OBJECTIVE: To produce a consensus list of the top 10 signs and symptoms suggestive of adverse drug events (ADEs) for monitoring in residents of long-term care facilities (LTCFs) who use antipsychotics, benzodiazepines, or antidepressants.
METHODS: A 3-round Delphi study.
METHODS: Geriatricians, psychiatrists, pharmacologists, general practitioners, pharmacists, nurses, and caregivers from 13 Asia Pacific, European, and North American countries.
METHODS: Three survey rounds were completed between April and June 2023. In Round 1, participants indicated their level of agreement on a 9-point Likert scale on whether 41 signs or symptoms identified in a systematic review should be routinely monitored. Participants considered signs and symptoms that reduce quality of life or cause significant harm, are observable or measurable by nurses or care workers, and can be assessed at a single time point. Round 1 statements were included in a list for prioritization in Round 3 if ≥ 70% of participants responded ≥7 on the Likert scale. Statements were excluded if ≤ 30% of participants responded ≥7. In Round 2, participants indicated their level of agreement with statements that did not reach initial consensus, plus amended statements based on Round 1 participant feedback. Round 2 statements were included in Round 3 if ≥ 50% of the participants responded ≥7 on the Likert scale. In Round 3, participants prioritized the signs and symptoms.
RESULTS: Forty-four participants (93.6%) completed all 3 rounds. Four of 41 signs and symptoms reached consensus for inclusion after Round 1, and 9 after Round 2. The top 10 signs and symptoms prioritized in Round 3 were recent falls, daytime drowsiness or sleepiness, abnormal movements (eg, shaking or stiffness), confusion or disorientation, balance problems, dizziness, postural hypotension, reduced self-care, restlessness, and dry mouth.
CONCLUSIONS: The top 10 signs and symptoms provide a basis for proactive monitoring for psychotropic ADEs.

Residential care services are under increasing pressure to lower service provision costs while maintaining quality of care. Using a translog cost function, this paper examines the relationship between cost, quality and output in England\'s learning disability (LD) residential care sector. It finds genuine but diminishing economies of scale in LD residential care services vis-à-vis output (i.e., care weeks). However, some variation exists: higher-quality LD residential care homes appear to have larger economies of scale than lower-quality ones. Supplementary regression analysis, examining quality-size, further finds quality (a) is negatively associated with LD care homes of six or fewer beds; (b) shows no association with homes of more than six beds. These findings enhance residential care literature and raise the possibility that, by promoting the establishment of larger high-quality care homes, cost savings may be achieved without sacrificing quality.

In China, the population is rapidly ageing and the capacity of the system that cares for older people is increasingly a concern. In this Review, we provide a profile of the long-term care system and policy landscape in China. The long-term care system is characterised by rapid growth of the residential care sector, slow development of home and community-based services, and increasing involvement of the private sector. The long-term care workforce shortage and weak quality assurance are concerning. Public long-term care financing is minimal and largely limited to supporting welfare recipients and subsidising the construction of residential care beds and operating costs. China is piloting social insurance long-term care financing models and, concurrently, programmes for integrating health care and long-term care services in selected settings across the country; the effectiveness and sustainability of these pilots remain to be seen. Informed by international long-term care experiences, we offer policy recommendations to strengthen the evolving care system for older people in China.

OBJECTIVE: To evaluate psychometric properties of the Chinese version of Dementia Quality of Life Measure - Proxy (C-DEMQoL-Proxy).
METHODS: Care home residents aged ≥60 years who were diagnosed with dementia or demonstrated impairment in cognition were recruited from four care facilities in Hong Kong. Caregivers of these participants were also invited to participate. The original DEMQoL-Proxy was translated into Chinese (Cantonese) by a trained translator. The forward-translated version was reviewed by an expert panel of six experienced healthcare professionals. Revisions were made based on comments. The instrument was back-translated to English to check whether further changes were necessary. Demographic data (age, sex, type and severity of dementia, and Mini-Mental State Examination [MMSE] score) were collected from medical records of participants with dementia. Caregivers were interviewed by an occupational therapist or personnel supervised by the occupational therapist using the C-DEMQoL-Proxy and the Chinese version of Quality of Life-Alzheimer\'s Disease-Proxy (C-QoL-AD-Proxy). Acceptability, reliability, and validity of the C-DEMQoL-Proxy were evaluated using standard psychometric methods.
RESULTS: 90 individuals (82.2% women) with dementia aged 72 to 102 years were included. Their diagnosis included Alzheimer\'s disease (23.3%), vascular dementia (15.6%), mixed and other types of dementias (51.1%), and missing (10%). Severity was mild in 12.2%, moderate in 62.2%, and severe in 25.6%. The mean MMSE score was 12.0 ± 4.9. 20% of the caregivers were family members and the rest were professional carers. The C-DEMQoL-Proxy had good acceptability, with no floor or ceiling effects or missing data. It had good internal consistency (Cronbach alpha = 0.91) and test-retest reliability (intraclass correlation coefficients = 0.83). It was mildly correlated with C-QoL-AD-Proxy (r = 0.29, p < 0.01). Age and sex were not correlated with C-DEMQoL-Proxy scores. C-DEMQoL-Proxy scores were not significantly different between dementia types, severity levels, or between those with higher or lower MMSE scores.
CONCLUSIONS: The C-DEMQoL-Proxy is a valid and reliable instrument to assess health-related quality of life in individuals with dementia.

The transition to residential care facilities can be stressful for older people, entailing numerous challenges. Many qualitative studies focused on the adjustment and the experiences associated with older adults\' admission to residential care facilities. However, there have been few studies to synthesize qualitative studies and pay attention to the cultural factors influencing adaptation. The aim is to appraise the adaptation of older people\' s transition to the residential care facilities.
We followed the method of Preferred Reporting Items of Systematic Review and Meta-Analysis (PRISMA). Six databases (CINHAL, Cochrane, Embase, Pubmed, PsycInfo, and Web of Science) were searched systematically from their inception until April 2020 using Medical Subject Headings (MSH) or Subject Headings plus free-text words. The CASP evaluation for qualitative studies was used for quality appraisal and meta-aggregation was used in the data analysis.
Ten studies (from 7 countries on 3 continents) were included in this review. We synthesized two main findings: the impacts of culture on adaptation and the transition process.
Understanding the cultural factors helps nursing staff to gain new insight into older adults\' transition to residential care facilities. The consideration of cultural factors might be incorporated into tailored interventions for residents during transition. Nursing staff is advised to pay attention to the decision-making process before residents\' admission to the residential care facilities, and care plans are best made by residents, family members, and staff members together at the beginning of the decision-making process.

China is one of the most rapidly ageing countries and has the largest ageing population in the world. The demand for long-term care is increasing. Nursing home placement is one of the most stressful events in a person\'s life. Although research on relocation adjustment has been conducted in many countries, few studies have been related to the predictors of nursing home adjustment in mainland China. This study aimed to identify the predictors of nursing home adjustment in the context of filial piety in mainland China.
This was a descriptive study that employed a cross-sectional survey. A total of 303 residents from 22 nursing homes in Nanjing, China, were recruited. A structured questionnaire about residents\' characteristics, activities of daily living, social support, resilience, and nursing home adjustment was administered. Multiple linear regression was used to identify the predictors of adaptation to nursing homes.
The predictors of nursing home adjustment were the satisfaction with services(β = .158, P < .01), number of diseases(β = -.091, P < .05), length of stay(β = .088, P < .05), knowledge of the purpose of admission (β = .092, P < .05), resilience(β = .483, P < .001) and social support(β = .186, P < .001). The total explained variance for this model was 61.6%.
Nursing staff members should assess the characteristics of residents to promote their better adjustment. Resilience had the most significant influence on the level of adaptation, which has been the primary focus of interventions to improve adjustment. The management of disease comorbidities in nursing homes should be standardized and supervised by the government. More volunteers from universities and communities should be encouraged to provide social support to residents. Moreover, a caring culture needs to be emphasized, and the value of filial piety should be advocated in nursing homes of East Asian countries.

As the population is aging rapidly, the irrationality of residential care facility (RCF) configuration has impacted the efficiency and quality of the aged care services so significantly that the optimization of RCF configuration is urgently required. A multi-objective spatial optimization model for the RCF configuration is developed by considering the demands of three stakeholders, including the government, the elderly, and the investor. A modified immune algorithm (MIA) is implemented to find the optimal solutions, and the geographic information system (GIS) is used to extract information on spatial relationships and visually display optimization results. Jing\'an District, part of Shanghai, China, is analyzed as a case study to demonstrate the advantages of this integrated approach. The configuration rationality of existing residential care facilities (RCFs) is analyzed, and a detailed recommendation for optimization is proposed. The results indicate that the number of existing RCFs is deficient; the locations of some RCFs are unreasonable, and there is a large gap between the service supply of existing RCFs and the demands of the elderly. To fully meet the care demands of the elderly, 6 new facilities containing 1193 beds are needed to be added. In comparison with the optimization results of other algorithms, MIA is superior in terms of the calculation accuracy and convergence rate. Based on the integration of MIA and GIS, the quantity, locations, and scale of RCFs can be optimized simultaneously, effectively, and comprehensively. The optimization scheme has improved the equity and efficiency of RCF configuration, increased the profits of investors, and reduced the travel costs of the elderly. The proposed method and optimization results have reference value for policy-making and planning of RCFs as well as other public service facilities.

To investigate the dementia knowledge and care approach used by caregivers in residential aged care facilities (RACFs) in China.
A cross-sectional survey of 785 caregivers from a random sample of 34 RACFs in China. Caregivers\' knowledge and care approach were assessed using the Chinese version of the Dementia Knowledge Assessment Tool 2 and Advanced Dementia Care Questionnaire.
The majority of caregivers showed limited knowledge of dementia and tended not to adopt a person-centered approach to care. Educational level, dementia care training, and years of work experience were positively associated with dementia knowledge. Educational level and years of work experience were also associated with a person-centered approach to care.
This study provides insight into the care available to people with dementia in RACFs in China. The results suggest dementia care education programs as well as person-centered care training are urgently needed for caregivers in China.

BACKGROUND: According to the theory of compensating differentials, caregivers with high levels of intrinsic motivation should exhibit a higher-than-average satisfaction with their pay. Whereas studies conducted in Western countries have provided empirical evidence for the theory of compensating differentials in various care settings, few studies have been conducted in China that focus on caregivers employed in residential homes for the elderly (RHE). The sociodemographic characteristics of caregivers in China different significantly from their counterparts in Western countries.
OBJECTIVE: This study was developed to analyze the mediating role of job burnout to assess the influence of intrinsic motivation on pay satisfaction among caregivers in RHE.
METHODS: Structural equation modeling was used to examine the influences of intrinsic motivation on pay satisfaction in a sample of 1,212 caregivers employed in RHE in China by analyzing the mediating role of job burnout.
RESULTS: Intrinsic motivation was found to relate positively to pay satisfaction (β = .11, p < .05). Negative relationships were identified between intrinsic motivation and job burnout (β = -.46, p < .01) and between job burnout and pay satisfaction (β = -.13, p < .01). Job burnout was found to have a significant mediating effect on the relationship between intrinsic motivation and pay satisfaction (β = .06, p < .01).
CONCLUSIONS: A significant relationship was found between intrinsic motivation and pay satisfaction, with job burnout playing a mediating role in caregivers employed in RHE in China. This research has profound implications for nursing education, practice, and research. First, greater efforts should be focused on instilling nursing values in nursing students to foster intrinsic motivation. Second, nonpecuniary rewards may be offered to caregivers to acknowledge the values of care work and strengthen intrinsic motivation. Third, a supportive working climate should be fostered to reduce job burnout. Fourth, caregivers should be informed of their rights to decent pay and their right to bargain collectively through unions. Fifth, appropriate public policies should be implemented to provide pay for caregivers at levels that recognize and appreciate their intrinsic motivation.

Hong Kong is a major international travel hub and a densely populated city geographically adjacent to Mainland China. Despite these risk factors, it has managed to contain the COVID-19 epidemic without a total lockdown of the city. Three months on since the outbreak, the city reported slightly more than 1,000 infected people, only four deaths and no infection in residential care homes or adult day care centers. Public health intervention and population behavioral change were credited as reasons for this success. Hong Kong\'s public health intervention was developed from the lessons learned during the SARS epidemic in 2003 that killed 299 people, including 57 residential care residents. This perspective summarizes Hong Kong\'s responses to the COVID-19 virus, with a specific focus on how the long-term care system contained the spread of COVID-19 into residential care homes and home and community-based services.