaoning Province's medical and health care institutions. However, the professional nursing talents were very short, and the education level and years of experience in elderly care were the main influencing factors of the comprehensive quality.
10.1186/s12877-022-03092-6
The Quality of Caregivers for the Elderly in Long-Term Care Institutions in Zhejiang Province, China.
Zeng Yuhang,Hu Xiaoqian,Li Yuanyuan,Zhen Xuemei,Gu Yuxuan,Sun Xueshan,Dong Hengjin
International journal of environmental research and public health
China is facing challenges in caring for older adults. This paper aimed to understand knowledge, attitude, and practice (KAP) regarding the quality of caregivers for the elderly in long-term care institutions in Zhejiang Province, and also to find related factors to improve the quality of caregivers. A cross-sectional survey was conducted from April to June 2016 in Zhejiang Province. In total, 84 caregivers were interviewed face-to-face with questionnaires on KAP towards elderly care. Multiple linear regression was used to find the related factors to KAP. A conceptual model was made to process path analysis among KAP and influencing factors using structural equation modeling. The study found that most caregivers in Zhejiang Province were middle-aged, female, and with a diploma below middle school. Many caregivers had not received any pre-employment training. Their salary was low although they undertook high-intensity work. Education and working years had a positive effect on knowledge and practice scores, and pre-employment training had a positive effect on knowledge and attitude scores. Knowledge and attitude regarding elderly care could positively affect elderly care practices. The quality of caregivers in Zhejiang Province was at a low level compared to developed countries. Continuous and regular elderly care training should be provided for caregivers to improve their elderly care knowledge and hence the quality of elderly care.
10.3390/ijerph16122164
Situation and Countermeasures of the Management Team of the Elderly Care Institutions from the Perspective of the Combination of Medical and Health Care: A Cross-Sectional Study.
Yang Li,Peng Hongmei,Yang Yunfan,Ouyang Linqi,Li Yunfeng
Journal of healthcare engineering
Objective:In order to provide evidence for improving the quality of managers in elderly care institutions, this paper explored the situation of managers of elderly care institutions in a city in Central China under the national guidelines for the combination of medical and elderly health care. Design:A cross-sectional study carried out in a city in Central China was designed. . The online questionnaire was distributed to the managers of six elderly care institutions in a city in Central China. . The questionnaire was sent to 61 recipients; from this, 60 responses were obtained. Results:There was a 98% response rate. The study found that most managers in elderly care institutions were middle-aged, with low education level and years of management. The job mobility was high, and 27% of the managers had no relevant certificates. Management years had a significant influence on the rate of certificate holding ( < 0.05). Some managers were less than 30 years old and had college degree or above, which indicated that people with young and high levels of education were more likely to become managers. However, there was no significant difference in educational level among managers of different ages ( > 0.05). 56.6% of the managers have received provincial or municipal training, and few managers have received the national level training. The education level is positively related to the access to training opportunities. More than half of the managers earn less than ¥3000 a month. The study showed that the education level was positively related to the career growth space ( < 0.05). Conclusions:Specialized training and high salary should be provided for managers to improve their elderly care skills and hence the quality of elderly care service. In addition, in order to improve the education level of managers, a long-term continuing education system should be established gradually. Through expanding the enrollment scale of the nursing school, carrying out training about elderly care skills, and issuing vocational skills certificates to those who pass the examination, the number of local nurses for the elderly will be increasing, and the quality of the elderly care service will be improving.
10.1155/2020/8826007