The impact of the physical environment on communication for residents of long-term care (LTC) facilities has not been examined in depth. No study currently exists which explores environmental influences on communication within the long-term care setting. Investigation of such facilities is important because of the a large impact environmental features have on the quality of life of residents due to the often restricted nature of daily routines and reduced level of cognitive and/or physical function of residents. A definition of environment is needed in order to create a methodology for assessment and treatment of residents in LTC facilities. This study investigates what factors contribute to a positive communication environment in long-term care facilities and how the physical environment should be assessed. Observational data was obtained for three LTC residents with different types of physical and communicative impairments to determine what environmental factors inhibit or support communication. Barriers and facilitators to communication are identified, and recommendations for assessment of the long-term care environment are made. Contributions from the fields of aphasiology, environmental gerontology, and environmental psychology are described in order to contribute to the understanding of what contributes to a positive communication environment. Study results included support for: participant observation as a component of resident assessment, assessment of multiple environments, the importance considering individual needs during assessment, and assessment of resident perception of environment. Furthermore, this study presents a checklist to be used to guide observational assessments. / text

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Many older adults residing in long term care (LTC) homes have underlying health conditions and limited functionality. The objective of this research was to address the issues which might affect the health status and functionality of older adults (age ≥ 60y) living in LTC homes. To achieve this objective, the research was carried out as four studies. In the first study, supplement and medication use was examined, specifically exploring the impact of dementia, and to assess pill burden in older adults residing in LTC home. In the second study, menu served in this LTC was assessed for recommendations of Canada’s Food Guide servings, macro, micro nutrients, and diet quality score. This menu analysis was compared to a similar analysis conducted a decade ago to find out what changes had occurred over time. In the third study, LTC residents were assessed for blood inflammatory markers, 25-hydroxyvitamin D (25(OH)D), metabolic syndrome, physical functioning, cognition, pain, and associations between inflammation and markers of functionality. Similar analyses on healthy community dwelling older and younger adults was conducted to draw differences amongst all three groups, i.e., older frail (LTC residents), older healthy, and younger healthy (community dwelling). In the fourth study the option of adding an anti-inflammatory diet was explored to address the issues of inflammation and compromised menus in LTC. Major findings suggested that there was inappropriate overuse of supplements, yet vitamin D supplements were consumed by only one-third residents of the LTC home. The LTC menu did not meet the recommendations for Canada’s Food Guide servings except for Fruits & Vegetables. Diet quality of the LTC menu was low and indicated the need of improvement, however, the comparison of current menu to a decade old menu showed some improvements. Inflammatory markers in LTC older adults were high, and the majority of subjects had insufficient 25(OH)D. Metabolic syndrome was seen in about more than one-third of subjects. Significant correlations between C-reactive protein, cognition and activities of daily living were detected. The anti-inflammatory diet was validated from research, and strategies of incorporating it into the diets of LTC residents were addressed.

Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC.

Older adults with developmental disabilities often experience similar age-related health changes as their typically developing peers. However, they also face challenges associated with aging with a life-long disability. Because of the changes in life expectancy for people with developmental disabilities, there is a growing need for long-term residential care. The current study examines a sample of 90 counties in the state of Georgia. In addition to descriptive analysis, regression analysis was used to examine bed availability with county type (urban, rural, and metropolitan), age, race, income, education, and disability status as potential predictors. Preliminary analyses revealed that rural counties, on the whole, had more beds available than urban or metropolitan counties. However, these results were partially mediated by the following within county variables: adult disability status, income, older age, and racial makeup of the county.

Person-centred care is a holistic care approach that aims to build up and support the personhood of residents with dementia, and thereby enhance quality of life. Through a review of the literature on mealtimes in long term care homes, four main aspects of person-centred mealtime care were identified: providing food choices and preferences, supporting residents’ independence, promoting the social side of eating, and showing respect. Using a critical realist lens, this descriptive qualitative study examined current implementation of person-centred mealtime care, the influences on its implementation, and steps to more fully adopt a person-centred approach. Semi-structured interviews were conducted with 52 staff from four diverse long term care homes in southern Ontario. Participants included frontline workers, registered health care professionals, and managers. Interviews were transcribed and analysed for themes. A conceptual framework was developed through analysis of the interview data, identifying five key ways to support staff to provide person-centred care: forming a strong team, working together to provide care, enabling staff to know the residents better, equipping staff with a toolbox of strategies, and creating flexibility to optimize care. Specific strengths and areas for improvement in implementation of person-centred mealtime care were identified and explained using this conceptual framework. Elements of the framework were also applied to explain important considerations for hiring staff, educating and training staff, developing a culture of good teamwork, and involving family members and volunteers in mealtime care. / Canadian Foundation for Dietetic Research; Alzheimer Society of Canada

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Bibliotherapy is an innovative therapeutic technique that uses reading as a helping process for dealing with stress. It has been proposed as a mental health approach for individuals facing social, psychological or developmental problems. As reading tends to be a non-threatening method of sharing problems, a bibliotherapy group was implemented for 12 weeks with eight alert elderly people who had difficulties coping with their current life situation in a long-term care institution. The effectiveness of a bibliotherapeutic approach with this population is evaluated and implications for social work policy, practice and research are discussed.

Manitoba’s population is aging. Trends in personal care home (PCH) use have also changed so that residents today have more cognitive impairments including Alzheimer’s disease and related dementias (ADRD). While quality of life (QoL) has emerged as an important PCH research outcome, this literature is relatively sparse for residents with versus without ADRD. This study was conducted to examine the QoL of PCH residents with ADRD, using a recently developed but as of yet untested framework by Kane and colleagues (1999, as cited in Frytak; Kane 2001, 2003). The specific aims of this study were to gather family caregivers’ perspectives on: (a) the meaning of the six domains that constitute Kane et al.’s ADRD-specific PCH-QoL framework; (b) domains they considered to be more important or lacking from this framework; and, (c) general PCH policies, practices, and activities that currently (or could better) facilitate positive QoL experiences for their loved ones.