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.

Background: Food 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. Methods: We 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. Results: Use 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). Conclusions: Care 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 registration: Trial 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.

Purpose: This study aims to explore the experiences of residents and staff with new restaurant‐style meal provision in four residential care homes in Norfolk, England.Design/methodology/approach: Meal and drink provision were observed over a full day in each home and unstructured individual interviews with 16 residents and 32 staff recorded and transcribed. Content analysis was used to discover and explore main themes.Findings: Although older care home residents enjoyed the restaurant experience, they valued stable table companions more highly than flexibility. Residents appreciated attractive surroundings, good food and their ability to make choices, but in some circumstances and for frailer residents, choice was more limited with care staff making some decisions. While the central restaurant was valued for the main meal some residents indicated they preferred smaller “family‐type” dining for other meals. Care staff sometimes found the negotiation of their waitressing and caring roles difficult. Available space and the dining‐room's location also contributed to the comparative success of the restaurant‐style provision.Research limitations/implications: Residents valued the restaurant experience with attractive food, surroundings and the ethos of being served at lunch time, but other residents or the same residents at other meals, valued cosier stable family‐type dining more highly. Staff were also torn between service roles implied by restaurant settings and supporting residents to remain independent in the domestic model.Practical implications: When planning new eating facilities thought needs to be given to ensuring both restaurant and family‐type food provision are available, and staff roles in these settings discussed and negotiated.Originality/value: The research provides insights into the experiences of residents and staff of new dining facilities.

Purpose: – The purpose of this paper is to propose five organisational factors associated with abuse, neglect and/or loss of dignity of older people resident in care homes. It derives from one set of findings from 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 programme.Design/methodology/approach: – A knowledge synthesis method was selected to identify organisational aspects of elder mistreatment in residential care settings. The method was selected for its suitability in examining ill-defined and contested concepts such as; elder mistreatment – where the available evidence is dispersed and produced in varied forms. A rapid review comprising a search of three academic databases and a detailed examination of selected investigation reports into institutional mistreatment was followed by panel meetings with subject matter experts to complete the knowledge synthesis.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.Research limitations/implications: – Further research is needed to elaborate the influence of these organisational factors on mistreatment and to understand any interactions.Practical implications: – As an adjunct to personal factors, the knowledge synthesis indicates common organisational factors contributing to institutional abuse. This suggests that care quality is produced systemically and that it 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. However, as “problem” organisations are closed down, “problem” organisational factors continue to recur elsewhere.Originality/value: – The paper identifies and elaborates organisational aspects of elder mistreatment in residential care settings. The findings are original, valuable and grounded in relevant experience by the method of analysis and synthesis of the findings from inquiry reports as well as research and the contribution to the development of findings by those central to the issue, residents, relatives and care providers.