Magister Curationis - MCur / Worldwide concerns have been raised about the presence and association of depressive symptoms, cognitive impairment, and dementia in older adults (60 years and older), which are often unrecognised and untreated in long-term care facilities (LTCF’s). The progression of cognitive impairment to dementia reduces quality of life with negative consequences of physical, mental, and psychosocial health. In many LTCF’s internationally, the standardised interRAI system is used to capture depressive symptoms and cognitive impairment. However, there is a fragmentation of systems for making evidence-based decisions to plan and manage care for residents with depressive symptoms, cognitive impairment, and dementia. This study, being the first of its kind in South Africa, addressed this gap, by describing a profile of depressive symptoms and cognitive impairment in residents, and analysing their coexistence, using the interRAI-LTCF in a LTCF in the Cape Metropole in South Africa. A quantitative, descriptive, and analytical cross-sectional secondary data analysis was conducted using the records of all 173 resident’s medical records of residents with a last interRAI-LTCF assessment from 2014 and 2016. The objectives were to determine the levels of depressive symptoms and cognitive impairment, and to assess variously associated demographics and clinical variables between depressive symptoms and cognitive impairment of the interRAI-LTCF in residents in a LTCF. Secondary data were analysed, using the IBM Statistical Package for Social Sciences (SPSS) software, version 25, to test any statistically significant relationship between the extracted variables (Significance was set as p˂0.05).

This article describes the psychometric properties of the WHOQOL-OLD (an add-on module to the World Health Organization's Quality of Life measure for older people) in a South African sample. International literature cites three short versions of the WHOQOL-OLD instrument. The psychometric properties associated with these three short versions of the WHOQOL-OLD are also described. The unique challenges posed by ageing populations are evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). Regardless of integration policies in post-apartheid South Africa, especially in terms of housing arrangements, the majority of long-term care facilities in South Africa remain to be occupied predominantly by white older people. For this reason the participants of this study were mostly older white South Africans. It is, however, projected that this picture will change in future times due to more aggressive transformation-driven policies. A national audit of residential care facilities by the Department of Social Development in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undetermined. QoL research in South Africa has largely been conducted from socio-economic and health-care perspectives and has tended to focus on specific societies in which older people are usually not explicitly included. Evidence exists of various qualitative studies among older people living in long-term care facilities, from a psychological perspective. However, the short supply of quantitative studies in this setting is significant. The lack of measurements developed for an older population also resulted in an increasing need for the development of gerontological QoL measurements with sound psychometric properties. Internationally, various measures of QoL utilised in older age groups have become increasingly popular. This study took particular interest in the WHOQOL-OLD instrument. Under the auspices of the World Health Organization Quality of Life group, a collaborative effort among numerous researchers from various countries has led to the development of a measure focussing on the QoL in older population cohorts. The initial development of the generic WHOQOL measures of quality of life occurred in 15 different centres worldwide, excluding South Africa. In the development of an add-on module, 22 centres around the world were involved (again excluding South Africa). It cannot be assumed that measuring instruments developed in a Western context are applicable in an African context. South Africa is a very diverse nation - the majority of ethnic groups lead a collectivistic existence. As a result the determination of the psychometric properties of such instruments, for use within South Africa, was needed. It is of importance to note that the participants of this study were more individualistically inclined, which is comparable to Western societies. This study was the first step in exploring the instrument’s reliable use within South Africa. Surveys were completed by 176 older people who were fluent in both Afrikaans and English. Participants of the study resided in long-term care facilities in Potchefstroom in the North-West province of South Africa. Their ages varied between 61 and 95 and the mean age of participants was 77 years. Of the respondents, 50 were male and 126 were female. All reported average to good health and cognitive ability. The current study found encouraging results related to the original factor structure of the WHOQOL-OLD as well as the three shorter versions of this instrument. Results from the data of the current sample seem to fit the original structure model well. The reliabilities associated with the various sub-dimensions point to a reliable instrument. The original WHOQOL-OLD questionnaire with its 24 items or any of the three short versions of this instrument can therefore be utilised in a South African context. / MA (Clinical Psychology), North-West University, Potchefstroom Campus, 2015

This article describes the psychometric properties of the WHOQOL-OLD (an add-on module to the World Health Organization's Quality of Life measure for older people) in a South African sample. International literature cites three short versions of the WHOQOL-OLD instrument. The psychometric properties associated with these three short versions of the WHOQOL-OLD are also described. The unique challenges posed by ageing populations are evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). Regardless of integration policies in post-apartheid South Africa, especially in terms of housing arrangements, the majority of long-term care facilities in South Africa remain to be occupied predominantly by white older people. For this reason the participants of this study were mostly older white South Africans. It is, however, projected that this picture will change in future times due to more aggressive transformation-driven policies. A national audit of residential care facilities by the Department of Social Development in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undetermined. QoL research in South Africa has largely been conducted from socio-economic and health-care perspectives and has tended to focus on specific societies in which older people are usually not explicitly included. Evidence exists of various qualitative studies among older people living in long-term care facilities, from a psychological perspective. However, the short supply of quantitative studies in this setting is significant. The lack of measurements developed for an older population also resulted in an increasing need for the development of gerontological QoL measurements with sound psychometric properties. Internationally, various measures of QoL utilised in older age groups have become increasingly popular. This study took particular interest in the WHOQOL-OLD instrument. Under the auspices of the World Health Organization Quality of Life group, a collaborative effort among numerous researchers from various countries has led to the development of a measure focussing on the QoL in older population cohorts. The initial development of the generic WHOQOL measures of quality of life occurred in 15 different centres worldwide, excluding South Africa. In the development of an add-on module, 22 centres around the world were involved (again excluding South Africa). It cannot be assumed that measuring instruments developed in a Western context are applicable in an African context. South Africa is a very diverse nation - the majority of ethnic groups lead a collectivistic existence. As a result the determination of the psychometric properties of such instruments, for use within South Africa, was needed. It is of importance to note that the participants of this study were more individualistically inclined, which is comparable to Western societies. This study was the first step in exploring the instrument’s reliable use within South Africa. Surveys were completed by 176 older people who were fluent in both Afrikaans and English. Participants of the study resided in long-term care facilities in Potchefstroom in the North-West province of South Africa. Their ages varied between 61 and 95 and the mean age of participants was 77 years. Of the respondents, 50 were male and 126 were female. All reported average to good health and cognitive ability. The current study found encouraging results related to the original factor structure of the WHOQOL-OLD as well as the three shorter versions of this instrument. Results from the data of the current sample seem to fit the original structure model well. The reliabilities associated with the various sub-dimensions point to a reliable instrument. The original WHOQOL-OLD questionnaire with its 24 items or any of the three short versions of this instrument can therefore be utilised in a South African context. / MA (Clinical Psychology), North-West University, Potchefstroom Campus, 2015

Background: Quality of life (QoL) of long term care facility (LTC) residents is being recognized as an important outcome of care by LTC providers, researchers, and policy makers. For residents, measurement of QoL is a valued opportunity to express their perception of the quality of their daily life in the LTC facility. For clinicians, self-reported QoL provides useful information in planning and implementing resident-centred care. Purpose: The purposes of this study were: (1) to examine the distributional and psychometric properties of the interRAI Self-Report Nursing Home Quality of Life Survey (interRAI_QoL Survey); and (2) to explore the relationship of selected socio-demographic and clinical characteristics of residents and LTC facility attributes with residents’ self-reported QoL. Methodology: This was a cross-sectional observational study. A convenience sample of 48 volunteer LTC facilities from six Canadian provinces was involved in this study. Nine hundred and twenty eight (928) residents agreed to participate in this study. Resident inclusion required an interRAI Cognitive Performance Scale score of 0 (intact) to 3 (moderate impairment). Residents’ self-reported QoL was measured by trained surveyors using the interRAI_QoL Survey instrument. Residents’ socio-demographic and clinical characteristics were obtained from the most recentResident Assessment Instrument –Minimum Data Set 2.0 prior to the QoL interviews. LTC facility attributes were measured by a survey form specifically designed for this purpose. Descriptive statistics were used to describe the participating LTC facilities, the sample of residents, and residents’ self-reported QoL. Psychometric tests for reliability (test-retest and internal consistency) and validity (content and convergent) were conducted. Bivariate analyses were conducted to examine the relatioships between QoL and resident and facility charateristics. Multivariate linear and logistic regression analyses were conducted to identify predictors of residents’ QoL. Results: The study confirmed the feasibility of assessing LTC facility residents’ self-reported QoL. The findings showed positive ratings of some aspects of residents’ daily lives while negative ratings in other aspects. Psychometric tests showed that the interRAI_QoL Survey instrument had test-retest reliability, internal consistency, content validity and construct (convergent) validity. Several resident and facility characteristics were associated with self-reported QoL. Religiosity and highest education level attained were significantly and positively associated with QoL. Other resident characteristics such as age, gender and marital status were not. Mild cognitive impairment, depression, aggressive behaviour, hearing impairment, bowel and bladder incontinence, and extensive assistance in activities of daily living were significantly but negatively associated with QoL. LTC facility ownership showed significant association with QoL. Residents in municipal LTC facilities followed by private LTC facilities reported higer QoL in contrast to charitable LTC facilities. Profit status, accreditation and leadership stability were not associated with QoL. Residents in rural settings reported significantly higher QoL than those in urban settings. Facility size (measured in number of beds), registered nurse hours of care, nursing staff turnover, and ratios of registered to non-registered nursing staff did not have a significant association with QoL. However, higher management hours and total hours of care had significant and positive associations with residents’ overall QoL. Multiple linear regression showed that residents’ religiosity, degree of social engagement, post secondary education, dependence in activities of daily living, and positive global disposition, and LTC facilities situated in rural settings and ownership type together accounted for 24% (adjusted R2=0.24) of the variance in overall QoL (the dependent variable). In logistic regression, low QoL was used as the binary dependent variable. Residents who were religious, were socially engaged and had a positive global disposition were less likely to report low QoL. In contrast, residents with dependence in activities of daily living and post secondary education were more likely to report low QoL. Residents in LTC facilities located in rural settings and operated by municipal or private operators were less likely to report low QoL compared to charitable facilities. Strengths and Limitations: This study had several strengths, including a sample of 928 residents who self-reported on their QoL and the use of RAI-MDS 2.0 for objective, external indicators of QoL. This study had several limitations, including response bias due to method of sample selection, inability to draw causal inferences due to study design; limited generalizability due to use of a convenience sample, lack of monitoring of surveyors for the integrity of resident interviews, and exclusion of residents with cognitive performance scale scores of more than three or inability to communicate in English. Future research should address these limitations. As well, future research should conduct more stringent psychometric analyses such as factor analysis and use multi-level modeling procedures. Implications: The findings of this study have implications for improving residents’ QoL, LTC facility programming, future research, and social policy development. Conclusion: QoL can be measured from resident self-reports in LTC facilities. Self-reports from residents may be used by clinicians to plan and implement resident-centred care. There are significant associations of residents’ QoL with select resident socio-demographic and clinical characteristics and facility attributes. Some of these resident characteristics and facility attributes may serve as predictors of QoL.

No description available.

Background: Quality of life (QoL) of long term care facility (LTC) residents is being recognized as an important outcome of care by LTC providers, researchers, and policy makers. For residents, measurement of QoL is a valued opportunity to express their perception of the quality of their daily life in the LTC facility. For clinicians, self-reported QoL provides useful information in planning and implementing resident-centred care. Purpose: The purposes of this study were: (1) to examine the distributional and psychometric properties of the interRAI Self-Report Nursing Home Quality of Life Survey (interRAI_QoL Survey); and (2) to explore the relationship of selected socio-demographic and clinical characteristics of residents and LTC facility attributes with residents’ self-reported QoL. Methodology: This was a cross-sectional observational study. A convenience sample of 48 volunteer LTC facilities from six Canadian provinces was involved in this study. Nine hundred and twenty eight (928) residents agreed to participate in this study. Resident inclusion required an interRAI Cognitive Performance Scale score of 0 (intact) to 3 (moderate impairment). Residents’ self-reported QoL was measured by trained surveyors using the interRAI_QoL Survey instrument. Residents’ socio-demographic and clinical characteristics were obtained from the most recentResident Assessment Instrument –Minimum Data Set 2.0 prior to the QoL interviews. LTC facility attributes were measured by a survey form specifically designed for this purpose. Descriptive statistics were used to describe the participating LTC facilities, the sample of residents, and residents’ self-reported QoL. Psychometric tests for reliability (test-retest and internal consistency) and validity (content and convergent) were conducted. Bivariate analyses were conducted to examine the relatioships between QoL and resident and facility charateristics. Multivariate linear and logistic regression analyses were conducted to identify predictors of residents’ QoL. Results: The study confirmed the feasibility of assessing LTC facility residents’ self-reported QoL. The findings showed positive ratings of some aspects of residents’ daily lives while negative ratings in other aspects. Psychometric tests showed that the interRAI_QoL Survey instrument had test-retest reliability, internal consistency, content validity and construct (convergent) validity. Several resident and facility characteristics were associated with self-reported QoL. Religiosity and highest education level attained were significantly and positively associated with QoL. Other resident characteristics such as age, gender and marital status were not. Mild cognitive impairment, depression, aggressive behaviour, hearing impairment, bowel and bladder incontinence, and extensive assistance in activities of daily living were significantly but negatively associated with QoL. LTC facility ownership showed significant association with QoL. Residents in municipal LTC facilities followed by private LTC facilities reported higer QoL in contrast to charitable LTC facilities. Profit status, accreditation and leadership stability were not associated with QoL. Residents in rural settings reported significantly higher QoL than those in urban settings. Facility size (measured in number of beds), registered nurse hours of care, nursing staff turnover, and ratios of registered to non-registered nursing staff did not have a significant association with QoL. However, higher management hours and total hours of care had significant and positive associations with residents’ overall QoL. Multiple linear regression showed that residents’ religiosity, degree of social engagement, post secondary education, dependence in activities of daily living, and positive global disposition, and LTC facilities situated in rural settings and ownership type together accounted for 24% (adjusted R2=0.24) of the variance in overall QoL (the dependent variable). In logistic regression, low QoL was used as the binary dependent variable. Residents who were religious, were socially engaged and had a positive global disposition were less likely to report low QoL. In contrast, residents with dependence in activities of daily living and post secondary education were more likely to report low QoL. Residents in LTC facilities located in rural settings and operated by municipal or private operators were less likely to report low QoL compared to charitable facilities. Strengths and Limitations: This study had several strengths, including a sample of 928 residents who self-reported on their QoL and the use of RAI-MDS 2.0 for objective, external indicators of QoL. This study had several limitations, including response bias due to method of sample selection, inability to draw causal inferences due to study design; limited generalizability due to use of a convenience sample, lack of monitoring of surveyors for the integrity of resident interviews, and exclusion of residents with cognitive performance scale scores of more than three or inability to communicate in English. Future research should address these limitations. As well, future research should conduct more stringent psychometric analyses such as factor analysis and use multi-level modeling procedures. Implications: The findings of this study have implications for improving residents’ QoL, LTC facility programming, future research, and social policy development. Conclusion: QoL can be measured from resident self-reports in LTC facilities. Self-reports from residents may be used by clinicians to plan and implement resident-centred care. There are significant associations of residents’ QoL with select resident socio-demographic and clinical characteristics and facility attributes. Some of these resident characteristics and facility attributes may serve as predictors of QoL.

The main object of the research is to analyze the effect of the clinical intervention algorithms proposed for reducing antibiotic use for older adults in long-term care facilities (LTCFs) by managing urinary tract infections (UTIs). 20 paired nursing homes were enrolled in the 12-month study. Within each pair, one was randomized to use of the intervention algorithms and the other to use of regular management. Cluster-level paired t-tests (unweighted and weighted) and regression analyses (unweighted and weighted) were used in the analysis of the data. Paired t-tests show that the algorithms did not significantly reduce the antibiotic use, the number of urine cultures or the antibiotic use for urinary infections in most months. However, they did reduce the proportion of antibiotic use for urinary infections significantly in most months. Regression analysis indicates that the difference between the control group and intervention group has no significant increasing or decreasing trend with time (month). And the algorithms significantly reduced the antibiotic use for urinary infections, number of cultures and the proportions through the 12-month study. The analyses reached a similar conclusion using nonparametric methods and weighted analysis. / Thesis / Master of Science (MS)

Bakgrunn: Kontroll og overvåking av institusjonservervede infeksjoner (sykehusinfeksjoner) ble regulert i lov og forskrift i 1996. Helseinstitusjoner ble pålagt å ha infeksjonskontrollprogram. Hensikt: Å beskrive i hvilken utstrekning sykehjem i Akerhus fylke fulgte lovverket med å ha infeksjonskontrollprogram, inkludert infeksjonsforebyggende- og overvåkende tiltak. Metode: To tverrsnittsundersøkelser ble gjennomført i sykehjem i Akershus fylke i 2001 og 2005. En spørreundersøkelse ble utformet i 2001 for å kartlegge infeksjonskontrollprogram, inkludert lovverk, retningslinjer, ansattes helse og opplæring. I 2005 ble spørreundersøkelsen utvidet til å inkludere retningslinjer for meticillin resistente Staphylococcus aureus (MRSA), isolering, samarbeid med mikrobiolgoisk laboratorie og vaksinering. Spørreskjemaet ble sendt til institusjonssjef ved hvert sykehjem i fylket. I tillegg kontrollerte vi om institusjonene deltok i nasjonale prevalens registreringer og om de hadde erfaring med beboere med MRSA ved å benytte Nasjonale Folkehelseinstitutt sin database. Resultater: Antallet sykehjem som hadde etablert infeksjonskontrollprogram hadde steget fra 24 (48%) i 2001 til 45 (80%) i 2005 (Relativ risiko (RR)=1.6, 95% Konfidens interall (KI): 1.2-2.3). Det var en økning i kjennskap til fylkets lokale infeksjonskontrollprogram (RR=1.5, 95% KI: 1.1-2.1). Institusjonssjef vurderte det svært viktig å ha et infeksjonkontrollprogram (gjennomsnitt=6.2, variasjonsbredde 6.0-6.5 på en skala fra 1 til 7). Konklusjon: Det har vært økende oppmerksomhet på infeksjonskontroll og overvåking i sykehjem i Akershus fylke, Norge. Nasjonalt lovverk og gjentatte nasjonale prevalensregistreringer av institusjonservervede infeksjoner kan ha bidratt til dette / Background:In 1996, regulations regarding control and prevention of healthcare-associated infections in all healthcare institutions were implemented in Norway. It became mandatory for all healthcare facilities to have an infection control program. Objective: To describe to what extent long-term care facilities (LTCFs) in Akershus County have implemented infection control programs including guidelines and surveillance. Methods: A repeated, cross-sectional survey was performed among the LTCFs in Akershus County in 2001 and in 2005. A questionnaire was developed in 2001 investigating infection control programs including regulatory issues, guidelines, occupational health and training. In 2005, the questionnaire was expanded to include additional questions regarding policies and guidelines on methicillin-resistant Staphylococcus aureus (MRSA), isolation containment, collaboration with the microbiology laboratory and immunization policies. The questionnaire was sent to the head managing nurse of each LTCF in the county. Additionally, we searched for participation of LTCFs in the national prevalence surveys on healthcare-associated infections and for MRSA positive cases in the databases of Norwegian Institute of Public Health. Results: The number of LTCFs with an infection control program increased from 24 (48%) in 2001 to 45 (80%) in 2005 (Relative risk (RR) =1.6, 95% Confidence interval (CI): 1.2-2.3). There was an increasing knowledge about the county’s infection control program (RR=1.5, 95% CI: 1.1-2.1). The LTCF’s head managing nurses perceived having an infection control program as important (mean=6.2, range 6.0-6.5 on a scale of 1 to 7). Conclusion: There has been an increased attention towards infection control in LTCFs in Akershus County, Norway. National regulations and repeated national prevalence surveys on healthcare-associated infections may have contributed to this improvement. / <p>ISBN 978-91-85721-19-1</p>

This thesis concentrates on the issues of both negative manifestation of adaptation syndrome and individual nursing care planning in elderly patients during their first days after the admission to the rest home.The theoretical part is engaged in the problems of process of adaptation and adaptation syndrome itself. The results of the research projectare presented in the practical part of the thesis.In the realization of this research there has been used such techniques and methods and as direct observation, analysis of the residents documentetion, the review of causation initiating into the issue of adaptation of a women client suffering the severe form of dementia.

AN ABSTRACT OF THE DISSERTATION OF Stephanie Jerstad, for the Doctor of Philosophy degree in Criminology and Criminal Justice, presented on January 11, 2022, at Southern Illinois University Carbondale.TITLE: CARE FOR THE AGING: LONG-TERM CARE FACILITIES WILLINGNESS TO ACCEPT PERSONS CONVICTED OF SEXUAL OFFENDING MAJOR PROFESSOR: Dr. Breanne Pleggenkuhle The present study is a multi-pronged approach to examine the willingness of long-term care facilities (LTCF) to accept persons on the sex offender registry or with a sexual offense conviction. First, this dissertation utilizes a statutory analysis to examine all 50 states policies for admitting and managing such individuals in long-term care. Second, the study aims to explain why some states may enact a LTC/SO policy by examining state characteristics, policy and political affiliation. Third, the study sets out to better understand if facility-level characteristics matter to the acceptance of persons on the sex offender registry. And will discuss findings from semi-structured interviews of LTCF administrators of their decision-making processes, and their attitudes towards company policy. The findings of all three levels of analyses are presented and future research is discussed. Keywords: Sex offender, long-term care facility, SORN and residency restriction laws, statutory review, collateral consequences of sex offender policy