Background: patient and public involvement (PPI) in research can enhance its relevance. Older care-home residents are often not involved in research processes even when studies are care-home focused.Objective: to conduct a systematic review to find out to what extent and how older care-home residents have been involved in research as collaborators or advisors.Methods: a systematic literature search of 12 databases, covering the period from 1990 to September 2014 was conducted. A lateral search was also carried out. Standardised inclusion criteria were used and checked independently by two researchers.Results: nineteen reports and papers were identified relating to 11 different studies. Care-home residents had been involved in the research process in multiple ways. Two key themes were identified: (i) the differences in residents' involvement in small-scale and large-scale studies and (ii) the barriers to and facilitators of involvement.Conclusions: small-scale studies involved residents as collaborators in participatory action research, whereas larger studies involved residents as consultants in advisory roles. There are multiple facilitators of and barriers to involving residents as PPI members. The reporting of PPI varies. While it is difficult to evaluate the impact of involving care-home residents on the research outcomes, impact has been demonstrated from more inclusive research processes with care-home residents. The review shows that older care-home residents can be successfully involved in the research process.

BackgroundFood and drink are important determinants of physical and social health in care home residents. This study explored whether a pragmatic methodology including routinely collected data was feasible in UK care homes, to describe the health, wellbeing and nutritional status of care home residents and assess effects of changed provision of food and drink at three care homes on residents' falls (primary outcome), anaemia, weight, dehydration, cognitive status, depression, lipids and satisfaction with food and drink provision.MethodsWe measured health, wellbeing and nutritional status of 120 of 213 residents of six care homes in Norfolk, UK. An intervention comprising improved dining atmosphere, greater food choice, extended restaurant hours, and readily available snacks and drinks machines was implemented in three care homes. Three control homes maintained their previous system. Outcomes were assessed in the year before and the year after the changes.ResultsUse of routinely collected data was partially successful, but loss to follow up and levels of missing data were high, limiting power to identify trends in the data.This was a frail older population (mean age 87, 71% female) with multiple varied health problems. During the first year 60% of residents had one or more falls, 40% a wound care visit, and 40% a urinary tract infection. 45% were on diuretics, 24% antidepressants, and 43% on psychotropic medication.There was a slight increase in falls from year 1 to year 2 in the intervention homes, and a much bigger increase in control homes, leading to a statistically non-significant 24% relative reduction in residents' rate of falls in intervention homes compared with control homes (adjusted rate ratio 0.76, 95% CI 0.57 to 1.02, p = 0.06).ConclusionsCare home residents are frail and experience multiple health risks. This intervention to improve food and drink provision was well received by residents, but effects on health indicators (despite the relative reduction in falls rate) were inconclusive, partly due to problems with routine data collection and loss to follow up. Further research with more homes is needed to understand which, if any, components of the intervention may be successful.Trial registrationTrial registration: ISRCTN86057119.

The COVID-19 pandemic has affected care workers all over the globe, as older and more vulnerable people face a high risk of developing severe symptoms and dying from the virus infection. The aim of this study was to compare staff experiences of stress and anxiety as well as internal and external organizational support in Sweden, Italy, Germany, and the United Kingdom (UK) in order to determine how care staff were affected by the pandemic. A 29-item online questionnaire was used to collect data from care staff respondents: management (n = 136), nurses (n = 132), nursing assistants (n = 195), and other healthcare staff working in these organizations (n = 132). Stress and anxiety levels were highest in the UK and Germany, with Swedish staff showing the least stress. Internal and external support only partially explain the outcomes. Striking discrepancies between different staff groups’ assessment of organizational support as well as a lack of staff voice in the UK and Germany could be key factors in understanding staff’s stress levels during the pandemic. Structural, political, cultural, and economic factors play a significant role, not only factors within the care organization or in the immediate context.

This paper examines organisational aspects of elder mistreatment in light of the findings of the ResPECT Study of Organisational Dynamics of Elder Care commissioned by Comic Relief and Department of Health through the Prevention of Abuse and Neglect In the Care of Older Adults (PANICOA) programme. The study examined the organisational factors associated with abuse, neglect and/or loss of dignity of older people resident in care homes. Approach: The study involved a knowledge synthesis of organisational aspects of elder mistreatment in residential care settings. The knowledge synthesis method was purposively adapted for examining the ill-defined and contested concept of elder mistreatment, as the available evidence is in varied forms and dispersed. Extensive searching of databases of academic journals was combined with careful searching for official investigation reports into mistreatment. The review and synthesis was followed by panel meetings with subject matter experts. Findings: This paper identifies and elaborates five organisational factors associated with elder mistreatment; infrastructure, management and procedures, staffing, resident population characteristics and culture. It also indicates macro-structural factors affecting care quality. Investigation reports recognised common structural factors contributing to institutional abuse, however, as ‘problem’ organisations are closed down these circumstances recur elsewhere. Research implications: Further work is needed to understand the interaction between and the influence of these organisational factors on mistreatment. Practical implications: This may go some way towards explaining how care quality can collapse as a result of seemingly minor and unrelated organisational changes. Social implications: Care home safety and quality is an ongoing concern, with popular analysis frequently stopping at the point of describing individual errant behaviour. Policy and practice struggles to take on lessons learned in inquiries. This synthesis deepens analysis of the inter-related factors

This paper examines how space in care homes is experienced and negotiated by people who live and work in them. The analysis of qualitative data of five in-depth case studies of care homes in England revealed three key ways in which space is negotiated: a) the way in which values affect interactions inside versus outside the care home environment, b) the negotiation of boundaries and domains within the homes, and c) the sense of being at 'home'. The paper illuminates how the design of the buildings and organisational factors can reinforce or bridge dichotomies between inside and outside spaces. Residents' abilities to re-negotiate boundaries, domains and communal spaces within homes are shown to be affected by organisational factors such as priorities of staff members. Despite 'home' being a common discourse, the spaces within care homes were often organised, ordered and experienced as two distinct, co-present worlds: the dwelling place of residents and the workplace of staff.