Falls among older adults (age 65 years and older) residing in personal care homes (PCHs) are an important health concern. Atypical antipsychotic drugs (AADs) have been shown to be associated with fall risk among older adults. However, previous studies face some methodological limitations that affect the quality, consistency, and comparability of these studies. Therefore, a population-based study was undertaken to examine the effect of AAD use on the risk of falling among older PCH residents. A nested case-control study was conducted using the administrative healthcare records and Minimum Data Set for PCHs (MDS) housed at the Manitoba Centre for Health Policy in the Faculty of Medicine, University of Manitoba. The study period was from April 1, 2005 to March 31, 2007. Cases (n=626) were fallers as recorded in MDS. Using incidence density sampling, each case was matched to four controls on length of PCH stay, age, and sex (n=2,388). Exposure to AADs was obtained from the Drug Program Information Network database. Conditional logistic regression was used to model the effects of AAD use on the risk of falling while accounting for matching and for confounding of other covariates. While the adjusted odds of falling was statistically greater for AAD users versus nonusers (adjusted odds ratio = 1.60, 95% CI 1.10-2.32), this association was type and dose dependent. Compared to nonusers, the odds of falling was greater for quetiapine users, regardless of this drug's dose, and high dose risperidone users. On the other hand, low dose risperidone and olanzapine, irrespective of drug dose, use was not associated with the risk of falling. Furthermore, the effect of AAD use, in general, on the risk of falling was significantly greater for people with wandering problems (adjusted odds ratio = 1.84, 95% CI 1.09-3.09). Despite some methodological limitations, this research has provided some unique findings that enhance our understanding of AAD use as a fall risk factor. Study findings allow policymakers to further develop evidence-based interventions specific to AADs in order to better manage falls in the PCH setting. However, a great deal of research is still needed to address other important unanswered questions.

Thesis (M.S.)--University of Wisconsin-Madison, 1989. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 78-81).

The project is an investigation in how architecture can support the sense of home and the spatial understanding in care homes for people with dementia.Many of the existing care homes from the mid-20th century need to be renovated and often have a more institutional design. In the project a typical care home from the 1970s, with long corridors, a complex layout and environments with little variety is being renovated to became more suitable for people with dementia. The building’s flexible structure of columns and beams is used as a great asset as it can open for different apartment types and a varied environment. The focus in the project has been to transform the building from being institutional to homely. During the 1970s care homes were usually built with a rational structure with a focus on individual apartments, but often with a lack of social spaces. The interventions in the building have been to open up the building and to create a more easily layout with more social areas. To enhance the feeling of accessibility in the building, and to better include the building in its surrounding context, the middle part of the building has been opened to the public.

The project is an investigation in how architecture can support the sense of home and the spatial understanding in care homes for people with dementia.Many of the existing care homes from the mid-20th century need to be renovated and often have a more institutional design. In the project a typical care home from the 1970s, with long corridors, a complex layout and environments with little variety is being renovated to became more suitable for people with dementia. The building’s flexible structure of columns and beams is used as a great asset as it can open for different apartment types and a varied environment. The focus in the project has been to transform the building from being institutional to homely. During the 1970s care homes were usually built with a rational structure with a focus on individual apartments, but often with a lack of social spaces. The interventions in the building have been to open up the building and to create a more easily layout with more social areas. To enhance the feeling of accessibility in the building, and to better include the building in its surrounding context, the middle part of the building has been opened to the public.

No / Previous studies have found high levels of undetected psychological distress and unaddressed need among care home residents. The aim of this study was to investigate the usability and usefulness of the Distress Thermometer for the Elderly (DTE; modified from a measure used in cancer care) in the identification of distress and need with older people in care homes. Method: This was a single group, cross-sectional study. Staff in 12 nursing homes and one care home in England completed the DTE and a measure of depression with their older residents (n = 66). Quantitative methods were employed to investigate the relationship between the Distress Thermometer rating, depression scores and problems or needs selected on the DTE. Results: The DTE was found to be feasible for completion by residents with assistance from staff. The level of distress on the DTE was significantly related to depression, number of problems and practical–physical problems. Each of 50 problems in the checklist was checked by at least one of the respondents. More problem items and physical–practical problems were selected by individuals who reached clinical levels of depression. Conclusions: In this preliminary study, results indicate promising potential for the use of the DTE as a simple screening tool for distress, as well as to enable residents to record their perceived needs as part of care-planning and a broader person-centred approach.

Yes / Over half a million people aged 65+ live in care homes (ONS 2011). Yet, sex, sexuality and intimacy and old people remain overlooked in social policy and professional practice (Hafford-Letchfield 2008). We explore narratives from a feasibility study based in Northwest England that consulted on the significance of researching sexuality and intimacy. We draw on narratives generated with two focus groups of professional carers (n = 16) and interviews with three residents, (two male and one female) and four female spouses (n = 7). All three types of stakeholders expressed concern about privacy and environmental impediments to intimacy (e.g. shortage of double rooms). However, distinct concerns were expressed by each group. Residents’ expressed scepticism that the topic was ‘too personal’, that old people were post-sexual or that sex/intimacy were part of range of needs and could be eclipsed by those relating to grand-parenting, avoiding isolation and personalization of care. Spouses emphasized the importance of intimacy over sex/sexuality as an indicator of the depth and longevity of a relationship but were concerned about unmet needs and loss of influence over their partners’ care. Obliged to meet a complex of legal, professional, ethical and interpersonal obligations, care staff articulated a need for guidance to help them support residents and their significant others. We conclude with practical recommendations that address barriers to enabling intimacy.

Yes / People with dementia and their relatives find decisions about the person with dementia living in a care home difficult. Methods: We interviewed 20 people with dementia or family carers around the time of this decision in order to design a decision-aid. Results: Decision-makers balanced the competing priorities of remaining somewhere familiar, family’s wish they remain at home, reduction of risk and effects on carer’s and person with dementia’s physical health. The person with dementia frequently resented their lack of autonomy as decisions about care home moves were made after insight and judgment were impaired. Family consultation usually helped carers but sometimes exacerbated tensions. Direct professional support was appreciated where it was available. There is a need for healthcare professionals to facilitate these conversations around decision-making and to include more than signposting to other organisations. Conclusions: There is a need for a healthcare professional facilitated decision-aid. This should detail what might change for the person with dementia and their carer, possible resources and alternatives and assist in facilitating discussion with the wider family; further research will develop and test a tool to facilitate decision making about place of care needs.

Yes / An increasing demand for care homes in the UK, has necessitated the evaluation of innovative methods for delivering more effective health care. Videoconferencing may be one way to meet this demand. However, there is a lack of literature on the provision of videoconferencing in England. This mixed-methods study aimed to map current attitudes, knowledge and provision of videoconferencing in the Yorkshire and Humber region of England. Qualitative interviews with care home managers, a scoping review and field notes from a Special Interest Group (SIG) informed the development of a descriptive convenience survey which was sent out to care home managers in the Yorkshire and Humber region of England. The survey had a 14% (n = 124) response rate. Of those who responded, 10% (n = 12) reported using videoconferencing for health care; with over 78% (n = 97) of respondents’ care homes being based in urban areas. Approximately 62% (n = 77) of the 124 respondents had heard of videoconferencing for health care provision. Of those who reported not using videoconferencing (n = 112), 39% (n = 48) said they would consider it but would need to know more. The top ranked reason for not introducing videoconferencing was the belief that residents would not be comfortable using videoconferencing to consult with a healthcare professional. The main reason for implementation was the need for speedier access to services. Those already using videoconferencing rated videoconferencing overall as being very good (50%) (n = 6) or good (42%) (n = 5). Those who were not using it in practice appeared sceptical before implementing videoconferencing. The main driver of uptake was the home’s current access to and satisfaction with traditionally delivered health care services. / The Abbeyfield Research Foundation, grant number 2

No / The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. The three key themes from the interviews were variations in service demand, the service user’s expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

Background: Increasing numbers of older people are requiring residential care and there are high levels of depression in such settings. Existing literature suggests that social support can help maintain psychological wellbeing. This study aimed to examine perceived changes in social support following a move into residential care. The key theories drawn upon were socioemotional selectivity theory (Carstensen et al., 1999) and the convoy model (Kahn & Antonucci, 1980). Method: Forty care home residents were interviewed using a structured interview. A hierarchical network mapping technique was used to measure perceptions of total network, inner network and peripheral network size. Functional support from a key significant other was measured using the Significant Others Scale. Contact with network members, depression and demographic information were also examined. Retrospective ratings were obtained by asking participants to think back to before they moved into care. Current and retrospective ratings on all measures were compared using Wilcoxon signed rank tests. Results: Total network size was perceived to have decreased following a move into residential care. There was no significant difference between current and retrospective ratings of inner network size. Peripheral network size decreased but this difference was not statistically significant. There was no perceived change in emotional and practical social support received from a key significant other following the move. Discussion: The results suggest that an individual‟s social network is compacted following a move into care but that membership of the inner network remains stable. These findings are discussed in terms of socioemotional selectivity theory (Carstensen et al., 1999) and the convoy model (Kahn & Antonucci, 1980). Strengths and weaknesses of the study are discussed and clinical implications of the findings explored.