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The increase in life expectancy at birth witnessed in the twentieth century has been attributed to major public health achievements, including vaccination, control of infectious disease and reductions in tobacco use. Population aging came to be regarded as a triumph of modern life, with cancer, cardiovascular disease and dementia deemed to be the great obstacles to further progress in increasing health and life expectancy. The global pandemic of COVID-19 has brought infectious disease as a major threat to older persons back into sharp focus. The paper proposes five major changes to long-term care, with a view to protecting the elderly from the ravages of infectious disease while simultaneously providing greater quality of care and quality of life.

Abstract Background: Shared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently. Methods: The study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals’ and residents’ perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency.Results: At ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ=16.09) and 81.11/100 (σ=19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ=10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ=0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ=0.51) and competence (x̄=3.76/5, σ=0.27) with which these skills were practiced (P<0.001).Conclusions: Residents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the three-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.

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BackgroundProblems with mobility, functioning and social participation makes living independently difficult for frail older adults. Treatment adherence is a prerequisite for successfully continuing to live independently. The cause of non-compliance among older adults are multiple and complex. Insight into older adults’ perspectives regarding their functioning is essential and an important factor for treatment adherence.Objectives This study investigates the perspectives of older adults on their functioning, social participation and health, and the factors influencing these components.Method We conducted a qualitative study about the older adult’s perceived functioning, social participation and health. Fourteen home dwelling older adults suffering from chronic health issues were purposively selected. Semi-structured interviews were conducted with open-ended questions. Data were analysed following the Basic Logical Model of Abduction and the coding method of Creswell.ResultsAssistive devices, their dwelling and living environment, professional and informal support, and medication are perceived as important determinants. Attitude, social influence and personal effectiveness were found to be of influence whether or not a person will perform an activity, or choose to participate. A person’s attitude is related to the significance the activity has to that person, the importance of the activity, personal wellbeing, their values and the desire for autonomy. Peers and children have a social influence on the level of activity of the older person. Traditions and in particular, religious activities, along with personal effectiveness are motivating factors for whether or not to perform an activity or to participate. Personal effectiveness is linked to the belief in their personal competencies and to the relationship between effort and result.Finally, it appears that the type of coping strategy the older adult adopts, has an influence on his or her behavior. The older adults often used remarkable problem-focused strategies, which had a positive effect on their level of autonomy.ConclusionOlder adults have identified barriers and facilitators that influence their level of functioning and social participation. These findings help to create a framework for maintaining and increasing treatment adherence. This conceptual framework may be helpful in facilitating occupational therapists and other healthcare professionals to detect determinants of treatment adherence.