Prevalence, Characteristics, and Unmet Needs of Unbefriended Residents in Alberta Long-Term Care Homes
Bibliographic record
Abstract
Background: Older adults who lack decision-making capacity and a willing or able surrogate to act as their representative are defined as unbefriended. These unbefriended older adults often require a public guardian and reside in long-term care (LTC) homes. Unbefriended LTC residents are at risk of poor quality of care, yet very little is known about this vulnerable resident population. Purpose: The purpose of this dissertation was to assess the prevalence, characteristics, and potentially unmet needs of unbefriended residents in Alberta LTC homes. Methods: This dissertation consisted of four linked studies: (1) a scoping review of the peer-reviewed and grey literature on unbefriended older adults; (2) a qualitative interview study of LTC staff and public guardians to identity the characteristics and unmet needs of unbefriended LTC residents; (3) a prevalence survey to assess the prevalence of unbefriended residents in all 172 Alberta LTC homes; and (4) a retrospective cohort study of health administrative data to further assess the prevalence, characteristics and health outcomes of unbefriended residents from a LTC home sample from Alberta. Findings and Conclusions: Our findings demonstrated that there is little research on unbefriended older adults and no other Canadian studies or reports. Neither the United States (US) nor Canada systematically collect information on unbefriended older adults’ characteristics or quality of care. Unbefriended LTC residents are socially isolated. Compared to LTC residents with family, they had lower social engagement, worse symptoms of depression, and more aggressive behaviours. Across two of our studies (interviews and administrative data), our findings indicated that unbefriended residents had significant mental health issues including diagnoses of depression, schizophrenia, and bipolar disorder. Unbefriended residents have limited financial resources and have significant issues accessing personal care items and services. Our findings suggest that unbefriended individuals experience poor quality of care, particularly at the end of life. Public guardians visit unbefriended residents infrequently and are often unavailable when contacted by LTC staff. The public guardians’ scope of work does not reflect the needs of unbefriended LTC residents, leaving the LTC staff responsible for providing the additional care and support. Unbefriended residents accounted for over 4% of all LTC residents in Alberta. Facilities with the highest proportion of unbefriended residents had more than 135 beds and were public-not-for profit. Unbefriended residents experienced more symptoms of depression, more frequent and severe pain, and exhibited more aggressive behaviours than residents with family. The findings from this dissertation indicated the unbefriended LTC residents have complex care needs and are vulnerable to poor quality of care.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".