Differences in Assisted Living Staff Perceptions, Experiences, and Attitudes

Research within residential care/assisted living (RC/AL) settings has shown that the attitudes of personal care (PC) staff towards their organization, and its residents and families, can affect the quality of resident care. This paper describes the perceptions, experiences, and attitudes of PC staff and their supervisors and considers these data in the context of non-hierarchical staffing patterns – a philosophically expected, yet unproven tenet of RC/AL. Using data collected from 18 RC/AL communities, these analyses compared the characteristics, perceptions, experiences, and attitudes of PC staff (N=250) and supervisors (N=30). Compared to supervisors, PC staff reported greater burden, frustration, depersonalization, hassles, and feeling significantly more controlling of, and less in partnership with, families (p<0.05). Because the PC staff experience is crucial for their and resident outcomes, more work is needed to create a work environment where PC staff are less burdened and have better attitudes towards work and families

Dementia in Relation to Family Caregiver Involvement and Burden in Long-Term Care

To better understand the process and outcomes of family involvement for long-term care residents with varying stages of dementia, we analyzed family and staff data for 467 residents of 24 residential care/assisted living and nursing home settings. Adjusted analyses found that although the amount of family visitation did not significantly vary by resident cognitive status (15 versus 20 visits/month to persons with and without dementia, respectively), the nature of the visit did. Families of cognitively intact residents spent more time in activities related to social and community engagement, such as taking residents on trips and calling and writing letters (p<0.001), while families of more impaired residents spent more time on care-related activities, including tasks related to nutrition (p<0.027), mobility (p=0.001), and discussing care with staff (p=0.007), the latter of which was associated with greater burden (p<0.001). Staff identified similar patterns, but perceived less family involvement

Dementia in Relation to Family Caregiver Involvement and Burden in Long-Term Care

To better understand the process and outcomes of family involvement for long-term care residents with varying stages of dementia, we analyzed family and staff data for 467 residents of 24 residential care/assisted living and nursing home settings. Adjusted analyses found that although the amount of family visitation did not significantly vary by resident cognitive status (15 versus 20 visits/month to persons with and without dementia, respectively), the nature of the visit did. Families of cognitively intact residents spent more time in activities related to social and community engagement, such as taking residents on trips and calling and writing letters (p<0.001), while families of more impaired residents spent more time on care-related activities, including tasks related to nutrition (p<0.027), mobility (p=0.001), and discussing care with staff (p=0.007), the latter of which was associated with greater burden (p<0.001). Staff identified similar patterns, but perceived less family involvement

Sleep Quality Varies as a Function of 5-HTTLPR Genotype and Stress

Objective: To test the hypothesis that allelic variation in 5HTT gene-linked polymorphic region (5-HTTLPR) genotype was associated with sleep quality (Pittsburgh Sleep Quality Index, PSQI) as a main effect and as moderated by the chronic stress of caregiving. Serotonin (5HT) is involved in sleep regulation and the 5HT transporter (5HTT) regulates 5HT function. A common 44-base pair deletion (s allele) polymorphism in the 5-HTTLPR is associated with reduced 5HTT transcription efficiency and 5HT uptake in vitro. Methods: Subjects were 142 adult primary caregivers for a spouse or parent with dementia and 146 noncaregiver controls. Subjects underwent genotyping and completed the PSQI. Results: Variation in 5-HTTLPR genotype was not related to sleep quality as a main effect (p .36). However, there was a caregiver X 5-HTTLPR interaction (p .009), such that the s allele was associated with poorer sleep quality in caregivers as compared with controls. Conclusions: Findings suggest that the s allele may moderate sleep disturbance in response to chronic stress. Key words: 5-HTTLPR, serotonin transporter promoter gene polymorphism, sleep quality, gene-environment interaction, stress. 5HT serotonin; 5-HTTLPR 5HTT gene-linked polymorphic region; CSF cerebrospinal fluid; 5HIAA CSF levels of 5-hy-droxyindoleacetic acid; PSQI Pittsburgh Sleep Quality Index; SE standard error

Age-Friendly Communities Initiative:Public Health Approach to Promoting Successful Aging

Older adults consistently prefer aging in place, which requires a high level of community support and services that are currently lacking. With a rapidly aging population, the present infrastructure for healthcare will prove even more inadequate to meet seniors' physical and mental health needs. A paradigm shift away from the sole focus on delivery of interventions at an individual level to more prevention-focused, community-based approaches will become essential. Recent initiatives have been proposed to promote healthy lifestyles and preventive care to enable older adults to age in place. Prominent among these are the World Health Organization's Global Age-Friendly Communities (AFC) Network, with 287 communities in 33 countries, and AARP's Network of AFCs with 77 communities in the United States. In an AFC, older adults are actively involved, valued, and supported with necessary infrastructure and services. Specific criteria include affordable housing, safe outdoor spaces and built environments conducive to active living, inexpensive and convenient transportation options, opportunities for social participation and community leadership, and accessible health and wellness services. Active, culture-based approaches, supported and developed by local communities, and including an intergenerational component are important. This article provides a brief historical background, discusses the conceptualization of the AFC, offers a list of criteria, narrates case studies of AFCs in various stages of development, and suggests solutions to common challenges to becoming age-friendly. Academic geriatric psychiatry needs to play a major role in the evolving AFC movement to ensure that mental healthcare is considered and delivered on par with physical care

Age-Friendly Communities Initiative: Public Health Approach to Promoting Successful Aging.

Older adults consistently prefer aging in place, which requires a high level of community support and services that are currently lacking. With a rapidly aging population, the present infrastructure for healthcare will prove even more inadequate to meet seniors' physical and mental health needs. A paradigm shift away from the sole focus on delivery of interventions at an individual level to more prevention-focused, community-based approaches will become essential. Recent initiatives have been proposed to promote healthy lifestyles and preventive care to enable older adults to age in place. Prominent among these are the World Health Organization's Global Age-Friendly Communities (AFC) Network, with 287 communities in 33 countries, and AARP's Network of AFCs with 77 communities in the United States. In an AFC, older adults are actively involved, valued, and supported with necessary infrastructure and services. Specific criteria include affordable housing, safe outdoor spaces and built environments conducive to active living, inexpensive and convenient transportation options, opportunities for social participation and community leadership, and accessible health and wellness services. Active, culture-based approaches, supported and developed by local communities, and including an intergenerational component are important. This article provides a brief historical background, discusses the conceptualization of the AFC, offers a list of criteria, narrates case studies of AFCs in various stages of development, and suggests solutions to common challenges to becoming age-friendly. Academic geriatric psychiatry needs to play a major role in the evolving AFC movement to ensure that mental healthcare is considered and delivered on par with physical care