The Expectations and Acceptability of a Smart Nursing Home Model Among Chinese Older Adults and Family Members: A Qualitative Study

Knowledge, Attitude, and Practice of Chinese Medical Staff for Common Resident Emergencies in Elder Care Facilities: A Structural Equation Model-Based Survey

Aims/Background Increasing population longevity poses challenges to health care for the elderly. Facility-based care is a primary approach to elder care, and medical staff in these settings must be skilled in managing emergencies, as the elderly are more likely to experience emergencies than those living in the community. To aid in developing first aid training, procedures, and regulations for medical staff in elder care facilities, we evaluated the knowledge, attitude, and practice (KAP) levels concerning commonly reported emergencies, as well as the correlations between these factors. Methods The questionnaires were distributed among 1493 doctors and nurses within 258 residential facilities in Shanghai between 1 May 2023 and 31 October 2023. Of the 725 valid questionnaires, we obtained socio-demographic and KAP-related data. Structural equation modeling (SEM) was applied to determine associations between KAP elements. Results Chinese medical staff in elder care facilities had relatively suboptimal knowledge regarding first aid for common resident emergencies, with only 41.7% rated as good. Their levels of attitude and practice were optimistic. The proportion of medical staff demonstrating a positive attitude and appropriate practice in first aid was 79.31% and 68.00%, respectively. Age, gender, educational level, experience with witnessing and dealing with emergencies were identified as factors influencing knowledge, attitude, and practice. Structural equation modeling revealed that attitude and knowledge could directly or indirectly affect management approaches for common elderly emergencies, with a correlation coefficient of 0.11 between knowledge and attitude and 0.66 between attitude and practice. The "first aid for nine preventions" and "cardiac arrest and cardiopulmonary resuscitation" substantially influenced knowledge acquisition, with correlation coefficients of 0.66 and 0.48, respectively. "Attitude toward emergency management" had a significant impact on the attitude of the medical staff, with correlation coefficients of 0.90. Conclusion Knowledge, attitude, and practice are interconnected, with knowledge indirectly influencing behavior by shaping attitude. The medical staff in elder care facilities in Shanghai had a limited understanding of first aid for common resident emergencies. Targeted training and education are urgently required to enhance their knowledge and skills in managing common emergencies among elderly patients, while fostering a strong sense of responsibility. Such initiatives can ensure prompt and appropriate first aid actions, boosting their confidence and promoting a positive and harmonious environment for medical staff and elderly residents.

Demand, utilization, and supply of community smart senior care services for older people in China

Objective

Although smart senior care services offer numerous benefits, they have not yet gained widespread acceptance among the general populace, particularly seniors. Numerous related issues have surfaced, with the structural imbalance between supply and demand being most prominent. Currently, there is a lack of research distinguishing between the various categories of demand for smart ageing services and the associated behaviors of older individuals. In this study, we aimed to identify the types of demand and utilization of smart senior care services among Chinese older adults to understand their diverse characteristics and the factors that facilitate certain behaviors. We also analyzed the imbalance between supply and demand for smart senior care services and explored the factors influencing it, thereby providing a reference for optimizing smart senior services.

Methods

We conducted a cross-sectional study from January to March 2023 and analyzed 1037 valid questionnaires. Three types of smart senior care services were investigated: intelligent information, intelligent consultation, and intelligent monitoring. We identified the demand, utilization, and supply of these services among older individuals. Latent class analysis (LCA) was used to differentiate the heterogeneity of older adults in terms of service demand and utilization. Factors influencing service preferences were analyzed using binary logistic regression based on Andersen's behavioral model.

Results

Based on the LCA findings, service demand, and utilization were divided into two categories: positive demand (desire to use the services) or negative demand, and taking action or negative action to use the services. The persons with high demand but low utilization comprised the largest number of older people in this study (69.35%). The results indicated that the number of children (odds ratio (OR) = 1.491), community-provided smart devices (OR = 1.700), number of chronic diseases (OR = 1.218), and self-care capacity (OR = 0.214) are associated with positive demand. Meanwhile, pre-retirement employment, income sources, community device provided, community promotion, region, and self-care ability were significant predictors (p < 0.05) of taking action to use the services. In terms of community supply outcome, income situation had a significant effect on intelligent information services. Income sources were associated with intelligent information and intelligent monitoring services. Pre-retirement employment and housing type variables showed effect on IC services. Community promotion and self-care ability were associated with all three types of service supply (p < 0.05).

Conclusion

Older adults expressed a strong demand for smart ageing services; however, difficulties using smart technology remain a serious problem. Further investigation of how family support contributes to the perception and use of care services for older people is needed. Specific policies, such as financial assistance, should be established to support service use. Communities should expand their support and promotion of smart ageing services, focusing on enhancing digital health literacy among seniors to facilitate product utilization. Furthermore, personalized recommendations and applications tailored to the physical conditions of older adults are essential.

The expectations and acceptability of a smart nursing home model among Chinese older adults: a mixed methods study

BACKGROUND

Smart nursing homes (SNHs) integrate advanced technologies, including IoT, digital health, big data, AI, and cloud computing to optimise remote clinical services, monitor abnormal events, enhance decision-making, and support daily activities for older residents, ensuring overall well-being in a safe and cost-effective environment. This study developed and validated a 24-item Expectation and Acceptability of Smart Nursing Homes Questionnaire (EASNH-Q), and examined the levels of expectations and acceptability of SNHs and associated factors among older adults in China.

METHODS

This was an exploratory sequential mixed methods study, where the qualitative case study was conducted in Hainan and Dalian, while the survey was conducted in Xi'an, Nanjing, Shenyang, and Xiamen. The validation of EASNH-Q also included exploratory and confirmatory factor analyses. Multinomial logistic regression analysis was used to estimate the determinants of expectations and acceptability of SNHs.

RESULTS

The newly developed EASNH-Q uses a Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree), and underwent validation and refinement from 49 items to the final 24 items. The content validity indices for relevance, comprehensibility, and comprehensiveness were all above 0.95. The expectations and acceptability of SNHs exhibited a strong correlation (r = 0.85, p < 0.01), and good test-retest reliability for expectation (0.90) and acceptability (0.81). The highest tertile of expectations (X2=28.89, p < 0.001) and acceptability (X2=25.64, p < 0.001) towards SNHs were significantly associated with the willingness to relocate to such facilities. Older adults with self-efficacy in applying smart technologies (OR: 28.0) and those expressing a willingness to move to a nursing home (OR: 3.0) were more likely to have the highest tertile of expectations compared to those in the lowest tertile. Similarly, older adults with self-efficacy in applying smart technologies were more likely to be in the highest tertile of acceptability of SNHs (OR: 13.8).

CONCLUSIONS

EASNH-Q demonstrated commendable validity, reliability, and stability. The majority of Chinese older adults have high expectations for and accept SNHs. Self-efficacy in applying smart technologies and willingness to relocate to a nursing home associated with high expectations and acceptability of SNHs.

Long-Term Care Residents' Perceptions of Integrated Care From Physio-Psycho-Social Perspectives: A Qualitative Inquiry

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.