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Hajek A, Zwar L, Gyasi RM, Kretzler B, König HH. Prevalence and determinants of loneliness among the oldest old living in institutionalized settings : Study findings from a representative survey. Z Gerontol Geriatr 2024; 57:214-219. [PMID: 37266683 PMCID: PMC11078814 DOI: 10.1007/s00391-023-02196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/03/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND There is very limited knowledge regarding the prevalence and determinants of loneliness in oldest old residents of nursing or old age homes. OBJECTIVE To examine the prevalence and determinants of loneliness among the oldest old living in institutionalized settings in Germany. MATERIAL AND METHODS Data were taken from the representative survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+) including individuals ≥ 80 years living in North Rhine-Westphalia. The study focused on individuals living in institutionalized settings. Sociodemographic, lifestyle-related, and health-related determinants were included in multiple linear regression models. RESULTS Approximately 56.6% of the individuals were not lonely, 25.7% and 17.8% of the individuals were moderately and severely lonely, respectively. Regression analyses showed that higher loneliness was associated with being married (β = 0.48, p < 0.05), high education (compared to low education, β = 0.46, p < 0.05), having a small social network size (β = -0.02, p < 0.05), having poor self-rated health (β = -0.25, p < 0.05), and more depressive symptoms (β = 0.25, p < 0.001). CONCLUSION A significant proportion of the institutionalized oldest old individuals reported moderate or severe loneliness, which underpins the relevance of this topic. Understanding the determinants of loneliness may help to address institutionalized adults aged 80 years and over at risk of loneliness.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany.
| | - Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
| | - Razak M Gyasi
- Aging and Development Unit, African Population and Health Research Center, Nairobi, Kenya
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, Australia
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
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Lin PH, Fu SH, Lee YC, Yang SY, Li YL. Examining the effects of binaural beat music on sleep quality, heart rate variability, and depression in older people with poor sleep quality in a long-term care institution: A randomized controlled trial. Geriatr Gerontol Int 2024; 24:297-304. [PMID: 38319068 DOI: 10.1111/ggi.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE This study aimed to examine the effects of binaural beat music (BBM) on sleep quality, heart rate variability, and depression in older people with poor sleep quality in a long-term care institution. METHODS A single-blind randomized controlled trial design was employed, and 64 older participants with poor sleep quality were recruited from a long-term care institution in Taiwan. Participants were randomized into the BBM group or control group and received 14 days of intervention. During the intervention period, participants in the experimental group listened to 20 min of Taiwanese Hokkien oldies embedded with BBM once in the morning and afternoon three times a week. Participants in the control group only listened to Taiwanese Hokkien oldies. Questionnaires and heart rate variability analysis were used to assess participants' sleep quality, heart rate variability, and depressive symptoms. RESULTS Significant improvements were observed in sleep quality, along with an increase in heart rate variability means of heart rate and normal sinus beats, and a decrease in low-frequency normalized units and depression severity in the BBM group after the intervention. In the control group, effects on sleep quality were inconsistent, heart rate variability showed significant improvements in some autonomic nervous function regulation, and depression severity was significantly decreased. Furthermore, the BBM group showed a significant improvement in sleep quality and a significant reduction in sympathetic nervous activity compared with the control group. CONCLUSION This study demonstrates that 14 days of BBM intervention, a non-invasive intervention, could improve sleep quality and depression in older people with poor sleep quality in long-term care institutions. Geriatr Gerontol Int 2024; 24: 297-304.
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Affiliation(s)
- Pin-Hsuan Lin
- Department of Health and Beauty, Shu Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Shih-Hau Fu
- Department of Acupressure Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Shang-Yu Yang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yi-Lin Li
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Garnett A, Yurkiv H, Booth R, Connelly D, Donelle L. Web-Based Presence for Social Connectedness in Long-Term Care: Protocol for a Qualitative Multimethods Study. JMIR Res Protoc 2023; 12:e50137. [PMID: 37889518 PMCID: PMC10638636 DOI: 10.2196/50137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and resultant restrictions on social gatherings significantly impacted many peoples' sense of social connectedness, defined as an individual's subjective sense of having close relationships with others. Older adults living in long-term care homes (LTCHs) experienced extreme restrictions on social gatherings, which negatively impacted their physical and mental health as well as the health and well-being of their family caregivers. Their experiences highlighted the need to reconceptualize social connectedness. In particular, the pandemic highlighted the need to explore novel ways to attain fulfilling relationships with others in the absence of physical gatherings such as through the use of a hybridized system of web-based and in-person presence. OBJECTIVE Given the potential benefits and challenges of web-based presence technology within LTCHs, the proposed research objectives are to (1) explore experiences regarding the use of web-based presence technology (WPT) in support of social connectedness between older adults in LTCHs and their family members, and (2) identify the contextual factors that must be addressed for successful WPT implementation within LTCHs. METHODS This study will take place in south western Ontario, Canada, and be guided by a qualitative multimethod research design conducted in three stages: (1) qualitive description with in-depth qualitative interviews guided by the Technology Acceptance Model (TAM) and analyzed using content analysis; (2) qualitative description and document analysis methodologies, informed by content and thematic analysis methods; and (3) explicit between-methods triangulation of study findings from stages 1 and 2, interpretation of findings and development of a guiding framework for technology implementation within LTCHs. Using a purposeful, maximum variation sampling approach, stage 1 will involve recruiting approximately 45 participants comprising a range of older adults, family members (30 participants) and staff (15 participants) within several LTCH settings. In stage 2, theoretical sampling will be used to recruit key LTCH stakeholders (directors, administrators, and IT support). In stage 3, the findings from stages 1 and 2 will be triangulated and interpreted to develop a working framework for WPT usage within LTCHs. RESULTS Data collection will begin in fall 2023. The findings emerging from this study will provide insights and understanding about how the factors, barriers, and facilitators to embedding and spreading WPT in LTCHs may benefit or negatively impact older adults in LTCHs, family caregivers, and staff and administrators of LTCHs. CONCLUSIONS The results of this research study will provide a greater understanding of potential approaches that could be used to successfully integrate WPTs in LTCHs. Additionally, benefits as well as challenges for older adults in LTCHs, family caregivers, and staff and administrators of LTCHs will be identified. These findings will help increase knowledge and understanding of how WPT may be used to support social connectedness between older adults in LTCHs and their family members. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50137.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, ON, Canada
| | - Halyna Yurkiv
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, ON, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, ON, Canada
| | - Denise Connelly
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, ON, Canada
- University of South Carolina, Columbia, SC, United States
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Frey R, Balmer D. Psychosocial well-being in Long-Term Care in the Wake of COVID-19: Findings from a Qualitative Study in New Zealand. J Cross Cult Gerontol 2023; 38:263-283. [PMID: 37466844 PMCID: PMC10447292 DOI: 10.1007/s10823-023-09485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 07/20/2023]
Abstract
Drawing on Mason Durie's (1985) New Zealand Whare Tapa Whā model of health (spiritual, emotional, physical, and family domains), the goal was to link a model of well-being with the lived reality for long-term care residents and bereaved family members during COVID-19. Interviews were conducted with five residents and six family members of previous residents of one long-term care in one urban centre between July and September 2020. The increased demands imposed by the pandemic highlighted the gaps in well-being for residents and families. In particular, the inability to connect with family during COVID-19 restrictions reduced perceptions of well-being for residents. Study findings indicate that the provision of well-being for older adults and families in long-term care extends beyond the narrow bounds of the biomedical model. The Whare Tapa Whā model provides a valuable framework describing the holistic balance needed between the four health domains.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
- Western Australian Centre for Rural Health (WACRH), University of Western Australia, Geraldton, Australia
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Tripathi A, Samanta T. Leisure as social engagement: does it moderate the association between subjective wellbeing and depression in later life? FRONTIERS IN SOCIOLOGY 2023; 8:1185794. [PMID: 37649638 PMCID: PMC10465305 DOI: 10.3389/fsoc.2023.1185794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
Objectives To investigate the role of leisure (as social engagement) in moderating the association between subjective wellbeing and depressive symptoms among older Indians. Methods The sample included data from 39,538 older adults (aged 55-80) from the Longitudinal Aging Study in India (LASI, Wave-1), 2017-2018. Individual level questionnaire was used to examine the relationship among social engagement, subjective wellbeing, and depressive symptoms. Moderating effects of leisure activities were estimated through interaction analysis and linear multivariable modeling. Results Low participation in social engagement activities (or leisure) was associated with greater likelihood of depressive symptoms. Leisure activities positively and significantly moderated the subjective wellbeing among older adults with depressive symptoms. Results suggest a significant wealth gradient where affluent older Indians having a clear advantage in heightened levels of social engagement and subsequently lower likelihood of depressive symptoms. Additionally, being in an urban area, co-residence in a "joint" household and belonging to the dominant social groups in terms of caste and religious categories are associated with gains in wellbeing. Discussion The direct and indirect effects of social engagement suggest that depressive symptoms can be mitigated while enhancing overall wellbeing of older adults. This holds promise for social policy in redirecting efforts to develop age-friendly initiatives and social infrastructure that enhance the link between engagement and wellbeing.
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Affiliation(s)
- Ashwin Tripathi
- Indian Institute of Technology Gandhinagar, Gandhinagar, India
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Ding C, Li L, Li G, Li X, Xie L, Duan Z. Impact of workplace violence against psychological health among nurse staff from Yunnan-Myanmar Chinese border region: propensity score matching analysis. BMC Nurs 2023; 22:242. [PMID: 37495998 PMCID: PMC10369719 DOI: 10.1186/s12912-023-01402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Owing to different social background factor in Yunnan-Myanmar Chinese border region, stressful working environment may lead to extra psychological burden among nurse staff in China. However, the prevalence of workplace violence and its effect on psychological characteristics among nurse staff are still unclear. This study aims to explore the effect of workplace violence against psychological health among nurse staff from Yunnan-Myanmar Chinese border region. METHODS A cross-sectional survey was conducted among 18 local governmental hospitals in Dehong districts. Participants were 1,774 nurses. Psychosocial characteristics were screened by sleep quality, the 9-item Patient Health Questionnaire for depressive symptoms, the generalized anxiety disorder-7 for anxiety symptoms, the Connor Davidson Resilience Scale - 10 item for resilience, the multidimensional scale of perceived social support for social support, the Chinese version of Work place Violence Scale for workplace violence. Propensity score matching and multivariate linear regression were applied to analyze the data. RESULTS The nurse staff with workplace violence have a higher risk of bad sleep quality (b = -0.883, 95%CI = [-1.171, -0.595]), anxiety symptoms (b = 2.531, 95%CI = [2.031, 3.031]) and depressive symptoms (b = 3.227, 95%CI = [2.635, 3.819]), loneliness (b = 0.683, 95%CI = [0.503, 0.863]), perceived cognitive deficits (b = 1.629, 95%CI = [1.131, 2.127]), poor resilience (b = -2.012, 95%CI = [-2.963, -1.061]), and poor social support (b = -5.659, 95%CI = [-7.307, -4.011]). CONCLUSIONS Preventing workplace violence can improve mental health outcomes significantly among nurse staff, including loneliness, perceived cognitive deficits, anxiety symptoms, depressive symptoms, sleep quality, resilience and social support.
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Affiliation(s)
- Changmian Ding
- The Medical Record Management Department, Dehong People's Hospital, Yunnan, China
| | - Lidan Li
- The Nursing Department, Dehong People's Hospital, Yunnan, China
| | - Guizhi Li
- The Medical Record Management Department, Dehong People's Hospital, Yunnan, China
| | - Xuehua Li
- The Medical Record Management Department, Dehong People's Hospital, Yunnan, China
| | - Linli Xie
- The Nursing Department, Dehong People's Hospital, Yunnan, China
| | - Zhizhou Duan
- Preventive health service, Jiangxi provincial people's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China.
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Badawy A, Solberg M, Obstfelder AU, Alnes RE. Together, at a distance: experiences with a novel technology for social contact among older people and their relatives in Norway during the COVID-19 pandemic. BMC Geriatr 2023; 23:218. [PMID: 37024822 PMCID: PMC10078031 DOI: 10.1186/s12877-023-03869-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The recognition that people are social beings is fundamental for person-centered care. During the COVID-19 pandemic, the lives of older people were restricted in ways that dramatically reduced their opportunities for face-to-face contact. Limited contact with family members due to social distancing raised concerns about the well-being of older people. In Norway, interactive technologies were therefore introduced to older people to help them maintain social contact while practicing physical distancing. OBJECTIVES This study was designed to examine how older people and their relatives experienced the use of technology-mediated communication through KOMP, a tablet-like device for supporting social contact in care facilities and homes during the pandemic. METHODS We adopted an open phenomenological approach inspired by Kvale and Brinkmann (2009) to explore how the use of KOMP became meaningful during the pandemic. The study was based on individual interviews with 4 residents in care facilities and 13 relatives. RESULTS The lived experiences of using KOMP among older people and their relatives revealed that adopting digital communication helped older people, and their families mitigate social distancing and maintain relationships with each other, despite the restrictions imposed by the government. Virtual involvement through KOMP afforded meaningful interconnections in the social lives of the users and their distant family members, thereby supporting their roles as parents and grandparents despite the distance, and promoting cross-generational connections among family members. Digital meetings also provided opportunities for older people and their relatives to enjoy each other's presence in favored places, by conveying a homely atmosphere, for instance. These virtual encounters did not rely exclusively on talk as the only means of communication. CONCLUSION This study suggests that communicating via KOMP was a meaningful activity for the participants. Technologies for social contact can, to some extent, facilitate person-centered care for older people in care facilities and their private homes, despite circumstances requiring social distancing.
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Affiliation(s)
- Abeer Badawy
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Larsgårdsvegen 2, Ålesund, 6009, Norway.
| | - Mads Solberg
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Larsgårdsvegen 2, Ålesund, 6009, Norway
| | - Aud Uhlen Obstfelder
- Center for Care Research, Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Teknologivegen 22, Gjøvik, 2815, Norway
| | - Rigmor Einang Alnes
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Larsgårdsvegen 2, Ålesund, 6009, Norway
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Naudé B, Rigaud AS, Kamali L, Pino M. Barriers and Enablers for the Use of Digital Interactive Television in Nursing Home Settings: An Interview Case Study with Older Adults and Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1813. [PMID: 36767181 PMCID: PMC9914084 DOI: 10.3390/ijerph20031813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Increasingly, public health programs are recommending the use of information and communication technologies to address the psychosocial needs of Older Adults (OAs). Recently, several applications that allow access to communication and stimulation functionalities using digital interactive television (DiTV) have been developed. The use of the television interface to access digital services seems to help meet several accessibility and usability needs of OAs. However, its use entails other challenges related to different dimensions (organizational, technological, ethical, etc.). This study aims to identify the factors that enable or hinder the use of DiTV by OAs living in geriatric institutions. A qualitative interview case study was conducted in three French geriatric facilities. A total of 25 semi-structured interviews were carried out with residents and care professionals, between February and April 2022, to identify enablers and barriers to DiTV use. Data were processed using a thematic deductive analysis inspired by a multidimensional Health Technology Assessment model. The analysis showed that DiTV use may be limited by organizational (e.g., workload), technological (e.g., ergonomic issues), human (e.g., health issues), ethical (e.g., privacy), and safety factors (e.g., frustration due to technical problems). A summary of these factors and five recommendations for DiTV implementation in geriatric settings are presented in this paper.
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Affiliation(s)
- Bérangère Naudé
- Faculté de Médecine, Université Paris Cité, Maladie d’Alzheimer, F-75013 Paris, France
- Broca Living Lab, CEN STIMCO, F-75013 Paris, France
| | - Anne-Sophie Rigaud
- Faculté de Médecine, Université Paris Cité, Maladie d’Alzheimer, F-75013 Paris, France
- Broca Living Lab, CEN STIMCO, F-75013 Paris, France
- Service Gériatrie 1&2, Centre Mémoire de Ressources et Recherches Ile de France-Broca, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Laila Kamali
- School of Medicine, Royal College of Surgeons, D02 YN77 Dublin, Ireland
| | - Maribel Pino
- Faculté de Médecine, Université Paris Cité, Maladie d’Alzheimer, F-75013 Paris, France
- Broca Living Lab, CEN STIMCO, F-75013 Paris, France
- Service Gériatrie 1&2, Centre Mémoire de Ressources et Recherches Ile de France-Broca, AP-HP, Hôpital Broca, F-75013 Paris, France
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Tingvold L, Moholt JM, Førland O, Jacobsen FF, Tranvåg O. Intended, Unintended, Unanticipated? Consequences of Social Distancing Measures for Nursing Home Residents During the Covid-19 Pandemic. Glob Qual Nurs Res 2023; 10:23333936231176204. [PMID: 37261277 PMCID: PMC10227487 DOI: 10.1177/23333936231176204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
During the outbreak of the COVID-19 pandemic, Norwegian health authorities introduced social distancing measures in nursing homes. The aim was to protect vulnerable residents from contracting the potentially deadly infection. Drawing on individual interviews with nursing home managers and physicians, and focus groups with nursing staff, we explore and describe consequences the social distancing measures had on nursing home residents' health and wellbeing. The analysis indicates that most residents became socially deprived, while some became calmer during the nursing home lockdown. Nursing home staff, physicians and managers witnessed that residents' health and functional capacity declined when services to maintain health, such as physiotherapy, were put on hold. In conclusion, we argue that although Norwegian health authorities managed to keep the infection rates low in nursing homes, this came at a high price for the residents however, as the social distancing measures also negatively impacted their health and wellbeing.
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Affiliation(s)
- Laila Tingvold
- Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | | | - Oddvar Førland
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Oscar Tranvåg
- Western Norway University of Applied Sciences, Bergen, Norway
- Norwegian Research Centre for Women’s Health, University Hospital, Oslo, Norway
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Rodriguez-Rodriguez V, Rojo-Perez F, Perez de Arenaza Escribano C, Molina-Martínez MÁ, Fernandez-Mayoralas G, Sánchez-González D, Rojo-Abuin JM, Rodríguez-Blázquez C, Forjaz MJ, Martín García S. The Impact of COVID-19 on Nursing Homes: Study Design and Population Description. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16629. [PMID: 36554508 PMCID: PMC9779101 DOI: 10.3390/ijerph192416629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 05/15/2023]
Abstract
Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.
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Affiliation(s)
| | - Fermina Rojo-Perez
- Grupo de Investigacion sobre Envejecimiento (GIE), IEGD, CSIC, 28037 Madrid, Spain
| | | | - María-Ángeles Molina-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain
| | | | - Diego Sánchez-González
- Departamento de Geografía, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain
| | | | - Carmen Rodríguez-Blázquez
- National Epidemiology Centre, Carlos III Institute of Health, Network Centre for Biomedical Research in Neurodegenerative Diseases (CIBERNED), 28029 Madrid, Spain
| | - Maria João Forjaz
- National Epidemiology Centre, Carlos III Institute of Health, Health Service Research Network on Chronic Diseases (REDISSEC) and Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 28029 Madrid, Spain
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The effects of social isolation stress and discrimination on mental health. Transl Psychiatry 2022; 12:398. [PMID: 36130935 PMCID: PMC9490697 DOI: 10.1038/s41398-022-02178-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Social isolation and discrimination are growing public health concerns associated with poor physical and mental health. They are risk factors for increased morbidity and mortality and reduced quality of life. Despite their detrimental effects on health, there is a lack of knowledge regarding translation across the domains of experimental research, clinical studies, and real-life applications. Here, we review and synthesize evidence from basic research in animals and humans to clinical translation and interventions. Animal models indicate that social separation stress, particularly in early life, activates the hypothalamic-pituitary-adrenal axis and interacts with monoaminergic, glutamatergic, and GABAergic neurotransmitter systems, inducing long-lasting reductions in serotonin turnover and alterations in dopamine receptor sensitivity. These findings are of particular importance for human social isolation stress, as effects of social isolation stress on the same neurotransmitter systems have been implicated in addictive, psychotic, and affective disorders. Children may be particularly vulnerable due to lasting effects of social isolation and discrimination stress on the developing brain. The effects of social isolation and loneliness are pronounced in the context of social exclusion due to discrimination and racism, during widespread infectious disease related containment strategies such as quarantine, and in older persons due to sociodemographic changes. This highlights the importance of new strategies for social inclusion and outreach, including gender, culture, and socially sensitive telemedicine and digital interventions for mental health care.
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Resnick B, Galik E, McPherson R, Boltz M, Van Haitsma K, Kolanowski A. Gender Differences in Disease, Function, and Behavioral Symptoms in Residents with Dementia. West J Nurs Res 2022; 44:812-821. [PMID: 34044668 PMCID: PMC8627520 DOI: 10.1177/01939459211018822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The purpose of this study was to consider gender differences in depressive symptoms, agitation, resistiveness to care, physical function, and use of psychotropic medications in older adults with moderate to severe dementia in nursing homes. Sixty-seven nursing homes and 889 residents from two states were included. The majority of the participants were female (n = 640, 72%) and White (n = 618, 70%) with a mean age of 86.58 years (SD = 10.31). Differences by gender with regard to age, physical function, depressive symptoms, agitation/aggression, and resistiveness to care were tested using multivariate analysis of variance. Older females with moderate to severe dementia present with more depressive symptoms (anxiety, sadness, and somatic complaints) than males. Males present with more aggressive behavior and are more likely to receive anticonvulsants. Caregivers should focus on preventing and managing depressive symptoms including anxiety, sadness, and somatic complaints among older females and aggressive behavior in older males with dementia.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Rachel McPherson
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marie Boltz
- School of Nursing, Pennsylvania State University, University Park, PA, USA
| | | | - Ann Kolanowski
- School of Nursing, Pennsylvania State University, University Park, PA, USA
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13
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Friendships, loneliness and psychological wellbeing in older adults: a limit to the benefit of the number of friends. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Loneliness is linked to many negative health outcomes and places strain on the economy and the National Health Service in the United Kingdom. To combat these issues, the determinants of loneliness need to be fully understood. Although friendships have been shown to be particularly important in relation to loneliness in older adults, this association has thus far not been explored more closely. Our exploratory study examines the relationship between number of friends and loneliness, depression, anxiety and stress in older adults. Data were obtained from 335 older adults via completion of an online survey. Measures included loneliness (UCLA Loneliness Scale version 3), depression, anxiety and stress (Depression Anxiety Stress Scales DASS-21). Participants also reported their number of close friends. Regression analyses revealed an inverse curvilinear relationship between number of friends and each of the measures tested. Breakpoint analyses demonstrated a threshold for the effect of number of friends on each of the measures (loneliness = 4, depression = 2, anxiety = 3, stress = 2). The results suggest that there is a limit to the benefit of increasing the number of friends in older adults for each of these measures. The elucidation of these optimal thresholds can inform the practice of those involved in loneliness interventions for older adults. These interventions can become more targeted; focusing on either establishing four close friendships, increasing the emotional closeness of existing friendships or concentrating resources on other determinants of loneliness in this population.
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14
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Older people's experiences of community engagement in aged care: A qualitative study. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Yang Y, Graf L, Longdin M, Khait AA, Shellman J. Scoping review of reminiscence research undertaken in long-term care communities. Geriatr Nurs 2022; 46:191-198. [PMID: 35749863 DOI: 10.1016/j.gerinurse.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
Mental health conditions ranging from minor depressive symptoms to major depression, loneliness and poor quality of life are significant concerns in long-term care communities. Reminiscence is one intervention that has shown to reduce depressive symptoms and improve quality of life. The purpose of this scoping review was to determine the extent of reminiscence research undertaken in long-term care communities. Arksley and O'Malley's six stage method provided the framework for the review. Studies published in peer reviewed literature were identified based on searches in three databases (CINAHL, PUBMED, PsycINFO). Thirty-two studies met inclusion criteria. Of the 32 articles examined, 2 studies were conducted in the United States. Twenty-five health outcomes were examined, including twenty-three psychological outcomes and two physiological outcomes. Depression and cognitive functions were the most frequently measured outcomes. Lack of theoretical frameworks underpinning the studies, inadequate sample sizes, and weak methodology were noted in this review. Recommendations for future reminiscence research in long-term care communities are discussed.
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Affiliation(s)
- Yuxuan Yang
- University of Connecticut School of Nursing, Storrs, CT, USA.
| | - Leah Graf
- University of Connecticut School of Nursing, Storrs, CT, USA
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16
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Beadle JN, Gifford A, Heller A. A Narrative Review of Loneliness and Brain Health in Older Adults: Implications of COVID-19. Curr Behav Neurosci Rep 2022; 9:73-83. [PMID: 35729992 PMCID: PMC9187924 DOI: 10.1007/s40473-021-00237-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
Purpose of Review This narrative review highlights important factors contributing to loneliness in older adults prior to and during the COVID-19 pandemic and effects on brain health. Recent Findings We characterize risk factors for loneliness in older adulthood and the impact of COVID-19. Furthermore, we discuss the implications of loneliness for older adults’ brain health. Summary Understanding the multifactorial causes of loneliness in different subpopulations of older adults both before and during the COVID-19 pandemic will provide insights for the development of interventions targeted to reduce loneliness in older adults based on their specific risk factors.
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Affiliation(s)
- Janelle N. Beadle
- Department of Gerontology, University of Nebraska at Omaha, 6001 Dodge Street, CPACS Room 211, Omaha, NE USA
| | - Angela Gifford
- Department of Psychology, Neuroscience and Behavior Graduate Program, University of Nebraska at Omaha, Omaha, NE USA
| | - Abi Heller
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE USA
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17
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"It Makes You Feel Good to Help!": An Exploratory Study of the Experience of Peer Mentoring in Long-Term Care. Can J Aging 2022; 41:451-459. [PMID: 35538870 DOI: 10.1017/s0714980821000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors (n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.
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18
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Naudé B, Rigaud AS, Pino M. Video Calls for Older Adults: A Narrative Review of Experiments Involving Older Adults in Elderly Care Institutions. Front Public Health 2022; 9:751150. [PMID: 35096731 PMCID: PMC8795665 DOI: 10.3389/fpubh.2021.751150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Social isolation in geriatric institutions is a real threat to older adults' (OAs) well-being. Visits from family members, when they are not impacted by geographical distance or illness, sometimes fail to provide sufficient opportunities for social connectedness and interaction to prevent and/or combat OAs' loneliness and social isolation. Information and Communication Technologies (ICTs) offer promising solutions to this problem. Video calls provide a quick and convenient way for remote communication between OAs and their families, and a complement to face-to-face visits in geriatric settings. Over the last months, during the several confinements imposed to stop the transmission of COVID-19 over the world, several care homes and long-care facilities have equipped themselves with laptops, tablets and video call applications to help OAs remain in contact with their relatives. However, numerous technical and human-related factors may hinder the use of video calls in these settings. The complexity of technological devices, as well as OAs limited digital skills, low confidence and experience in the use of technology are some examples. Furthermore, the specific context of use and the required implication of multiple actors (care professionals, family members) should also be considered when examining the use and implementation of video calls in geriatric institutions. We conducted a narrative review of literature describing the use of video calls in geriatric institutions between 2000 and 2021, especially because of the little information related to OAs' use of video calls in geriatric settings. One thousand one hundred ninety-seven references were screened and 15 studies focusing on the usability, acceptability and effectiveness of video calls were included. A qualitative, deductive thematic analysis inspired by a Health Technology Assessment (HTA) multidimensional model was used to identify barriers, enablers and solutions to video calls implementation in geriatric institutions. The results from the HTA-based analysis provide encouraging evidence for the feasibility of video call use in geriatric settings, and its efficacy on reducing social isolation among residents. However, numerous technical, human-related, ethical and organizational barriers persist and should be addressed in future works. The present analysis has also allowed the identification of potential solutions to overcome these barriers, which are discussed in this publication.
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Affiliation(s)
| | - Anne-Sophie Rigaud
- Université de Paris, Maladie d'Alzheimer, Paris, France
- Services de gériatrie 1 & 2, AP-HP, Hôpital Broca, Paris, France
| | - Maribel Pino
- Université de Paris, Maladie d'Alzheimer, Paris, France
- Services de gériatrie 1 & 2, AP-HP, Hôpital Broca, Paris, France
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19
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Boyano I, Nieto S, Serra JA, Alcaide M, Caparros M, Varela M. An intergenerational programme delays health impairment in nursing home residents: the Duplo project. Eur Geriatr Med 2022; 13:1365-1375. [PMID: 36251169 PMCID: PMC9574837 DOI: 10.1007/s41999-022-00700-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/22/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To analyse whether an intergenerational programme in which students interacted with institutionalised older persons had any impact on the older persons' functional status. METHODS Each academic year, a group of older adults living in nursing homes were divided into two arms. For the next four months, the first group received daily visits from a group of students during which they followed a pre-established activity plan, whilst the other arm proceeded with their normal activity. After 4 months, the groups crossed over, and the second arm received the student visits, whilst the first group returned to their normal activity. A battery of tests was performed at inception, crossover and the end of the second period. The tests explored mobility (Timed Up-and-Go), cognition (Mini-Mental Examination), executive function (Frontal Assessment Battery) and mood (Geriatric Depression Scale). A dichotomous aggregate "significant impairment" variable was deemed to be present when there was at least a 20% loss of function (compared to the value at the beginning of the period) in any of the aforementioned tests. RESULTS The study included 289 older adults who visited with 91 students. Subjects in the active phase had a lower incidence of significant impairment than those in the control phase (O.R. 0.90, p < 0.01). There were no significant differences in the individual variables. CONCLUSION An intergenerational project with students visiting older adults in nursing homes had a protective effect, delaying functional decay in older adults.
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Affiliation(s)
- Inmaculada Boyano
- grid.440814.d0000 0004 1771 3242Geriatric Department, Hospital Universitario de Mostoles, Madrid, Spain ,grid.449795.20000 0001 2193 453XUniversidad Francisco de Vitoria, Madrid, Spain
| | - Sonia Nieto
- grid.440814.d0000 0004 1771 3242Geriatric Department, Hospital Universitario de Mostoles, Madrid, Spain ,grid.449795.20000 0001 2193 453XUniversidad Francisco de Vitoria, Madrid, Spain
| | - Jose-Antonio Serra
- grid.410526.40000 0001 0277 7938Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain ,grid.512892.5Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, Madrid, Spain ,grid.4795.f0000 0001 2157 7667School of Medicine, Universidad Complutense, Madrid, Spain
| | | | | | - Manuel Varela
- grid.440814.d0000 0004 1771 3242Department of Internal Medicine, Hospital Universitario de Mostoles, Madrid, Spain
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20
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Chew SY. Loneliness experience among cognitively-intact elderly nursing home residents in Singapore – an exploratory mixed methods study. Arch Gerontol Geriatr 2022; 98:104572. [DOI: 10.1016/j.archger.2021.104572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/02/2022]
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21
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Davis L, Botting N, Cruice M, Dipper L. A systematic review of language and communication intervention research delivered in groups to older adults living in care homes. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:182-225. [PMID: 34841623 DOI: 10.1111/1460-6984.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The communication skills of older adults living in care homes is an underexplored topic. Ageing can lead to reduced communication ability and activity; and in the care home environment there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being, but no systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population. AIMS To identify and evaluate the evidence for behavioural interventions with older adults, delivered in groups in care homes, that specifically included a language or communication activity. To explore the impact of such intervention on the specific domains of language, communication and social interaction. To determine whether behavioural mechanisms of action can be identified. METHODS & PROCEDURES Embase, Medline, Ovid Nursing database, Psych info and CINAHL complete were searched and produced 158 records for screening, of which 22 remained for review. In order to identify and evaluate the quality of the evidence base presented the following research questions were posed: What research has been conducted in this area? What is the methodological quality of the studies identified? How complete is the intervention reporting? How was change measured in the domains of language, communication and social interaction? Is there evidence of efficacy, indicated by statistically significant improvement, in these domains? How did the interventions work? Synthesis tools employed included the PEDro-P Scale, the TIDieR checklist and the ITAX. MAIN CONTRIBUTION A total of 22 studies met the criteria for review. One study used solely language or communication interventions, but the remaining 21 studies used behavioural interventions which incorporated language and communication activities to varying degrees. Studies fell into four broad intervention types: reminiscence or life review; cognitive stimulation; narrative or storytelling; and multi-modality group communication. The majority of studies were of fair methodological quality, with a moderate level of detail provided in treatment reporting. Statistically significant improvement was reported by authors in all four intervention types and across language, communication and social domains. Social interaction, social support and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions. CONCLUSIONS & IMPLICATIONS Despite limitations in the evidence base, there are important positive signs for the beneficial effects of supporting language and communication in care homes. Blinding of assessors, and the accuracy and accessibility of statistical reporting are important areas to address in order to improve the quality of the evidence base. WHAT THIS PAPER ADDS Ageing can lead to reduced communication ability and activity, and in the care home setting there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being. The communication skills of older adults living in care homes is an underexplored topic. No systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population. This review reveals important positive signs for the beneficial effects of supporting language and communication in care homes. Social interaction, social support, and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions.
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Affiliation(s)
- Lydia Davis
- Division of Language and Communication Science, School of Health Sciences, University of London, London, UK
| | - Nicola Botting
- Division of Language and Communication Science, School of Health Sciences, University of London, London, UK
| | - Madeline Cruice
- Division of Language and Communication Science, School of Health Sciences, University of London, London, UK
| | - Lucy Dipper
- Division of Language and Communication Science, School of Health Sciences, University of London, London, UK
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22
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Social participation and depressive symptoms among older adults during the Covid-19 pandemic in Serbia: A cross-sectional study. Geriatr Nurs 2021; 44:8-14. [PMID: 34999368 PMCID: PMC8733672 DOI: 10.1016/j.gerinurse.2021.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/28/2022]
Abstract
Objectives To determine the predictors and level of social participation and depressive symptoms within the context of isolation during the COVID-19 pandemic and investigate if the residence and type of housing had a moderating role in the relationship between social participation and depressive symptoms. Methods This cross-sectional, comparative, and correlational study was conducted on a sample of 299 participants. Research instruments used in this study included: socio-demographic questionnaire, the Geriatric Depression Scale, the Maastricht Social Participation Profile, and Mini-Mental State Exam. Results Social participation was found to contribute negatively to symptoms of depression (β = -0.245, p < .01), with a higher level of depression being found in older adults living in nursing homes (β = -0.152, p < .05). Conclusions The study confirmed a strong relationship between social participation and depressive symptoms in the COVID-19 pandemic.
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23
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Theurer KA, Stone RI, Suto MJ, Timonen V, Brown SG, Mortenson WB. 'It makes life worthwhile!' Peer mentoring in long-term care-a feasibility study. Aging Ment Health 2021; 25:1887-1896. [PMID: 33256458 DOI: 10.1080/13607863.2020.1849023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Loneliness and depression are of increasing concern in long-term care homes made more urgent by viral outbreak isolation protocols. An innovative program called Java Mentorship was developed that engaged community volunteers and resident volunteers (mentors) as a team. The team met weekly, received education, and provided visits and guidance in pairs to socially disengaged residents (mentees). The purpose of this study was to assess the feasibility of conducting a larger study.Method: We conducted a mixed-methods pre-post study to evaluate the program. We collected feasibility data associated with the program implementation, including assessment of the sample and ability to recruit; procedures for data collection; retention, program adherence and acceptability; and residents' responses including loneliness, depression, purpose in life, social identity and sense of belonging outcomes. We enrolled community mentors (n = 65), resident mentors (n = 48) staff facilitators (n = 24) and mentees (n = 74) in 10 Canadian sites.Results: Most feasibility objectives were met, and adherence and acceptability were high. Some resource challenges and low retention rates among resident mentors were noted. We found a 29% reduction in depression scores (p = .048; d = .30) and 15% reduction in loneliness scores (p = .014; d = .23). Purpose in life, social identity and sense of belonging were unchanged. Interviews among participants indicated high acceptability and positive perceptions of the program.Conclusion: The study findings reveal a potential role for mentorship as a viable approach to reducing loneliness and depression in long-term care settings and lay the groundwork for future research.
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Affiliation(s)
- Kristine A Theurer
- Faculty of Graduate Studies, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robyn I Stone
- Leading Age LTSS Center @UMass Boston, Washington, DC, USA
| | - Melinda J Suto
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Virpi Timonen
- School of Social Work and Social Policy, Trinity College Dublin, Dublin 2, Ireland
| | - Susan G Brown
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - W Ben Mortenson
- GF Strong Rehabilitation Research Program, International Collaboration on Repair Discoveries, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Yildirim E, Ogel-Balaban H. Cognitive functions among healthy older adults using online social networking. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 30:401-408. [PMID: 34310244 DOI: 10.1080/23279095.2021.1951269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Online social network sites provide possibilities to enhance social relationships and engage in cognitive activities for older adults. The present study aimed to investigate the relationship between the use of one social network site, Facebook, and cognitive functions in older adults considering different dimensions of Facebook use together with different cognitive functions. Seventy healthy older adults completed the use of Facebook form, Multidimensional Scale of Perceived Social Support, and Social Network Index. Their cognitive functions were measured with Digit Span Tasks, Free and Cued Selective Reminding Test, Letter and Category Fluency Tests, Stroop Test, Digit Symbol Substitution Test, and Trail Making Test (TMT-A and TMT-B). After controlling for age, gender, education level, we found that Facebook users performed better on TMT-A compared to non-users. Among Facebook users, the length of having an account, the network size, the daily duration of use, and the frequency of active and passive use correlated with cognitive performance after controlling offline sociality. These findings, which need confirmation by experimental and longitudinal studies, suggested that being connected to a larger network via more prolonged and active use of social media might be associated with higher cognitive functioning.
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Affiliation(s)
- Elif Yildirim
- Department of Psychology, Isik University, Istanbul, Turkey
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25
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Khan MSR, Kadoya Y. Loneliness during the COVID-19 Pandemic: A Comparison between Older and Younger People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157871. [PMID: 34360164 PMCID: PMC8345648 DOI: 10.3390/ijerph18157871] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022]
Abstract
The precautionary measures and uncertainties surrounding the COVID-19 pandemic have serious psychological impacts on peoples' mental health. We used longitudinal data from Hiroshima University to investigate loneliness before and during the pandemic among older and younger people in Japan. We provide evidence that loneliness among both older and younger people increased considerably during the pandemic. Although loneliness among younger people is more pervasive, the magnitude of increase in loneliness during the pandemic is higher among older people. Our logit regression analysis shows that age, subjective health status, and feelings of depression are strongly associated with loneliness before and during the pandemic. Moreover, household income and financial satisfaction are associated with loneliness among older people during the pandemic while gender, marital status, living condition, and depression are associated with loneliness among younger people during the pandemic. The evidence of increasing loneliness during the pandemic is concerning for a traditionally well-connected and culturally collectivist society such as Japan. As loneliness has a proven connection with both physical and mental health, we suggest immediate policy interventions to provide mental health support for lonely people so they feel more cared for, secure, and socially connected.
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26
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Drageset J, Haugan G. Associations between nurse-patient interaction and loneliness among cognitively intact nursing home residents - a questionnaire survey. Geriatr Nurs 2021; 42:828-832. [PMID: 34090227 DOI: 10.1016/j.gerinurse.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/24/2022]
Abstract
Nursing home (NH) residents risk loneliness because of many losses. Nurse-patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months' residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked "Do you sometimes feel lonely?" and used the Nurse-Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse-patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse-patient interaction associates with residents' loneliness and might be important in alleviating loneliness.
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Affiliation(s)
- Jorunn Drageset
- Department of Global Health and Primary Care, University of Bergen, Postboks 7804, 5020 Bergen, Norway; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Gørill Haugan
- Department of Public Health and Nursing and Center for Health Promoting Research, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway; Nord University, Faculty of Nursing and Health Science, Bodø, Norway.
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27
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Choi HK, Lee SH. Trends and Effectiveness of ICT Interventions for the Elderly to Reduce Loneliness: A Systematic Review. Healthcare (Basel) 2021; 9:293. [PMID: 33800099 PMCID: PMC8002106 DOI: 10.3390/healthcare9030293] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 01/22/2023] Open
Abstract
Elderly people are sensitive to loneliness, which may contribute to mental and physical health, serious illness, and increased mortality. This study investigates the development trend of information communication technology (ICT) interventions designed for the elderly to reduce loneliness and synthesize its effect. We searched relevant articles on 23 May 2020 using three databases: Ovid-Medline, Ovid-EMBASE, and the Cochrane library. Data extraction and quality assessment were independently performed by two authors. The development is changing from animal robots to online social platforms and from simple emotional support to a multifaceted system that promotes social participation, cognition, physical activity, and nutrition. Our systematic review reported that ICT interventions are being developed to alleviate loneliness and increase social participation. Our study revealed an increase in the use of ICT interventions among the elderly and a positive change in their attitude toward ICT interventions. ICT interventions in the field of nursing should continue to be developed in the future to meet social, health, and safety needs. In the context of coronavirus disease 2019 (COVID-19), ICT interventions are needed to respond effectively to the needs of the elderly. This study is expected to provide basic knowledge for the development of ICT interventions for the elderly.
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Affiliation(s)
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 21936, Korea;
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28
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Mikkelsen AS, Kristiansen M. Qualitative Study of the Implementation and Potential of a Social Intervention at Nursing Homes in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1808. [PMID: 33673281 PMCID: PMC7918481 DOI: 10.3390/ijerph18041808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: The effect of social relations on health and wellbeing is well documented. However, knowledge about social interventions specifically in nursing homes and their potential for health and wellbeing is inadequate. In this qualitative study, we explore the implementation of a social intervention entitled Tell Stories for Life implemented in Danish nursing homes. (2) Methods: Through a qualitative multi-perspective longitudinal approach, nursing home residents and employees were interviewed from May-December 2016 (N = 14). The authors made participatory observations and took field notes. (3) Results: The intervention did not appear to establish or strengthen social relations between nursing home residents. However, nursing home residents enjoyed participating, narrating and having someone listen to their stories. The identity of nursing home residents and their relationships to nursing home employees facilitating the intervention appeared to be strengthened. Barriers were related to lack of support from management, nursing home employees' educational backgrounds and experiences, and nursing home residents' cognitive ability. (4) Conclusions: This study found that the Tell Stories for Life intervention did not appear to strengthen and establish social relations among nursing home residents. However, we found that there might be potential for strengthening residents' sense of identity and the relation between residents and nursing home employees.
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Affiliation(s)
- Anne Sophie Mikkelsen
- Center for Healthy Aging, Section for Health Services Research, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
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Cook C, Henrickson M, Atefi N, Schouten V, Mcdonald S. Iatrogenic loneliness and loss of intimacy in residential care. Nurs Ethics 2021; 28:911-923. [PMID: 33509027 DOI: 10.1177/0969733020983394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive. AIM To consider how the loss of intimacy and sexuality in residents' lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together. RESEARCH DESIGN The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing. PARTICIPANTS AND RESEARCH CONTEXT Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people. FINDINGS Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment. ETHICAL CONSIDERATIONS The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld. DISCUSSION Residents' expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness. CONCLUSIONS Nurses have a pivotal role in ensuring policies and practice enhance social citizenship.
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Drageset J, Eide GE. Loneliness Among Cognitively Intact Residents of Nursing Homes With and Without Cancer: A 6-Year Longitudinal Study. SAGE Open Nurs 2021; 6:2377960820907778. [PMID: 33415270 PMCID: PMC7774416 DOI: 10.1177/2377960820907778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/06/2019] [Accepted: 01/26/2020] [Indexed: 11/17/2022] Open
Abstract
Limited information exists regarding the natural development of loneliness and
its determinants among cognitively intact nursing home residents. We aimed to
examine loneliness among nursing home residents by following up for 6 years and
to determine whether sociodemographic factors, diagnosis of cancer, sense of
coherence, social support, and depression symptoms influence loneliness. The
study was longitudinal and prospective and included baseline assessment and
6-year follow-up. After baseline assessment of 227 cognitively intact nursing
home residents (Clinical Dementia Rating score ≤0.5), 52 respondents were
interviewed a second time at the 5-year follow-up and 18 respondents a third
time at the 6-year follow-up. Data from the interviews were recorded using a
global question of loneliness, the Social Provisions Scale, Sense of Coherence
Scale, and Geriatric Depression Scale. Scores on Groll’s index
(p = .02) and the Sense of Coherence Scale
(p = .04) were positively correlated with loneliness and
negatively correlated with geriatric depression (p = .001).
Having a diagnosis of cancer, social support, and age were not correlated with
loneliness 6 years from baseline. Loneliness did not change during the 6 years
of follow-up, and symptoms of depression and the sense of coherence appeared to
be important components of loneliness. Finally, having a diagnosis of cancer and
social support were not associated with loneliness.
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Affiliation(s)
- Jorunn Drageset
- Department of Nursing, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
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Fukaya Y, Kawaguchi M, Kitamura T. Does Everyday Conversation Contribute to Cognitive Functioning? A Comparison of Brain Activity During Task-Oriented and Life-Worldly Communication Using Near-Infrared Spectroscopy. Gerontol Geriatr Med 2020; 6:2333721420980309. [PMID: 33354591 PMCID: PMC7734534 DOI: 10.1177/2333721420980309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/11/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
This study aimed to explore differences in frontal lobe brain activity associated with two types of communication: task-oriented and life-worldly, the latter of which largely overlaps with everyday conversation. Using near-infrared spectroscopy, we explored differences by comparing oxygenated hemoglobin concentrations associated with periods of rest and conversation in two experimental groups comprising older and younger adults. Artifacts were removed from the signals using discrete wavelet transforms. Paired t-tests were used to compare the resulting data for the two types. The results showed that oxygenated hemoglobin levels during life-worldly communication were significantly higher than at baseline or during task-oriented communication, particularly for the older adult group. In addition, during life-worldly communication, relatively high levels of brain activity were found in the upper part of the Broca area and in the premotor cortex. These results, which suggest that life-worldly communication generates more activity in the frontal lobe, could potentially contribute to improving how caregivers communicate with older patients/residents in hospitals and nursing homes.
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Naik MHSc P, Ueland PhD VI. How Elderly Residents in Nursing Homes Handle Loneliness-From the Nurses' Perspective. SAGE Open Nurs 2020; 6:2377960820980361. [PMID: 33912665 PMCID: PMC8047972 DOI: 10.1177/2377960820980361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/08/2020] [Accepted: 11/22/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Elderly people who leave their home environment and move to a
nursing home enter a phase in life with diminishing contact with
family and friends. This situation often results in a feeling of
loneliness with a concomitant deterioration in physical and
mental health. By exploring the topic through the lens of the
nurses, this study takes a novel approach to address an
under-researched area in the nursing field. Objective The objective of the study was to identify, based on the nurses’
experience, how elderly residents handle loneliness in the
nursing home. Methods This study used a qualitative explorative approach with data
collected through two focus group interviews with nine nurses at
two elderly care facilities in Norway. The resulting transcripts
were examined using an approach based on inductive content
analysis. Results Three main categories emerged as crucial to help lonely nursing
home residents cope with day-to-day life: (i) maintaining ties
to one’s earlier life; (ii) engaging in recreational pursuits;
and (iii) building new networks. Conclusion Analysing the findings based on sense of coherence (SOC) and
person-centred care (PCC) theories illustrates the importance of
maintaining a connection with both family and friends. To that
point, having access to familiar objects from their earlier life
seemingly provides meaning to the residents by bridging the past
and the present. Recreational activities, ideally adapted to
each person’s needs and ability, have a positive impact by
providing structure and meaning that help overtake feelings of
loneliness. Building a new network with fellow residents and
staff imparts a sense of meaningful community belonging and
projects both dignity and self-worth.
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Pirhonen J, Tiilikainen E, Pekkarinen S, Lemivaara M, Melkas H. Can robots tackle late-life loneliness? Scanning of future opportunities and challenges in assisted living facilities. FUTURES 2020; 124:102640. [PMID: 33041358 PMCID: PMC7534874 DOI: 10.1016/j.futures.2020.102640] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 05/07/2023]
Abstract
This future-oriented study examines the opportunities and challenges offered by social robots and communication technology when aiming to decrease emotional and social loneliness in older people residing in assisted living (AL). The paper draws on prior literature on loneliness, elder care and social robots. The aim is to scan the futures regarding technology support for the frail older people in future AL. The analytical frame was built on Robert Weiss' division of relational functions: attachment, social integration, opportunity for nurturance, reassurance of worth, sense of reliable alliance, and guidance in stressful situations, and on a distinction between direct and indirect social robots. Our examinations show that social robots could tackle both emotional and social loneliness in assisted living by empowering people to engage in different forms of social interaction inside and outside the facility. However, ethical concerns of objectification, lack of human contact, and deception need to be thoroughly considered when implementing social robots in care for frail older people.
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Affiliation(s)
- Jari Pirhonen
- Faculty of Social Sciences, University of Helsinki, P.O. Box 4, 00014, Finland
| | - Elisa Tiilikainen
- Department of Social Sciences, University of Eastern Finland, Faculty of Social Sciences and Business Studies, 70211 Kuopio, Finland
| | - Satu Pekkarinen
- School of Engineering Science, Lappeenranta-Lahti University of Technology LUT, Mukkulankatu 19, 15210 Lahti, Finland
| | - Marjut Lemivaara
- Faculty of Social Sciences, Tampere University, P.O. Box 100, 33014, Finland
| | - Helinä Melkas
- School of Engineering Science, Lappeenranta-Lahti University of Technology LUT, Mukkulankatu 19, 15210 Lahti, Finland
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Quan NG, Lohman MC, Resciniti NV, Friedman DB. A systematic review of interventions for loneliness among older adults living in long-term care facilities. Aging Ment Health 2020; 24:1945-1955. [PMID: 31602993 DOI: 10.1080/13607863.2019.1673311] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study aimed to review loneliness interventions for older adults living in long-term care (LTC) facilities over the past 10 years, to categorize interventions by type, and to compare effectiveness of loneliness interventions in these settings. METHODS Systematic review followed PRISMA guidelines. Articles matching search criteria were collected from PubMed, PsycINFO, and Web of Science from 2009 to 2019. The inclusion criteria were as follows: 1) English language, 2) intervention studies with a quantitative measure that compares pre-trial to post-trial changes, 3) loneliness as a primary or secondary outcome 4) subjects age >65, and 5) subjects living in a LTC facility, such as a nursing home, assisted-living, or hospice. RESULTS A total of 15 intervention studies qualified for systematic review. Most of these interventions were psychological therapies and leisure/skill development interventions. Approximately, 87% of studies reported significant decreases in loneliness following intervention. Laughter therapy, horticultural therapy, and reminiscence therapy were associated with the greatest decreases in loneliness. DISCUSSION Results suggest that, although less common than interventions in the community, there are several effective interventions to reduce loneliness among older adults living in LTC facilities. Lack of standardized measures and high-quality studies limits comparisons between intervention types and generalizability to different populations.
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Affiliation(s)
- Nicolas G Quan
- Biological Sciences, University of South Carolina, Columbia, SC, USA
| | - Matthew C Lohman
- Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nicholas V Resciniti
- Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Stephens J, Simpson T, Holmes OS, Collins R, Silver M, Bhar SS. Volunteers Befriending Older Adults in Aged Care Residencies: Three Case Studies. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12160] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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COVID-19: it is time to balance infection management and person-centered care to maintain mental health of people living in German nursing homes. Int Psychogeriatr 2020; 32:1157-1160. [PMID: 32393407 PMCID: PMC7264450 DOI: 10.1017/s1041610220000897] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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37
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Chung BPM, Olofsson J, Wong FKY, Rämgård M. Overcoming existential loneliness: a cross-cultural study. BMC Geriatr 2020; 20:347. [PMID: 32928151 PMCID: PMC7491097 DOI: 10.1186/s12877-020-01753-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moving into a long-term care facility (LTCF) can reduce the ability for older adults to engage in meaningful roles and activities and the size of their social network. These changes and losses can lead them to experience existential loneliness (EL)-the intolerable emptiness and lack of meaningful existence resulted from the losses they have experienced. While EL has often been understood as a universal human experience, it has primarily been studied in people from Western cultures; little is known about how EL may be experienced by and manifested in people from Eastern cultures. Hence, this qualitative study aimed to describe the experience and coping of EL in Hong Kong Chinese and Swedish older adults living in LTCFs. METHODS A qualitative study using Thorne's (2004) interpretive description was conducted. Thirteen Chinese and 9 Swedes living in LTCFs in Hong Kong, China and Malmo, Sweden, respectively were interviewed about their experience of EL in two series of semi-structured interviews. Data were analyzed using thematic analysis. RESULTS The core theme of "overcoming EL" described the participants' experience of EL, which came about through the combined process of "Feeling EL" and "Self-Regulating". Both Chinese and Swedish participants had similar experience with EL. Realizing that they did not want to living with EL anymore, they coped by reframing their experience and identifying new meaning in their life. CONCLUSIONS The study findings suggested that early and clear counselling support that help older adults to define new meaning in life may help them cope. In addition, more opportunities should be available at the LTCFs to promote quality relationships, enable older adults to reflect on their lives with pride, and support their ability to do the things they enjoy.
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Affiliation(s)
- B P M Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China
| | - J Olofsson
- Faculty of Health and Society, Institute of Care Science, Malmo University, 25, Hus F, Malmo, Malmo, Sweden
| | - F K Y Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China.
| | - M Rämgård
- Faculty of Health and Society, Institute of Care Science, Malmo University, 25, Hus F, Malmo, Malmo, Sweden
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Drageset J, Taasen SE, Espehaug B, Kuven BM, Eide WM, André B, Rinnan E, Haugan G. Associations Between Nurse-Patient Interaction and Sense of Coherence Among Cognitively Intact Nursing Home Residents. J Holist Nurs 2020; 39:16-28. [PMID: 32700622 PMCID: PMC8041445 DOI: 10.1177/0898010120942965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To investigate the association between nurse-patient interaction and sense of coherence among cognitively intact nursing home residents. Method: In a cross-sectional design, data were collected in 2017 and 2018 using the Nurse-Patient Interaction Scale (NPIS) and the 13-item Sense of Coherence Scale (SOC-13). Of the 204 cognitively intact nursing home residents who met the inclusion criteria, 188 (92%) participated, representing 27 nursing homes. Multiple regression in a general linear model estimated the possible effects of the 14 NPIS items on SOC-13 sum score, the possible effects of the NPIS (sum score) on SOC-13 (sum score) as well as on the subdimensions of SOC-13, comprehensibility, meaningfulness, and manageability (both without and with adjusting for sex and age). Results: Four of the 14 NPIS items revealed highly significant correlations with SOC-13 (sum score; unadjusted and adjusted for age and gender). Furthermore, the analysis adjusted for age and gender showed significant associations for NPIS (sum score) with SOC-13 (sum score), manageability, and comprehensibility. The correlation between NPIS and meaningfulness was not statistically significant. Conclusion: Nurse-patient interaction is significantly associated with SOC-13 and its subdimensions of comprehensibility and manageability but not meaningfulness. Nurse-patient interaction might be an important resource in relation to residents' sense of coherence and its subdimensions.
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Affiliation(s)
- Jorunn Drageset
- Western Norway University of Applied Sciences.,University of Bergen
| | | | | | | | | | | | - Eva Rinnan
- Norwegian University of Science and Technology
| | - Gørill Haugan
- Norwegian University of Science and Technology.,Nord University
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Syed Elias SM, Neville C, Scott T, Petriwskyj A. The effectiveness of spiritual reminiscence therapy for older people with loneliness, anxiety and depression in Malaysia. JOURNAL OF RELIGION, SPIRITUALITY & AGING 2020. [DOI: 10.1080/15528030.2020.1765448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Christine Neville
- University of Southern Queensland, Darling Heights, Queensland, Australia
| | - Theresa Scott
- The University of Queensland, St Lucia, Queensland, Australia
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Dadswell A, Bungay H, Wilson C, Munn-Giddings C. The impact of participatory arts in promoting social relationships for older people within care homes. Perspect Public Health 2020; 140:286-293. [PMID: 32508239 PMCID: PMC7522769 DOI: 10.1177/1757913920921204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Loneliness and social isolation negatively affect wellbeing and quality of life. Despite the proximity of others, older people living in care homes often experience loneliness and social isolation. The impact of participatory arts on wellbeing is widely acknowledged; however, relational impacts have received less attention. This article explores the impact of participatory arts in care homes on the social relationships between older people and older people and care staff. METHODS 'Creative Journeys', an initiative led by Essex County Council, provides opportunities for older people living in care homes to participate in arts activities. In this study, three arts organisations (reminiscence arts, seated dance, and orchestral music participation) delivered participatory arts in three homes. Stage 1 of the research comprised mixed-methods case studies in each home. Stage 2 involved an online survey across care homes in Essex to provide a broader perspective, with follow-up interviews in three further homes, and a focus group with the arts organisations. Findings presented here focus on the qualitative data around the impact of participatory arts on the social relationships in care homes between older people and older people and care staff. RESULTS Participatory arts enhanced social relationships between older people and between older people and care staff in care homes. Through engagement in shared experiences leading to increased communication and interaction, participatory arts facilitated social connectedness between residents, and changed the relationship dynamics between older people and care staff, thus promoting reciprocity. CONCLUSION Participatory arts enable older people to express themselves creatively, and make meaningful contributions to their social relationships. Policy makers and those working in the care sector should consider including participatory arts as an integral and necessary component of quality care for older people living in care homes.
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Affiliation(s)
- A Dadswell
- Research Fellow, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, UK
| | - H Bungay
- Reader in Health Services Research, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - C Wilson
- Senior Research Fellow, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - C Munn-Giddings
- Professor of Participative Inquiry and Collaborative Practice, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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41
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Jansson AH, Savikko N, Kautiainen H, Roitto HM, Pitkälä KH. Changes in prevalence of loneliness over time in institutional settings, and associated factors. Arch Gerontol Geriatr 2020; 89:104043. [PMID: 32442846 DOI: 10.1016/j.archger.2020.104043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to examine changes in the prevalence of loneliness over time from 2011 to 2017 in long-term care facilities; and its related factors. MATERIAL AND METHODS Repeated cross-sectional studies exploring loneliness and its associated factors among residents in long-term care facilities were conducted in Helsinki, Finland in 2011 (N = 4966) and 2017 (N = 3767). Residents in temporary respite care or with severe cognitive impairment, and those unable or refusing to respond to the loneliness item were excluded. The total number of participants in this analysis was 1563 in 2011, and 1367 in 2017. In both samples, we used the same loneliness measurement by asking "Do you suffer from loneliness?" (never/sometimes/often or always). When comparing the samples in order to reduce the effect of confounding between them, we used propensity score matching. A multivariable logistic regression model explored the relationship between various characteristics and loneliness. RESULTS Loneliness showed no change in prevalence over time: propensity score-adjusted loneliness was 36 % in 2011 and 2017. In the multivariate logistic regression model, feeling depressed was the only independent characteristic associated with loneliness. Of the respondents who did not feel depressed, 24 % suffered from loneliness at least sometimes. Among the respondents who felt depressed, the respective figure was 55 %. CONCLUSION Loneliness is common in institutional settings. It remained stable, and not decreased over time. Because loneliness impairs the well-being, quality of life and health of residents, it needs to be addressed. Screening loneliness and developing interventions to alleviate it, is essential.
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Affiliation(s)
- A H Jansson
- Department of General Practice and Helsinki University Hospital, University of Helsinki, Unit of Primary Health Care, PO Box 20, FI-00014 Helsinki, Finland.
| | - N Savikko
- Department of General Practice and Helsinki University Hospital, University of Helsinki, Unit of Primary Health Care, PO Box 20, FI-00014 Helsinki, Finland; City of Espoo, Asemakuja 2 A, FI-02070, Espoo, Finland.
| | - H Kautiainen
- Department of General Practice and Helsinki University Hospital, University of Helsinki, Unit of Primary Health Care, PO Box 20, FI-00014 Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland.
| | - H-M Roitto
- Department of General Practice and Helsinki University Hospital, University of Helsinki, Unit of Primary Health Care, PO Box 20, FI-00014 Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki Hospital Geriatric Clinic, PO Box 6600, FI-00099, Helsinki, Finland.
| | - K H Pitkälä
- Department of General Practice and Helsinki University Hospital, University of Helsinki, Unit of Primary Health Care, PO Box 20, FI-00014 Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland.
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Menn L, Corsten S, Lauer N, Wallace SJ. The Effectiveness of Biographical Approaches in Long-Term Care: A Systematic Review. THE GERONTOLOGIST 2020; 60:e309-e328. [PMID: 31175820 DOI: 10.1093/geront/gnz074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults in long-term residential aged care experience loneliness and reduced quality of life (QoL). Biographical approaches use the recall of the past events to increase self-efficacy, promote acceptance, and improve QoL. The aim of the systematic review was to examine the effectiveness of biographical approaches in improving the QoL of older adults in long-term residential aged care. RESEARCH DESIGN AND METHODS This systematic review was conducted in accordance with PRISMA guidelines, using databases Medline, CINAHL, and the Cochrane Library. A 2-phase search strategy was used to identify research literature relating to the use of biographical interventions. Narrative analysis was used to synthesize results. RESULTS Twenty-one studies met inclusion criteria for this review, comprising both group and individual interventions. The findings were inconsistent. Subjective elements of QoL of older adults improved in a narrow majority of the studies. Of a total of 21 outcomes investigated in group interventions, 11 resulted in significant improvements in QoL. The 16 outcomes of the individual interventions resulted in 10 significant improvements. The most significant influence was observed in life satisfaction. Group reminiscence also had a particularly strong influence on self-esteem. DISCUSSION AND IMPLICATIONS Although benefits were observed, it remains unclear why some interventions led to improvements in subjective elements of QoL and others did not. Exploration of the participant perspective through qualitative data collection and more detailed description of interventions in future studies could lead to a better understanding of the treatment components that are related to improved outcomes for older adults.
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Affiliation(s)
- Lara Menn
- Department for Health Care and Nursing, Catholic University of Applied Sciences, Mainz, Germany
| | - Sabine Corsten
- Department for Health Care and Nursing, Catholic University of Applied Sciences, Mainz, Germany
| | - Norina Lauer
- Department for Social & Health Care Sciences, OTH Regensburg-Technical University of Applied Sciences, Germany
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Sundström M, Blomqvist K, Edberg A. Being a volunteer encountering older people’s loneliness and existential loneliness: alleviating loneliness for others and oneself. Scand J Caring Sci 2020; 35:538-547. [DOI: 10.1111/scs.12869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Malin Sundström
- Research Platform for Collaboration for Health Faculty of Health Science Kristianstad University Kristianstad Sweden
- Faculty of Health and Society Malmö University Malmö Sweden
| | - Kerstin Blomqvist
- Research Platform for Collaboration for Health Faculty of Health Science Kristianstad University Kristianstad Sweden
| | - Anna‐Karin Edberg
- Research Platform for Collaboration for Health Faculty of Health Science Kristianstad University Kristianstad Sweden
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Simard J, Volicer L. Loneliness and Isolation in Long-term Care and the COVID-19 Pandemic. J Am Med Dir Assoc 2020; 21:966-967. [PMID: 32505516 PMCID: PMC7205644 DOI: 10.1016/j.jamda.2020.05.006] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 12/01/2022]
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Seddigh M, Hazrati M, Jokar M, Mansouri A, Bazrafshan MR, Rasti M, Kavi E. A Comparative Study of Perceived Social Support and Depression among Elderly Members of Senior Day Centers, Elderly Residents in Nursing Homes, and Elderly Living at Home. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:160-165. [PMID: 32195163 PMCID: PMC7055191 DOI: 10.4103/ijnmr.ijnmr_109_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/17/2018] [Accepted: 12/06/2019] [Indexed: 11/04/2022]
Abstract
Background Social support perceived by the elderly can reduce mental health problems including depression. In Iranian society, some elderly people spend their elderly years in senior day care centers established to promote social protection for the elderly. Therefore, the purpose of this study was to assess perceived social support and depression in the elderly members of senior day care centers and compare the results with that of elderly individuals living at nursing homes and at home. Materials and Methods This descriptive, cross-sectional study was conducted on 315 elderly people. The participants were selected using stratified random sampling method and a random number table. The data collection tools used consisted of a demographic characteristics questionnaire, the Barthel index for assessing Activities of Daily Living (ADL), Social Support Appraisals (SSS-As) scale, and Geriatric Depression Scale short form (GDS-15). ANOVA, Chi-square, the Pearson correlation coefficient, and linear regression analysis were used to examine the hypotheses. Results The results showed that with increasing social support, depression decreased in all three groups, which was statistically significant in the two elderly groups living in nursing homes (r = -0.19, p = 0.044) and elderly members of senior day centers (r = -0.18, p = 0.049). Conclusions According to the results, it can be concluded that senior day care centers have been able to promote perceived social support in the elderly through their participation in daily activities and social activities, and thus were able to reduce depression significantly compared to the other two groups.
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Affiliation(s)
- Maryam Seddigh
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Maryam Hazrati
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Jokar
- Department of Nursing, Khomein University of Medical Sciences, Khomein, Iran
| | - Amir Mansouri
- Department of Paramedical School, Gerash University of Medical Sciences, Gerash, Iran
| | - Mohammad-Rafi Bazrafshan
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Maryam Rasti
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Esmaeil Kavi
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
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Biography work in in long-term residential aged care with tablet support to improve the quality of life and communication – study protocol for app development and evaluation / Biografiearbeit in Senioreneinrichtungen mit Tablet-Unterstützung zur Verbesserung der Lebensqualität und Kommunikation (BaSeTaLK) – Studienprotokoll zur App-Entwicklung und Evaluation. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2020. [DOI: 10.2478/ijhp-2020-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Older adults in care facilities face a high risk of experiencing depression. The impact that early interventions like biographical work have on the quality of life for older adults in such facilities is unknown.
Aim
To develop and evaluate a tablet-supported intervention for biographical work in long-term residential aged care to increase the quality of life for older adults.
Design
The study will be conducted in a randomized pretest–posttest control group design with follow-up testing in group and single settings. Participants will be randomized to the experimental intervention (tablet-supported biographic work) or the control intervention (planned tablet-supported game playing), each guided by senior volunteers. A total of 80 residents and 16 volunteers will be recruited. The primary outcome for the residents and volunteers will be quality of life as measured with the World Health Organization Quality of Life Assessment-for older adults. Secondary measures will be self-esteem and life satisfaction. In addition, we will examine residents’ ability to communicate and their functional independence.
Method
The first stage of the project involves developing an app. The app is developed in a user-centered, agile development process. It will use multimedia to prepare life history topics and links them to key questions. Next, a workshop is developed for the volunteers who accompany the use of the app in the institutions. During the second phase, biographic work stimulated by the app will be conducted in groups or individually with residents.
Discussion
This is the first known program tailored to older adults in care facilities and senior volunteers that aims to prevent depression by providing digitally supported biographic work.
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Alnes RE, Berg H, Krøvel B, Blindheim K. «Du har på en måte hatt besøk, vet du!». TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2019-02-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Helen Berg
- NTNU, Institutt for samfunnsmedisin og sykepleie, Trondheim
| | | | - Kari Blindheim
- NTNU, Institutt for helsevitenskap, Ålesund og Senter for omsorgsforskning
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Abstract
AbstractThe purpose of the study is to explore feelings of loneliness among residents in assisted living facilities in terms of how loneliness is experienced and articulated, and what specific factors are related to the experiences. The study used a mixed-method approach. We individually interviewed 13 residents twice over six months. We conducted two focus group interviews and noted our observations each time we met the respondents. Data analysis leaned on abductive reasoning. The respondents described loneliness in versatile, rich ways. It proved to be time and place dependent. It was dependent on the time of day, days of the week and seasons. Lonely time was meaningless and filled with a feeling of waiting. Loneliness was also intertwined with place. None of the respondents called their apartment home; instead they called it a hospital, even a prison. They had to spend long periods of time in their apartments against their will, and their desire to interact with other residents was not met. The respondents felt invisible. Residents’ experiences of loneliness in assisted living facilities are unique and distinctive. Time- and place-dependent experiences of loneliness act as important signals for reflection on how care practices in these facilities could be more satisfying. Loneliness should therefore be a key topic and the target of prevention and interventions.
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Petrovsky DV, Sefcik JS, Hanlon AL, Lozano AJ, Cacchione PZ. Social Engagement, Cognition, Depression, and Comorbidity in Nursing Home Residents With Sensory Impairment. Res Gerontol Nurs 2019; 12:217-226. [PMID: 31283831 DOI: 10.3928/19404921-20190627-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/22/2019] [Indexed: 11/20/2022]
Abstract
Sensory impairment, explicitly vision and hearing impairment, among nursing home (NH) residents decreases their ability to socially engage. However, it is not known to what extent visual, hearing, or dual impairment is associated with social engagement. The aims of the current retrospective, cross-sectional descriptive study were to determine the relationship between social engagement and (a) levels of sensory impairment (vision, hearing, and dual); (b) depression; and (c) cognition. The authors analyzed baseline data from 213 NH residents with sensory impairment from the I-SEE study. Multivariable model results demonstrated that sensory impairment was not associated with social engagement when adjusting for all covariates. Greater social engagement was associated with less depression, better cognition, and greater comorbidity. Clinicians should be aware of these risks to social engagement in NH residents with sensory impairment and monitor for decreased social engagement and isolation in residents with less comorbidities, higher depression levels, and poorer cognition. [Res Gerontol Nurs. 2019; 12(5):217-226.].
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Mikkelsen ASB, Petersen S, Dragsted AC, Kristiansen M. Social Interventions Targeting Social Relations Among Older People at Nursing Homes: A Qualitative Synthesized Systematic Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958018823929. [PMID: 30791836 PMCID: PMC6376508 DOI: 10.1177/0046958018823929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Social relations are part of the complex set of factors affecting health and well-being in old age. This systematic review seeks to uncover whether social interventions have an effect on social and health-related measures among nursing home residents. The authors screened PubMed, Scopus, and PsycINFO for relevant peer-reviewed literature. Interventions were included if (1) they focused primarily on social relations or related terms such as loneliness, social support, social isolation, social network, or being involuntarily alone either as the base theory of the intervention or as an outcome measure of the intervention; (2) they were implemented at nursing homes (or similar setting); (3) they had a narrative activity as its core (as opposed to dancing, gardening or other physical activity); (4) their participants met either physically or nonphysically, ie, via video-conference or the like; and if (5) they targeted residents at a nursing home. The authors systematically appraised the quality of the final selection of studies using the Mixed Methods Assessments Tool (MMAT) version 2011 and did a qualitative synthesis of the final study selection. A total of 10 studies were included. Reminiscence therapy was the most common intervention. Studies also included video-conference, cognitive, and support group interventions. All studies found the social interventions brought about positive trends on either/or the social and health-related measures included. Despite limited and very diverse evidence, our systematic review indicated a positive social and health-related potential of social interventions for older people living in nursing homes or similar institutions.
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Affiliation(s)
- Anne Sophie Bech Mikkelsen
- 1 Section for Health Services Research, Department of Public Health & Center for Healthy Aging, University of Copenhagen, Denmark
| | - Signe Petersen
- 1 Section for Health Services Research, Department of Public Health & Center for Healthy Aging, University of Copenhagen, Denmark
| | - Anne Cathrine Dragsted
- 1 Section for Health Services Research, Department of Public Health & Center for Healthy Aging, University of Copenhagen, Denmark
| | - Maria Kristiansen
- 1 Section for Health Services Research, Department of Public Health & Center for Healthy Aging, University of Copenhagen, Denmark
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