Optimism,Social Support,and Caregiving Burden among the Long-Term Caregivers:The Mediating Effect of Psychological Resilience

Background:As the elderly population grows,the demand for long-term care services is increasing.Despite significant investments in care quality and workforce training,long-term care workers often face challenges such as work fatigue,heavy workloads,and inadequate support.These issues can impact job satisfaction,mental health,and care quality,leading to staff turnover.This study examines how optimism,social support,and psychological resilience relate to caregiving burden,aiming to understand their effects on caregivers’well-being and performance to enhance the quality of long-term care services.Methods:The participants were 542 long-term care workers.Descriptive statistics,t-tests,one-way ANOVA,and hierarchical regression were used for data analysis.Results:(1)Optimism and social support were significantly and positively correlated with psychological resilience and significantly and negatively associated with caregiving burden.(2)Regarding differences in optimism,social support,psychological resilience,and caregiving burden among long-term care workers,females scored significantly higher than males in“social support;”married workers scored significantly higher than unmarried workers in“optimism,”“social support,”and“psychological resilience”;workers aged 45–65 scored significantly higher than those aged 25–45 in“optimism”;workers aged 25–45 scored significantly higher than those aged 45–65 in“caregiving burden”;social workers scored significantly higher than nursing staff in“optimism.”(3)Psychological resilience partially mediated the relationship between social support and caregiving burden concerning explanatory and predictive power.Conclusions:These findings suggest that optimism,social support,and psychological resilience are essential factors in reducing the caregiving burden among long-term care workers.The study highlights the importance of promoting psychological resilience and providing social support to alleviate the burden of caregiving.

Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Distribution of soil aggregates and organic carbon in deep soil under long-term conservation tillage with residual retention in dryland

To ascertain the effects of long-term conservation tillage and residue retention on soil organic carbon(SOC) content and aggregate distribution in a deep soil(>20-cm depth) in a dryland environment,this paper analyzed the SOC and aggregate distribution in soil, and the aggregate-associated organic carbon(OC) and SOC physical fractions. Conservation tillage(reduced tillage with residue incorporated(RT) and no-tillage with residue mulch(NT)) significantly increased SOC sequestration and soil aggregation in deep soil compared with conventional tillage with residue removal(CT). Compared with CT, RT significantly increased the proportion of small macroaggregates by 23%–81% in the 10–80 cm layer, and the OC content in small macroaggregates by 1%–58% in the 0–80 cm layer. RT significantly increased(by 24%–90%) the OC content in mineral-SOC within small macroaggregates in the 0–60 cm layer, while there was a 23%–80% increase in the 0–40 cm layer with NT. These results indicated that:(1) conservation tillage treatments are beneficial for soil aggregation and SOC sequestration in a deep soil in a dryland environment; and(2)the SOC in mineral-associated OC plays important roles in soil aggregation and SOC sequestration. In conclusion, RT with NT is recommended as an agricultural management tool in dryland soils because of its role in improving soil aggregation and SOC sequestration.

Investigating adverse events in long-term care facilities:a systematized review

Objective:This systematized review aimed to synthesize the results of empirical studies focused on the types and factors of adverse events(AEs)that contribute to them in long-term care(LTC)settings.Methods:The search was conducted in Pro Quest,Scopus,and Pub Med in January 2021 and resulted in 1057 records.The content analysis method was used in the data analysis.Results:In all,35 studies were identified as relevant for the review.The analysis revealed 133 different types of AEs and 60 factors that contributed to them.Conclusions:In LTC,various AEs occur,most of which are preventable,while many factors that influence their occurrence could be significantly modifiable.Through an effective analysis of AEs in LTC,it is possible to minimize their occurrence and,at the same time,minimize their negative impact on all par ties concerned.

Dignity and its related factors among older adults in long-term care facilities:A cross-sectional study

Objectives:This study aimed to explore the dignity and related factors among older adults in long-term care facilities.Methods:Cross-sectional data were obtained from a sample of 253 Chinese older adults dwelling in long-term care facilities.Dignity among older adults was measured using the Dignity Scale,and its potential correlates were explored using multiple linear regressions.Results:Results showed that the total score of the Dignity Scale is 151.95±11.75.From high to low,the different factors of dignity among older adults in long-term care facilities were as follows:caring factors(4.83±0.33),social factors(4.73±0.41),psychological factors(4.66±0.71),value factors(4.56±0.53),autonomous factors(4.50±0.57),and physical factors(4.38±0.55).A higher score of the Dignity Scale was associated with higher economic status,fewer chronic diseases,less medication,better daily living ability and long-time lived in cities.Conclusion:Older adults with low economic status,more chronic diseases,and poor daily living ability,taking more medications,or the previous residence in rural areas seem to be most at low-level dignity in long-term care facilities and thus require more attention than their peers.

Impact of disease severity on gastric residual volume in critical patients

AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were enrolled. Sequential Organ Failure Assessment (SOFA) score was assessed immediately preceding the start of the study. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded on the first, fourth, seventh, and fourteenth day of the study period. GRV was measured every 4 h during enteral feeding. The relationship be-tween mean daily GRV and SOFA scores and the correlation between mean daily GRV and mean APACHE Ⅱ score of all patients were evaluated and compared. RESULTS: Of the 61 patients, 43 patients were survivors and 18 patients were non-survivors. The mean daily GRV increased as SOFA scores increased (P < 0.001, analysis of variance). Mean APACHE Ⅱ scores of all patients correlated with mean daily GRV (P = 0.011, Pearson correlation) during the study period. Patients with decreasing GRV in the first 2 d had better survival than patients without decreasing GRV (P = 0.017, log rank test). CONCLUSION: GRV is higher in more severely ill medical ICU patients. Patients with decreasing GRV had lower ICU mortality than patients without decreasing GRV.

Survey of <i>C. difficile</i>-Specific Infection Control Policies in Local Long-Term Care Facilities

Introduction: The incidence and severity of Clostridium difficile infection (CDI) has been increasing and long-term care facility (LTCF) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. Infection control policies are crucial for controlling CDI, but there are currently no regulatory guidelines in the United States. Therefore, we evaluated infection control policies in local LTCFs to define the CDI-specific policies and the administrative and staff understanding of CDI, so as to identify perceived barriers for compliance. Methods: IRB approval was sought and exemption granted, all 8 local LTCFs were asked to participate. Each facility was visited by study personnel who interviewed the administrative Infection Control Practitioner (ICP) and 3-4 Licensed Practical Nurses (LPNs) with distinct survey format. Infection control policies were then compared to the SHEA recommendations for CDI in LTCFs. Results: Of the eligible facilities, 75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All facilities accept residents with active CDI and 2 had written CDI-specific infection control policies. All facilities had hand hygiene or glove use policies and 2 had policies for the use of sporicidal environmental cleaning. No facility restricted antibiotic use. Each facility has a policy to instruct their staff through in-services, either annually or upon new hire, but 33% (n = 7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs felt comfortable with the facility CDI policies, only 11 accurately restated it. ICPs felt the most relevant barrier to staff compliance was time constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10, 48%) and poor communication (n = 2, 10%). Discussion and Conclusions: With the increasing incidence and severity of CDI in LCTF, few of the facilities surveyed had CDI-specific policies. Despite CDI-specific training, there is a perceived knowledge and communication gap for staff caring for residents with CDI.

Equity of access to long-term care among the Korean elderly

The aim of the current study is to examine the extent to which equity in the utilization of longterm care services has been achieved in the Republic of Korea (hereafter Korea), based on the Aday—Andersen Access Framework that takes into consideration a series of variables hypothesized as predictive of utilization. The current study used cross-sectional survey data collected and conducted by the Korea Labor Institute (KLI) between August 1 to December 22, 2006. The sample for this study was 5544 persons who are older than 60 years. The study was extracted from a larger nationally representative cross-sectional survey of 10,255 individuals. The stratified cluster sampling technique was used to draw the survey respondents. A self-administered questionnaire was used to collect the data from the sample. Descriptive and logistic regression analysis was performed examining the relationship between the dependent variable and the independent variables and the relative importance of factors. The results indicate that a universal health insurance system has not yielded a fully equitable distribution of services. The limitation of benefit coverage as well as disparities in consumer cost-sharing and associated patterns of utilization across plans high out-of-pocket payment can be a barrier to health care utilization, which results in inequity and differential long-term care utilization between sub-groups of older adults. Health policy reforms in Korea must continue to concentrate on expanding insurance coverage, reducing the inequities reflected in disparities in consumer cost-sharing and associated patterns of utilization across plans, and establishing a financially separate insurance system for poor older adults. The behavioral responses of physicians to the method of reimbursement, and the subsequent impact on overall rates of utilization and expenditures need to be more fully understood. In addition, further research is needed to identify the nonfinancial barriers that persist for certain demographic subgroups, i.e., those 70 and older, men, lacking social network members, those who have four or more family members, and those who have no schooling.

Safety and Quality of Care Evaluation in Japanese Long-Term Facilities Focused on the Activity Condition and Cognitive Function of Residents

Objective: Currently, standards for evaluating long-term care facilities do not exist in Japan. This study aimed to evaluate the quality of healthcare services in Japan’s long-term care facilities and identify the structural and process indicators associated with the facilities’ outcome indicators. Methods: This retrospective study assessed changes in residents’ abilities to participate in physical activities, their cognitive function, and their vulnerability to injuries. From 2012 to 2013, we collected information on the healthcare services at 1067 long-term care facilities registered with Japan’s Welfare, Health and Medical Care Information Network in the Welfare and Medical Service Agency. We examined 12 structural indicators, 26 process indicators, and 7 outcome indicators. We used multivariate linear regression models adjusted to analyze relationships between outcome indicators and structural or process indicators. Results: Residents’ activity and cognitive function indicators either improved by 80% - 90% or were maintained for one year. The Geriatric Functional Independence Measures, the Barthel Index, and holding conferences related to care were all considered activities of daily living. Three adverse events—tumbles and falls, behavioral problems, and aimless wandering or leaving the facility without permission—were factors that restricted residents’ behavior and number of residents per care staff member. Conclusions: Maintaining or improving levels of independence and cognition in daily living requires a care process system that enables ongoing monitoring of residents’ activities of daily living and cognitive functioning. Ensuring the safety of residents and improving the quality of care in long-term care facilities without securing adequate care staff are not possible.

The research of the community-home elderly long-term care service system

With the rapid development of the aging of the population, the demand of long-term care services in the elderly is growing. Because of family miniaturization, core, and currently limited social accumulation are difficult to meet the demand of the elderly in long-term care.Community provides the elderly long-term care services, and provides the elderly all kinds of household helping services. They just make up for the inadequacy of the family and society.And how to make the community elderly long-term care services become more suitable for the needs of the elderly at home, provide better service for the elderly, are our current problems to be solved.

Building Long-Term Care Insurance System in China

The objective is to explore the foundation of the elderly long-term care insurance system in China, which is to face the problem resulted from aging of the population. Adopting the contrastive analysis to introduce briefly the long-term care insurance system in German, Japan and America for our learning. Therefore, China＇s long-term care insurance system could not totally indiscriminately imitate the mandatory long-term care insurance system in German and Japan, it also could not copy the business model of nursing insurance system in America. The conclusion is that long-term care insurance system in China should use the experience of developed countries based on the basic national conditions, doing some relative works, such as establishing policies and regulations, strengthening personnel training, and improving the market specification.

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.

Nursing culture assessment tool (NCAT): Empirical validation for use in long-term care

Background:Capturing general aspects of the occupational subculture of nursing is needed in long-term care(LTC)given its latent influence on the quality of care that residents receive and on the ability of nursing staff(licensed nurses and certified nursing assistants)to implement evidence-based practice innovations.The psychometrically validated Nursing Culture Assessment Tool(NCAT)provides a comprehensive assessment using six dimensions(teamwork,communication,satisfaction,professional commitment,behaviors,and expectations),and evaluation of these dimensions could help positively reshape the culture before any change implementation.Purpose:Aims were to:(1)assess the validity and reliability of the NCAT across nursing staff in a single type of clinical setting e LTC facilities,and(2)present a refined theoretical model of the interaction of culture and practice implementation.Methods:A cross-sectional,exploratory investigation of the NCAT in LTC settings was conducted.Empirical construct validity of the 19-item NCAT's six subscales was investigated by confirmatory factor analysis using a sample of licensed nurses and certified nursing assistants(n?318).Results:The model fit was judged using the comparative fit index(0.94)and standardized root mean-square residual(0.05).Cronbach's alpha correlation coefficients of items in each subscale and in the overall scale ranged from 0.76 to 0.94.Conclusion:A summary of the NCAT development and report on its psychometric properties when administered in LTC settings is provided,extending previous findings of the NCAT's enhanced stability when used in assessing nursing staff perceptions in LTC and by demonstrating that the NCAT is a reliable and valid psychometric screening tool for nursing culture.

Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

Analysis on Long-Term Care and Influencing Factors of Empty-Nest Differently Abled Elderly People in China —Based on the Data from the Chinese Longitudinal Healthy Longevity Survey

Purpose: This study aimed to understand the actual needs of empty-nest differently abled elderly people and analyze their long-term care status including the factors affecting choice of care mode so adequate resources can be allocated to meet their healthcare needs. Methods: An empty-nest group was compared with a non-empty-nest group based on data from the 2014 Chinese Longitudinal Healthy Longevity Survey. Individual characteristics, family characteristics, and sociological factors were considered as independent variables, and long-term care model was the dependent variable in the three binary logistic regression method. Results: Age, gender, marriage, and disability were the most important factors influencing the choice of long-term care mode, including the willingness of the differently abled elderly. Family care can no longer meet the needs of the severely disabled elderly. Long-term care for such elderly people should be undertaken by professional and specialized social institutions. Conclusion: Multi-level services should be provided according to the elderly peoples’ needs, and the skill and expertise of professional personnel of care institutions should be strengthened. The government should deploy fund-raising initiatives, actively use the power of non-governmental organizations, and strive to resolve the financial issues faced by the empty-nested elderly people with disability.

Vitamin D and Number of Falls in a Long-Term Care Facility

Falls represent a significant contribution to the morbidity and mortality of the elderly population. Because vitamin D is important in bone physiology, the use of vitamin D to restore deficient bone and ameliorate the effects of bone fractures due to falls has become a common practice in recent years. Following introduction of widespread use, reports began to emerge that vitamin D not only aided in repair of fall-induced bone fractures, but that it also reduced the occurrence of falls. Vitamin D now has become a routine intervention as a fall-prevention measure. Early analyses found evidence of prevention efficacy (reduced falls), but recent analyses are more equivocal. We retrospectively examined the records of 350 patients in a long-term care facility in which vitamin D administration and the number of falls were recorded as part of a comprehensive database of care. We found a dramatic rise in vitamin D use over the period covered (2006 – 2011) and a corresponding dramatic decrease in the number of falls. However, the number of falls continued to decline after 2008, despite a plateau in number of patients on vitamin D, particularly females. It appears that other factors contribute to the overall decline.

Path Exploration for Long-term Care of Rural Disabled Elderly: A Case Study of G Town in South Shaanxi

Field survey of G Town in South Shaanxi indicates that current situations and existing problems of rural disabled elderly. According to these situations and problems,this paper analyzes difficulties in long-term care of rural disabled elderly. From the perspective of welfare pluralism,it comes up with development paths for long-term care of rural disabled elderly with joint participation of government,communities,non-profit organizations on the basis of the family endowment.

The Effect of Knowledge and Attitude on Fall Prevention Activities among Nursing Staff in Long-Term Care Hospitals

Background: The fall prevention activities of nursing staff are emphasized more in order to reduce the incidence of falls in elderly people in long-term care hospitals. Objectives: To examine the extent of knowledge and attitude about falls and the degree of fall prevention activities among nursing staff in long-term care hospitals, and to identify the effect of knowledge and attitude about falls on prevention activities. Design: The data collection was, in the period between July 10th, 2017 and August 10th, 2017, accumulated by constructive questionnaires targeting 138 nurses and nurse aids who are employed within five long-term care hospitals. Methods: The statistical processing was as follows: the frequency, percentage, mean and standard deviation, independent t-test, one-way ANOVA, Pearson’s correlation coefficients, and hierarchical regression analysis. Results: The fall prevention activities showed a significant difference statistically in the fields of age (F = 5.33, p = 0.002), working career (F = 3.98, p = 0.014), positions (t = 2.71, p = 0.008), subject’s experience with patient falls (t = 2.15, p = 0.033), fall prevention education (t = 3.32, p = 0.001). As for the correlation between knowledge and attitude towards falls and fall prevention activities, knowledge and attitude towards fall (r = 0.45, p < 0.001), knowledge and fall prevention activities (r = 0.27, p < 0.002), attitude towards falls and fall prevention activities (r = 0.42, p < 0.001) had significantly positive correlations. As for the fall prevention activities of nursing staff in long-term care hospitals, their attitude towards falls (β = 0.32, p < 0.001) had an effect on fall prevention activities. Conclusion: In order to increase fall prevention activities in long-term care hospitals, nursing staff’ attitude towards falls is important. Therefore, we need to explore diverse strategies to promote fall prevention activities of nursing.

Fitness Age Score and the Risk of Long-Term Care Insurance Certification—The Kyoto-Kameoka Longitudinal Study

Long-Term Care Insurance System has been introduced to provide appropriate care for the elderly who needs nursing care in Japan. Physical function is one of most important function for the elderly to live independently. A previous study had established a Fitness Age Score (FAS) based on a theory for biomarker of aging. This study clarified whether the FAS could be used to predict the need for certification of long-term care (CLTC) in independent elderly people. We included 939 independent, community-dwelling-elderly (average age, 74.4 years) whose physical function was measured and for whom the CLTC was tracked for 24 months. The FAS comprised five physical fitness items: Walking time, grip strength, one-leg standing, vertical jump, and functional reach test. Based on the FAS, we calculated the odds ratio (OR) for the CLTC. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) was used for further analysis. We also used the Youden Index (YI), minimum distance method (MD), and two-graph ROC method (TG) to calculate cutoff values (CVs) for screening. We divided subjects into the low and high physical fitness group with CVs. We developed cumulative CLTC curves using the Kaplan-Meier method. Sixteen people could not be tracked for the full 24 months. The measurement of FAS was completed for 798 people, of whom 28 became CLTC. The measurement of FAS was not completed for 125 people, of whom 21 became CLTC. The CLTC OR for people with incomplete FAS was 5.553. The AUC was 0.72 (p < 0.001). The CVs for the FAS were -0.29 for YI (sensitivity, 92.9% and specificity, 40.4%), -1.23 for MD (57.1% and 73.4%), and -0.81 for TG (60.7% and 60.9%). The cumulative CLTC curves according to CVs all showed significant differences (p = 0.000 - 0.020). In conclusion, the FAS can be used to predict CLTC.

Comparison of research hotspots and trends in long-term care for the elderly between China and Australia: a bibliometric analysis

Objective:To explore the current status and development of long-term care(LTC)research in terms of publications in China and Australia,to identify the major contributing authors and institutions,and to compare the research hotspots and trends between China and Australia in order to encourage informed collaborations and work in future.Methods:We collected bibliometric data on the LTC of the elderly in China and Australia from 2009 to 2020 using Chinese National Knowledge Infrastructure(CNKI)and Web of Science(WOS).Cite Space software was used to analyze co-authorships,co-institutions,and co-keywords.Results:A total of 826 ar ticles in Chinese and 393 in English were included for analysis.The total number of publications showed an upward trend in both countries.The top 10 productive researchers and institutions in China and Australia were identified,and their collaboration network was revealed.Then,the knowledge maps of cooccurring keywords,respectively,showed the hotspots of"LTC insurance,disabled elderly,combination of medical and health care,nursing home"and"nursing home,dementia,quality of life,intervention"in China and Australia.Strong citation burst keywords illustrated the emerging trends of"combination of medical and health care,healthy aging"in China and"polypharmacy,prevention"in Australia.Conclusions:This article provided an insight into LTC of the elderly in China and Australia,and research in this field is developing rapidly and is being increasingly valued.The findings will be useful for future researchers to facilitate collaboration,identify new topics,and suppor t urgently needed research of LTC in China.