BACKGROUND: Falls are a serious health problem in long-term care facilities (LTCFs), affecting more than 50% of residents. A key role of LTCF staff is to assess fall risks and implement fall prevention activities. Understanding the barriers and facilitators is key to successful implementation.
METHODS: This descriptive qualitative study involving four LTCF facilities (varied provider types and sizes) in southwest Ireland. We recruited a convenience sample of 17 LTCF staff, who participated in semi-structured online 1:1 interviews (n = 7) or small group interviews (n = 10). The data were analysed using Braun and Clarke\'s reflective thematic analysis.
RESULTS: The participants included two directors of nursing, three therapists, one ward manager, one general practitioner, five nurses and five healthcare assistants. Six main themes were identified, reflecting factors that influenced fall prevention: a need for sufficient staff and appropriate skill mix; fall policy, documentation and leadership; equipment and safe environments; person-centred care; staff knowledge, skills and awareness in falls prevention; and staff communication and collaborative working. A wide range of approaches that supported LTCF staff to overcome barriers were identified, including audits and feedback, falls champions, fall prevention leaders, daily communication (e.g., safety pauses) and staff collaboration. Formal multidisciplinary meetings and identification systems to highlight residents at high risk of falling were not considered helpful. Staff suggested that education should be briefer, ongoing and practice-based (\"brief but often\") to promote ownership and responsibility.
CONCLUSIONS: LTCF staff identified several approaches to prevent falls in LTCFs as part of usual care, rather than lengthy, formal meetings and training. The potential role of families in fall prevention was under-appreciated and should be investigated further.

The physical and mental health of home care recipients: A quantitative secondary data analysis Abstract: Background: Although more and more people are being supported by home care services, there is a lack of information regarding the health limitations and needs of this group. Aim: The objective of this study was to examine the health status of people with home care needs in Switzerland. Method: A secondary data analysis based on the HomeCareData database, which contains routine data on people with home care requirements in Switzerland, was conducted. All cases with a fully completed Resident Assessment Instrument (RAI-HC) were included. Data on various items of the RAI-HC and other standardized scale scores with reference to physical or mental health were analyzed using descriptive statistics. Results: In total, 74,674 data records were evaluated. Physical limitations most frequently manifested in the form of fatigue (40.6%), pain (29.7%) or within the scope of impaired hearing (21.9%). Around a third of individuals sampled had experienced a fall in the last 90 days. With regard to mental health, the most frequent signs were fear of falling (33.5%), loneliness (13.9%), depression (12.8%) and anxiety (4%). Approximately one third showed signs of impaired cognition and polypharmacy was detected in almost 68% of those evaluated. Conclusion: Considering the comparatively high prevalence of mental health problems among people with home care requirements, there is a need to develop appropriate skills of employees in home care services and for adequate care planning.
Zusammenfassung: Hintergrund: Obwohl immer mehr Menschen durch häusliche Pflegedienste unterstützt werden, fehlen Informationen über die gesundheitlichen Einschränkungen und Bedürfnisse dieser Gruppe. Ziel: Ziel dieser Studie war es, den Gesundheitszustand von Menschen mit häuslichem Pflegebedarf in der Schweiz zu untersuchen. Methode: Es wurde eine Sekundärdatenanalyse basierend auf der HomeCareData-Datenbank mit Routinedaten von Menschen mit häuslichem Pflegebedarf in der Schweiz durchgeführt. Eingeschlossen wurden alle Fälle mit einem vollständig ausgefüllten Resident Assessment Instrument (RAI-HC). Daten zu verschiedenen Items des RAI-HC sowie weitere standardisierte Skalenwerte mit Bezug zur physischen oder psychischen Gesundheit wurden mittels deskriptiver Statistik analysiert. Ergebnisse: Insgesamt wurden 74 674 Datensätze ausgewertet. Körperliche Einschränkungen äußerten sich am häufigsten in Form von Müdigkeit (40.6%), Schmerzen (29.7%) oder im Bereich des Gehörs (21.9%). Rund ein Drittel der Stichprobenteilnehmenden stürzte in den letzten 90 Tagen. Auf psychischer Ebene zeigten sich am häufigsten Anzeichen von Sturzangst (33.5%), Einsamkeit (13.9%), Depressionen (12.8%) und Angst (4%). Etwa ein Drittel zeigte Hinweise auf eine Beeinträchtigung der Kognition und bei knapp 68% konnte eine Polypharmazie nachgewiesen werden. Schlussfolgerungen: Angesichts der vergleichsweisen hohen Prävalenz von psychischen Problemen unter Menschen mit häuslichem Pflegebedarf besteht ein Bedarf an der Kompetenzentwicklung der Mitarbeitenden häuslicher Pflegedienste und an einer adäquaten Versorgungsplanung.

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BACKGROUND: In Germany, around 2.250 children and adolescents are diagnosed with cancer each year. Despite generally positive long-term survival rates, many patients must cope with late effects of the disease and its treatment. This highlights the need for a well-structured, long-term approach addressing both physical and mental health issues. Currently, the German healthcare system lacks such comprehensive structures. Our study aims to evaluate the effectiveness of a structured, multidisciplinary long-term approach compared to conventional \"treatment as usual\" (TAU).
METHODS: A prospective, multicenter study with ten pediatric university clinics in Germany will be conducted. The cluster-randomization takes place at the clinic level. Children and adolescents who completed their cancer treatment at least five years ago and their parents will be eligible to participate. While the control group (CG) receives TAU, the intervention group (IG) participates in a structured program. This program includes risk-based medical treatment and psychosocial interventions tailored to each patient\'s individual needs within a two-month timeframe. The primary outcome is the improvement of self-efficacy. Secondary outcomes are satisfaction with health care, improvement of health-related quality of life (HRQoL), reduction of mental health problems, and improvement of transition readiness.
CONCLUSIONS: This approach has the potential to optimize the health care for individuals who survived cancer during childhood or adolescence. It addresses the challenges of overuse, underuse, and misuse of health care resources. By considering both medical and psychosocial factors and promoting increased self-efficacy, independent from parental involvement, it may facilitate a smoother transition to adult medicine and enhance adherence to lifelong aftercare. If proven successful, this approach will contribute to the integration of multidisciplinary strategies into standard healthcare practice.
BACKGROUND: German Clinical Trials Register DRKS00029269. Registered on December 23, 2022.

BACKGROUND: A Strategic Guiding Council (SGC) was created within a Family Carer Decisions Support study, to engage family carers of persons with advanced dementia as advisors to inform the design and implementation of the study. The SGC consists of an international group of family advisors from Canada, the Republic of Ireland, the United Kingdom, the Netherlands, and the Czech Republic. There are limited studies that have explored the integration of Patient and Public Involvement (PPI) in dementia research, end-of-life care and long-term care. Therefore, this study explores PPI engagement in health research with family carers to understand further their interest in being involved in the SCG within the FCDS intervention which is focused on supporting caregivers to make decisions about end-of-life care for residents with advanced dementia.
METHODS: This study utilized an interpretive descriptive design and explored the motivations of ten family advisors from Canada, the Republic of Ireland, the United Kingdom, and the Netherlands in being part of the SGC. Semi-structured interviews were conducted by phone or videoconferencing and were recorded, transcribed, and analyzed using thematic analysis.
RESULTS: Three themes generated from the findings of the study were (1) engaging in reciprocal learning; (2) using lived experience to support other family carers; and (3) creating a collective momentum for advocacy and change.
CONCLUSIONS: Family carers motivations to being part of the SCG was driven by their intent to help carers navigate the health system and to create a psychosocial support system for other carers experiencing end-of-life with their loved ones. Being part of the SCG provided a benefit to family carers which provided a venue for them to contribute meaningful information from their experience, learn from other health professionals, research and other advisors and an avenue for advocacy work to improve access to end-of-life care supports through education. To our knowledge, this is the first study that explores the motivations of an international group of family advisors\' engagement in health research to promote integration of a palliative approach to dementia care in long-term care homes. This study further contributes to the literature from an international perspective the importance of PPI in research. Further research is warranted that explores PPI in research to improve access to end-of-life supports.
Patient and public involvement (PPI) in research has been growing worldwide and ensures that research conducted is relevant to the needs of patients. Within the Family Carer Decisions Support study, we created a Strategic Guiding Council (SGC) to engage family carers of persons with advanced dementia as advisors to improve access to a palliative approach to care. The SGC includes family advisors from Canada, the Republic of Ireland, the United Kingdom, the Netherlands, Italy and the Czech Republic. The goal of the strategy was to engage with family advisors in research activities to improve access to a palliative approach and quality of care provided to people with dementia receiving end-of-life care. Including patients and family in research is extremely important, therefore our aim in this study was to explore family advisors’ motivations to engaging in the SGC. Family advisors reported encountering challenges with navigating the health system with end-of-life care and they chose to participate in the SGC to support other carers who are experiencing a similar situation. Being part of the SGC also provided the family advisors with an avenue to advocate on the importance of improving access to end-of-lifesupports and the opportunity to learn from other advisors, health professionals and researchers.

OBJECTIVE: To meet a growing demand for direct care workers (DCWs) in the United States, structural, organizational, and policy-related solutions are needed. Unionization of the workforce may be one such mechanism; however, its impact on outcomes remains poorly understood. To examine the impact of unionization on DCWs\' financial well-being and employment attitudes, as well as patient outcomes.
METHODS: A systematic search of AgeLine, CINAHL, PubMed, Scopus, and Web of Science from database inception through June 20, 2024. We included peer-reviewed empirical studies that used observational, quasi-experimental, and experimental designs.
METHODS: Studies pertained to DCWs who provided care in the home and long-term care settings. We focused on studies that illustrated the financial outcomes of DCWs (wages, compensation, benefits), employment outcomes (job satisfaction, turnover), and health-related outcomes of DCWs and their patients.
METHODS: Covidence was used to screen studies for inclusion criteria. Study characteristics were abstracted manually by prespecified domains. The Downs and Black tool was used for quality assessment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed.
RESULTS: A total of 19 studies met inclusion criteria; they were predominantly observational (94%), with local (50%) and national (50%) samples. Three studies focused on compensation and all found that unionization was associated with higher wages and benefits among DCWs. Seven studies focused on employment, finding that unionization was associated with greater job satisfaction, quality, and retention, particularly among nursing home staff and home health aides. Unionized workplaces reported better care quality and safety, including fewer injuries and better equipment provision. Unionization\'s impact on patient outcomes showed mixed results, particularly among nursing home residents. Overall, the quality of the research studies varied, with limitations in methodology and sampling affecting reliability.
CONCLUSIONS: Unionization among DCWs was generally associated with higher wages, benefits, and job satisfaction, as well as reduced turnover; however, its impact on worker and patient outcomes varied across studies. The overall quality of the studies was fair to poor, highlighting the need for more rigorous research in this area.

In psychiatry, psychomotricians can play an essential role in multidisciplinary teams. The specificity of their clinical vision and analysis, as well as their care tools, make them specialists in understanding the symptoms expressed by the body, and in body-mediated therapy. Able to propose interventions for patients in crisis, and to plan long-term care for stabilized chronic patients, they adapt to the temporality of the pathology. Committed to teamwork, they play their part in the multi-disciplinary weave of containing and structuring that the psychiatric institution confers on the most fragile patients.

OBJECTIVE: This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy.
METHODS: A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into \"non-participation,\" \"participation without uploading,\" and \"participation with uploading\" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation.
RESULTS: A total of 440 participants (10.2 %) were included in the \"participation with uploading\" group and 206 (4.8 %) in the \"participation without uploading\" group. Compared with \"non-participation,\" the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for \"participation with uploading\" and 1.02 (95 % CI: 0.75-1.38) for \"participation without uploading\". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline.
CONCLUSIONS: The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.

In response to the aging population, an integrated care policy has been put forward and implemented in China. The key aspect of this policy is the reform of services within long-term care facilities, representing a significant shift and innovation. This study aims to explore the perceptions and experiences of integrated care among older residents living in long-term care facilities. A descriptive qualitative design was applied in our study. Utilizing a purposive sampling method, 18 older adults from 5 long-term care institutions in Shanghai, China were selected. Data were collected through semi-structured in-depth interviews from October 2022 to April 2023, continuing until data saturation was reached. Directed content analysis was applied to analyze the interview data, guided by the Fundamentals of Care (FoC) Framework. Five themes and 11 subthemes were identified, including (1) Policy level: positive attitude and negative feelings. (2) Physiological level: satisfied basic daily life, primary medical services accessibility and chronic care management enhancement needed. (3) Psychological level: need for psychological support and need for self-perception recognition. (4) Relationship level: enhancement of humanistic care and need for a family atmosphere. (5) Social level: interpersonal communication constrained by the times and inadequate social engagement. Strengthening the awareness and participation of older people in the integrated care policy, and fully meeting the diverse needs including advanced medical care, chronic disease management, personalized life care, psychological support, humanistic care and social engagement will contribute to the improvement of the policy, so as to better adapt the demographic shift.

This study assesses the quality of work life for Nova Scotian continuing care assistants (CCAs) (n = 266), nurses (n = 144) and managers (n = 45) from 10 long-term care (LTC) homes in late 2021. CCAs scored significantly worse than nurses and managers on measures of mental health and anxiety. All groups reported high levels of cynicism and emotional exhaustion; CCAs\' scores were higher than nurses or managers. CCAs scored significantly higher on professional efficacy than other groups. CCAs can derive a strong sense of accomplishment from their work, but results raise concerns of a potential breaking point. This suggests the need for continued action to support LTC staff.